See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/320877130

Guidelines for the Management of Traumatic Dental Injuries: 3. Injuries in the

Primary Dentition

Article · October 2016

CITATIONS READS

36 9,666

14 authors, including:

Barbro Malmgren Jens Ove Andreasen

Karolinska Institutet Rigshospitalet
44 PUBLICATIONS   3,978 CITATIONS    331 PUBLICATIONS   27,987 CITATIONS   

SEE PROFILE SEE PROFILE

Marie Therese Flores Agneta Robertson

Universidad de Valparaíso (Chile) University of Gothenburg
28 PUBLICATIONS   4,031 CITATIONS    46 PUBLICATIONS   1,365 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Root Canal Anatomy View project

Vital Pulp Therapy and Pulp Regeneration View project

All content following this page was uploaded by Nestor Cohenca on 22 November 2017.

The user has requested enhancement of the downloaded file.

Dental Traumatology 2012; 28: 174–182; doi: 10.1111/j.1600-9657.2012.01146.x

International Association of Dental

Traumatology guidelines for the
management of traumatic dental injuries: 3.
Injuries in the primary dentition

Barbro Malmgren1,*, Jens O. Abstract – Traumatic injuries to the primary dentition present special pro-
Andreasen2,*, Marie Therese Flores3,*, blems and the management is often different as compared with the perma-
Agneta Robertson4,*, Anthony J. nent dentition. The International Association of Dental Traumatology
DiAngelis5,*, Lars Andersson6, (IADT) has developed a consensus statement after a review of the dental
Giacomo Cavalleri7, Nestor literature and group discussions. Experienced researchers and clinicians
Cohenca8, Peter Day9, Morris Lamar from various specialities were included in the task group. In cases where
Hicks10, Olle Malmgren11, Alex J. the data did not appear conclusive, recommendations were based on the
Moule12, Juan Onetto13, Mitsuhiro consensus opinion or majority decision of the task group. Finally, the
Tsukiboshi14 IADT board members were giving their opinion and approval. The pri-
1
Division of Pediatric Dentistry, Department of mary goal of these guidelines is to delineate an approach for the immediate
Dental Medicine, Karolinska Institutet,
Huddinge, Sweden; 2Department of Oral and or urgent care for management of primary teeth injuries. The IADT can-
Maxillofacial Surgery, Center of Rare Oral not and does not guarantee favorable outcomes from strict adherence to
Diseases, Copenhagen University Hospital, the guidelines, but believe that their application can maximize the chances
Rigshospitalet, Copenhagen, Denmark;
3
Department of Pediatric Dentistry, Faculty of of a positive outcome.
Dentistry, Universidad de Valparaiso,
Valparaiso, Chile; 4Department of Pedodontics,
Institute of Odontology, Gothenburg University,
Gothenburg, Sweden; 5Department of Dentistry,
Hennepin County Medical Center and University
of Minnesota School of Dentistry, Minneapolis,
MN, USA; 6Department of Surgical Sciences,
Faculty of Dentistry, Health Sciences Center,
Kuwait University, Kuwait City, Kuwait;
7
Department of Dentistry, University of Verona,
Verona, Italy; 8Department of Endodontics,
University of Washington, Seattle, WA, USA;
9
Pediatric Dentistry, Leeds Dental Institute and
Bradford District Care Trust Salaried Dental
Service, Leeds, UK; 10Department of
Endodontics, University of Maryland School of
Dentistry, Baltimore, MD, USA; 11Orthodontic
Clinic, Folktandvården, Uppsala, Sweden;
12
Private Practice, University of Queensland,
Brisbane, QLD, Australia; 13Department of
Pediatric Dentistry, Faculty of Dentistry,
Universidad de Valparaiso, Valparaiso, Chile;
14
Private Practice, Amagun, Aichi, Japan

Key words: tooth; trauma; primary; luxation;

fracture; review

Correspondence to: Barbro Malmgren, DDS,

PhD, DrMed, Karolinska Institutet, Department
of Dental Medicine, Division of Pediatric
Dentistry, POB 4064, SE-14104 Huddinge,
Sweden
Tel.: +46 739851788
Fax: +46 8 7743395
e-mail: barbro.malmgren@ki.se
Accepted 26 March, 2012

*Members of the Task Group.

