bTRAUMATIC INJURIES TO PRIMARY DENTITION A. VICTOR SAMUEL III MDS DEPARTMENT OF PEDODONTICS Contents Introduction Etiology Epidemiology Classification Examination & Diagnosis Treatment Sequlae of injuries to primary dentition Conclusion References 1996. run. climb & play adventurously Thinner & more elastic alveolar bone ² displaced. . Close proximity of two dentition Infection developing subsequent to injury poses threat. Oral and Dental Trauma in children and Adolescents. Vertical position Graham Roberts.3 yrs of age Learning to walk. Peter Longhurst. United States: Oxford University Press. 1st ed.INTRODUCTION Most injuries : 1. Denmark: Mosby. Andreasen FM. 1st ed. Peter Longhurst. Oral and Dental Trauma in children and Adolescents. In: Andreasen JO. . Classification. Andreasen FM. Graham Roberts.ETIOLOGY Iatrogenic newborns injuries in Automobile injuries Assaults Torture Mental Retardation Epilepsy Drug-related injuries Dentinogenesis imperfecta Falls in infancy Child physical abuse Falls and collisions Bicycle injuries Sports Horseback riding Andreasen JO. United States: Oxford University Press.1996. Text Book and Color Atlas of Traumatic Injuries to the Teeth. 1994: Chapter 3 . Etiology and Epidemiology. 3rd edn. Traumatic dental injuries in nursery schoolchildren from Baghdad. Traumatic injuries to teeth in Swedish children living in an urban area. Iraq Community Dent Oral Epidemiol1988. Pugliesi DM.Williams S. Trauma to primary teeth of South African pre-school children. Occurrence of primary incisor traumatism in Brazilian children: a house by-house survey. Tedestam G. MelloVieira AE. Swed Dent J 1990. Endod Dent Traumatol 1999. Matejka JM. Roberts GJ. Lopes ES.16:292-3.15:73-6. Oral trauma in Brazilian patients aged 0-3 years. Dent Traumatol 2001. Nazhat NY. Bijella MF. Cleaton-Jones PE. Forsberg CM.57:424-7. . Hargreaves JA.EPIDEMIOLOGY The prevalence of traumatic injuries in the 0 to 6 year segment varies from11 to 30%. ASDC J Dent Child 1990.Yared FN.Kuder SA.14:115-22. YagotKH.17:210-12. BijellaVT. Cunha RF. 140:152. time and costs.9:242-5. Llarena del Rosario ME. Curr Opin Pediatr 1997. Emergency management of oral trauma in children. Anterior tooth trauma in the primary dentition.8:213-4. Incidence. FayeM. treatment. classification. treatment methods. and sequelae: a reviewof the literature. . Complications of injuries to the deciduous teeth. Ba I. Nelson LP. Fried I. Garcia-Godoy F. the risk of trauma increases with incidence twice as high as the average incidence for all children . Clinical and radiographic evaluation: perspectives on management and prevention (apropos 4 cases). ASDCJ Dent Child 1995. Shusterman S. YamAA.23:5-9. Swed Dent J Suppl 2000. Acosta AV. OdontostomatolTrop 2000.EPIDEMIOLOGY When the child starts walking alone.62:256-61.Tamba-Ba A. Erickson P.Diop F. Glendor U. Incidence. On dental trauma in children and adolescents. Traumatic injuries to primary teeth in Mexico City children. Endod Dent Traumatol 1992. between18 and 30months. risk. 3:126-9. Bezerra AC.9:101-4. Garcia-Godoy F. Aust Dent J 2000.McNamaraJR. Braz Dent J 1998. CarvalhoJC. Needleman HL. MestrinhoHD. Soporowski NJ.Traumatic dental injuries in Brazilian pre-school children. Garcia-Godoy F. Luxation injuries of primary anterior teeth its prognosis and related correlates. Primary teeth traumatic injuries at a private pediatric dental center.EPIDEMIOLOGY At this age. . Epidemiology of dental trauma: a review of the literature. Erickson P. Allred EN. Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. Pediatr Dent 1994. FreerTJ. Fried I. Schwartz S.45:2-9. Garcia-Godoy FM. Endod Dent Traumatol 1987. the home is the place where most trauma occurs in males and females as a result of falls.18:145-51. Bastone EB. Keenan K. Pediatr Dent 1996.16:96-101. Summary . CLASSIFICATION . 50) Fracture with loss of tooth substance confined to the enamel Andreasen JO. Text Book and Color Atlas of Traumatic Injuries to the Teeth. Andreasen FM. Denmark: Mosby. 3rd edn. Classification. 