traumatic injuries to primary dentition

A. VICTOR SAMUELIII MDS

DEPARTMENT OF PEDODONTICS

TRAUMATIC INJURIES TO PRIMARY DENTITION

Contents• Introduction• Etiology• Epidemiology• Classification• Examination & Diagnosis• Treatment • Sequlae of injuries to primary dentition• Conclusion• References

INTRODUCTION• Most injuries : 1- 3 yrs of age• Learning to walk, run, climb & play

adventurously• Thinner & more elastic alveolar bone – displaced.• Close proximity of two dentition• Infection developing subsequent to injury poses

threat.• Vertical position

Graham Roberts, Peter Longhurst. Oral and Dental Trauma in children and Adolescents. 1st ed. United States: Oxford University Press;1996.

ETIOLOGY• Automobile injuries• Assaults• Torture• Mental Retardation• Epilepsy• Drug-related injuries• Dentinogenesis

imperfecta

Andreasen JO, Andreasen FM. Classification, Etiology and Epidemiology. In: Andreasen JO, Andreasen FM. Text Book and Color Atlas of Traumatic Injuries to the Teeth. 3rd edn. Denmark: Mosby, 1994: Chapter 3 .Graham Roberts, Peter Longhurst. Oral and Dental Trauma in children and Adolescents. 1st ed. United States: Oxford University Press;1996.

• Iatrogenic injuries in newborns

• Falls in infancy• Child physical abuse• Falls and collisions• Bicycle injuries• Sports• Horseback riding

EPIDEMIOLOGY

The prevalence of traumatic injuries in the 0 to 6 year segment varies from11 to 30%.

Cunha RF, Pugliesi DM, MelloVieira AE. Oral trauma in Brazilian patients aged 0-3 years. Dent Traumatol 2001;17:210-12.Hargreaves JA, Cleaton-Jones PE, Roberts GJ,Williams S, Matejka JM. Trauma to primary teeth of South African pre-school children. Endod Dent Traumatol 1999;15:73-6.Bijella MF,Yared FN, BijellaVT, Lopes ES. Occurrence of primary incisor traumatism in Brazilian children: a house by-house survey. ASDC J Dent Child 1990;57:424-7.Forsberg CM, Tedestam G. Traumatic injuries to teeth in Swedish children living in an urban area. Swed Dent J 1990;14:115-22.YagotKH, Nazhat NY,Kuder SA.Traumatic dental injuries in nursery schoolchildren from Baghdad. Iraq Community Dent Oral Epidemiol1988;16:292-3.

EPIDEMIOLOGY

When the child starts walking alone, between18 and 30months, the risk of trauma increases with incidence twice as high as the average incidence for all children .

Llarena del Rosario ME, Acosta AV, Garcia-Godoy F. Traumatic injuries to primary teeth in Mexico City children. Endod Dent Traumatol 1992;8:213-4.Fried I, Erickson P. Anterior tooth trauma in the primary dentition. Incidence, classification, treatment methods, and sequelae: a reviewof the literature. ASDCJ Dent Child 1995;62:256-61.Nelson LP, Shusterman S. Emergency management of oral trauma in children. Curr Opin Pediatr 1997;9:242-5. YamAA,Diop F, FayeM,Tamba-Ba A, Ba I. Complications of injuries to the deciduous teeth. Clinical and radiographic evaluation: perspectives on management and prevention (apropos 4 cases). OdontostomatolTrop 2000;23:5-9.Glendor U. On dental trauma in children and adolescents. Incidence, risk, treatment, time and costs. Swed Dent J Suppl 2000;140:1-52.

EPIDEMIOLOGY

At this age, the home is the place where most trauma occurs in males and females as a result of falls.

MestrinhoHD, Bezerra AC, CarvalhoJC.Traumatic dental injuries in Brazilian pre-school children. Braz Dent J 1998;9:101-4.Garcia-Godoy F, Garcia-Godoy F, Garcia-Godoy FM. Primary teeth traumatic injuries at a private pediatric dental center. Endod Dent Traumatol 1987;3:126-9.Bastone EB, FreerTJ,McNamaraJR. Epidemiology of dental trauma: a review of the literature. Aust Dent J 2000;45:2-9.Fried I, Erickson P, Schwartz S, Keenan K. Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. Pediatr Dent 1996;18:145-51.Soporowski NJ, Allred EN, Needleman HL. Luxation injuries of primary anterior teeth its prognosis and related correlates. Pediatr Dent 1994;16:96-101.