174 © 2012 John Wiley & Sons A/S

 IADT guidelines for injuries in the primary dentition 175

Trauma to the oral region occurs frequently and periodic updates. These 2012 Guidelines in the journal
comprises 5% of all injuries for which people seek treat- Dental Traumatology appear in three parts.
ment (1–3). In preschool children, head and facial non- Part I: Fractures and luxations of permanent teeth (Dent
oral injuries make up as much as 40% of all somatic Traumatol 2012;28:issue 1)
injuries (1–3). In the age group 0–6 years, oral injuries Part II: Avulsion of permanent teeth (Dent Traumatol
are ranked as the second most common injury covering 2012;28:issue 2)
18% of all somatic injuries (1–3). Of the oral injuries, Part III: Injuries in the primary dentition (Dent
dental injuries are the most frequent, followed by oral Traumatol 2012;28:issue 3)
soft-tissue injuries. Luxation injuries affecting both mul- Guidelines offer recommendations for diagnosis and
tiple teeth and surrounding soft tissues are mainly treatment of specific traumatic dental injuries (TDIs);
reported in children 1–3 years of age and are typically however, they cannot provide comprehensive nor
as a result of falls (2, 4–11). Emergency situations there- detailed information found in textbooks, scientific litera-
fore present a challenge to clinicians worldwide. It is ture, and most recently the dental trauma guide (DTG).
now recognized that child injuries are a major threat to The latter can be accessed on http://www.dentaltrau-
child health and that they are a neglected public health maguide.org. Additionally, the DTG is also available
problem (12). A healthcare professional′s decision on on the IADT web page (http://www.iadt-dentaltrauma.
how to treat combined with parental consent and org) and provides a visual and animated documenta-
patient assent (13) is the preferred scenario encountered tion of treatment procedures as well as estimates of
when facing pediatric emergencies (14). prognosis for the various TDIs.
Guidelines for the management of primary teeth Because the management of permanent and primary
injuries should assist dentists, other healthcare profes- traumatized dentitions differs significantly, separate
sionals, and parents or carers in decision making. They guidelines have been developed (Tables 1 and 2).
should be credible, readily understandable, and practi-
cal with the aim of delivering the best care possible in
Special considerations for trauma to primary teeth
an efficient manner.
The International Association of Dental Traumatol- A young child is often difficult to examine and treat
ogy (IADT) has developed an updated set of guidelines because of the lack of cooperation and because of fear.
based on a review of the current dental literature utiliz- The situation is distressing for both the child and
ing EMBASE, MEDLINE, and PubMed searches from parents or carers (17).
1996 to 2011 as well as a search of the Journal of Den- Furthermore, there are varying conditions in differ-
tal Traumatology from 2000 to 2011. Search words ent countries concerning economic and social aspects
included primary dentition, deciduous dentition, crown as well as treatment philosophies (7, 17, 18). How-
fracture, primary incisor fracture, tooth fractures, root ever, child and family-centered pediatric practices and
fractures, tooth luxation, lateral luxation and primary institutions should consider the best interests of chil-
teeth, intruded primary teeth, luxated primary teeth, dren and prepare clinicians to ensure the fulfillment
tooth avulsion, and tooth/crown injuries. Additionally, of children′s rights when treatment decisions are
some relevant articles prior to 1996, which have served made (19).
as the basis for further research in the field of dental It is important to keep in mind that there is a close
traumatology, as well as recent policy statements relationship between the apex of the root of the injured
regarding holistic care and management of the injured primary tooth and the underlying permanent tooth
child, were also included. germ. Tooth malformation, impacted teeth, and erup-
The IADT published its first set of guidelines in tion disturbances in the developing permanent
2001 (15) and updated them in 2007 (16). As with the dentition are some of the consequences that can occur
previous guidelines, the working group included experi- following severe injuries to primary teeth and/or alveo-
enced researchers and clinicians in pediatric dentistry lar bone (5, 20–23). White or yellow-brown discolor-
and oral and maxillofacial surgery. This revision repre- ation of crown and hypoplasia of permanent incisors
sents the best evidence from the available literature and are, however, the most common sequelae following
expert professional judgement. In cases where the data intrusion and avulsion of primary teeth in children dur-
did not appear conclusive, recommendations were ing the ages of 1–3 years (21–27). Because of these
based on the consensus opinion of the working group potential sequelae, treatment selections should be
followed by review by the members of the IADT Board aimed at minimizing any additional risks of further
of Directors. It is understood that guidelines are to be damage to the permanent successors. It is therefore not
applied with judgement of the specific clinical circum- recommended, for instance, to replant an avulsed
stances, clinicians′ prudence, and patients’ characteris- primary incisor (16, 28, 29).
tics, including but not limited to compliance, finances A child′s maturity and ability to cope with the emer-
and understanding of the immediate and long-term gency situation, the time for shedding of the injured
outcomes of treatment alternatives versus non-treat- tooth, and the occlusion, are all important factors that
ment. The IADT cannot and does not guarantee favor- influence treatment selection.
able outcomes from strict adherence to the Guidelines, Repeated trauma episodes are frequent in children.
but believe that their application can maximize the It should be taken into consideration if planning
chances of a positive outcome. Guidelines undergo root canal treatment in an injured primary tooth