1994: Chapter 3 .CLASSIFICATION Injuries to the Hard Dental Tissues and the Pulp Enamel Infraction (N 502. Andreasen FM. Etiology and Epidemiology. .50) Incomplete fracture of the enamel without loss of tooth. In: Andreasen JO. Enamel Fracture (Uncomplicated Crown Fracture) (N 502. 51) (Uncomplicated Crown Fracture with loss of tooth substance confined to enamel and dentin. Andreasen FM.52) Fracture involving enamel and dentin. but not involving the pulp.CLASSIFICATION Injuries to the Hard Dental Tissues and the Pulp Enamel-Dentin Fracture Fracture) (N 502. In: Andreasen JO. Denmark: Mosby. 1994: Chapter 3 . Andreasen JO. . Text Book and Color Atlas of Traumatic Injuries to the Teeth. and exposing the pulp. Classification. Andreasen FM. Complicated Crown Fracture(N 502. Etiology and Epidemiology. 3rd edn. 54) Fracture involving enamel. 1994: Chapter 3 . Classification. but not exposing the pulp. Text Book and Color Atlas of Traumatic Injuries to the Teeth. Complicated Crown-Root Fracture(N 502. Andreasen FM.CLASSIFICATION Injuries to the Hard Dental Tissues and the Pulp Uncomplicated Crown-Root Fracture(N 502. dentin and cementum. Denmark: Mosby. Andreasen JO. 3rd edn. In: Andreasen JO. . Andreasen FM.54) Fracture involving enamel. Etiology and Epidemiology. dentin and cementum. but exposing the pulp. 1994: Chapter 3 . Andreasen JO. Etiology and Epidemiology.53) Fracture involving dentin and cementum. Denmark: Mosby. Classification. Text Book and Color Atlas of Traumatic Injuries to the Teeth. . and the pulp. 3rd edn. In: Andreasen JO.CLASSIFICATION Injuries to the Hard Dental Tissues and the Pulp Root Fracture(N 502. Andreasen FM. Andreasen FM. 3rd edn.20) Injury to the tooth-supporting structures without abnormal loosening or displacement of the tooth. Andreasen FM. but without displacement of tooth Andreasen JO. .20) Injury to the tooth-supporting structures with abnormal loosening. Denmark: Mosby. 1994: Chapter 3 . Text Book and Color Atlas of Traumatic Injuries to the Teeth.CLASSIFICATION Injuries to the Periodontal Tissues Concussion (N503. In: Andreasen JO. Classification. Etiology and Epidemiology. Andreasen FM. but with marked reaction to percussion Subluxation (Loosening) (N 503. 20) Displacement of tooth in a direction other than axially. Andreasen FM.CLASSIFICATION Injuries to the Periodontal Tissues Extrusive Luxation (Peripheral dislocation. Andreasen FM. This is accompanied by comminution or fracture of the alveolar socket. 3rd edn. 1994: Chapter 3 . In: Andreasen JO. Partial avulsion) (N503. Etiology and Epidemiology. Lateral Luxation (N 503. . Text Book and Color Atlas of Traumatic Injuries to the Teeth.20) Partial displacement of the tooth out of its socket. Classification. Andreasen JO. Denmark: Mosby. 20) Displacement of the tooth into the alveolar bone. 1994: Chapter 3 . Andreasen FM. Denmark: Mosby.CLASSIFICATION Injuries to the Periodontal Tissues Intrusive Luxation (Central Dislocation) (N503. . Text Book and Color Atlas of Traumatic Injuries to the Teeth.22) Complete displacement of tooth out of its socket. In: Andreasen JO. This injury is accompanied by comminution or fracture of the alveolar socket. Andreasen FM. 3rd edn. Etiology and Epidemiology. Avulsion (N 503. Classification. Andreasen JO. . Classification. Andreasen FM. 3rd edn. Etiology and Epidemiology. Andreasen FM. This condition is found concomitantly with intrusive and lateral luxations.40) or Maxillary (502.40)alveolar socket Crushing and compression of the alveolar socket. Fracture of the Mandibular(N 502. Andreasen JO. Text Book and Color Atlas of Traumatic Injuries to the Teeth. In: Andreasen JO.CLASSIFICATION Injuries to the Supporting Bone Comminution of the Mandibular (N 502.60) or Maxillary (N 503.22) alveolar socket wall A fracture confined to the facial or oral socket wall. Denmark: Mosby. 1994: Chapter 3 . Andreasen JO.CLASSIFICATION Injuries to the Supporting Bone Fracture of the Mandibular(N 502. Andreasen FM. The fracture may or may not involve the alveolar socket.60) or Maxillary (N 502. Denmark: Mosby.22) A fracture involving the base if the mandible or maxilla and often the alveolar process. 