Summary

CLASSIFICATION

CLASSIFICATIONInjuries to the Hard Dental Tissues and the

Pulp

• Enamel Infraction (N 502.50)Incomplete fracture of the enamel without loss of tooth.

• Enamel Fracture (Uncomplicated Crown Fracture) (N 502.50)Fracture with loss of tooth substance confined to the enamel

Andreasen JO, Andreasen FM. Classification, Etiology and Epidemiology. In: Andreasen JO, Andreasen FM. Text Book and Color Atlas of Traumatic Injuries to the Teeth. 3rd edn. Denmark: Mosby, 1994: Chapter 3 .


Pulp

• Enamel-Dentin Fracture (Uncomplicated Crown Fracture) (N 502.51)Fracture with loss of tooth substance confined to enamel and dentin, but not involving the pulp.

• Complicated Crown Fracture(N 502.52)Fracture involving enamel and dentin, and exposing the pulp.



Pulp

• Uncomplicated Crown-Root Fracture(N 502.54)Fracture involving enamel, dentin and cementum, but not exposing the pulp.

• Complicated Crown-Root Fracture(N 502.54)Fracture involving enamel, dentin and cementum, but exposing the pulp.



Pulp

• Root Fracture(N 502.53)Fracture involving dentin and cementum, and the pulp.


CLASSIFICATIONInjuries to the Periodontal Tissues

• Concussion (N503.20)Injury to the tooth-supporting structures without abnormal loosening or displacement of the tooth, but with marked reaction to percussion

• Subluxation (Loosening) (N 503.20)Injury to the tooth-supporting structures with abnormal loosening, but without displacement of tooth



• Extrusive Luxation (Peripheral dislocation, Partial avulsion) (N503.20)Partial displacement of the tooth out of its socket.

• Lateral Luxation (N 503.20)Displacement of tooth in a direction other than axially. This is accompanied by comminution or fracture of the alveolar socket.



• Intrusive Luxation (Central Dislocation) (N503.20)Displacement of the tooth into the alveolar bone. This injury is accompanied by comminution or fracture of the alveolar socket.

• Avulsion (N 503.22)Complete displacement of tooth out of its socket.


CLASSIFICATIONInjuries to the Supporting Bone

• Comminution of the Mandibular (N 502.40) or Maxillary (502.40)alveolar socketCrushing and compression of the alveolar socket. This condition is found concomitantly with intrusive and lateral luxations.

• Fracture of the Mandibular(N 502.60) or Maxillary (N 503.22) alveolar socket wallA fracture confined to the facial or oral socket wall.


CLASSIFICATIONInjuries to the Supporting Bone

• Fracture of the Mandibular(N 502.60) or Maxillary (N 502.40) alveolar processA fracture of the alveolar process which may or may not involve the alveolar socket.

• Fracture of the Mandible(N 502.61) or Maxilla (N 503.22)A fracture involving the base if the mandible or maxilla and often the alveolar process. The fracture may or may not involve the alveolar socket.


CLASSIFICATIONInjuries to Gingiva or Oral Mucosa

• Laceration of Gingiva or oral Mucosa (S 01.50)A shallow or deep wound in the resulting from a tear, and usually produced by a sharp object.

• Contusion of Gingiva or Oral Mucosa (S 00.50)A bruise usually produced by impact with a blunt object and not accompanied by a break in the mucosa, usually causing submucosal hemorrhage.


CLASSIFICATIONInjuries to Gingiva or Oral Mucosa

• Abrasion of Gingival or Oral Mucosa (S 00.50)A superficial wound produced by rubbing or scraping of the mucosa leaving a raw, bleeding surface.


Summary

CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITION

Uncomplicated crown fracture

An enamel fracture or an enamel-dentin fracture -the mesial angles or the incisal edges of the upper central incisors.

A periapical X-ray is recommended as a baseline.

