# Dental Trauma: Primary Dentition ## DENT 5312 Paediatric Dentistry Module **Dr Jilen Patel** *Specialist Paediatric Dentist* *Senior Lecturer, Clinical Dentistry* *UWA Dental School* #### Course Information - **Module:** DENT 5312 Paediatric Dentistry Module #### Presenter Profile - **Dr Jilen Patel** - Specialist Paediatric Dentist - Senior Lecturer, Clinical Dentistry - UWA Dental School Dental Trauma – Primary Dentition Prevalence in preschool children: head and facial injuries make up 40% of somatic injuries Glendor et al. 1996 toddlers fall over on average 17 times per hour! Adolph et al. 2012   #### Statistical Overview - In preschool children, head and facial injuries account for 40% of all somatic injuries (Glendor et al. 1996). - Toddlers fall an average of 17 times per hour (Adolph et al. 2012). Line drawing labeled 'A', showing a simple indoor playroom layout viewed from above to provide a baseline comparison. Line drawing labeled 'B', depicting a chaotic tangle of lines overlaid on the playroom scene, illustrating the potential confusion of environment monitoring. # Dental Trauma – Primary Dentition *** ### Prevalence 30% of the children had sustained injuries to primary teeth 46% of the children had a history of traumatic injuries to primary and/or permanent teeth *Andreasen and Ravn 1972* Dr Jilen Patel #### Injury Frequency - 30% of children sustained injuries specifically to primary teeth. - 46% of children had a history of traumatic injuries involving primary and/or permanent teeth (Andreasen and Ravn 1972). # Dental Trauma – Primary Dentition ### Examination **Dr Jilen Patel** A rational examination procedure is essential in order to establish a complete and correct diagnosis of all soft and hard tissue injuries (Andreasen and Andreasen 1985, Bakland and Andreasen 1996, Andreasen et al. 2007). * **Clean the face and the oral cavity with water or saline**. If there are soft tissue wounds, a mild detergent should be used. This cleaning will make the patient feel more comfortable and facilitate extraoral and oral examination. * **Make a short medical and dental history**. The medical history should reveal possible allergies, blood disorders and other information that may influence treatment. The dental history should indicate previous dental traumas, information which may explain radiographic findings such as pulp canal obliteration or apical pathology. ### Questions relating to the injury * **Where did the injury occur?** This information may have legal implication for the patient and may on occasion indicate the possibility of contamination. * **How did the injury occur?** This may lead to identification of the impact zones, i.e. a chin injury is often combined with crown or crown-root fractures in premolar and molar regions. * **When did the injury occur?** This information may be essential in relation to many injury types. In relation to a tooth avulsion the extent of time and the extraoral storage condition becomes very decisive for later treatment. * **Was there a period of unconsciousness?** If so, for how long? Amnesia, nausea and vomiting are all signs of brain damage and require medical attention. * **Is there any disturbance in the bite?** An affirmative answer may indicate a luxation injury with displacement, an alveolar or jaw fracture or a fracture of the condylar region. * **Is there any reaction in the teeth to cold and/or heat exposure?** A positive finding indicates exposed dentin and/or pulp. ### Clinical examination * *Examine* the face, lips and oral muscles for soft tissue lesions. * *Palpate* the facial skeleton for signs of fractures. * *Inspect* the dental trauma region for fractures, abnormal tooth position, tooth mobility and abnormal response to percussion. Furthermore, registration of direction of displacement in case of luxation injuries. In case of fractures their relation to the gingival sulcus area is noted as well as possible pulp involvement. * *Pulp testing* (usually electrometric) completes the clinical examination. A rational examination procedure is essential to establish a complete and correct diagnosis of all soft and hard tissue injuries. #### Initial Preparation and History - **Clean the face and oral cavity**: Use water or saline. For soft tissue wounds, use a mild detergent to improve patient comfort and facilitate the examination. - **Medical and Dental History**: Identify allergies, blood disorders, or previous dental traumas that may explain radiographic findings like pulp canal obliteration or apical pathology. #### Diagnostic Questions - **Where did the injury occur?