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Trauma to the Primary Incisors and Its Effect on the Permanent Successors

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Trauma to the Primary Incisors and Its Effect on the Permanent Successors PEDIATRICDENTISTRY/Copyright ©1984 by TheAmerican Academy of Ped0dontics/Vol.6 No. 2 SCIENTIFIC Trauma to the primary incisors and its effect on the permanent successors Ilana Brin, DMD Yocheved Ben-Bassat, DMD Anna Fuks, CD Yerucham Zilberman, DMD Abstract The objective of this investigation is to assess the One hundred and twenty-four children who had prevalence of morphol’ogical disturbances in perma- experienced trauma to their primary incisors were nent incisors due to trauma to their primary prede- included in this clinical investigation in an attempt to cessors, as well as to evaluate the intra- and interarch correlate the type of injury occurring to the primary relationships of the incisors. teeth, the age of the patient at the time of traumawith mineralization defects, and intra- and interarch Methods and Materials relationships of the permanentincisors. Thirty-four per cent of the children had Angle Class II Data was obtained from 450 files of children who malocclusion. The intra- and interarch relationships were suffered trauma to their primary incisors. Three not correlated significantly with any type of injury. hundred and twenty of those children, whose per- Developmentaland mineralization defects were noticed manent incisors were expected to have been erupted morefrequently in central incisors (32.4%discoloration already, were recalled for examination. Only 124 chil- and 11%hypoplasia). Most of the children with affected dren (38.7%, 67 males and 57 females) with 264 in- permanentincisors experienced trauma prior to age five. jured primary teeth attended the recall examination. The incisal one-third of the central and lateral incisors Fourteen children with recurrent trauma to their pri- was the most commonlocation of mineralization defects. mary dentition were not included in the study, re- Discoloration at this location seemedto be unrelated to ducing the number of examined children to 110 and the child’s age at the time of trauma. the number of teeth to 235. The mean age of the children at the time of trauma was 4, while the mean Trauma to the anterior segment of the dental age at the time of the recent recall examination was 11. arches is a well-known local etiologic factor in mal- The distribution of the sample according to the an- occlusion. Injuries to this region seem to occur fre- teroposterior arch relationship was as follows: 83 chil- quently at the stage of the primary dentition and local dren had Angle Class I molar relations; 30 had Class disturbances to individual teeth have been described II, Division 1 malocclusion; 1 had Class II, Division widely. 1-~ Little, however, is known about subse- 2; and 10 children had Class II subdivision (right or quent occlusal consequences to the permanent den- left). A total of 414 permanent maxillary incisors were tition. The sequellae of injury to the primary incisors examined. The clinical re-examination consisted of: generally depends on the spacial relationship with their permanent successors and the stage of devel- A. Morphological examinations of the four maxil- opment of the latter. lary incisors including the following parameters: The possible deleterious effect on the crown or root 1. Assessment of crown discoloration and its lo- of the permanent incisors has been related to such cation factors as the degree of resorption of the primary root 2. Estimation of the extent of enamel hypoplasia at the time of injury, the direction of the traumatic and its location force, s the type of injury to the primary incisor, and 3. Measurement of the gingival margin height the developmental stage of the permanent tooth bud and vertical incisal edge position of the central at the time of the ir~jtlry. 6 No special attention how- incisors ever, has been paid to the consequences of trauma 4. Determination of time of eruption (in older to the primary dentition regarding the intra- and in- patients information was obtained from par- terarch relationship in the permanent dentition. ents) 78 TRAUMATO PRIMARY INCISORS/EFFECTON PERMANENTSUCCESSORS: Brin et al. 35- Incisal 1/3 Incisal ÷ middle 1/3 30- Middle 1/3 B. Determination of intra-arch relationships of the 1" Middle ÷gingival 1/3 I- four maxillary incisors, including estimation of I~l 25- (~ingival 1/3 crowding and recording of individual tooth real- Whole tooth position 20- C. Determination of inter-arch relationships includ- .