© 2012 John Wiley & Sons A/S

176 Malmgren et al.

Table 1. Treatment guidelines for fractures of teeth and alveolar bone

Follow-up Favorable and Unfavorable outcomes include
procedures some, but not necessarily all, of the following
for fractures
Radiographic of teeth and Favorable Unfavorable
Clinical findings findings Treatment alveolar bone Outcome Outcome
Enamel fracture
● Fracture ● No ● Smooth
involves radiographic sharp
enamel abnormalities edges

Enamel dentin fracture

● Fracture ● No If possible, 3–4
involves radiographic seal completely weeks C
enamel abnormalities. the involved
and dentin; The relation dentin with glass
the pulp is between the ionomer to
not fracture and prevent
exposed the pulp microleakage.
chamber will In case of
be disclosed large lost
tooth structure,
the tooth can
be restored
with composite
Crown fracture with exposed pulp
● Fracture ● The stage of ● If possible, 1 week C ● Continuing root ● Signs of apical
involves root preserve pulp 6–8 weeks development in periodontitis;
enamel development vitality by C+R immature teeth no continuing
and dentin, can be partial 1 year C+R and a hard root
and the determined pulpotomy. tissue barrier development
pulp is from Calcium in immature
exposed one exposure hydroxide is a teeth
suitable material Extraction or
for such root canal
procedures. treatment
A well-condensed
layer of pure
calcium
hydroxide
paste can be
applied
over the pulp,
covered with a
lining such as
reinforced glass
ionomer. Restore
the tooth with
composite
● The treatment
is depending
on the child′s
maturity and
ability to
cope. Extraction
is usually
the alternative
option
Crown–root fracture

© 2012 John Wiley & Sons A/S

 IADT guidelines for injuries in the primary dentition 177

Table 1. Continued
Follow-up Favorable and Unfavorable outcomes include
procedures some, but not necessarily all, of the following
for fractures
Radiographic of teeth and Favorable Unfavorable
Clinical findings findings Treatment alveolar bone Outcome Outcome
● Fracture ● In laterally Depending on In cases of ● Asymptomatic; ● Symptomatic;
involves enamel, positioned the clinical fragment, continuing signs of apical
dentin, and fractures, the findings, two removal only: root periodontitis;
root structure; extent in treatment 1 week C development in no continuing
the pulp may relation to scenarios may 6–8 weeks immature teeth root development
or may not the gingival be considered: C+R in immature
be exposed margin can be ● Fragment 1 year C(*) teeth
● Additional seen removal
findings may One exposure only if the
include loose, is necessary fracture
but still to disclose involves only
attached, multiple a small part
fragments of fragments of the root
the tooth and the stable
● There is fragment is
minimal to large enough
moderate to allow
tooth coronal
displacement restoration
● Extraction in
all other
instances
Root fracture
● The coronal ● The fracture is ● If the coronal ● No ● Signs of repair None
fragment may usually located fragment is not displacement: between fractured
be mobile mid-root or in displaced, no 1 week C, segments
and may be the apical third treatment is ● 6–8 weeks ● Continuous
displaced required C, resorption of the left
● If the coronal ● 1 year C+R apical fragment
fragment is and C(*)
displaced, each
repositioning and subsequent
splinting might be year until
considered exfoliation
Otherwise extract ● Extraction
only that fragment. 1 year C+R
The apical fragment and C(*)
should be left to be each
resorbed subsequent
year until
exfoliation
Alveolar fracture
● The fracture ● The horizontal ● Reposition any 1 week C ● Normal ● Signs of apical
involves the fracture line to displaced segment 3–4 weeks S+C occlusion periodontitis or
alveolar bone the apices of the and then splint +R ● No signs external
and may extend primary teeth ● General anesthesia 6–8 weeks C of apical inflammatory root
to adjacent bone and their is often indicated +R periodontitis resorption of
● Segment permanent ● Stabilize the 1 year C+R ● No signs of primary teeth
mobility and successors will segment for and C(*) each disturbances in the ● Signs of
dislocation are be disclosed 4 weeks subsequent year permanent disturbances in the
common ● A lateral ● Monitor until exfoliation successors permanent
findings radiograph may teeth in successors require
● Occlusal also give fracture line follow up until full
interference information about eruption
is often the relation
noted between the two
dentitions and if
the segment is
displaced in
labial direction
C, Clinical examination; R, Radiographic examination; S, Splint removal; (C*), Clinical and radiographic monitoring until eruption of the permanent successor.