** Relevant for legal implications and identifying potential contamination. - **How did the injury occur?** Helps identify impact zones (e.g., a chin injury often correlates with premolar/molar fractures). - **When did the injury occur?** Critical for treatment decisions, especially regarding extraoral storage time for avulsed teeth. - **Was there unconsciousness?** Amnesia, nausea, and vomiting are signs of brain damage requiring medical attention. - **Is there a bite disturbance?** May indicate luxation, displacement, alveolar/jaw fractures, or condylar fractures. - **Is there sensitivity to temperature?** Positive findings indicate exposed dentin or pulp. #### Clinical Assessment Steps - **Soft Tissue**: Examine face, lips, and oral muscles for lesions. - **Skeletal**: Palpate the facial skeleton for fractures. - **Dental Region**: Inspect for fractures, abnormal positioning, mobility, and percussion response. Note displacement direction and relationship of fractures to the gingival sulcus or pulp. - **Pulp Testing**: Complete the examination with electrometric pulp testing. # Dental Trauma – Primary Dentition [The University of Western Australia logo] **Dr Jilen Patel** ## Examination ### Radiographic examination * The completed clinical examination has now identified the trauma region and this site should now be examined with relevant radiographic techniques. Several clinical studies have shown that multiple radiographic procedures are needed to detect displacement of the tooth in its socket as well as presence of root fractures (Andreasen and Andreasen 1985, Andreasen and Andreasen 1988). > It is essential to consider the radiographic film format used in order to achieve a high quality image of the traumatized tooth. A steep occlusal exposure (using a size 2 film (DF 58, EP 21)) of the traumatized anterior region gives an excellent view of most lateral luxations, apical and mid-root fractures and alveolar fractures. The standard periapical bisecting angle exposure of each traumatized tooth (using a size 1 film (DF 56, EP 11)) provides information about cervical root fractures as well as other tooth displacements. Thus, a radiographic examination comprising one steep occlusal exposure and three periapical bisecting angle exposures of the traumatized region will provide sufficient information in determining the extent of trauma to an incisor region. Multiple radiographic procedures are necessary to detect tooth displacement in the socket and the presence of root fractures. #### Radiographic Techniques and Film Formats - **Steep Occlusal Exposure**: Using a size 2 film (DF 58, EP 21). Provides an excellent view of lateral luxations, apical and mid-root fractures, and alveolar fractures. - **Periapical Bisecting Angle Exposure**: Using a size 1 film (DF 56, EP 11) for each traumatized tooth. Provides information on cervical root fractures and other displacements. #### Recommended Examination Protocol A comprehensive examination of the incisor region should comprise: 1. One steep occlusal exposure. 