1994: Chapter 3 . Etiology and Epidemiology. Andreasen FM. Fracture of the Mandible(N 502. In: Andreasen JO. Classification.40) alveolar process A fracture of the alveolar process which may or may not involve the alveolar socket. 3rd edn.61) or Maxilla (N 503. Text Book and Color Atlas of Traumatic Injuries to the Teeth. . 50) A bruise usually produced by impact with a blunt object and not accompanied by a break in the mucosa. Contusion of Gingiva or Oral Mucosa (S 00. Etiology and Epidemiology. 3rd edn.CLASSIFICATION Injuries to Gingiva or Oral Mucosa Laceration of Gingiva or oral Mucosa (S 01. Classification.50) A shallow or deep wound in the resulting from a tear. Andreasen JO. In: Andreasen JO. Andreasen FM. . Denmark: Mosby. usually causing submucosal hemorrhage. 1994: Chapter 3 . and usually produced by a sharp object. Text Book and Color Atlas of Traumatic Injuries to the Teeth. Andreasen FM. Andreasen FM. Denmark: Mosby. Andreasen JO. . In: Andreasen JO.50) A superficial wound produced by rubbing or scraping of the mucosa leaving a raw. Text Book and Color Atlas of Traumatic Injuries to the Teeth. 1994: Chapter 3 .CLASSIFICATION Injuries to Gingiva or Oral Mucosa Abrasion of Gingival or Oral Mucosa (S 00. 3rd edn. Classification. Etiology and Epidemiology. Andreasen FM. bleeding surface. Summary . GutmannJL. (the tooth can be restored with an obturation using glass ionomer or composite).1st edn. Flores MT. Dent Traumatol 2001. .1999. Flores MT. Traumatic dental injuries. A periapical X-ray is recommended as a baseline. Treatment: Polish the sharp edges if there is minimal enamel loss. Bakland LK.17:1-4. Feiglin B. et al. Bakland LK.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 manual. Andreasen JO. Copenhagen: Munksgaard. Oikarinen K. Guidelines for the evaluation and management of traumatic dental injuries. Andreasen JO. Andreasen FM. Casamassimo PS. Preisch J.13:12-15. A periapical X-ray is recommended (size 2 film)to evaluate the size of the pulp chamber.CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITION Complicated crown fracture Enamel and dentine fracture with pulp exposure. stage of root development. and degree of root resorption. . Wilson S. Pediatr Emerg Care 1997. Epidemiology of dental trauma treated in an urban pediatric emergency department. Treatment decisions are often based on the child·s cooperation and on the further life expectancy of the affected primary tooth. Smith GA. Complicated crown fracture . . Oikarinen K. Flores MT. Pediatr Dent 1994. Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report. Holan G. (iii) root canal therapy (iv) extraction. Feiglin B. Bakland LK. et al. Andreasen JO. GutmannJL. Guidelines for the evaluation and management of traumatic dental injuries.17:1-4.16:44-8. Dent Traumatol 2001. *Ram D.CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITION Treatment alternatives: (i) Partial pulpotomy is indicated when the pulp has been exposed before the apex is closed in the young primary incisor * (ii) pulpotomy with formocresol and ZOE in cases when the primary tooth has not yet started the physiological resorption process. Crown. In: Andreasen JO. Andreasen FM. Feiglin B. Guidelines for the evaluation and management of traumatic dental injuries. Bakland LK. . 3rd edn. There is little or moderated tooth displacement. Pediatr Dent 1994. Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report.16:44-8.CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITION Complicated Crown-root fracture A multiple crown fracture where the pulp may or not be involved. 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. Andreasen JO. The coronal fragment is attached to the gingiva and is mobile.Root Fractures. Andreasen JO. Text Book and Color Atlas of Traumatic Injuries to the Teeth. Ram D. Andreasen FM. Dent Traumatol 2001. et al. Denmark: Mosby.17:1-4. Oikarinen K. 1994. Treatment: Extraction Flores MT. Holan G. GutmannJL. Text Book and Color Atlas of Traumatic Injuries to the Teeth.Root Fractures.CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITION Root fracture (2-4%) The tooth is mobile and the coronal fragment may be displaced. Dent Traumatol 2001. Ram D. 3rd edn. In: Andreasen JO. Crown. Feiglin B.16:44-8. Oikarinen K. Holan G. Guidelines for the evaluation and management of traumatic dental injuries. Andreasen FM.17:1-4. Take a periapical X-ray (size 2 film). Andreasen JO. . Denmark: Mosby. GutmannJL. et al. Andreasen FM. 1994. Pediatr Dent 1994. Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report. Flores MT. Andreasen JO. Bakland LK. it is important to inform the parents .39:817-35. The apical fragment is left to be resorbed physiologically. a wire-composite splint.not displaced. Traumatic injuries in the preschool child. Feiglin B. Dent Traumatol 2001. In this case.17:1-4. root is complete. Dent Clin North Am1995. Extraction of only the coronal fragment is the treatment of choice.CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITION Root fracture Treatment: If Coronal fragment . Oikarinen K. Camp JH. and the patient cooperates. et al. the loss of the crown may be anticipated. Guidelines for the evaluation and management of traumatic dental injuries. Bakland LK. Flores MT.certain mobility until its normal replacement. GutmannJL. Harding AM. Also. . Andreasen JO. Bakland LK. Oikarinen K. Andreasen JO. Harding AM.17:1-4. Dent Clin North Am1995. Guidelines for the evaluation and management of traumatic dental injuries. Traumatic injuries in the preschool child. et al. GutmannJL. . Flores MT. Feiglin B. Camp JH.39:817-35. Take a periapical X-ray (size 2 film). Seek a discontinuity in the surrounding oral mucosa.CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITION Alveolar fracture The tooth in the affected segment is mobile and usually displaced. Dent Traumatol 2001. Dent Traumatol 2001. Dent Clin North Am1995. .CLINICAL ASSESSMENT AND TREATMENT OF TEETH OR BONE FRACTURES IN THE PRIMARY DENTITION Alveolar fracture Treatment: repositioning the segment. Traumatic injuries in the preschool child. Flores MT. splint for 2-3 weeks more or extract. Feiglin B. Oikarinen K. GutmannJL.17:1-4. Guidelines for the evaluation and management of traumatic dental injuries. If it is necessary to achieve stability. Andreasen JO.39:817-35. Harding AM. et al. Camp JH. Splint to adjacent teeth for up to 4weeks. Bakland LK. Traumatic dental injuries. *Flores MT. Guidelines for the evaluation and management of traumatic dental injuries. A manual.39:817-35.1st edn. Dent Traumatol 2001. Keenan K. Traumatic injuries in the preschool child. Pediatr Dent 1996.17:49-52. Andreasen FM. Feiglin B. Andreasen JO. Copenhagen: Munksgaard. Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. Schwartz S. Camp JH. Erickson P. Bakland LK. but there is neither mobility nor evidence of sulcus bleeding.Harding AM. Treatment: To keep the tooth under observation. Flores MT. Dent Clin North Am1995.18:145-51. GutmannJL. Oikarinen K. et al.* *Fried I.Clinical assessment and treatment of luxations and avulsions in the primary dentition Concussion Tooth tender to touch.1999 . *Andreasen JO. Bakland LK. The diagnostic value of coronal darkgray discoloration in primary teeth following traumatic injuries. .Clinical assessment and treatment of luxations and avulsions in the primary dentition Concussion In a clinical study (Holan 1996). and periapical osteitis.18:224-7. Fuks AB. unless associated infection exists. *Holan G. Pediatr Dent 1996. do not perform root canal treatment in discolored teeth. Pulp necrosis was found in 37 discolored teeth. without presenting tenderness to percussion. * Therefore. endodontic treatment was performed on 48 primary incisors with dark-gray discoloration of the crowns. increased mobility. Flores MT. Traumatic dental injuries. Sulcus bleeding may or not be present. Andreasen JO. Copenhagen: Munksgaard.1999. A manual.1st edn. .Clinical assessment and treatment of luxations and avulsions in the primary dentition Subluxation The tooth is mobile without displacement. Andreasen FM. Bakland LK. Erickson P. If there is careful bacterial control by good oral hygiene. Bakland LK.1st edn. and swelling of the gingiva will be seen due to associated infection. Andreasen FM. tooth will return to normality within 2weeks. Oikarinen K. Traumatic dental injuries.17:49-52. A manual. Dent Traumatol 2001. Pediatr Dent 1996. *Flores MT. GutmannJL.18:145-51. Feiglin B. *Andreasen JO. Flores MT. *Fried I. Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. Keenan K. Guidelines for the evaluation and management of traumatic dental injuries. et al. Copenhagen: Munksgaard. Schwartz S. Andreasen JO. the tooth will increase its mobility. Bakland LK.1999. Otherwise. .Clinical assessment and treatment of luxations and avulsions in the primary dentition Subluxation Treatment: Observation*. Erickson P. Schwartz S. usually in a palatal direction. A manual. *Fried I.Clinical assessment and treatment of luxations and avulsions in the primary dentition Lateral luxation The tooth is displaced laterally with the crown. Guidelines for the evaluation and management of traumatic dental injuries. Pediatr Dent 1996. displacement of the apex toward or through the labial bone plate may be seen. with size 2 film. . Keenan K. Copenhagen: Munksgaard. Dent Traumatol 2001. Oikarinen K. In the lateral X-ray. Andreasen FM.1st edn.17:49-52. Bakland LK.1999. Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. occlusal and lateral. Traumatic dental injuries. Take two X-rays. Andreasen JO. *Andreasen JO.18:145-51. Flores MT. Feiglin B. Bakland LK. GutmannJL. The occlusal X-ray is better for the detection of the increase in periodontal space apically. *Flores MT. et al. Andreasen JO. Traumatic dental injuries.21:459-62.14:31-44.16:96-101. Needleman HL. A manual. Part I.1999. Copenhagen: Munksgaard. BorumMK. Endod DentTraumatol 1998. Flores MT. Luxation injuries of primary anterior teeth ^ prognosis and related correlates. reposition the affected tooth and splint to adjacent teeth for 2-3weeks. Allred EN. Holan G. . Complications in the primary dentition. Conservative treatment of severely luxated maxillary primary central incisors: case report. Pediatr Dent 1999. AndreasenJO. Andreasen FM.1st edn. If there is occlusal interference. Bakland LK.Clinical assessment and treatment of luxations and avulsions in the primary dentition Lateral luxation Treatment: that if there is no occlusal interference. Pediatr Dent 1994. Soporowski NJ. leave the tooth to return to its position spontaneously. Sequelae of traumato primary maxillary incisors. Clinical assessment and treatment of luxations and avulsions in the primary dentition Lateral luxation From a prospective study (Borum 1998) of 104 lateral luxated teeth. . Endod DentTraumatol 1998. Sequelae of traumato primary maxillary incisors.14:31-44. Part I. Complications in the primary dentition. AndreasenJO. 99%were realigned within the first year. BorumMK. Soporowski NJ. Allred EN. repositioning of lateral luxation was associated with an increased risk of developing pulp necrosis. Needleman HL. Pediatr Dent 1994.16:96-101. However. almost disclose any complication.s . it was found that of 52 teeth that were 60% left for did not spontaneous reposition. Luxation injuries of primary anterior teeth its prognosis and related correlates.Clinical assessment and treatment of luxations and avulsions in the primary dentition Lateral luxation In an observational study (Soprowski 1994). 3rd edn. . Denmark: Mosby. Text Book and Color Atlas of Traumatic Injuries to the Teeth. In: Andreasen JO. Andreasen FM. Luxation Injuries. 1994 Chapter 9. Andreasen FM. Radiograph: Can reveal the position of displaced teeth in relation to the permanent successors.Clinical assessment and treatment of luxations and avulsions in the primary dentition Intrusion The PDL space will partially or totally disappear. Apico-facially : Apico-palatally: appears shorter appears elongated (displaced towards permanent) Or a lateral projection Andreasen JO. . . Text Book and Color Atlas of Traumatic Injuries to the Teeth. Denmark: Mosby. 