Ali Baghalian, Assistant Professor of Pediatric Dentistry, Qazvin Dental School

Introduction Trauma to primary teeth, Bone fracture Trauma to primary teeth development (left side??) Initial stages of development Prevalence 12-69% 10% of enamel hypoplasia related to trauma to the primary teeth Type of dental trauma determines type and degree of developmental disturbance

Introduction Avulsion & intrusive luxation high risk Subluxation & extrusion low risk 4 years old Jaw fractures (osteosynthesis) Oral surgical procedures Extraction of primary molars

Differential Diagnosis Enamel Hypolplasia resulting from pathological conditionas MIH

Close proximity of primary anterior teeth to developing teeth

Enamel Hypoplasia of Primary Teeth

Dilaceration of primary tooth germ due to endotracheal intubation

Osteosynthesis

D extraction?

Evaluation Impossible before complete eruption Serious sequelae can be diagnosed radiographically

Classification White or yellow-brown discoloration of enamel White or yellow-brown discoloration of enamel with circular enamel hypoplasia Crown dilaceration Odontoma like malformation Root duplication Vestibular root angulation Lateral root angulation or dilaceration Partial or complete arrest of root formation Sequestration of permanent tooth germ Disturbance in eruption

White or yellow-brown discoloration of enamel

23% frequency Facial surfaces of maxillary incisors Small spot to large fields 2-7 years old Usually not associated with clinically detectable defects Turner teeth Jaw fractures Usually defect in enamel mineralization Only diagnosed after tooth eruption

White or yellow-brown discoloration with circular enamel hypoplasia

Narrow horizontal groove which encircles the crown cervical to the discolored area 12% frequency 2 years old Injury to primary teeth is either intrusion, avulsion or extrusion Can usually be diagnosed radiographically before eruption Interference in enamel mineralization Surface defects reflects direct injury to the enamel matrix Whit or yellow-brown??

Crown Dilaceration

3% frequency Non-axial displacement of already formed formed hard tissue in relation to the developing soft tissue Maxillary or mandibular incisors 50% will be impacted 2 years old Most often half of the crown is formed Loss of enamel on facial surface A cone of hard tissue on lingual aspect projects into the root canal Enamel covered cusp on lingual aspect Maxillary incisors usually deviate in lingual and mandibular usually deviate to labial Radiographically foreshortened

Crown Dilaceration

Odontoma-like malformation

Only in maxillary incisors 1-3 years old Intrusive or avulsive injury of primary teeth Affect the morphogenetic stage Radiographically seen as radio-opaque mass May be seen after extraction of primary molars due to pulpal complications

Intrusion of primary left central incisor at 2 years old Odontoma at age 8 years old

Odontoma-like malformation

Root Duplication Rare frequency Intrusive luxation of primary teeth Half or less of the crown is formed Mesial & distal root

Root Duplication

Vestibular Root Angulation Marked curvature of root Injury at the age of 2-5 years old Only in maxillary incisors Impacted Intrusive and avulsive injury to primary teeth 6 times more frequent in girls Traumatic origin?? Ectopic development of tooth germ

Vestibular Root Angulation

Vestibular Root Angulation appears foreshortened Lateral projection

Lateral Root Angulation or Dilaceration 1% frequency Usually associated with avulsion of primary incisors and jaw fractures 2-7 years old Usually affects maxillary incisors Usually erupts # vestibular root angulation

Lateral Root Angulation

Partial or Complete Arrest of Root Formation 2% frequency 5-7 years old Maxillary incisor Avulsion of primary incisors or jaw fractures May remain impacted or if erupts usually exfoliates May be associated with premature loss of primary incisors Calciotraumatic line May be seen with root resorption

Arrest of Root Formation

Partial or complete arrest of root formation

Sequestration of Permanent Tooth Germs-Dentigerous Cyst Usually associated with infection in jaw fractures Chronic periapical infection of primary incisors may cause proliferation of REE leading to dentigerous cyst Radiography: osteolytic changes around tooth germ, disappearance of the cortical outline of dental crypt and expanded cortical alveolar bone

Sequestration of permanent central incisor germ in 1.5 years old child

Disturbances in eruption Abnormal changes in the connective tissue overlying the tooth germ 1 year delay in eruption Ectopic eruption in labial usually Impaction common in malformation confined to either crown or root

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