Developmental Disturbance of a Maxillary Permanent Lateral Incisor Following Trauma at the Age of 16 Months: A 6-Year Follow-Up.

A 3 year and 8 months old Chinese boy was referred for a consultation regarding his missing maxillary anterior teeth. He had a history of trauma to his primary maxillary anterior teeth due to a fall at the age of 16 months. Clinical examination of the patient indicated multiple carious lesions and inadequate oral hygiene. Radiographic examination revealed intrusion of the primary left lateral incisor, with evidence of damage to the permanent tooth germ. Subsequently, the patient was followed-up for almost six years during which his permanent maxillary left lateral incisor erupted exhibiting an unusual morphology. Clinically enamel hypoplasia and radiographically dens invaginatus were evident in affected tooth.

Infected Dental Follicle Secondary to Mandibular Parasymphyseal Fracture: A Case Report.

Mandibular fractures are one of the most common maxillofacial traumatic injuries. They are also reported to be associated with highest rate of post-operative infection. In mixed dentition, management of tooth buds in line of fracture present great challenge to the surgeon. Timely management and non-invasive techniques can help in alleviating complications associated with fractures in children. Such cases should be kept on long-term follow-up for evaluation of proper growth and development. This case report documents a child having a history of previous mandibular fracture and extra-oral sinus tract associated with infected dental follicle.

ATYPICAL DISLOCATION OF IMPACTED PERMANENT TEETH IN CHILDREN. OWN EXPERIENCE.

INTRODUCTION: Disturbances in forming of the hard tissue of teeth and bones can be a cause of their malformation and translocation. The impact of permanent teeth is one of them. It can occur with translocation of the tooth germ. The aim of the study was to present an atypical translocation of impacted permanent teeth in children. MATERIAL AND METHODS: 3.5 year clinical observation was carried out in 14 children (5 girls and 9 boys), aged between 9 and 12 years old. Patients were referred to our Department by orthodontists, paedodontists and General Dental Practitioners, due to impacted permanent teeth. According to the interview, in 8 cases children suffered from a trauma of a facial part of the skull, caused by a fall. On admitance patients were generally healthy. Basing on the clinical and radiological examination, translocation of the impacted permanent teeth has been diagnosed. In 9 cases it concerned medial maxillary incisors, whereas in remaining children--maxillary premolars. The extraction of such teeth has been performed as a part of the one day surgery procedures. CONCLUSION: In the cases where basing on the radiogram, the position of the tooth allows to predict the latter translocation, the germ has to be extracted.

Teeth in the line of mandibular fractures.

PURPOSE: This study aims to review the literature regarding the evolution of current thoughts on the management of teeth in the line of mandibular fractures (MFs). METHODS: An electronic search in PubMed was undertaken in June 2012. The titles and abstracts from these results were read to identify studies within the selection criteria-studies reporting clinical series of MFs in which the management of teeth in the fracture line was analyzed. RESULTS: The search strategy initially yielded 731 references. Twenty-seven studies were identified without repetition within the selection criteria. Additional hand searching yielded 12 additional papers. CONCLUSIONS: It is suggested that rigid fixation systems and the use of antimicrobial agents have reduced the incidence of infection in cases of teeth in the line of MFs. Tooth buds in the line of MFs should not be removed or replaced in the (alleged) proper position despite the degree of displacement, since studies showed that even tooth buds in the early stage of calcification and those involved in widely displaced fracture sites continued development and erupted. Its removal should be considered in cases of infection, which is a predictive factor of abnormality and/or impaction. Intact teeth in the fracture line should be left in situ if they show no evidence of severe loosening or inflammatory change. Permanent teeth maintained in the line of fracture should be followed up clinically and radiographically for at least 1 year to ensure that any unnecessary endodontic treatment is avoided. Teeth in the line of fracture that prevents reduction of fractures, teeth with fractured roots, a partially impacted wisdom tooth with pericoronitis, and a tooth with extensive periapical lesion should be removed. Teeth in the line of MFs should also be removed when located in sites where there is extensive periodontal damage, with broken alveolar walls, resulting in the formation of a deep pocket (making optimal healing doubtful).

Trauma to the primary dentition and its sequelae.