3rd edn. Luxation Injuries.Clinical assessment and treatment of luxations and avulsions in the primary dentition Intrusion Treatment: usually re-erupt or reposition themselves spontaneously within a period of 1 to 6 months. When apex is displaced towards the permanent successor ² extracted atraumatically. In: Andreasen JO. Andreasen FM. 1994 Chapter 9. . Andreasen FM. Andreasen JO. (proper decision). This is manifested clinically as swelling and hyperemia of the gingiva.Clinical assessment and treatment of luxations and avulsions in the primary dentition Intrusion In case of spontaneous re-eruption ² risk of acute inflammation around the displaced tooth. Andreasen FM. In: Andreasen JO. 3rd edn. Andreasen FM. sometimes with abscess formation and oozing of pus from the gingival crevice. Andreasen JO. Rise in temperature and pain : Extracted and antibiotic therapy. Text Book and Color Atlas of Traumatic Injuries to the Teeth. Denmark: Mosby. Luxation Injuries. 1994 Chapter 9. . 21:242-7. the apices of more than 80% of the teeth were pushed labially. Holan G. Sequelae and prognosis of intruded primary incisors: a retrospective study. Ram D. Pediatr Dent 1999. It was found that most of them re-erupted for and survived with no post complications more than 36months trauma. even in cases of complete intrusion and fracture of the labial bone plate. .Clinical assessment and treatment of luxations and avulsions in the primary dentition Intrusion In a retrospective study (Holan 1999) of 172 intruded teeth. Clinical assessment and treatment of luxations and avulsions in the primary dentition Extrusion Tooth is mobile and is usually out of the socket. In: Andreasen JO. Andreasen FM. Denmark: Mosby. Immediate changes are complete rupture of the PDL fibers and the neurovascular supply to the pulp. 3rd edn. Andreasen JO. After 3 wks the PDL appears normal. In monkeys the split in the PDL is filled with endothelial cells and young fibroblasts. 1994 Chapter 9. . Andreasen FM. Text Book and Color Atlas of Traumatic Injuries to the Teeth. After 2 wks newly formed collagen fibers are seen. Luxation Injuries. Text Book and Color Atlas of Traumatic Injuries to the Teeth.Clinical assessment and treatment of luxations and avulsions in the primary dentition Extrusion It can either be repositioned or extracted when there is occlusal interference. Andreasen FM. Andreasen FM. In: Andreasen JO. Denmark: Mosby. 1994 Chapter 9. 3rd edn. . Luxation Injuries. Andreasen JO. Text Book and Color Atlas of Traumatic Injuries to the Teeth. Andreasen FM. Clinically the socket is found empty or filled with a coagulum. 3rd edn. Andreasen FM.Clinical assessment and treatment of luxations and avulsions in the primary dentition Avulsion The tooth is completely displaced out of its socket. . Luxation Injuries. Denmark: Mosby. Andreasen JO. 1994 Chapter 9. In: Andreasen JO. Clinical assessment and treatment of luxations and avulsions in the primary dentition Avulsion Treatment: an avulsed primary tooth must not be replanted. GutmannJL. Dent Clin North Am1995. Dent Clin North Am 2000. CampJH. 3rd edn. Feiglin B.39:817-35. Text Book and Color Atlas of Traumatic Injuries to the Teeth.47: 1067-84.Traumatic injuries in the preschool child.44:597-632. Diagnosis and management of dental injuries in children. Guidelines for the evaluation and management of traumatic dental injuries. Garcia-Godoy F. Flores MT. In: Andreasen JO. Pulver F. McTigue DJ. Oikarinen K. Andreasen FM. Denmark: Mosby..Treatment of trauma to the primary and young permanent dentitions. . 1994 Chapter 9. Bakland LK. Luxation Injuries. Andreasen JO. Andreasen JO. Andreasen FM. et al.17:1-4. because of the potential damage that it may cause to the developing tooth germ. Pediatr Clin North Am 2000. Dent Traumatol 2001. Harding AM. 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. Intrusive Luxation . Pre & Post Operative Pictures . Intrusive Luxation . Intrusive Luxation . Treatment Done in Department From July November 2010 for Injuries to Primary Dentition Complicated crown-root fracture 9% Uncomplicated crownroot facture 9% Uncomplicated crown facture 9% Intrusive Luxation 55% Lateral Luxation 18% . . 2010. Hayriye S. Eur J Dent.