2. Three periapical bisecting angle exposures. # Dental Trauma – Primary Dentition **Examination** ## Radiographic examination The completed clinical examination has now identified the trauma region and this site should now be examined with relevant radiographic techniques. Several clinical studies have shown that multiple radiographic procedures are needed to detect displacement of the tooth in its socket as well as presence of root fractures (Andreasen and Andreasen 1985, Andreasen and Andreasen 1988). A *steep occlusal exposure* (using a size 2 film DF 58, EP 21) of the traumatized anterior region gives an excellent view of most lateral luxations, apical and mid-root fractures and alveolar fractures. The standard periapical bisecting angle exposure of each traumatized tooth (using a size 1 film DF 56, EP 11)) provides information about cervical root fractures as well as other tooth displacements. Thus, a radiographic examination comprising one steep occlusal exposure and three periapical bisecting angle exposures of the traumatized region will provide sufficient information in determining the extent of trauma to an incisor region.    Clinical studies emphasize that multiple radiographic views are required to accurately identify displacement and root fractures. #### Standard Imaging Views - **Steep Occlusal Exposure (Size 2 film)**: Best for detecting lateral luxations, apical/mid-root fractures, and alveolar fractures. - **Periapical Bisecting Angle Exposure (Size 1 film)**: Essential for identifying cervical root fractures and specific tooth displacements. #### Summary of Protocol To provide sufficient diagnostic information for the incisor region, the examination should include one steep occlusal exposure and three periapical bisecting angle exposures. Photo showing a teddy bear sitting on a child's dental chair, illustrating the use of a comfort object during consultation for pediatric patients. Photo depicting a dental examination on a young boy, showing a clinician positioning a rectangular frame near the patient's mouth while holding dental forceps. Line diagram illustrating a radiographic projection with an angle of 65 degrees, credited to 'Hintze and Espelid'. # Dental Trauma – Primary Dentition **Examination** **Photographic examination** ## What bruises are suspicious? <table> <tr> <td><b>Accidental = peripheral</b></td> <td><b>Non-accidental = central</b></td> </tr> </table> <img src="placeholder.png" alt="Illustration showing the difference between accidental (peripheral) and non-accidental (central) bruising patterns on a child's body. The accidental patterns are shown in green, while the non-accidental patterns are shown in red." width="500" height="300"> Santos et al. 2007   #### Screening for Non-Accidental Injury When performing a photographic examination, it is critical to distinguish between accidental and suspicious bruising patterns: - **Accidental Bruising**: Typically located in peripheral areas. - **Non-Accidental Bruising**: Typically located in central areas of the body (Santos et al. 2007). Illustration showing the difference between accidental (peripheral) and non-accidental (central) bruising patterns on a child's body. The accidental patterns are shown in green, while the non-accidental patterns are shown in red, located under the question 'What bruises are suspicious?'. Photograph of a child from the side showing distinctive bruising on the back of the shoulder and upper torso. The image is credited to Santos et al. 2007. # Dental Trauma – Primary Dentition Dr Jilen Patel ## Fractures <img title='The image depicts various types of dental fractures in primary dentition. The fractures are categorized and illustrated as follows:' src='https://eventos2023.s3.amazonaws.com/img/5713266003738AA00/Webinar+Dental+Trauma+2.2.pptx.1479408670438687.png'> - **Infraction** - **Enamel fracture** - **Enamel-dentin fracture** - **Enamel-dentin-pulp fracture** - **Crown-root fracture without pulp involvement** - **Crown-root fracture with pulp involvement** - **Root fracture** - **Alveolar fracture**  #### Classification of Fractures - Infraction - Enamel fracture - Enamel-dentin fracture - Enamel-dentin-pulp fracture - Crown-root fracture (with or without pulp involvement) - Root fracture - Alveolar fracture A composite illustration displaying various types of dental fractures in primary dentition, as labeled in the text below. The diagram categorizes injuries including Infraction, Enamel fracture, Enamel-dentin fracture, Enamel-dentin-pulp fracture, Crown-root fracture (with and without pulp involvement), Root fracture, and Alveolar fracture. # Dental Trauma – Primary Dentition Dr Jilen Patel The University of Western Australia ## Luxations ### Concussion <sub>[Image: A diagram showing a tooth with minimal periodontal ligament injury.