© 2012 John Wiley & Sons A/S

178 Malmgren et al.

because trauma recurrence will shorten the survival 3 Extra-oral lateral view of the tooth in question may
time for the primary tooth (30). reveal the relationship between the apex of the dis-
There is no consensus in the literature about best placed tooth and the permanent tooth germ as well
treatment for the traumatized primary dentition. Fur- as the direction of dislocation (size 2 film, vertical
thermore, children with dental injuries are not always view), but is seldom indicated as it rarely adds extra
brought in for treatment immediately, which may be information.
due the to lack of access to dental care (31, 32). While
some reports advocate routine tooth extraction, others
stress the importance of a more conservative approach Splinting
by saving primary teeth whenever possible (29, 33). Splinting is used only for alveolar bone fractures and
Traumatic pulp exposures of primary incisors are rare possibly for intra-alveolar root fractures.
but can be treated with partial pulpotomy (34). Pulpec-
tomy with zinc oxide eugenol or calcium hydroxide/
iodoform paste is recommended in some countries Use of antibiotics
(30,35,36). However, if full cooperation of the child can There is no evidence for the use of systemic antibiotics
not be achieved, extraction is usually the alternative in the management of luxation injuries in the primary
option. dentition. Antibiotic use remains at the discretion of
It has been demonstrated that most luxation inju- the clinician as TDIs are often accompanied by soft tis-
ries heal spontaneously (37, 38), avoiding the trau- sue and other associated injuries that may require sig-
matic experience of a tooth extraction. The clinician′s nificant surgical intervention. In addition, the child′s
skills and experience with pediatric patients is of out- medical status may warrant antibiotic coverage. When-
most importance for managing the patient′s and the ever possible, contact the pediatrician who may give
parents′ or carers′ behavior in the emergency situa- recommendations for a specific medical condition.
tion (17). After an accurate diagnosis and explana-
tion of various treatment options to the parents or
carers, the clinician and parents or carers must Sensibility and percussion tests
decide the treatment planning for the child′s own
Sensibility and percussion tests are not reliable in
benefit.
primary teeth because of the inconsistent results.

Guidelines for the clinician

Crown discoloration
These Guidelines contain recommendations for diagno-
Although these Guidelines recommendations focus
sis and treatment of traumatic injuries in the primary
on the management of acute dental injuries, crown
dentition, for caries-free, healthy primary teeth, using
discoloration may be considered as it is a frequently
proper examination procedures.
asked question by the parents or carers, mainly
for esthetic reasons. Discoloration is a common com-
Clinical examination plication after luxation injuries (47–50). Such discol-
Information about the examination of traumatic inju- oration may fade, and the tooth may regain its
ries in the primary dentition can be found in a number original shade (8, 47, 50, 51). Teeth with persisting
of current textbooks (4, 39). The possibility of child dark discoloration may remain asymptomatic clini-
abuse should be considered when assessing children cally and radiographically or they may develop api-
under the age of 5 years who present with intra-oral cal periodontitis (52, 53). There is an association
trauma affecting the lips, gums, tongue, palate, and between crown discoloration and pulp necrosis in
severe tooth injuries (40–46). traumatized primary teeth (48, 54). Unless associated
infection exists, root canal treatment is not indicated
(55).
Radiographic examination

