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Effect of Trauma to the Primary Incisors on Permanent Successors in Different Developmental Stages Abstract Methods and Material

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Effect of Trauma to the Primary Incisors on Permanent Successors in Different Developmental Stages Abstract Methods and Material PEDIATRICDENTISTRY/Copyright ©1985 by TheAmerican Academy of Pediatric Dentistry Volume7 Number1 Effect of trauma to the primary incisors on permanent successors in different developmental stages Yocheved Ben Bassat, DMD Ilana Brin, DMD Anna Fuks, CD Yerucham Zilberman, DMD Abstract third was the most commonlocation of these defects in all age groups examined. This led to the hypothesis This clinical and radiographic investigation was that chronologic age might not express sufficiently undertaken in an attempt to correlate the developmental stage of the permanenttooth buds, the chronological age the developmental status of the dentition. Further- at the time of trauma, and the degree of primary root more, since young children are prone to injuries that resorption with mineralization defects in the permanent often are unnoticed by parents, clinical examinations Successors. and anamnestic information might have been insuf- One hundred children who had experienced trauma to ficient in the previous study. their primary incisors were recalled and their immediate The objectives of this investigation were: posttrauma radiographs were examined. Sixty-four exhibited possible signs of previously unnoticed and 1. To assess radiographically the degree of devel- unreported trauma and were eliminated from the study. opment of the permanent incisors at the time of This high percentage of unnoticed injury indicates the injury need for careful radiographic examinationto discover 2. To evaluate the immediate posttrauma radio- signs of previous trauma whenattempting to correlate graphs for possible evidence of previously un- developmental disturbances with injury to primary noticed injury incisors. 3. To correlate the roentgenographic and clinical Discoloration of the crown of the permanenttooth was findings from the time of trauma with the clin- evident in 16%of the children with the incisal one-third ical appearance of the permanent incisors. being the most commonsite. Hypoplasia was evident in 9%of the permanentteeth. No association could be established between the amountof primary root resorption Methodsand Materials and the appearanceof mineralization defects on the The permanent incisors of 124 children whose pri- permanent successors. mary predecessors had been traumatized were ex- amined clinically (findings have been reported Correlation between trauma to the primary teeth previouslyg). The files of 100 of these children with a total of 213 and the presence of mineralization defects in the per- 17 injured teeth were available and immediate post- manent dentition has been described previously. trauma periapical radiographs were examined. The The influence of injury to the primary incisors on following parameters were recorded from these their permanent successors was related to the spatial radiographs: relationship of the involved teeth, the child’s age at the time of trauma, and the type of injury, s Findings 1. Degree of development of the permanent cen- from a previous report 9 did not confirm an age rela- tral and lateral incisors according to Nolla1° (Ta- tionship between the location of developmental dis- ble 1) turbances in the permanent dentition and injury of 2. Degree of root development and physiologic re- their primary predecessors. In that study the incisal sorption of the primary incisors PEDIATRICDENTISTRY: March 1985/Vol. 7 No. ~1 37 T,~BLEl° 1. Stagesof Dental DevelopmentAccording to Nolla Stage 0 Absenceof crypt Incisal V3 50 14iddle Stage 1 Presenceof crypt ~ Gingival Stage 2 Initial calcification ~ ~0 Unaffected incisors Stage 3 One-third of crown completed Discoloration Stage 4 Two-thirds of crown completed Hypoplasia Stage 5 Crown almost completed ~ 30 Stage 6 Crown completed Stage 7 One-third of root completed e~~o Stage 8 Two-thirds of root completed z Stage 9 Root almost completed -- open apex Stage 10 Apical end of root completed 10 a bc a bc abc 1-3ysors 3.5-Syears 5.5~years 3. Presence of periapical radiolucencies, pathologic AGE root resorption and pulpal pathologic changes -- arrest of dentin formation, pulp obliteration, F~ 1. Distribution of mineralization defects according to or diffuse intracanal calcifications. (The pres- age groups and location (some of the teeth were affected by both hypoplasia and discoloration and are presented ence of any of the aforementioned signs were in both groups). considered as possible indications of unreported or unnoticed previous trauma. Radiographs of teeth presenting with deep caries were ex- o Incisol q3 cluded, since complications of caries also could b Hiddle ~/$ lead to mineralization disturbances, thus leav- c Gi~givol ~h ing a "refined" group.) 