</sub> ### Subluxation <sub>[Image: A diagram showing a tooth with loosening but without displacement.</sub> ### Extrusion <sub>[Image: A diagram showing a tooth displaced apically.</sub> ### Lateral Luxation <sub>[Image: A diagram showing a tooth displaced horizontally.</sub> ### Intrusion <sub>[Image: A diagram showing a tooth displaced coronally.</sub> ### Avulsion <sub>[Image: A diagram showing a tooth completely dislodged from the socket.</sub>         #### Classification of Luxation Injuries - **Concussion**: Injury to the tooth-supporting structures without increased mobility or displacement. - **Subluxation**: Injury resulting in increased mobility but without displacement. - **Extrusion**: Partial displacement of the tooth out of its socket (apical displacement). - **Lateral Luxation**: Displacement of the tooth in a direction other than axially (horizontal displacement). - **Intrusion**: Displacement of the tooth deeper into the alveolar bone (coronal displacement of the root). - **Avulsion**: Complete displacement of the tooth out of its socket. The University of Western Australia logo located in the top right corner. A composite image displaying six distinct figures illustrating dental luxations, each with a caption below: Concussion, Subluxation, Extrusion, Lateral luxation, Intrusion, and Avulsion. Diagram labeled 'Concussion' showing a tooth with minimal periodontal ligament injury. Diagram labeled 'Subluxation' showing a tooth with loosening but without displacement. Diagram labeled 'Extrusion' showing a tooth displaced apically. Diagram labeled 'Lateral luxation' showing a tooth displaced horizontally across the vestibular or lingual aspects. Diagram labeled 'Intrusion' showing a tooth displaced coronally into the alveolar bone. Figure labeled 'Avulsion' showing a tooth completely dislodged from the socket. # Dental Trauma – Primary Dentition | **Dr Jilen Patel** <br> **The University of WA** | |---| ## Treatment options 1. **Conservative management** * soft diet, analgesia, ongoing review and monitoring **OR** 2. **Extraction** * extent of injury * occlusal interference * pulpal exposure * degloving injuries Andersson et al. 2012 Treatment for primary dentition trauma generally follows two paths (Andersson et al. 2012): 1. **Conservative Management** - Soft diet and analgesia. - Ongoing review and monitoring. 2. **Extraction** - Indicated based on the extent of injury. - Necessary for occlusal interference or pulpal exposure. - Required for degloving injuries. # Dental Trauma – Primary Dentition **Dr Jilen Patel** **The University of Western Australia** ## Treatment options 1. Conservative management * soft diet, analgesia, ongoing review and monitoring **Concussion or subluxation:** **Low risk of complications (less than 10%)** *(Complications: pulp necrosis, resorption, PCO, premature loss)* *Most complications occur within the first 12months* *More likely in children >4yrs old* Lauridsen et al. 2017 > <img src=">**Figure: Diagram of a tooth and intraoral photo of a child's teeth**"> <!-- only text elements    #### Concussion and Subluxation - **Management**: Soft diet, analgesia, and ongoing monitoring. - **Risk Profile**: Low risk of complications (less than 10%). - **Potential Complications**: Pulp necrosis, resorption, pulp canal obliteration (PCO), and premature loss. - **Timeline**: Most complications occur within the first 12 months. - **Demographics**: Complications are more likely in children over 4 years of age (Lauridsen et al. 2017). An anatomical illustration showing the internal structure of a tooth, including the pulp and surrounding enamel, situated next to clinical photos of a child's dentition. A clinical close-up intraoral photograph showing the upper front teeth, highlighting the affected tooth among others in the primary dentition. A clinical occlusal view photograph of a child's upper