1. (REFERENCE: AAPD Handbook of Pediatric Dentistry)
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
Extract if root tip is
displaced into
permanent tooth bud
Allow 6 months for
spontaneous
re-eruption. Advise
parents of potential
damage to adult tooth
Follow up in 4 weeks: Advise parents of
possible injury / damage to permanent teeth

2. Intrusive Luxation Most common in upper primary incisors
Management: allow to re-erupt or extract

3. Tooth Not Retrieved Post Trauma
Confirm Intrusion with Periapical
Monitor up to 6 months for re-eruption

4. 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

5. Intrusive Luxation Primary Teeth
One of the most dangerous injuries to the developing tooth bud
Management: Minimize damage by assessing displacement of permanent bud

6. Ideally, a lateral film should be taken to confirm that intruded tooth has not displaced permanent tooth bud. If so, extraction recommended

7. 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

8. Intrusion Luxation: Re-eruption of Primary Tooth
2 months after injury
3 months after injury
1 year after injury

9. Primary Dentition ROOT FRACTURES : RECOMMENDATIONS
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
Extract coronal
segment. Leave
apical segment if not
visible/easily removed No
Clinical and radiographic follow up in 4 weeks:
Advise parents of possible injury / damage to
permanent teeth.
NO SPLINT IS INDICATED

10. Root Fractures Primary Teeth
Radiograph
Apical 1/3
- Most teeth maintain vitality and are
minimally mobile
- Apical fragment should
resorb normally
- Monitor with radiographs

11. 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

12. 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

13. 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

14. Complications of Trauma
Permanent teeth malformation:
hypomineralization
hypoplasia
dilaceration
arrested development

15. History of Intrusive Luxation Primary Teeth
Hypomaturation/Hypomineralization #8

16. History of Intrusion Luxation of Primary Tooth
Severe dilaceration of Root

17. 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

18. 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

19. Answer the following questions on your worksheets
Competency Exam
Answer the following questions on your worksheets

20. 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

21. Case #1: “Anna”
What other clinical procedures do you need to perform? List at least 3.

22. “Anna’s” Pedo Occlusal
Is this radiograph within normal limits, or do you see any abnormalities or pathology?

23. Case #1 “Anna”
What is your plan for treatment and followup care for Anna?
What are your care instructions for mother?

24. 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

25. “Bart”
What radiographs are indicated for Bart?

26. Pedo Occlusal for “Bart”
Bart was not cooperative for further radiographs. What is your diagnosis based on this film?

27. Case #2 “Bart”
What is your plan for treatment and followup care?

28. 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

29. 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?

30. Pedo Occlusal for “Charlie”

31. Case #3 “Charlie”
What is your plan for treatment and followup care for Charlie?

32. Case #4 “Davonne”
Davonne is a 12 year old boy with a non-contributory Health History
He and his parents are at your office for comprehensive care.
The chief complaint is “discolored lower front teeth.”

33. Davonne Clinical Photo

34. Davonne What most likely caused this discoloration?
What are treatment options?

35. Competency Exam
Answer Discussion

36. 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

37. 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

38. “Anna’s” Pedo Occlusal
Is this radiograph within normal limits, or do you see any abnormalities or pathology?
Answer: Within Normal Limits

39. 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

40. 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

41. “Bart” What radiographs are indicated for Bart?
Periapical (pedo occlusal)
Lateral

42. Pedo Occlusal for “Bart”
Bart was not cooperative for further radiographs. What is your diagnosis based on this film?
Intrusion. No fracture detected.

43. 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

44. 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

45. Charlie’s Clinical Appearance
What radiographs would you order for Charlie?
Periapical (pedo occlusal)

46. Pedo Occlusal for “Charlie”

47. 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

48. Case #4 “Davonne”
Davonne is a 12 year old boy with a non-contributory Health History
He and his parents are at your office for comprehensive care.
The chief complaint is “discolored lower front teeth.”

49. Davonne Clinical Photo

50. Davonne What most likely caused this discoloration?
History of primary tooth trauma/intrusion
What are treatment options?
No treatment
Cosmetic bonding