A detailed radiographic examination is essential to Pulp canal obliteration

establish the extent of the injury to the supporting tis-
sues, the stage of root development, and the relation to Pulp canal obliteration is common sequela to luxation
the permanent successors. Depending on the child’s injuries. It has been found to occur in 35–50% (48, 50,
ability to cope with the procedure and the type of 53) and indicates ongoing pulp vitality (48, 56).
injury suspected, the clinician should decide which A yellowish hue can be noted.
radiograph is required for confirming diagnosis.
Always consider minimizing the risk of radiation to the Parents’ instructions
child. Several angles are recommended. Select the
appropriate radiographic examination: Good healing following an injury to the teeth and oral
tissues depends, in part, on good oral hygiene. To opti-
1 90° horizontal angle with central beam through the mize healing, parents and carers should be advised
tooth in question (size 2 film, horizontal view) regarding care of the injured tooth/teeth and the pre-
2 Occlusal view (size 2 film, horizontal view) vention of further injury by supervising potentially

© 2012 John Wiley & Sons A/S

 IADT guidelines for injuries in the primary dentition 179

Table 2. Treatment guidelines for luxation injuries

Favorable and Unfavorable outcomes
include some, but not necessarily all,
of the following
Radiographic Favorable Unfavorable
Clinical findings findings Treatments Follow up Outcome Outcome
Concussion
● The tooth is No radiographic ● No treatment is 1 week C ● Continuing root ● No continuing
tender to abnormalities. needed. Observation 6–8 weeks C development in root
touch. It has Normal periodontal immature teeth development in
normal space immature teeth
mobility and ● Dark
no sulcular discoloration of
bleeding crown. No
treatment is
needed unless
apical
periodontitis
develops
Subluxation
● The tooth has Radiographic ● No treatment is 1 week C ● Continuing root ● No continuing
increased abnormalities are needed. Observation. 6–8 weeks C development in root
mobility but usually not found Brushing with a soft Crown immature teeth development in
has not been Normal periodontal brush and use of discoloration ● Transient red/ immature teeth
displaced space alcohol-free 0.12% might occur. No gray ● Dark
● Bleeding from An occlusal chlorhexidine treatment is discoloration discoloration of
gingival exposure is topically on the needed unless a A yellow crown
crevice may be recommended to affected area with fistula develops discoloration No treatment is
noted screen for possible cotton swabs twice a Dark discolored indicates pulp needed unless
signs of day for 1 week teeth should be obliteration and apical
displacement or the followed has a good periodontitis
presence of a root carefully to prognosis develops
fracture. The detect sign of
radiograph can infection as
furthermore be soon as
used as a reference possible
point in case of
future complications
Extrusive luxation
● Partial Increased ● Treatment decisions 1 week C ● Continuing root ● No continuing
displacement periodontal are based on the 6–8 weeks C development in root
of the tooth ligament space degree of +R immature teeth development in
out of its apically displacement, 6 months C+R ● Transient red/ immature teeth
socket mobility, root 1 year C+R gray ● Dark
● The tooth formation, and the Discoloration discoloration discoloration of
appears ability of the child to might occur A yellow crown
elongated and cope with the Dark discolored discoloration No treatment is
can be emergency situation teeth should be indicates pulp needed unless
excessively ● For minor extrusion followed obliteration and apical
mobile (<3 mm) in an carefully to has a periodontitis
immature developing detect sign of good prognosis develops
tooth, careful infection as
repositioning or soon as
leaving the tooth for possible
spontaneous
alignment can be
treatment options
Extraction is the
treatment of choice
for severe extrusion
in a fully formed
primary tooth