arch, contrasting the alignment of primary teeth, likely used to demonstrate dental trauma cases related to the lecture topic. # Dental Trauma – Primary Dentition **Dr Jilen Patel** ## Treatment options ### 1. Conservative management * soft diet, analgesia, ongoing review and monitoring ### Intrusion: > * **80% of intruded teeth re-erupt spontaneously** > *(BUT 1/3 will develop complications e.g. **infection** or **ankylosis**)* > * Lauridsen et al. 2017 > > * *lowest risk **risk of pulp necrosis** in children <2years of age* > * *degree of intrusion or concomitant fracture did not affect complication rate*  #### Intrusion Management - **Spontaneous Re-eruption**: Occurs in 80% of intruded primary teeth. - **Complication Rate**: Approximately 1/3 will develop complications such as infection or ankylosis. - **Risk Factors (Lauridsen et al. 2017)**: - Lowest risk of pulp necrosis in children under 2 years of age. - The degree of intrusion or presence of a concomitant fracture does not significantly affect the complication rate. Anatomical illustration showing an intruded tooth positioned vertically inside the alveolar socket, surrounded by periodontal structures and gingiva, visually representing the condition described in the 'Intrusion' section. # Dental Trauma – Primary Dentition Dr Jilen Patel ## Case Example   #### Clinical Case Example [Section reserved for case documentation] Close-up clinical photograph showing severe intrusive luxation of teeth 51 and 61 in the primary dentition, as labeled below. Follow-up clinical photograph showing spontaneous re-eruption of teeth six months later. ### Dental Trauma – Primary Dentition #### Case Example  - **[Lauridsen et al. 2017](#)** - **[Koch et al. 2017](#)** - **Dr Jilen Patel**    #### Clinical References for Case Management - Lauridsen et al. 2017 - Koch et al. 2017 Clinical photo of primary dentition with trauma, showing missing or displaced teeth and soft tissue injury in the upper front region. Dental radiograph showing primary teeth and underlying structures, likely associated with trauma or abnormal alignment. Dental radiograph showing posterior and anterior primary teeth, possibly illustrating trauma-related bone or root changes. # **Dental Trauma – Primary Dentition** ### **Dr Jilen Patel** ## Treatment options ### 1. Conservative management * soft diet, analgesia, ongoing review and monitoring --- **Extrusive or *lateral* luxation:** * **Extrusion:** ~15-43% complication rate * **Lateral luxation:** ~20-40% complication rate * *(Complications:** pulp necrosis, resorption, PCO, premature loss*) * *Most complications occur within the first 12 months (~96%)* * *More likely: in children >4 yrs old and concomitant crown fracture* Lauridsen et al. 2017  #### Extrusive and Lateral Luxation - **Complication Rates**: - Extrusion: 15–43% - Lateral Luxation: 20–40% - **Types of Complications**: Pulp necrosis, resorption, PCO, and premature tooth loss. - **Prognostic Factors (Lauridsen et al. 2017)**: - 96% of complications occur within the first 12 months. - Higher risk in children over 4 years of age or when a concomitant crown fracture is present. Anatomical illustration showing the progression or types of dental trauma. It displays cross-sections of two teeth within bone, visually representing the 'Extrusive or lateral luxation' condition described in the accompanying text. # Dental Trauma – Primary Dentition --- **Dr Jilen Patel** ## Treatment options 1. Conservative management - soft diet, analgesia, ongoing review and monitoring **OR** 2. Extraction - extent of injury - occlusal interference - pulpal exposure - degloving injuries --- *Andersson et al. 2012* #### Indications for Extraction vs. Conservative Care Extraction is preferred over conservative management (soft diet/monitoring) when the following are present (Andersson et al. 2012): - Severe extent of injury. - Occlusal interference that prevents normal closing. - Direct pulpal exposure. - Degloving injuries. # Dental Trauma – Primary Dentition **Dr Jilen Patel** * Crown fractures in the primary dentition * **uncomplicated** * conservative management and review * **complicated** * usually extraction * can be referred to a paediatric dentist if the parents want to look at options to maintain the tooth  #### Management Protocols by Fracture Type - **Uncomplicated Crown Fractures**: - Managed via conservative treatment and regular clinical review. - **Complicated Crown Fractures**: - Extraction is the standard treatment. - Referral to a paediatric dentist may be considered if parents wish to explore specialized options to maintain the tooth. A clinical photograph showing a child's open mouth with an injured upper primary tooth, fitting the context of 'Crown fractures in the primary dentition'. # Dental Trauma – Complications | | | | | | --- | --- | --- | --- | | **Dr Jilen Patel** | **THE UNIVERSITY OF WESTERN AUSTRALIA** | | | | | | | | | | | **SEEK WISDOM** | | * Pulp necrosis * Pulp canal obliteration * Discolouration * Ankylosis * Gingival defect * Premature tooth loss * Root resorption #### Common Post-Traumatic Sequelae - Pulp necrosis - Pulp canal obliteration (PCO) - Tooth discolouration - Ankylosis - Gingival defects - Premature tooth loss - Root resorption <div align="right"> <p align="right"><b>THE UNIVERSITY OF</b> <b>WESTERN</b> <b>AUSTRALIA Dr Jilen Patel</b></p> </div> # Dental Trauma – Complications ## **Borum & Andreasen** **Table 1.** Frequencies of all complications seen among 387 traumatized primary teeth during the follow-up period according to type of luxation. One avulsed and replanted tooth and 7 teeth with no luxation diagnosis are excluded from the table | | Con ocussion $N=14$ | | Subluxation $N=132$ | | Extrusion $N=10$ | | Intrusion $N=85$ | | Lateral luxation | | Total $N=387$ | | | :--- | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | **Complication** | **$n$ ($\%$)** | **$n$ ($\%$)** | **$n$ ($\%$)** | **$n$ ($\%$)** | **$n$ ($\%$)** | **$n$ ($\%$)** | **$n$ ($\%$)** | **$n$ ($\%$)** | **$n$ ($\%$)** | **$n$ ($\%$)** | | Color changes | **5 $(35.7)$** | | **56 (42.4)** | | **8 (80.0)** | | **41 (48.2)** | | **91 $(62.3)$** | | **203 $(52.4)$** | | | Pulp necrosis (PN) | **1 (7.1)** | | **19 $(14.4)$** | | **3 $(30.0)$** | | **32 $(37.6)$** | | **41 $(28.1)$** | | **98 (25.3)** | | | Pulp canal obliteration (PCO) | **4 (28.6)** | | **34 (25.8)** | | **7 $(70.0)$** | | **35 $(41.1)$** | | **61 (41.8)** | | **142 $(36.7)$** | | | Gingival retraction | **0 (0.0)** | | **8 $(6.1)$** | | **1 (10.0)** | | **2 (2.4)** | | **10 $(6.8)$** | | **22 $(6.7)$** | | | Permanent displacement | **0 (0.0)** | | **0 (0.0)** | | **1 (10.0)** | | **15 (17.6)** | | **5 $(3.4)$** | | **21 $(5.7)$** | | | Surface resorption | **0 (0.0)** | | **0 (0.0)** | | **0 (0.0)** | | **1 $(1.2)$** | | **2 $(1.4)$** | | **3 (0.8)** | | | Inflammatory resorption | **1 (7.1)** | | **5 (3.8)** | | **0 (0.0)** | | **12 (14.1)** | | **19 $(13.0)$** | | **38 (9.8)** | | | Ankylosis | **0 (0.0)** | | **0 (0.0)** | | **0 (0.0)** | | **2 (2.4)** | | **1 (0.7)** | | **3 (0.8)** | | | Disturbed physiological resorption | **0 (0.0)** | | **1 (0.8)** | | **1 (10.0)** | | **2 (2.4)** | | **7 (4.8)** | | **12 (3.1)** | | | No complications | **8 $(57.1)$** | | **57 (43.2)** | | **0 (0.0)** | | **10 (11.8)** | | **17 (11.6)** | | **97 $(25.1)$** | |  #### Complication Frequencies by Luxation Type (Borum & Andreasen) Data based on 387 traumatized primary teeth: - **Color Changes**: Highest in Extrusion (80.0%) and Lateral Luxation (62.3%). - **Pulp Necrosis (PN)**: Highest in Intrusion (37.6%) and Extrusion (30.0%). - **Pulp Canal Obliteration (PCO)**: Highest in Extrusion (70.0%) and Lateral Luxation (41.8%). - **Inflammatory Resorption**: Most frequent in Intrusion (14.1%) and Lateral Luxation (13.0%). - **Permanent Displacement**: Seen primarily in Intrusion (17.6%). - **No Complications**: Most common in Concussion (57.1%) and Subluxation (43.2%); 0% for Extrusion cases. Table 1 shows frequencies of all complications seen among 387 traumatized primary teeth. It lists complications like color changes, pulp necrosis, and resorption against types of