Treatment: Polish the sharp edges if there is minimal enamel loss. (the tooth can be restored with an obturation using glass ionomer or composite).

Flores MT, Andreasen JO, Bakland LK, Feiglin B, GutmannJL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:1-4.Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Traumatic dental injuries. A manual,1st edn. Copenhagen: Munksgaard;1999.

CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITION

Complicated crown fracture

Enamel and dentine fracture with pulp exposure. A periapical X-ray is recommended (size 2 film)to evaluate the size of the pulp chamber, stage of root development, and degree of root resorption. Treatment decisions are often based on the child’s cooperation and on the further life expectancy of the affected primary tooth.

Wilson S, Smith GA, Preisch J, Casamassimo PS. Epidemiology of dental trauma treated in an urban pediatric emergency department. Pediatr Emerg Care 1997;13:12-15.

Complicated crown fracture

CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITIONTreatment alternatives:(i) Partial pulpotomy is indicated when the pulp hasbeen exposed before the apex is closed in theyoung primary incisor *(ii) pulpotomy with formocresol and ZOE in caseswhen the primary tooth has not yet started thephysiological resorption process,(iii) root canal therapy(iv) extraction.

Flores MT, Andreasen JO, Bakland LK, Feiglin B, GutmannJL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:1-4.*Ram D, Holan G. Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report. Pediatr Dent 1994;16:44-8.

CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITIONComplicated Crown-root fracture

A multiple crown fracture where the pulp may ornot be involved.

The coronal fragment is attached to the gingiva and is mobile. There is little or moderated tooth displacement.A periapical X-ray is recommended (size 2 film) where a radiolucency oblique line that compromises crown and root in a vertical direction is seen.Treatment: Extraction

Flores MT, Andreasen JO, Bakland LK, Feiglin B, GutmannJL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:1-4.Ram D, Holan G. Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report. Pediatr Dent 1994;16:44-8.Andreasen JO, Andreasen FM. Crown- Root Fractures. In: Andreasen JO, Andreasen FM. Text Book and Color Atlas of Traumatic Injuries to the Teeth. 3rd edn. Denmark: Mosby, 1994.

CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITIONRoot fracture (2-4%)

The tooth is mobile and the coronal fragment may be displaced. Take a periapical X-ray (size 2 film).

Flores MT, Andreasen JO, Bakland LK, Feiglin B, GutmannJL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:1-4.Ram D, Holan G. Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report. Pediatr Dent 1994;16:44-8.Andreasen JO, Andreasen FM. Crown- Root Fractures. In: Andreasen JO, Andreasen FM. Text Book and Color Atlas of Traumatic Injuries to the Teeth. 3rd edn. Denmark: Mosby, 1994.

CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITIONRoot fracture

Treatment: If Coronal fragment - not displaced, root is complete, and the patient cooperates, a wire-composite splint. In this case, it is important to inform the parents - certain mobility until its normal replacement. Also, the loss of the crown may be anticipated.Extraction of only the coronal fragment is the treatment of choice. The apical fragment is left to be resorbed physiologically.

Flores MT, Andreasen JO, Bakland LK, Feiglin B, GutmannJL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:1-4.Harding AM, Camp JH. Traumatic injuries in the preschool child. Dent Clin North Am1995;39:817-35.

CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITIONAlveolar fracture

The tooth in the affected segment is mobile and usually displaced. Seek a discontinuity in the surrounding oral mucosa. Take a periapical X-ray (size 2 film).


CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITIONAlveolar fracture

Treatment: repositioning the segment. Splint to adjacent teeth for up to 4weeks. If it is necessary to achieve stability, splint for 2-3 weeks more or extract.