© 2012 John Wiley & Sons A/S

180 Malmgren et al.

Table 2. Continued
Favorable and Unfavorable outcomes
include some, but not necessarily all,
of the following
Radiographic Favorable Unfavorable
Clinical findings findings Treatments Follow up Outcome Outcome
Lateral luxation
● The tooth is Increased ● If there is no 1 week C ● Asymptomatic ● No continuing
displaced, periodontal ligament occlusal interference, 2–3 weeks C ● Clinical and root
usually in a space apically is as is often the case 6–8 weeks C radiographic development in
palatal/lingual, best seen on the in anterior open bite, +R signs of normal immature teeth
or labial occlusal exposure. the tooth is allowed 1 year C+R or healed ● Dark
direction And an occlusal to reposition periodontium discoloration of
● It will be exposure can spontaneously ● Transient crown
immobile sometimes also ● In case of minor discoloration No treatment is
show the position occlusal interference, might occur needed unless
of the displaced slight grinding is apical
tooth and its indicated periodontitis
relation to the ● When there is more develops
permanent severe occlusal
successor interference, the tooth
can be gently
repositioned by
combined labial and
palatal pressure after
the use of local
anesthesia
● In severe
displacement, when
the crown is
dislocated in a labial
direction, extraction is
the treatment of
choice
Intrusive luxation
● The tooth is When the apex is If the apex is displaced 1 week C ● Tooth in place ● Tooth locked
usually displaced toward or toward or through the 3–4 weeks or erupting in place
displaced through the labial labial bone plate, the C+R ● No or ● Persistent
through the bone plate, the tooth is left for 6–8 weeks C transient discoloration
labial bone apical tip can be spontaneous 6 months C+R discoloration ● Radiographic
plate, visualized and the repositioning ● 1 year C+R signs of apical
or can be tooth appears If the apex is and (C*) periodontitis
impinging upon shorter than its displaced into the ● Damage to the
the contra lateral developing tooth permanent
succedaneous When the apex is germ, extract successor
tooth bud displaced toward
the permanent tooth
germ, the apical tip
cannot be visualized
and the tooth
appears elongated

Avulsion
The tooth is A radiographic It is not 1 week C Damage to the
completely out of examination is recommended 6 months permanent
the socket essential to ensure to replant C+R successor
that the missing avulsed primary 1 year C + R
tooth is not teeth and (C*)
intruded

C, Clinical examination; R, Radiographic examination; (C*), Clinical and radiographic monitoring until eruption of the permanent successor.

© 2012 John Wiley & Sons A/S

 IADT guidelines for injuries in the primary dentition 181

hazardous activities. Brushing with a soft brush and p. 145–55. http://whqlibdoc.who.int/publications/2008/