* Traffic Collision accidents 0% 0% Percentage Toy accidents 0% Falls 100% *Volkan A. Saziye S. 4:447-53. The Prevalence and Treatment Outcomes of Primary Tooth Injuries. . Even when luxations are considered to be complicated injuries. 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. most of them heal spontaneously if parents take care of the child·s oral hygiene. especially in their early years.CONCLUSION Children are commonly affected by luxation injuries. Andreasen FM.Yared FN. United States: Oxford University Press. Matejka JM. Oral trauma in Brazilian patients aged 0-3 years. Pugliesi DM. Etiology and Epidemiology. . ASDC J Dent Child 1990.1996. Denmark: Mosby. In: Andreasen JO.17:210-12. Cleaton-Jones PE. Text Book and Color Atlas of Traumatic Injuries to the Teeth.15:73-6. Oral and Dental Trauma in children and Adolescents. Bijella MF. Lopes ES. Hargreaves JA.57:424-7. BijellaVT.REFERENCES Graham Roberts. 1994: Chapter 3 . 1st ed. Andreasen JO. Peter Longhurst. Andreasen FM. Classification. Cunha RF. Endod Dent Traumatol 1999. Dent Traumatol 2001. MelloVieira AE.Williams S. Trauma to primary teeth of South African preschool children. 3rd edn. Occurrence of primary incisor traumatism in Brazilian children: a house by-house survey. Roberts GJ. Traumatic injuries to teeth in Swedish children living in an urban area.14:115-22.Traumatic dental injuries in nursery schoolchildren from Baghdad. Shusterman S. Garcia-Godoy F. Incidence.REFERENCES Forsberg CM. classification. Swed Dent J 1990. Llarena del Rosario ME. Anterior tooth trauma in the primary dentition.Kuder SA. Erickson P. YagotKH.16:292-3. . Nazhat NY. Nelson LP.8:213-4. Traumatic injuries to primary teeth in Mexico City children. and sequelae: a reviewof the literature. Acosta AV. Emergency management of oral trauma in children. treatment methods. Curr Opin Pediatr 1997.62:256-61. Tedestam G. Fried I. ASDCJ Dent Child 1995.9:242-5. Iraq Community Dent Oral Epidemiol1988. Endod Dent Traumatol 1992. Ba I. Garcia-Godoy F.REFERENCES YamAA.Tamba-Ba A. Bastone EB. Endod Dent Traumatol 1987. FayeM. Incidence. On dental trauma in children and adolescents. MestrinhoHD. CarvalhoJC. time and costs. Garcia-Godoy FM. Aust Dent J 2000. Clinical and radiographic evaluation: perspectives on management and prevention (apropos 4 cases). Primary teeth traumatic injuries at a private pediatric dental center. Garcia-Godoy F.140:1-52. risk.23:5-9. Bezerra AC. OdontostomatolTrop 2000.9:101-4.Diop F.45:2-9. Glendor U. Swed Dent J Suppl 2000. Complications of injuries to the deciduous teeth. FreerTJ. Braz Dent J 1998.3:126-9.Traumatic dental injuries in Brazilian pre-school children. treatment. Epidemiology of dental trauma: a review of the literature. .McNamaraJR. Flores MT. Soporowski NJ. Andreasen FM. 1994. Oikarinen K. Luxation injuries of primary anterior teeth its prognosis and related correlates. Needleman HL.16:448. Pediatr Dent 1996. Denmark: Mosby. Holan G.18:145-51. et al.17:1-4. Text Book and Color Atlas of Traumatic Injuries to the Teeth. Andreasen JO.REFERENCES Fried I. Subluxation injuries of maxillary primary anterior teeth: epidemiology and prognosis of 207 traumatized teeth. GutmannJL. Dent Traumatol 2001. Feiglin B. Pediatr Dent 1994. . Guidelines for the evaluation and management of traumatic dental injuries. Keenan K. Erickson P. 3rd edn. Schwartz S. Andreasen FM.16:96-101. Pediatr Dent 1994. Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report. Crown. Bakland LK.Root Fractures. In: Andreasen JO. *Ram D. Allred EN. Andreasen JO. Treatment of trauma to the primary and young permanent dentitions.18:224-7. Traumatic injuries in the preschool child. Holan G.REFERENCES Harding AM. Pediatr Clin North Am 2000. Diagnosis and management of dental injuries in children. Dent Clin North Am1995. 2000. Dent Clin North Am 2000. Pediatr Dent 1996. Garcia-Godoy F. Pulver F. MitsuhiroTsukiboshi.44:597-632. .47: 1067-84.39:817-35. Camp JH. The diagnostic value of coronal darkgray discoloration in primary teeth following traumatic injuries. Treatmnet Planning for Traumatized Teeth. McTigue DJ. Tokyo: Quintessence Publishing. Fuks AB. THANK YOU .