Clinical assessment and treatment of luxations and avulsions in the primary dentitionConcussion

Tooth tender to touch, but there is neither mobility nor evidence of sulcus bleeding.Treatment: To keep the tooth under observation.*

*Fried I, Erickson P, Schwartz S, Keenan K. Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. Pediatr Dent 1996;18:145-51.Harding AM, Camp JH. Traumatic injuries in the preschool child. Dent Clin North Am1995;39:817-35.*Flores MT, Andreasen JO, Bakland LK, Feiglin B, GutmannJL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:49-52.*Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Traumatic dental injuries. A manual,1st edn. Copenhagen: Munksgaard;1999

Clinical assessment and treatment of luxations and avulsions in the primary dentitionConcussion

In a clinical study (Holan 1996), endodontic treatment was performed on 48 primary incisors with dark-gray discoloration of the crowns. Pulp necrosis was found in 37 discolored teeth, without presenting tenderness to percussion, increased mobility, and periapical osteitis. *

Therefore, unless associated infection exists, do not perform root canal treatment in discolored teeth.

*Holan G, Fuks AB. The diagnostic value of coronal darkgray discoloration in primary teeth following traumatic injuries. Pediatr Dent 1996;18:224-7.

Clinical assessment and treatment of luxations and avulsions in the primary dentitionSubluxation

The tooth is mobile without displacement. Sulcus bleeding may or not be present.

Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Traumatic dental injuries. A manual,1st edn. Copenhagen: Munksgaard;1999.

Clinical assessment and treatment of luxations and avulsions in the primary dentitionSubluxation

Treatment: Observation*. If there is careful bacterial control by good oral hygiene, tooth will return to normality within 2weeks. Otherwise, the tooth will increase its mobility, and swelling of the gingiva will be seen due to associated infection.

*Fried I, Erickson P, Schwartz S, Keenan K. Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. Pediatr Dent 1996;18:145-51.*Flores MT, Andreasen JO, Bakland LK, Feiglin B, GutmannJL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:49-52.*Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Traumatic dental injuries. A manual,1st edn. Copenhagen: Munksgaard;1999.

Clinical assessment and treatment of luxations and avulsions in the primary dentitionLateral luxation

The tooth is displaced laterally with the crown, usually in a palatal direction.

Take two X-rays, occlusal and lateral, with size 2 film. The occlusal X-ray is better for the detection of the increase in periodontal space apically. In the lateral X-ray, displacement of the apex toward or through the labial bone plate may be seen.

*Fried I, Erickson P, Schwartz S, Keenan K. Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. Pediatr Dent 1996;18:145-51.*Flores MT, Andreasen JO, Bakland LK, Feiglin B, GutmannJL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:49-52.*Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Traumatic dental injuries. A manual,1st edn. Copenhagen: Munksgaard;1999.


Treatment: that if there is no occlusal interference, leave the tooth to return to its position spontaneously. If there is occlusal interference, reposition the affected tooth and splint to adjacent teeth for 2-3weeks.

BorumMK, AndreasenJO. Sequelae of traumato primary maxillary incisors. Part I. Complications in the primary dentition. Endod DentTraumatol 1998;14:31-44.Soporowski NJ, Allred EN, Needleman HL. Luxation injuries of primary anterior teeth ^ prognosis and related correlates. Pediatr Dent 1994;16:96-101.Holan G. Conservative treatment of severely luxated maxillary primary central incisors: case report. Pediatr Dent 1999;21:459-62.Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Traumatic dental injuries. A manual,1st edn. Copenhagen: Munksgaard;1999.


From a prospective study (Borum 1998) of 104 lateral luxated teeth, 99%were realigned within the first year.

BorumMK, AndreasenJO. Sequelae of traumato primary maxillary incisors. Part I. Complications in the primary dentition. Endod DentTraumatol 1998;14:31-44.

Clinical assessment and treatment of luxations and avulsions in the primary dentition

Lateral luxation

In an observational study (Soprowski 1994), it was found that of 52 teeth that were left for spontaneous reposition, almost 60% did not disclose any complication. However, repositioning of lateral luxation was associated with an increased risk of developing pulp necrosis.

Soporowski NJ, Allred EN, Needleman HL. Luxation injuries of primary anterior teeth its prognosis and related correlates. Pediatr Dent 1994;16:96-101.s


Intrusion

The PDL space will partially or totally disappear.

Radiograph: Can reveal the position of displaced teeth in relation to the permanent successors.

Apico-facially : appears shorter

Apico-palatally: appears elongated (displaced towards

permanent)

Or a lateral projection

Andreasen JO, Andreasen FM. Luxation Injuries. In: Andreasen JO, Andreasen FM. Text Book and Color Atlas of Traumatic Injuries to the Teeth. 3rd edn. Denmark: Mosby, 1994 Chapter 9.