~ Lateral incisor O 15- ing Angle classification and measurement of ov- B Central incisor erjet of the right and left central incisors. The following data were registered from the pa- tient’s file: age at the time of injury, type of trauma, and number and location of the traumatized teeth. The teeth in proximity to the injured teeth are re- a b c d e f a b c d e f a b c d e f ferred to as "nontrauma." Disturbances in the per- 1-3 years 3.5 - 5 years 5.5÷ years manent dentition were registered using Andreasen’s 6 classification. FIGURE1. Distribution of discoloration location according Radiographs of the maxillary incisors using the long to age groups at the time of trauma. cone technique were taken. Chi-square and t-tests were applied to examine the intervention was necessary to allow eruption of the possible correlations of mineralization defects and incisors. Thirty of the teeth presenting with delayed position of the permanent teeth with: eni-ption were suhhessors of traumatized primary in- 1. Type of traumatic injury to the primary teeth cisors. (luxation, intrusion, or exfoliation, etc.) Four hundred and fourteen maxillary permanent 2. Results of the immediate postinjury radio- incisors were examined. Of these, 134 (32.4%) pre- graphic examination sented with discoloration. The central incisors were 3. Age of the child at the time of trauma -- the the most frequently affected (63%) and white discol- children were grouped arbitrarily into the fol- oration was the predominant type. lowing age groups: 1-3; 3.5-5; and 5.5 +. Hypoplasia was found in 11%of the examined teeth; 77% of these were associated with discoloration. In Results most of the cases, the hypoplastic area did not exceed The clinical findings were analyzed at the individ- 32. mm ual tooth level, at the arch level, and at the interarch The presence of mineralization defects (hypoplasia level,a and discoloration) and their location and size in re- Tooth Level lation to the patient’s age at the time of trauma are presented in Figures 1 and 2. Most of the children Seventeen children presented with delayed erup- with at least one affected upper incisor experienced tion of 36 maxillary incisors. In two children, surgical trauma prior to age five. This finding was supported " Detailedtables of the results can be obtainedupon request from statistically in the case of discoloration (p = .01) and Dr.Brin. less so in the case of hypoplasia (p = .11). The incisal TABLE1. Mineralization Defects as Related to the Most CommonTypes of Injury to the Primary Incisor Teeth With Teeth With Teeth With Number Teeth Without Discoloration HypoplasiaDiscoloration And Type of Trauma of Teeth Defects Onl~/ Only Hypoplasia Luxation 73 (100%) 39 21 5 8 (53.5%) (28.7%) (6.8%) (11%) Palatal 30 (100%) 21 8 0 1 displacement (70%) (26.7%) (0%) (3.3%) Intrusion 30 (100%) 13 10 0 7 (43.4%) (33.3%) (0%) (23.3%) Exfoliation 23 (100%) 11 9 0 3 (47.8%) (39.1%) (0%) (13.1%) Nontrauma* 190 (100%) 143 32 4 11 (75.3%) (16.8%) (2.1%) (5.8%) * Teethin proximityto the injuredtooth. PEDIATRICDENTISTRY: June 1984Nol. 6 No. 2 79 25 Incisal 1/3, Incisal ÷ Middle I/3 I- manent successors was studied; children who were lU 20 Middle 1/3 lU Coingival 1/3 referred to the Oral Surgery Department following trauma to their primary incisors were examined. The ~ Lateral incisor referral to the Oral Surgery Department might indi-" cate a more severe injury since most emergencies in 0 Central incisor ~0 B children are treated in the Pedodontic Department. One hundred and twenty-four children (38.7% of the original sample) appeared for re-examination. There was no possibility of assessing whether the poor re- sponse to the recall was related to a lesser severity of a b c d a b c d a b c d the sequellae of trauma or to a lack of dental aware- 1-3 yrs 3.5-5yrs 5.5÷ yrs ness amongthe remaining 61.3% of recalled patients. AGE It has been reported widely that children with Class II malocclusions are highly susceptible to trauma to FIGURE2. Distribution of hypoplasia location according to 7-1° age groups at the time of trauma. their anterior teeth. One-third of the patients in this study presented with a Class II malocclusion in their permanent dentition. It should be remembered, third of the central and lateral incisors was the most however, that these patients experienced trauma to commonlocation (72%) of discoloration in all age their primary dentition. groups (Figure 1). In the younger age group the in- Wecan assume that a similar occlusal relationship cisal third was affected slightly more by hypoplastic existed in at least part of the children at that stage. defects than the middle or the gingival thirds; in the This is based on the fact that there is generally no older age groups hypoplasia appeared mainly on the decrease in the frequency of Class II cases in the tran- incisal third (Figure 2). sition from primary to permanent dentition. If the Table 1 describes the percentage of mineralization first permanent molars erupt directly into a Class I or defects in the permanent teeth as related to the most full Class II relationship there is no change in their commontypes of injury to the primary predecessors.
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