Follow up in 4 weeks: Advise parents of

1
INTRUSION INJURIES RECOMMENDATIONS
Primary Dentition
Root tip is displaced towards buccal cortical
plate or vertical
All treatment is ideal and assumes patient has
manageable behavior. Recommendations also
assume radiographs ( periapical and lateral
anterior taken where appropriate). (REFERENCE
AAPD Handbook of Pediatric Dentistry)
No
Yes
Extract if root tip is displaced into permanent
tooth bud
Allow 6 months for spontaneous re-eruption.
Advise parents of potential damage to adult
tooth
Follow up in 4 weeks Advise parents of possible
injury / damage to permanent teeth
2
Intrusive Luxation

• Most common in upper primary incisors
• Management allow to re-erupt or extract

3
Tooth Not Retrieved Post Trauma

• Confirm Intrusion with Periapical
• Monitor up to 6 months for re-eruption

4
Intrusive LuxationPrimary Teeth

• Consider antibiotic therapy - monitor for
  infection
• Tetanus immunization current?
• Extract if there are signs of swelling,
  spontaneous bleeding, abscess and fever

Day of the Trauma
2 weeks Post Trauma
5
Intrusive LuxationPrimary Teeth

• One of the most dangerous injuries to the
  developing tooth bud
• Management Minimize damage by assessing
  displacement of permanent bud

6

• Ideally, a lateral film should be taken to
  confirm that intruded tooth has not displaced
  permanent tooth bud. If so, extraction
  recommended

7
Lateral Anterior Radiograph for Intruded Primary
Tooth

• Angulation of intruded tooth
• Occlusal or size 4 extraoral film next to
  childs cheek and perpendicular to radiographic
  beam
• Exposure time is doubled

8
Intrusion Luxation Re-eruption of Primary Tooth
2 months after injury
3 months after injury
1 year after injury
9
ROOT FRACTURES RECOMMENDATIONS
Primary Dentition
All treatment is ideal and assumes patient has
manageable behavior. Recommendations also assume
appropriate pre-operative radiographs. (Source
AAPD Handbook of Pediatric Dentistry)
Fracture located in coronal 1/3 of root or
segment is aspiration risk

Extract coronal segment. Leave apical segment
if not visible/easily removed
Yes
No
Clinical and radiographic follow up in 4 weeks
Advise parents of possible injury / damage to
permanent teeth. NO SPLINT IS INDICATED
10
Root FracturesPrimary Teeth

• Radiograph
• Apical 1/3
• - Most teeth maintain vitality and are
• minimally mobile
• - Apical fragment should
• resorb normally
• - Monitor with radiographs

11
Root FracturesPrimary Teeth

• Radiograph
• Middle or Cervical 1/3
• - Most teeth mobile. Extraction indicated
• - Gently attempt to retrieve apical fragment
  
• If not successful, monitor
• - Dont disrupt permanent tooth bud

12
Avulsion Primary Teeth

• Radiograph
• Do not re-implant!
• Space loss may not occur if primary canines are
  present
• Permanent tooth eruption may be delayed due to
  scar tissue/bone

13
Parents Question Will the permanent teeth be
damaged?

• May not be able to be determined until the teeth
  erupt and can be evaluated clinically
• The accident has happened - we cant reverse it
• Monitor clinically and radiographically

14
Complications of Trauma

• Permanent teeth malformation
• hypomineralization
• hypoplasia
• dilaceration
• arrested development

15
History of Intrusive LuxationPrimary Teeth

• Hypomaturation/Hypomineralization 8

16
History of Intrusion Luxation of Primary Tooth

• Severe dilaceration of Root

17
History of Avulsion E Prior to Eruption of
Primary Canines

• Space maintainer not possible for pre-coop tot
  with incisors only
• Ortho/space regaining will be needed

18
Acknowledgements

• Photos and Diagrams taken from
• Textbook and Color Atlas of Traumatic Injuries to
  the Teeth, 4th edition J.O. Andreasen (2007)
• Pediatric Dentistry, 4th edition Pinkham (2005)
• Odontologia Para o Bebe Walter L.R.F. (1996)
• University of Iowa, Department of Pediatric
  Dentistry

19
Competency Exam

• Answer the following questions on your worksheets

20
Case 1 Anna

• Anna is a 4 y.o. girl who fell against the edge
  of a table about 2 hours ago
• Her mother has given her childrens Tylenol and
  is at your office for evaluation
• The upper incisors are tender, but non-mobile.
• Her mother raises her lip to show you a 2 mm tear
  in the labial frenum area
• Anna is cooperative

21
Case 1 Anna

• What other clinical procedures do you need to
  perform? List at least 3.

