Aim: This case report illustrates the multidisciplinary treatment of a 12-year-old boy with esthetic challenges and endodontic problems in his maxillary incisors after severe dental injury at the age of 2½ years.
Background: The close anatomic relationship of the primary tooth to the permanent tooth germ explains why traumatic dental injuries in primary dentition may affect the development of permanent teeth especially in the maxillary anterior region. Developmental defects of enamel (DDE) as well as crown/root dilacerations are often seen after displacement injuries such as intrusion or avulsion occurring at lower age.
Case description: A 12-year-old boy with severe discoloration and enamel hypoplasia of his maxillary incisors was treated with composite restorations. History of avulsion injury of teeth 51 and 61 at the age of 2½ years explained the DDE, the severe dilaceration, and delayed tooth eruption of tooth 21. Use of cone-beam computed tomography (CBCT) was decisive in diagnosis and treatment planning of esthetic concerns and endodontic complications.
Conclusion: Trauma to primary teeth taking place at early childhood may have severe consequences on permanent successors.
Clinical significance: Severe morphological variations in permanent incisors caused by dental injuries in the predecessor teeth require monitoring and multidisciplinary approach. Advanced three-dimensional radiographic imaging is useful in identification and treatment planning of such cases.
Glendor U. Epidemiology of traumatic dental injuries--a 12 year review of the literature. Dent Traumatol 2008;24(6):603–611. DOI: 10.1111/j.1600-9657.2008.00696.x.
Petti S, Glendor U, Andersson L. World traumatic dental injury prevalence and incidence, a meta-analysis-one billion living people have had traumatic dental injuries. Dent Traumatol 2018;34(2):71–86. DOI: 10.1111/edt.12389.
Lenzi MM, Alexandria AK, Ferreira DM, et al. Does trauma in the primary dentition cause sequelae in permanent successors? A systematic review. Dent Traumatol 2015;31(2):79–88. DOI: 10.1111/edt.12149.
Flores MT, Onetto JE. How does orofacial trauma in children affect the developing dentition? long-term treatment and associated complications. J Endod 2019;45(12S):S1–S12. DOI: 10.1016/j.joen.2019.05.006.
Andreasen JO, Ravn JJ. The effect of traumatic injuries to primary teeth on their permanent successors. II. A clinical and radiographic follow-up study of 213 teeth. Scand J Dent Res 1971;79(4):284–294.
Da Silva Assuncao LR, Ferelle A, Iwakura ML, et al. Effects on permanent teeth after luxation injuries to the primary predecessors: a study in children assisted at an emergency service. Dent Traumatol 2009;25(2):165–170. DOI: 10.1111/j.1600-9657.2008.00759.x.
Skaare AB, Aas AL, Wang NJ. Enamel defects on permanent successors following luxation injuries to primary teeth and carers’ experiences. Int J Paediatr Dent 2015;25(3):221–228. DOI: 10.1111/ipd.12136.
Topouzelis N, Tsaousoglou P, Pisoka V, et al. Dilaceration of maxillary central incisor: a literature review. Dent Traumatol 2010;26(5):427–433. DOI: 10.1111/j.1600-9657.2010.00915.x.
de Amorim CS, Americano GCA, Moliterno LFM, et al. Frequency of crown and root dilaceration of permanent incisors after dental trauma to their predecessor teeth. Dent Traumatol 2018;34(6):401–405. DOI: 10.1111/edt.12433.
Becker A. Maxillary central incisors. In: Becker A, ed. The orthodontic treatment of impacted teeth. UK: Informa; 2007. pp. 61–91.
Crescini A, Doldo T. Dilaceration and angulation in upper incisors consequent to dental injuries in the primary dentition: orthodontic management. Prog Orthod 2002;3(1):29–41. DOI: 10.1034/j.1600-9975.2002.00017.x.
White SC, Scarfe WC, Schulze RKW, et al. The image gently in dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;118(3):257–261. DOI: 10.1016/j.oooo.2014.06.001.
Rehani MM, Gupta R, Bartling S, et al. Radiological protection in cone beam computed tomography (CBCT). ICRP publication 129. Ann ICRP 2015;44(1):9–127. DOI: 10.1177/0146645315575485.
Mizban L, El-Belihy M, Vaidyanathan M, et al. An audit and service evaluation of the use of cone beam computed tomography (CBCT) in a paediatric dentistry department. Dentomaxillofac Radiol 2019;48(5):20180393. DOI: 10.1259/dmfr.20180393.
Castellucci A. Access cavity and endodontic anatomy. In: Castellucci A, ed. Endodontics. 3rd ed., Martina; 2013. p. 250 www.edizionimartina.com.
Marshman Z, Gibson B, Robinson PG. The impact of developmental defects of enamel on young people in the UK. Community Dent Oral Epidemiol 2009;37(1):45–57. DOI: 10.1111/j.1600-0528.2008.00453.x.