UNLABELLED: Trauma to the primary dentition is common. This injury may have an impact on the child and his/her parents. The examining dentist should take appropriate factors into consideration before providing the required treatment. This paper discusses the management of trauma to the primary teeth and describes the sequelae of injury to both the primary and secondary dentitions. CLINICAL RELEVANCE: In cases of trauma to the primary teeth, diagnosis and appropriate management is necessary to alleviate the pain and discomfort for the child and to decrease the risk of damage to the permanent successor. It is important to prevent inducing fear and dental anxiety in children during the management of this injury.

Developmental disturbances of a maxillary central incisor due to trauma to its predecessor: a case report.

OBJECTIVE: To report the effects of a primary tooth trauma on the underlying permanent tooth germ. CLINICAL PRESENTATION AND INTERVENTION: A 12-year-old girl was referred to our clinic with a complaint of poor aesthetic appearance. The crown of the permanent maxillary left central tooth exhibited an increased clinical crown height with an 'enamel hyperplasia' in the cervical third and had hypoplastic enamel with yellowish-brown discoloration extending from the middle third to the incisal edge. Radiographic examination revealed that the permanent maxillary left central tooth had abnormal root morphology with root dilaceration. The patient revealed a history of trauma at the age of 4 years. An aesthetic restoration with light-curing resin composite was performed on the vestibular surface of the maxillary left permanent central tooth. CONCLUSION: Sequelae of a primary tooth trauma on the permanent tooth were restored. We recommend that parents should be aware of the consequences of untreated trauma to a primary tooth. Educational and preventive programmes on dental trauma are required to educate parents about emergency knowledge and sequelae of dental trauma.

Replantation of avulsed primary incisors: a critical review of a controversial treatment.

Compared with the abundant literature on the replantation of avulsed permanent teeth, the literature on replantation of avulsed primary teeth is significantly more limited. A search of PubMed, using the terms: primary teeth, primary incisors, avulsion, exarticulation, replantation and reposition, and search in the reference list of the relevant articles, revealed 16 case reports of replantation of 31 primary incisors in 24 children. This article is a critical review of the arguments against replantation that have been presented in textbooks, review articles, and clinical guidelines.

Developmental malformation of primary and permanent dentition: a rare sequel of trauma.

Dentofacial injuries that occur prior to the eruption of primary teeth can result in developmental disturbances not only in the primary but also in permanent dentition. Here we report a rare case of long term sequelae of trauma in a female child of 4 to 5 months of age which resulted in dilaceration and impaction of maxillary primary central incisors and subsequent enamel hypoplasia of the permanent maxillary central incisors.

Custom-made intraoral mandibular distraction as treatment for neonatal airway obstruction.

Hypoplastic mandible related airway obstruction therapy may vary from non-surgical to surgical, depending on the severity of the obstruction. Since its introduction in 1992, distraction osteogenesis (DO) has been used to lengthen the mandible. A new intraoral device is presented here. It has no need of screw fixation, whilst placement and activation are intraoral, leading to simple placement and removal. Seven cases with hypoplastic mandible related airway obstruction were treated between 2001 and 2008 with intraoral DO at the authors' institution. Six patients had a tracheostomy and one received continuous positive airway pressure (CPAP). After the distraction phase, five patients could be decanulated and in one case CPAP was no longer required. In one case the desired effect was not achieved. The findings suggest that early mandibular DO leads to damage to the permanent tooth buds resulting in missing teeth. The effectiveness of mandibular DO regarding early discharge of the patient is shown, leading to an overall cost reduction. Knowledge of alternative modalities such as mandibular DO in case of hypoplastic mandible related airway obstruction in neonatal healthcare should lead to early referral to a dedicated maxillofacial surgeon, possibly avoiding long-term airway support or tracheotomy.

Dentigerous cyst in an uncommon site: a rare entity.

Trauma to the deciduous teeth may have severe consequences. Pulp necrosis is the commonly observed sequel in traumatized primary teeth and is one of the possible etiologic factors for the development of dentigerous cyst. Dentigerous cyst is more commonly seen in mandibular third molar and maxillary canine region and is rarely associated with other teeth. This article addresses a case of dentigerous cyst associated with the germ of upper permanent central incisor, an uncommon site of occurrence, which was impacted, dislodged from its natural site of eruption after trauma to the predecessor incisor.

Interdisciplinary management of impacted maxillary central incisor with dilacerated crown.