22
Annas Pedo Occlusal

• Is this radiograph within normal limits, or do
  you see any abnormalities or pathology?

23
Case 1 Anna

• What is your plan for treatment and followup care
  for Anna?
• What are your care instructions for mother?

24
Case 2 Bart

• Bart is a 2 y.o. boy who fell against the edge of
  the bathtub about 1 hour ago
• Mother felt his tooth completely broke off at
  the gumline, but could not find the piece
• Clinically there are no additional findings

25
Bart

• What radiographs are indicated for Bart?

26
Pedo Occlusal for Bart

• Bart was not cooperative for further radiographs.
  What is your diagnosis based on this film?

27
Case 2 Bart

• What is your plan for treatment and followup
  care?

28
Case 3 Charlie

• Charlie is a healthy 3 y.o. boy who fell against
  the fireplace at home this morning
• His father is with him
• Clinical exam reveals enamel fracture E and
  dentin fracture F
• No excessive mobility, no luxation
• Occlusion is normal
• Charlie is cooperative , but impatient and wiggly

29
Charlies Clinical Appearance (photo is a
representation of the injury, not an actual photo
of this patient)

• What radiographs would you order for Charlie?

30
Pedo Occlusal for Charlie
31
Case 3 Charlie

• What is your plan for treatment and followup care
  for Charlie?

32
Case 4 Davonne

• Davonne is a 12 year old boy with a
  non-contributory Health History
• He and his parents are at your office for
  comprehensive care.
• The chief complaint is discolored lower front
  teeth.

33
Davonne Clinical Photo
34
Davonne

• What most likely caused this discoloration?
• What are treatment options?

35
Competency Exam

• Answer Discussion

36
Case 1 Anna

• Anna is a 4 y.o. girl who fell against the edge
  of a table about 2 hours ago
• Her mother has given her childrens Tylenol and
  is at your office for evaluation
• The upper incisors are tender, but non-mobile.
• Her mother raises her lip to show you a 2 mm tear
  in the labial frenum area
• Anna is cooperative

37
Case 1 Anna

• What other clinical procedures do you need to
  perform? List at least 3.
• Periapical radiograph (pedo occlusal)
• Mobility check
• Percussion check
• Occlusion check
• Complete hard and soft tissue assessment

38
Annas Pedo Occlusal

• Is this radiograph within normal limits, or do
  you see any abnormalities or pathology?
• Answer Within Normal Limits

39
Case 1 Anna

• What is your plan for treatment and followup care
  for Anna?
• Do not suture
• Observe clinically and radiographically
• What are your care instructions for mother?
• OTC pain meds prn
• Soft diet for about 1 week
• Tooth may discolor, but this may reverse
• Periodic reassessment needed

40
Case 2 Bart

• Bart is a 2 y.o. boy who fell against the edge of
  the bathtub about 1 hour ago
• Mother felt his tooth completely broke off at
  the gumline, but could not find the piece
• Clinically there are no additional findings

41
Bart

• What radiographs are indicated for Bart?
• Periapical (pedo occlusal)
• Lateral

42
Pedo Occlusal for Bart

• Bart was not cooperative for further radiographs.
  What is your diagnosis based on this film?
• Intrusion. No fracture detected.

43
Case 2 Bart

• What is your plan for treatment and followup
  care?
• Monitor for re-eruption
• Consider antibiotic therapy and assess tetanus
  immunization
• Explain signs and symptoms of infection.
• Re-assess in 2 weeks

44
Case 3 Charlie

• Charlie is a healthy 3 y.o. boy who fell against
  the fireplace at home this morning
• His father is with him
• Clinical exam reveals enamel fracture E and
  dentin fracture F
• No excessive mobility, no luxation
• Occlusion is normal
• Charlie is cooperative , but impatient and wiggly

45
Charlies Clinical Appearance

• What radiographs would you order for Charlie?
• Periapical (pedo occlusal)

46
Pedo Occlusal for Charlie
47
Case 3 Charlie

• What is your plan for treatment and followup care
  for Charlie?
• Smooth E
• GI Bandaid F or composite if cooperation
  allows
• Periodic clinical and radiographic followup

48
Case 4 Davonne

• Davonne is a 12 year old boy with a
  non-contributory Health History
• He and his parents are at your office for
  comprehensive care.
• The chief complaint is discolored lower front
  teeth.

49
Davonne Clinical Photo
50
Davonne

• What most likely caused this discoloration?
• History of primary tooth trauma/intrusion
• What are treatment options?
• No treatment
• Cosmetic bonding