Intrusion

Treatment: usually re-erupt or reposition themselves spontaneously within a period of 1 to 6 months. (proper decision). When apex is displaced towards the permanent successor – extracted atraumatically.



Intrusion

In case of spontaneous re-eruption – risk of acute inflammation around the displaced tooth. This is manifested clinically as swelling and hyperemia of the gingiva, sometimes with abscess formation and oozing of pus from the gingival crevice. Rise in temperature and pain : Extracted and antibiotic therapy.



Intrusion

In a retrospective study (Holan 1999) of 172 intruded teeth, the apices of more than 80% of the teeth were pushed labially. It was found that most of them re-erupted and survived with no complications for more than 36months post trauma, even in cases of complete intrusion and fracture of the labial bone plate.

Holan G, Ram D. Sequelae and prognosis of intruded primary incisors: a retrospective study. Pediatr Dent 1999; 21:242-7.


Extrusion

Tooth is mobile and is usually out of the socket.

Immediate changes are complete rupture of the PDL fibers and the neurovascular supply to the pulp. In monkeys the split in the PDL is filled with endothelial cells and young fibroblasts. After 2 wks newly formed collagen fibers are seen. After 3 wks the PDL appears normal.



Extrusion

It can either be repositioned or extracted when there is occlusal interference.



Avulsion

The tooth is completely displaced out of its socket. Clinically the socket is found empty or filled with a coagulum.



Avulsion

Treatment: an avulsed primary tooth must not be replanted, because of the potential damage that it may cause to the developing tooth germ.

Andreasen JO, Andreasen FM. Luxation Injuries. In: Andreasen JO, Andreasen FM. Text Book and Color Atlas of Traumatic Injuries to the Teeth. 3rd edn. Denmark: Mosby, 1994 Chapter 9.Garcia-Godoy F, Pulver F.Treatment of trauma to the primary and young permanent dentitions. Dent Clin North Am 2000;44:597-632.McTigue DJ. Diagnosis and management of dental injuries in children. Pediatr Clin North Am 2000;47: 1067-84.Harding AM, CampJH.Traumatic injuries in the preschool child. Dent Clin North Am1995;39:817-35. Flores MT, Andreasen JO, Bakland LK, Feiglin B, GutmannJL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:1-4..

Summary

Sequlae of injuries to primary dentition

•Hypoplasia and pigmentation•Malformation of crown•Deformity•Bending•Bending of root•Lack of root development

MitsuhiroTsukiboshi. Treatmnet Planning for Traumatized Teeth. Tokyo: Quintessence Publishing, 2000.

CASES TREATED IN OUR DEPARTMENT

Intrusive Luxation

Pre & Post Operative Pictures

Intrusive Luxation

Intrusive Luxation55%

Lateral Luxation18%

Uncomplicated crown facture9%

Uncomplicated crown-root fac-

ture9%

Complicated crown-root fracture9%

Treatment Done in Department From July – November 2010 for In-juries to Primary Dentition

Falls100%

Percentage

*Volkan A, Saziye S, Hayriye S. The Prevalence and Treatment Outcomes of Primary Tooth Injuries. Eur J Dent. 2010; 4:447-53.

*

CONCLUSION

Children are commonly affected by luxation injuries, especially in their early years. Even when luxations are considered to be complicated injuries, most of them heal spontaneously if parents take care of the child’s oral hygiene. It is appropriate to intervene to alleviate pain or when there is a risk of damage to the permanent tooth germ.

Hence a thorough knowledge regarding traumatic injuries to primary dentition is a must to every dentist in treating these kind of patients.

REFERENCES• Graham Roberts, Peter Longhurst. Oral and Dental Trauma in

children and Adolescents. 1st ed. United States: Oxford University Press;1996.

• Andreasen JO, Andreasen FM. Classification, Etiology and Epidemiology. In: Andreasen JO, Andreasen FM. Text Book and Color Atlas of Traumatic Injuries to the Teeth. 3rd edn. Denmark: Mosby, 1994: Chapter 3 .