30 ~- r] Unaffected incisors ~ Discoloration A clear distinction was made between the total Hypoplosia -- 20 ~ sample (100 children) and a refined group that in- 251 ~ cluded 36 children (19 males, 17 females) with 76 in- jured primary incisors. The mean age at the time of trauma was 3.5 years. In this refined group no evi- s. n_ ~]... ¯ . ,,, L"~L~JL~ obc:JL ~JL~obc obc~JL~ obc:JL~’c_JL abc obc :_JL~ dence of previous trauma or deep caries could be 7 Stages of development ( Nolla disclosed from the radiographic assessment. An attempt was made to correlate the presence and FIG 2. Distribution of the location of mineralization defects location of mineralization defects in the permanent according to tooth developmentstages -- after Nolla (some incisors of the refined group with: of the teeth were affected by both hypoplasia and discol- oration and are presented in both groups). 1. The child’s chronologic age at the time of trauma 2. The stage of development of the permanent in- The incisal third was the most common location of cisor at the time of trauma discoloration (Figs 1, 2). Hypoplasia observed in 3. The stage of root resorption of the primary in- teeth (9%) occurred only in the younger age group cisor at the time of trauma 4. The type of t:rauma. 3 years of age and in Stages 1-5. The location of the hypoplastic defects moved cervically with increasing Further, the present results were compared to those crown development. 9 obtained in the previous report. The vast majority (80%) of the primary teeth of the refined group revealed no root resorption, since they Results probably belonged to the young age group at the time The appearance and location of mineralization de- of trauma. The remaining 20% of primary incisors fects of the permanent incisors of the refined group presented with various degrees of root resorption. are presented in Figures 1 and 2. Some of the teeth The same pe.rcentage of mineralization defects (25%) were affected by both discoloration and hypoplasia appeared in the permanent successors of traumatized and therefore are included in both groups. It appears primary teeth with and without root resorption. that the frequency of these defects decreases with The most common type of injury sustained by chil- increasing age at the time of trauma. (Fig 1). Discol- dren in this study and the distribution of mineral- oration appeared on 24 teeth (16%) and affected all ization defects in their permanent incisors are age1° groups and Stages 3-6 as described by Nolla. presented in Table 2. Luxation was the most common 38 EFFECTS OF TRAUMA TO THE MAXILLARY INCISORS: Ben Bassat et al. ~gBI[ 2. Mineralization Defects as Relatedto the MostCommon Types of Injury to the PrimaryIncisors Teeth With Teeth With Teeth With Teeth Without Discoloration Hypoplasia Discoloration Total numberof Type of Trauma No. of Teeth Defects Only Only and Hypoplasia Affected Teeth Luxation 23 (100%) 11 (50%) 5 (20%) 3 (13%) 4 (17%) 12 (50%) Palatal/dis- 21 (100%) 17 (80%) 4 (20%) 0 0 4 (20%) placement Instrusion 7 (100%) 4 (57%) 2 (28%) 0 1 (15%) 3 (43%) Nontrauma* 62 (100%) 54 (87%) 1 2 5 (5%) 8 (13%) Teethin proximityto the injuredtooth. type of injury, followed by palatal displacement. Fifty different stages of crown mineralization, ranging from per cent of permanent successors to luxated primary one-third crown formation to crown completion. This incisors appeared with mineralization defects, while finding agrees with Andreasen and Ravn, 3 who ex- only 20% were affected similarly in case of palatal plain these findings as being a manifestation of dis- displacement. Thirteen per cent of the teeth adjacent turbed "secondary" mineralization. Deutsch et aI. u,12 to the traumatized incisors (nontrauma) were fol- have shown that some secondary mineralization (ma- lowed by developmentally affected permanent inci- turing) of enamel takes place even when the crown sors. is full size and root formation has begun. As in the previous study, mainly the incisal edge 9 Discussion was affected by discoloration in all age groups. This may be due to the proximity of the developing crown In a previous report, no direct correlation was found toz,~ the primary roots, between the child’s age at the time of trauma and the Hypoplasia was present in 9%of the teeth and af- location of mineralization defects in the permanent fected only the young age group. This confirmed the successors. 9 That study included only children with- expected results, since hypoplasia is a manifestation out clinical signs of traumatic injuries to their primary of trauma sustained during the formation stages of teeth, such as cracked, fractured, or discolored teeth, the permanent tooth germ. Thus, a tooth that ap- and premature loss of primary incisors. In addition, peared radiographically to be in an early stage of de- parents were asked about possible previous injuries velopment would present with a hypoplastic lesion to the primary teeth. Despite the care taken in selec- located more incisally than a tooth in a more ad- tion of the study sample, several findings led to the vanced stage of crown development. However, suspicion that some unreported and unnoticed pre- radiographic evaluation is not precise, and areas that vious trauma might have been included in the sam- are not mineralized entirely would not be evident in ple.
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