luxation such as concussion, subluxation, and intrusion, with specific counts and percentages. # Dental Trauma – Complications **The University of Western Australia** **Dr Jilen Patel** **Initial Presentation** * 14mos old boy * 51 intrusive and palatal luxation * Repositioned under LA > **Figure 1**: Initial examination: **a)** clinical view of the traumatized area; **b)** radiographic aspect of the intruded tooth. ### Figure 1 <img width="190" height="135" src="https://i.imgur.com/qL9c2.jpg" alt="Clinical view of a traumatized area (a) showing a tooth intruded into the socket with visible blood, and a corresponding X-ray (b) confirming the intruded tooth position." /> **12 month review** > **Figure 2**: Clinical and radiographic views, 1 year after trauma: **a)** clinical examination revealed normal mucosa and no discolouration of the dental crown; **b)** radiographic examination showed normal characteristics. ### Figure 2 <img width="190" height="135" src="https://i.imgur.com/GgQ6D.jpg" alt="Clinical view of the dentition showing a year post-injury appearance (a), indicating healthy gums and teeth, and an accompanying X-ray (b) demonstrating normal tooth structure and root development standards." /> --- **Gomes et al. 2010**   #### Initial Presentation and 12-Month Review - **Patient**: 14-month-old boy. - **Injury**: Tooth 51 intrusive and palatal luxation. - **Treatment**: Repositioned under local anaesthesia (LA). - **1-Year Follow-up**: Clinical examination showed normal mucosa and no crown discolouration. Radiographs showed normal characteristics (Gomes et al. 2010). Figure 1 showing the initial examination of a 14-month-old boy with tooth 51 intruded and palatally luxated: a clinical photo of the injured tooth and an X-ray showing the intruded position. Figure 2 depicting the 12-month review after trauma: a clinical evaluation indicating normal mucosa and crown color, and an X-ray showing normal characteristics of the tooth. # Dental Trauma – **Complications** * *Gomes et al.* **2010** * **Dr Jilen Patel** --- ### 4 year review <img src="IMAGE_3.jpg" alt="Figure 3" style="height: 178px; width: 300px; object-fit: cover; border: none;"> **Figure 3**: Radiographic examination 4 years after dental trauma revealed signs of alteration in the germ of the maxillary right central permanent incisor. <img src="IMAGE_4.jpg" alt="Figure 4" style="height: 226px; width: 300px; object-fit: cover; border: none;"> **Figure 4**: Crown malformation of the permanent teeth: **a)** intraoral view showing enamel hypoplasia on the permanent maxillary right central incisor and circular enamel hypoplasia on the permanent left central incisor; **b)** intraoral view showing dilaceration of the crown of tooth 11 and discoloration.   #### 4-Year Review: Long-term Sequelae - **Radiographic Findings**: Signs of alteration in the germ of the maxillary right central permanent incisor. - **Permanent Tooth Malformations**: - Enamel hypoplasia on the permanent maxillary right central incisor. - Circular enamel hypoplasia on the permanent left central incisor. - Dilaceration and discoloration of the crown of tooth 11 (Gomes et al. 2010). Figure 3 is a radiographic examination taken 4 years after dental trauma, showing signs of alteration in the germ of the maxillary right central permanent incisor, with associated text '4 year review'. Figure 4 shows crown malformation in permanent teeth. Part a) displays enamel hypoplasia on the maxillary right and left central incisors, while part b) shows dilaceration and discoloration of tooth 11. # Dental Trauma – Complications Dr Jilen Patel <figure> <img src="Dental_Trauma-Complications" /> **4 year review** **Figure 3:** Radiographic examination 4 years after dental trauma revealed signs of alteration in the germ of the maxillary right central permanent incisor. **Figure 4:** Crown malformation of the permanent teeth: **a**) intraoral view showing enamel hypoplasia on the permanent maxillary right central incisor and circular enamel hypoplasia on the permanent left central incisor; **b**) intraoral view showing discoloration