INTRUSION INJURIES: RECOMMENDATIONS
Primary Dentition
Root tip is displaced
towards buccal
cortical plate or
vertical
All treatment is ideal and assumes
patient has manageable behavior.
Recommendations also assume
radiographs ( periapical
and lateral anterior taken where
appropriate).
(REFERENCE: AAPD Handbook of Pediatric Dentistry)
No
Yes
Allow 6 months for
spontaneous
re-eruption. Advise
parents of potential
damage to adult tooth
Extract if root tip is
displaced into
permanent tooth bud
Follow up in 4 weeks: Advise parents of
possible injury / damage to permanent teeth
Intrusive Luxation

Most common in
upper primary
incisors

Management: allow
to re-erupt or extract
Tooth Not Retrieved Post Trauma


Confirm Intrusion with Periapical
Monitor up to 6 months for re-eruption
Intrusive Luxation
Primary Teeth

Consider antibiotic therapy - monitor for infection

Tetanus immunization current?

Extract if there are signs of swelling, spontaneous
bleeding, abscess and fever
Day of the Trauma
2 weeks Post Trauma
Intrusive Luxation
Primary Teeth


One of the most
dangerous injuries to the
developing tooth bud
Management: Minimize
damage by assessing
displacement of
permanent bud

Ideally, a lateral film
should be taken to
confirm that intruded
tooth has not
displaced permanent
tooth bud. If so,
extraction
recommended
Lateral Anterior Radiograph for
Intruded Primary Tooth



Angulation of intruded tooth
Occlusal or size 4 extraoral film next to child’s
cheek and perpendicular to radiographic beam
Exposure time is doubled
Intrusion Luxation:
Re-eruption of Primary Tooth
2 months after injury
3 months after injury
1 year after injury
ROOT FRACTURES : RECOMMENDATIONS
Primary Dentition
All treatment is ideal and
assumes patient has
manageable behavior.
Recommendations also assume
appropriate pre-operative radiographs.
(Source: AAPD Handbook of Pediatric Dentistry)
Fracture
located in coronal 1/3
of root or segment is
aspiration risk
Yes
No
Extract coronal
segment. Leave
apical segment if not
visible/easily removed
Clinical and radiographic follow up in 4 weeks:
Advise parents of possible injury / damage to
permanent teeth.
NO SPLINT IS INDICATED
Root Fractures
Primary Teeth

Radiograph

Apical 1/3
- Most teeth maintain vitality and are
minimally mobile
- Apical fragment should
resorb normally
- Monitor with radiographs
Root Fractures
Primary Teeth

Radiograph

Middle or Cervical 1/3
- Most teeth mobile. Extraction indicated
- Gently attempt to retrieve apical fragment
If not successful, monitor
- Don’t disrupt permanent tooth bud
Avulsion: Primary Teeth

Radiograph

Do not re-implant!

Space loss may not occur if
primary canines are present

Permanent tooth eruption
may be delayed due to scar
tissue/bone
Parents Question: Will the
permanent teeth be damaged?
May not be able to be determined until the
teeth erupt and can be evaluated clinically
 The accident has happened - we can’t
reverse it
 Monitor clinically and radiographically

Complications of Trauma
 Permanent teeth
malformation:
hypomineralization
hypoplasia
dilaceration
arrested development
History of Intrusive Luxation
Primary Teeth

Hypomaturation/Hypomineralization #8
History of Intrusion Luxation of
Primary Tooth

Severe dilaceration of Root
History of Avulsion #E :Prior to
Eruption of Primary Canines


Space maintainer not possible for pre-coop tot
with incisors only
Ortho/space regaining will be needed
Acknowledgements

Photos and Diagrams taken from:
 Textbook
and Color Atlas of Traumatic Injuries to the
Teeth, 4th edition: J.O. Andreasen (2007)
 Pediatric Dentistry, 4th edition; Pinkham (2005)
 Odontologia Para o Bebe’: Walter L.R.F. (1996)
 University of Iowa, Department of Pediatric Dentistry
Competency Exam
Answer the following
questions on your worksheets
Case #1 “Anna”





Anna is a 4 y.o. girl who fell against the edge of
a table about 2 hours ago
Her mother has given her children’s Tylenol and
is at your office for evaluation
The upper incisors are tender, but non-mobile.
Her mother raises her lip to show you a 2 mm
tear in the labial frenum area
Anna is cooperative
Case #1: “Anna”