INTRODUCTION: Dilaceration of the permanent teeth usually occurs because of trauma to their deciduous predecessors. Dilaceration in the crown is rare compared with that in the root and is more common in the maxillary and mandibular incisors. Generally, surgical exposure of the tooth followed by orthodontic traction or extraction of the tooth is the the choice of treatment. METHODS: This article highlights a surgical-endodontic approach to the management of the left permanent maxillary central incisor with dilaceration of the crown. RESULTS: The 1-year follow-up showed good stability of the prosthesis and good periodontal health. CONCLUSIONS: Surgical resection of the crown followed by endodontic treatment and restoration is a viable and rapid option for the management of crown dilaceration.

The reverberations of traumatized primary dentition: a practitioner's perspective.

UNLABELLED: The traumatized primary teeth have a great clinical significance because it not only have consequences on itself but also on its succedaneous developing permanent teeth due to its close anatomical relationship. The extent of severity is adjudged by the type of trauma and the age of the child at the time of trauma. For instance, avulsion and intrusive injuries present with high percentage of developmental disturbances in permanent teeth than subluxation and extrusive injuries. When considering the age of the child at the time of trauma, consequences are less severe in children over 4 years of age than in the younger age group. CLINICAL SIGNIFICANCE: It highlights the sequelae of trauma to primary teeth with the aim of aiding in detection of probable alterations in the traumatized primary teeth and its succedaneous permanent teeth.

Dilaceration of maxillary central incisor: a literature review.

The main purpose of this review is to present the aetiological factors and the mechanism that cause dilaceration of the maxillary central incisors. In early developmental stages, the permanent tooth germ of the maxillary incisor is situated palatally and superiorly to the apex of the primary incisor and gradually changes direction in a labial direction with its crown coming closer to the resorbing primary root. For reasons of this close relationship between the permanent tooth germ and the apex of the primary incisor, it is believed that an acute trauma to the primary predecessor can cause dilaceration of the long axis of the permanent successor. Clinically, dilaceration can be revealed by palpation high in the labial sulcus or in the hard palate, while its radiographic view is characteristic. The therapeutic approach to the dilacerated maxillary central incisors has to be carefully planned and needs the cooperation of several specialities to attain the final objective.

Morphologic and developmental disturbances of permanent teeth following trauma to primary dentition in a selected group of Maltese children.

OBJECTIVE: This study investigated the effects of trauma to primary teeth, related by age at the time of injury and type of injury sustained, to the frequency and type of developmental disturbances in the permanent successor teeth in a representative population of Maltese children. METHOD AND MATERIALS: Thirty-two children with 67 traumatized primary teeth were examined and any developmental disturbances of the corresponding permanent teeth recorded. RESULTS: Altogether, 52.2% of the permanent teeth exhibited developmental disturbances following trauma to their primary predecessors. The highest frequency of malformations was found following subluxation injuries. Intrusion injuries were associated with the most severe malformations. Age at the time of trauma to the primary dentition was a principal factor in the risk and severity of malformations developing in the permanent successors. CONCLUSION: The extent of malformation of the developing tooth germ was highly related to its developmental stage and to the severity and type of trauma sustained by the primary incisor.

Developmental disturbance of an unerupted permanent incisor due to trauma to its predecessor.

Developmental disturbances of permanent teeth can result from trauma to primary teeth because of the proximity of the root of the primary teeth to their permanent successors. We describe the case of a 14-month-old boy who was referred to the baby clinic of the School of Dentistry, Universidad Estadual Paulista, Araçatuba, Brazil, after sustaining a severe trauma that led to intrusion of the right primary central incisor. Radiographic examination 4 years after the trauma showed a developing morphological change in the germ of the permanent successor. On eruption of the permanent central incisor, a crown malformation along with enamel hypoplasia was observed. We conclude that radiographic follow-up is indicated after trauma to monitor possible sequelae in the permanent successors even before their eruption

14 year follow-up for a severe electrical burn to mouth and lip: case report.

INTRODUCTION: Electrical burns range from 4 to 7% of the total burn accidents and many of them affect primarily children biting on a live wire. Great confusion exists in the literature about the proper management of electrical burns to the mouth in the acute and late phases. CASE REPORT: 14 year results are shown in a severe electrical burn sustained in a 1 year 2 months old girl, involving 90% of the lips and commissures, tongue, alveolar ridges and teeth (primary central incisors and permanent dental germs). Two weeks after she was out of danger, an active splint expansion device was built and used for 8 months to prevent secondary microstomia. Later a new active splint device was used for a year after lip plastic surgery. At age 13, orthopedics and orthodontics were accomplished with a lip tattoo completed at age 15. CONCLUSION: No matter how good the final esthetic and occlusal results are, prevention is always the best option.