• Cunha RF, Pugliesi DM, MelloVieira AE. Oral trauma in Brazilian patients aged 0-3 years. Dent Traumatol 2001;17:210-12.

• Hargreaves JA, Cleaton-Jones PE, Roberts GJ,Williams S, Matejka JM. Trauma to primary teeth of South African pre-school children. Endod Dent Traumatol 1999;15:73-6.

• Bijella MF,Yared FN, BijellaVT, Lopes ES. Occurrence of primary incisor traumatism in Brazilian children: a house by-house survey. ASDC J Dent Child 1990;57:424-7.

REFERENCES• Forsberg CM, Tedestam G. Traumatic injuries to teeth in

Swedish children living in an urban area. Swed Dent J 1990;14:115-22.

• YagotKH, Nazhat NY,Kuder SA.Traumatic dental injuries in nursery schoolchildren from Baghdad. Iraq Community Dent Oral Epidemiol1988;16:292-3.

• Llarena del Rosario ME, Acosta AV, Garcia-Godoy F. Traumatic injuries to primary teeth in Mexico City children. Endod Dent Traumatol 1992;8:213-4.

• Fried I, Erickson P. Anterior tooth trauma in the primary dentition. Incidence, classification, treatment methods, and sequelae: a reviewof the literature. ASDCJ Dent Child 1995;62:256-61.

• Nelson LP, Shusterman S. Emergency management of oral trauma in children. Curr Opin Pediatr 1997;9:242-5.

REFERENCES• YamAA,Diop F, FayeM,Tamba-Ba A, Ba I. Complications of

injuries to the deciduous teeth. Clinical and radiographic evaluation: perspectives on management and prevention (apropos 4 cases). OdontostomatolTrop 2000;23:5-9.

• Glendor U. On dental trauma in children and adolescents. Incidence, risk, treatment, time and costs. Swed Dent J Suppl 2000;140:1-52.

• MestrinhoHD, Bezerra AC, CarvalhoJC.Traumatic dental injuries in Brazilian pre-school children. Braz Dent J 1998;9:101-4.

• Garcia-Godoy F, Garcia-Godoy F, Garcia-Godoy FM. Primary teeth traumatic injuries at a private pediatric dental center. Endod Dent Traumatol 1987;3:126-9.

• Bastone EB, FreerTJ,McNamaraJR. Epidemiology of dental trauma: a review of the literature. Aust Dent J 2000;45:2-9.

REFERENCES• Fried I, Erickson P, Schwartz S, Keenan K. Subluxation injuries

of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. Pediatr Dent 1996;18:145-51.

• Soporowski NJ, Allred EN, Needleman HL. Luxation injuries of primary anterior teeth its prognosis and related correlates. Pediatr Dent 1994;16:96-101.

• Flores MT, Andreasen JO, Bakland LK, Feiglin B, GutmannJL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol 2001;17:1-4.

• *Ram D, Holan G. Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report. Pediatr Dent 1994;16:44-8.

• Andreasen JO, Andreasen FM. Crown- Root Fractures. In: Andreasen JO, Andreasen FM. Text Book and Color Atlas of Traumatic Injuries to the Teeth. 3rd edn. Denmark: Mosby, 1994.

REFERENCES

• Harding AM, Camp JH. Traumatic injuries in the preschool child. Dent Clin North Am1995;39:817-35.

• Holan G, Fuks AB. The diagnostic value of coronal darkgray discoloration in primary teeth following traumatic injuries. Pediatr Dent 1996;18:224-7.

• Garcia-Godoy F, Pulver F.Treatment of trauma to the primary and young permanent dentitions. Dent Clin North Am 2000;44:597-632.

• McTigue DJ. Diagnosis and management of dental injuries in children. Pediatr Clin North Am 2000;47: 1067-84.

• MitsuhiroTsukiboshi. Treatmnet Planning for Traumatized Teeth. Tokyo: Quintessence Publishing, 2000.

THANK YOU

traumatic injuries to primary dentition

Documents

traumatic dental injuries

complications of injuries

b traumatic injuries

epidemiology of dental

enamel andreasen jo

pediatr dent

automobile injuries

endod dent traumatol