of the crown of tooth 11 and isolation on tooth 21. **Gomes et al. 2010** </figure>    #### Summary of 4-Year Review Findings - **Developmental Impact**: Radiographic evidence of trauma-induced alterations to the permanent successor germ. - **Clinical Presentation of Permanent Teeth**: - Enamel hypoplasia (maxillary right central incisor). - Circular enamel hypoplasia (left central incisor). - Discoloration of tooth 11 and isolation issues with tooth 21 (Gomes et al. 2010). A radiographic examination (Figure 3) showing a 4 year review of the teeth. A line drawing illustrating a tooth structure. A clinical photo (Figure 4) depicting Crown malformation of the permanent teeth, with parts a and b showing intraoral views of enamel hypoplasia and adverse coloration. # Dental Trauma – Primary Dentition **Dr Jilen Patel** * Recommended Reading * Dental Trauma Guide * *Andersson L, Andreasen JO, Day P. Guidelines for the Management of Traumatic Dental Injuries: 3. Injuries in the Primary Dentition. Dent Traumatol 2012;28:174-182* #### Clinical Resources and Guidelines - **Dental Trauma Guide** - **International Association of Dental Traumatology (IADT) Guidelines** - Andersson L, Andreasen JO, Day P. Guidelines for the Management of Traumatic Dental Injuries: 3. Injuries in the Primary Dentition. *Dental Traumatology* 2012; 28: 174-182. [^1]: Original PDF page 1: [[L8 Dental Trauma Primary Dentition.pdf#page=1|L8 Dental Trauma Primary Dentition, p.1]] [^2]: Original PDF page 2: [[L8 Dental Trauma Primary Dentition.pdf#page=2|L8 Dental Trauma Primary Dentition, p.2]] [^3]: Original PDF page 3: [[L8 Dental Trauma Primary Dentition.pdf#page=3|L8 Dental Trauma Primary Dentition, p.3]] [^4]: Original PDF page 4: [[L8 Dental Trauma Primary Dentition.pdf#page=4|L8 Dental Trauma Primary Dentition, p.4]] [^5]: Original PDF page 5: [[L8 Dental Trauma Primary Dentition.pdf#page=5|L8 Dental Trauma Primary Dentition, p.5]] [^6]: Original PDF page 6: [[L8 Dental Trauma Primary Dentition.pdf#page=6|L8 Dental Trauma Primary Dentition, p.6]] [^7]: Original PDF page 7: [[L8 Dental Trauma Primary Dentition.pdf#page=7|L8 Dental Trauma Primary Dentition, p.7]] [^8]: Original PDF page 8: [[L8 Dental Trauma Primary Dentition.pdf#page=8|L8 Dental Trauma Primary Dentition, p.8]] [^9]: Original PDF page 9: [[L8 Dental Trauma Primary Dentition.pdf#page=9|L8 Dental Trauma Primary Dentition, p.9]] [^10]: Original PDF page 10: [[L8 Dental Trauma Primary Dentition.pdf#page=10|L8 Dental Trauma Primary Dentition, p.10]] [^11]: Original PDF page 11: [[L8 Dental Trauma Primary Dentition.pdf#page=11|L8 Dental Trauma Primary Dentition, p.11]] [^12]: Original PDF page 12: [[L8 Dental Trauma Primary Dentition.pdf#page=12|L8 Dental Trauma Primary Dentition, p.12]] [^13]: Original PDF page 13: [[L8 Dental Trauma Primary Dentition.pdf#page=13|L8 Dental Trauma Primary Dentition, p.13]] [^14]: Original PDF page 14: [[L8 Dental Trauma Primary Dentition.pdf#page=14|L8 Dental Trauma Primary Dentition, p.14]] [^15]: Original PDF page 15: [[L8 Dental Trauma Primary Dentition.pdf#page=15|L8 Dental Trauma Primary Dentition, p.15]] [^16]: Original PDF page 16: [[L8 Dental Trauma Primary Dentition.pdf#page=16|L8 Dental Trauma Primary Dentition, p.16]] [^17]: Original PDF page 17: [[L8 Dental Trauma Primary Dentition.pdf#page=17|L8 Dental Trauma Primary Dentition, p.17]] [^18]: Original PDF page 18: [[L8 Dental Trauma Primary Dentition.pdf#page=18|L8 Dental Trauma Primary Dentition, p.18]] [^19]: Original PDF page 19: [[L8 Dental Trauma Primary Dentition.pdf#page=19|L8 Dental Trauma Primary Dentition, p.19]] [^20]: Original PDF page 20: [[L8 Dental Trauma Primary Dentition.pdf#page=20|L8 Dental Trauma Primary Dentition, p.20]] [^21]: Original PDF page 21: [[L8 Dental Trauma Primary Dentition.pdf#page=21|L8 Dental Trauma Primary Dentition, p.21]] [^22]: Original PDF page 22: [[L8 Dental Trauma Primary Dentition.pdf#page=22|L8 Dental Trauma Primary Dentition, p.22]] [^23]: Original PDF page 23: [[L8 Dental Trauma Primary Dentition.pdf#page=23|L8 Dental Trauma Primary Dentition, p.23]]