Treatment of large jaw bone cysts in children.

Odontogenic cysts are classified into 2 main types based on their formation mechanism: inflammatory and developmental. Radicular cysts are the most common inflammatory cysts, while dentigerous cysts are developmental cysts. We report 2 radicular cysts that developed at the apices of nonvital primary teeth and 2 dentigerous cysts. All 4 patients were young girls who experienced swelling in the mandibular molar region. Panoramic radiographs revealed a large cyst under the primary second molar, displacing the permanent second premolar or first molar to near the mandible's lower border. The treatment plan was begun with conservative decompression. Patients were followed up for several years. The process is described.

[Dens invaginatus. Review of the literature and diagnostic and therapeutic guidelines]. / Dens invaginatus. Literaturübersicht und Leitlinien zur Diagnostik und Therapie.

Dens invaginatus is a clinically relevant malformation of teeth resulting from an infolding of enamel and dentine into the dental structure during tooth formation, hence the former denomination "dens in dente". The dens invaginatus shows multiple morphological variations of crown and root formation. This frequently leads to caries, pulpal and periodontal involvement with necrosis and loss of attachment. Therefore, early diagnosis and prevention are of utmost importance. Due to the complexity of the malformation, treatment options in former days were limited. This article presents a profound review of the literature regarding etiology, epidemiology and histology. It discusses clinical appearance and diagnosis and it provides guidelines for decision-making and treatment of invaginated teeth.

Prevalence of sequelae in the permanent anterior teeth after trauma in their predecessors: a longitudinal study of 8 years.

The aim of this study was to determine the prevalence of sequelae in the permanent anterior teeth following trauma in their predecessors, and also to verify the existence of association between the sequelae in the permanent teeth and the type of injury in their predecessors according to the age group at the time of injury. This study was performed based on data from the records of 169 boys and 138 girls who received assistance at the dental clinic of the State University of Rio de Janeiro from March 1996 to December 2004. The sample was collected from 753 traumatized deciduous teeth of children aged 0-10 years. The number of boys and girls with dental trauma corresponded to 55.0% and 45.0%, respectively. The more affected age period was between 1 and 4 years (75.3%). The most common type of traumatic injury was the intrusion (29.3%), followed by avulsion (14.1%). Concerning permanent dentition, the most common developmental disturbances were discoloration of enamel and/or enamel hypoplasia (46.08%) and eruption disturbances (17.97%) due to the traumatic injury in their predecessors. It was not possible to find an association between the type of injury in primary teeth and sequelae in their successors in the studied age groups (P

Traumatic intrusion of primary teeth and its effects on the permanent successors: a clinical follow-up study.

OBJECTIVE: Owing to the anatomic proximity between the root of the primary tooth and its permanent successor, trauma to primary dentition may cause developmental disturbances in unerupted permanent teeth. STUDY DESIGN: This report presents the findings of a prospective 7-year study examining developmental disturbances of permanent teeth attributed to intrusive injury of their primary predecessors based on initial patient records and clinical observation. Intrusive injuries were diagnosed and grouped according to World Health Organization classifications, as modified by Andreasen et al. RESULTS: A total of 78 children (aged 12-48 months) presenting with intrusive trauma to 138 primary incisors were available for follow-up examinations. The most frequently intruded primary teeth were maxillary incisors (93.47%), with the right central primary incisor representing 41.3% of all intruded teeth. In 23 patients, 36 teeth were scheduled for extraction during the first visit. During the course of follow-up, 41 of the remaining teeth exhibited post-traumatic consequences, including pulp necrosis (78.0%), internal and/or external root resorption (14.6%), ankylosis (4.9%), and obliteration of the pulp canal (2.5%). In 74 permanent successors (53.6%), >or=1 of the following developmental disturbances were observed: enamel hypoplasia (28.3%), crown and/or root deformation (16.7%), and ectopic eruption (16.7%). CONCLUSION: There was no significant correlation between age of intrusion and frequency of subsequent developmental disturbances (P > .05).