use of alcohol-free 0.1% chlorhexidine gluconate topi- 9789241563574_eng.pdf (accessed 6 November 2011).
cally on the affected area with cotton swabs twice a 13. Harding AM. Pharmacologic considerations in pediatric
dentistry. Dent Clin North Am 1994;38:733–53.
day for 1 week are recommended to prevent accumula-
14. American Academy of Pediatrics. Policy statement- Consent
tion of plaque and debris. A soft diet for 10 days and for emergency medical services for children and adolescents.
restriction in the use of an intra-oral pacifier are also Pediatrics 2011;128:427–33.
recommended. 15. Flores MT, Andreasen JO, Bakland LK, Feiglin B, Gutmann
Parents or carers should be further advised about JL, Oikarinen K et al.Guidelines for the evaluation and man-
possible complications that may occur, like swelling, agement of traumatic dental injuries. Dent Traumatol
increased mobility, or sinus tracts. Children may not 2001;17:1–4.
complain about pain; however, infection may be pres- 16. Flores MT, Malmgren B, Andersson L, Andreasen JO,
Bakland LK, Barnett F et al.Guidelines for the management
ent, and parents or carers should watch for signs such
of traumatic dental injuries. III. Primary teeth. Dent Trauma-
as swelling of the gums; if present they should bring tol 2007;23:196–202.
the children in for treatment. 17. Needleman HL. The art and science of managing traumatic
Documentation that the parents and carers have injuries to primary teeth. Dent Traumatol 2011;27:295–9.
been informed about possible complications in the 18. Vlok JL, Worthington EM, Hindson JA, Davidson LE,
development of the permanent teeth, especially follow- Thomson WM, Drummond BK. Young people’s perceptions
ing intrusion, avulsion, and alveolar fracture injuries, is of photographs of dental trauma. Dent Traumatol
very important. 2011;27:109–12.
19. American Academy of Pediatrics. Policy statement-health
equity and children’s rights. Pediatrics 2010;125:838–49.
Acknowledgments 20. Andreasen JO, Sundstrom B, Ravn JJ. The effect of trau-
matic injuries to primary teeth on their permanent successors.
IADT is grateful to the team of Dental Trauma guide I. A clinical and histologic study of 117 injured permanent
www.dentaltraumaguide.org for kindly providing teeth. Scand J Dent Res 1971;79:219–83.
pictures to the article. 21. Diab M, elBadrawy HE. Intrusion injuries of primary inci-
sors. Part III: effects on the permanent successors. Quintes-
sence Int 2000;31:377–84.
References 22. Ravn JJ. Developmental disturbances in permanent teeth
after intrusion of their primary predecessors. Scand J Dent
1. Glendor U, Andersson L. Public health aspects of oral diseases Res 1976;84:137–41.
and disorders; dental trauma. In: Pine C, Harris R, editors. 23. Holan G, Ram D. Sequelae and prognosis of intruded primary
Community oral health. London: Quintessence 2007; p.203–14. incisors: a retrospective study. Pediatr Dent 1999;21:242–7.
2. Glendor U, Halling A, Andersson L, Eilert-Petersson E. Inci- 24. de Amorim Lde F, da Costa LR, Estrela C. Retrospective
dence of traumatic tooth injuries in children and adolescents study of traumatic dental injuries in primary teeth in a Brazil-
in the county of Vastmanland, Sweden. Swed Dent J ian specialized pediatric practice. Dent Traumatol 2011;
1996;20:15–28. 27:368–73.
3. Petersson EE, Andersson L, Sorensen S. Traumatic oral vs 25. Da Silva Assuncao LR, Ferelle A, Iwakura ML, Cunha RF.
non-oral injuries. Swed Dent J 1997;21:55–68. Effects on permanent teeth after luxation injuries to the
4. Flores MT, Holan G, Borum M, Andresen JO. Injuries to the primary predecessors: a study in children assisted at an
primary dentition. In: Andreasen JO, Andreasen FM, Anders- emergency service. Dent Traumatol 2009;25:165–70.
son L, editors. Textbook and color atlas of traumatic injuries 26. do Espirito Santo Jacomo DR, Campos V. Prevalence of
to the teeth, 4th edn. Oxford, England: Blackwell Munksg- sequelae in the permanent anterior teeth after trauma in their
aard; 2007. p. 516–41. predecessors: a longitudinal study of 8 years. Dent Traumatol
5. Andreasen JO, Ravn JJ. Epidemiology of traumatic dental 2009;25:300–4.
injuries to primary and permanent teeth in a Danish 27. Altun C, Cehreli ZC, Guven G, Acikel C. Traumatic intru-
population sample. Int J Oral Surg 1972;1:235–9. sion of primary teeth and its effects on the permanent succes-
6. Cunha RF, Pugliesi DM, de Mello Vieira AE. Oral trauma in sors: a clinical follow-up study. Oral Surg Oral Med Oral
Brazilian patients aged 0–3 years. Dent Traumatol Pathol Oral Radiol Endod 2009;107:493–8.
2001;17:210–2. 28. Christophersen P, Freund M, Harild L. Avulsion of primary
7. Borum MK, Andreasen JO. Therapeutic and economic impli- teeth and sequelae on the permanent successors. Dent
cations of traumatic dental injuries in Denmark: an estimate Traumatol 2005;21:320–3.
based on 7549 patients treated at a major trauma centre. Int J 29. Flores MT. Traumatic injuries in the primary dentition. Dent
Paediatr Dent 2001;11:249–58. Traumatol 2002;18:287–98.
8. Fried I, Erickson P, Schwartz S, Keenan K. Subluxation 30. Rocha MJ, Cardoso M. Survival analysis of endodontically
injuries of maxillary primary anterior teeth: epidemiology treated traumatized primary teeth. Dent Traumatol
and prognosis of 207 traumatized teeth. Pediatr Dent 2007;23:340–7.
1996;18:145–51. 31. Avsar A, Topaloglu B. Traumatic tooth injuries to primary
9. Llarena del Rosario ME, Acosta Alfaro VM, Garcia-Godoy teeth of children aged 0-3 years. Dent Traumatol 2009;25:
F. Traumatic injuries to primary teeth in Mexico City 323–7.
children. Endod Dent Traumatol 1992;8:213–4. 32. Lam R, Abbott P, Lloyd C, Kruger E, Tennant M. Dental
10. Bastone EB, Freer TJ, McNamara JR. Epidemiology of dental trauma in an Australian rural centre. Dent Traumatol
trauma: a review of the literature. Aust Dent J 2000;45:2–9. 2008;24:663–70.
11. McTigue DJ. Diagnosis and management of dental injuries in 33. Cunha RF, Pugliesi DM, Percinoto C. Treatment of trauma-
children. Pediatr Clin North Am 2000;47:1067–84. tized primary teeth: a conservative approach. Dent Traumatol
12. World Health Organization. World report on child injury 2007;23:360–3.
prevention. World Health Organization; 2008. Chapter 7.