What other clinical procedures do you need to
perform? List at least 3.
“Anna’s” Pedo Occlusal

Is this radiograph within normal limits, or do you
see any abnormalities or pathology?
Case #1 “Anna”


What is your plan for treatment and followup
care for Anna?
What are your care instructions for mother?
Case #2: “Bart”
Bart is a 2 y.o. boy who fell against the
edge of the bathtub about 1 hour ago
 Mother felt his tooth “completely broke off
at the gumline”, but could not find the
piece
 Clinically there are no additional findings

“Bart”

What radiographs are indicated for Bart?
Pedo Occlusal for “Bart”

Bart was not cooperative for further radiographs.
What is your diagnosis based on this film?
Case #2 “Bart”

What is your plan for treatment and followup
care?
Case #3: “Charlie”






Charlie is a healthy 3 y.o. boy who fell against
the fireplace at home this morning
His father is with him
Clinical exam reveals enamel fracture #E and
dentin fracture #F
No excessive mobility, no luxation
Occlusion is normal
Charlie is cooperative , but impatient and wiggly
Charlie’s Clinical Appearance
(photo is a representation of the injury, not an actual photo
of this patient)

What radiographs would you order for Charlie?
Pedo Occlusal for “Charlie”
Case #3 “Charlie”

What is your plan for treatment and followup
care for Charlie?
Case #4 “Davonne”
Davonne is a 12 year old boy with a noncontributory Health History
 He and his parents are at your office for
comprehensive care.
 The chief complaint is “discolored lower
front teeth.”

Davonne Clinical Photo
Davonne

What most likely
caused this
discoloration?

What are treatment
options?
Competency Exam
Answer Discussion
Case #1 “Anna”





Anna is a 4 y.o. girl who fell against the edge of
a table about 2 hours ago
Her mother has given her children’s Tylenol and
is at your office for evaluation
The upper incisors are tender, but non-mobile.
Her mother raises her lip to show you a 2 mm
tear in the labial frenum area
Anna is cooperative
Case #1: “Anna”

What other clinical procedures do you need to perform?
List at least 3.





Periapical radiograph (pedo occlusal)
Mobility check
Percussion check
Occlusion check
Complete hard and soft tissue assessment
“Anna’s” Pedo Occlusal

Is this radiograph within normal limits, or do you
see any abnormalities or pathology?
Answer: Within Normal Limits
Case #1 “Anna”

What is your plan for treatment and followup care for
Anna?



Do not suture
Observe clinically and radiographically
What are your care instructions for mother?




OTC pain meds prn
Soft diet for about 1 week
Tooth may discolor, but this may reverse
Periodic reassessment needed
Case #2: “Bart”
Bart is a 2 y.o. boy who fell against the
edge of the bathtub about 1 hour ago
 Mother felt his tooth “completely broke off
at the gumline”, but could not find the
piece
 Clinically there are no additional findings

“Bart”

What radiographs are indicated for Bart?
 Periapical
 Lateral
(pedo occlusal)
Pedo Occlusal for “Bart”

Bart was not cooperative for further radiographs.
What is your diagnosis based on this film?
 Intrusion.
No fracture detected.
Case #2 “Bart”

What is your plan for treatment and followup
care?
 Monitor
for re-eruption
 Consider antibiotic therapy and assess tetanus
immunization
 Explain signs and symptoms of infection.
 Re-assess in 2 weeks
Case #3: “Charlie”






Charlie is a healthy 3 y.o. boy who fell against
the fireplace at home this morning
His father is with him
Clinical exam reveals enamel fracture #E and
dentin fracture #F
No excessive mobility, no luxation
Occlusion is normal
Charlie is cooperative , but impatient and wiggly
Charlie’s Clinical Appearance

What radiographs would you order for Charlie?
 Periapical
(pedo occlusal)
Pedo Occlusal for “Charlie”
Case #3 “Charlie”

What is your plan for treatment and followup
care for Charlie?
 Smooth
#E
 GI “Bandaid “ #F or composite if cooperation allows
 Periodic clinical and radiographic followup
Case #4 “Davonne”
Davonne is a 12 year old boy with a noncontributory Health History
 He and his parents are at your office for
comprehensive care.
 The chief complaint is “discolored lower
front teeth.”

Davonne Clinical Photo
Davonne

What most likely
caused this
discoloration?
 History
of primary
tooth trauma/intrusion

What are treatment
options?
 No
treatment
 Cosmetic bonding