© 2012 John Wiley & Sons A/S

 182 Malmgren et al.

34. Kupietzky A, Holan G. Treatment of crown fractures with 46. Cairns AM, Mok JY, Welbury RR. Injuries to the head, face,
pulp exposure in primary incisors. Pediatr Dent 2003;25: mouth and neck in physically abused children in a community
241–7. setting. Int J Paediatr Dent 2005;15:310–8.
35. Trairatvorakul C, Chunlasikaiwan S. Success of pulpectomy 47. Auslander WP. Discoloration, a traumatic sequela. N Y State
with zinc oxide-eugenol vs calcium hydroxide/iodoform paste Dent J 1967;33:534–8.
in primary molars: a clinical study. Pediatr Dent 2008;30: 48. Schroder U, Wennberg E, Granath LE, Moller H. Trauma-
303–8. tized primary incisors - follow-up program based on fre-
36. Rocha MJ, Cardoso M. Federal University of Santa Catarina quency of periapical osteitis related to tooth color. Swed
endodontic treatment of traumatized primary teeth - part 2. Dent J 1977;1:95–8.
Dent Traumatol 2004;20:314–26. 49. Reed AJ 3rd, Sayegh FS. The dark primary incisor. Dent
37. Colak I, Markovic D, Petrovic B, Peric T, Milenkovic A. A Surv 1978;54:16–9.
retrospective study of intrusive injuries in primary dentition. 50. Borum MK, Andreasen JO. Sequelae of trauma to primary
Dent Traumatol 2009;25:605–10. maxillary incisors. I. Complications in the primary dentition.
38. Spinas E, Melis A, Savasta A. Therapeutic approach to intru- Endod Dent Traumatol 1998;14:31–44.
sive luxation injuries in primary dentition. A clinical follow- 51. Jacobsen I, Sangnes G. Traumatized primary anterior teeth.
up study. Eur J Paediatr Dent 2006;7:179–86. Prognosis related to calcific reactions in the pulp cavity. Acta
39. Andreasen JO, Bakland LK, Flores MT, Andreasen FM, Odontol Scand 1978;36:199–204.
Andersson L. Traumatic dental injuries, a manual. 3rd edn. 52. Holan G, Fuks AB. The diagnostic value of coronal dark-
Chichester, West Sussex: Wiley-Blackwell; 2011. p. 54–7 gray discoloration in primary teeth following traumatic inju-
40. Kellogg N. Oral and dental aspects of child abuse and ries. Pediatr Dent 1996;18:224–7.
neglect. Pediatrics 2005;116:1565–8. 53. Holan G. Development of clinical and radiographic signs
41. Becker DB, Needleman HL, Kotelchuck M. Child abuse and associated with dark discolored primary incisors following
dentistry: orofacial trauma and its recognition by dentists. traumatic injuries: a prospective controlled study. Dent
J Am Dent Assoc 1978;97:24–8. Traumatol 2004;20:276–87.
42. Tate RJ. Facial injuries associated with the battered child 54. Cardoso M, de Carvalho Rocha MJ. Association of crown
syndrome. Br J Oral Surg 1971;9:41–5. discoloration and pulp status in traumatized primary teeth.
43. da Fonseca MA, Feigal RJ, ten Bensel RW. Dental aspects Dent Traumatol 2010;26:413–6.
of 1248 cases of child maltreatment on file at a major county 55. Holan G. Long-term effect of different treatment modalities
hospital. Pediatr Dent 1992;14:152–7. for traumatized primary incisors presenting dark coronal dis-
44. Jessee SA. Physical manifestations of child abuse to the head, coloration with no other signs of injury. Dent Traumatol
face and mouth: a hospital survey. ASDC J Dent Child 2006;22:14–7.
1995;62:245–9. 56. Robertson A, Lundgren T, Andreasen JO, Dietz W, Hoyer I,
45. Naidoo S. A profile of the oro-facial injuries in child physical Noren JG. Pulp calcifications in traumatized primary incisors.
abuse at a children’s hospital. Child Abuse Negl 2000;24: A morphological and inductive analysis study. Eur J Oral Sci
521–34. 1997;105:196–206.

© 2012 John Wiley & Sons A/S

View publication stats