The document discusses the management of traumatic dental injuries, specifically intrusion injuries, in primary teeth. It presents a case study of spontaneous re-eruption of an intruded primary tooth in an 18-month old patient over 4 years of follow-up. The literature presented suggests waiting up to 1.5 years for spontaneous re-eruption is usually successful, though permanent tooth damage may still occur depending on the child's age at injury. Regular follow-ups are important to monitor healing and potential sequelae.

2.  Drs. Ruviére and Costa are post doctoral
students, and Dr. Cunha is adjunct professor, all in
the Department of Pediatric and Social
Dentistry, School of Dentistry of Araçatuba, São
Paulo State University (UNESP), Araçatuba, São
Paulo, Brazil. Correspond with Dr. Cunha at
cunha@foa.unesp.br
 J Dent Child 2009;76:87-91

3.  INTRUSION
Apical displacement of tooth into the
alveolar bone. The tooth is driven into
the socket, compressing the periodontal
ligament and commonly causes a
crushing fracture of the alveolar socket

4.  Dental traumatic injuries in infants and
young children are common.
 Retrospective and prospective studies
related that prevalence of these injuries
involving the primary dentition ranged
from 4% to 33%.

5.  color change,
 pulp necrosis,
 obliteration of the pulp canal,
 gingival retraction,
 primary tooth displacement,
 pathological root resorption, and
 premature loss of the primary tooth.

6.  tooth displacement within the socket
and
 can affect the crown, root, or entire
permanent tooth germ.
 anomalous development of the
permanent teeth, with a frequency
between 18% and 69%.

7.  The aim of diagnosis and treatment of
traumatic injuries in primary teeth is to
manage pain and prevent sequelae for
the developing permanent tooth germ

8.  If the apex is displaced toward or
through the labial bone plate, the tooth
is left for spontaneous re-eruption.
 If the apex is displaced toward the
permanent tooth germ, the tooth should
be extracted.

9.  To describe the treatment of a primary
maxillary right lateral incisor in which
spontaneous re-eruption after severe
traumatic intrusion occurred and its
possible consequences on the
developing successive permanent
germs.

10.  The research protocol was submitted for
review to the Ethics in Human Research
Committee of the School of Dentistry of
Araçatuba, São Paulo State
University, Araçatuba, São
Paulo, Brazil, and the case report design
was approved.
 18-month-old male

11.  The extraoral examination revealed a mild
edema and several small cuts and
lacerations on the maxillary and
mandibular lips.
 The intraoral examination revealed
complete intrusion of the primary maxillary
right lateral incisor, crown fracture of the
primary maxillary right central incisor
without pulp involvement, and disruption of
the superior labial frenum, with no pain
related.

12. 3 days after suffering dental trauma

13. 3 days after suffering dental trauma

14.  The primary maxillary right lateral incisor’s
apex was dislocated into the
vestibule, indicating a labial
displacement direction

15.  After 30 days, although the tooth had
not initiated the re-eruption
process, clinical examination showed a
normal aspect, characterized by no
dental crown discoloration, mobility, or
pain.
 Radiographic examination also revealed
normal aspects

16.  Sixty days following the dental trauma,
the beginning of spontaneous re-
eruption of the primary maxillary right
lateral incisor was observed clinically.

17. 4 months after dental trauma

18.  Twelve months after the trauma,
radiograph evaluations showed that the
root resorption was stabilized and clinical
findings revealed no pain, discoloration,
or mobility of the dental crown. The
endodontic intervention was not
performed.

19. 18 months after dental trauma

20. after 4 years

21. after 4 years

22.  The parents were informed of the
sequelae of the primary intruded tooth’s
condition and morphological alterations
in the permanents teeth.

24.  If the apex is dis-placed labially, the
apical tip can be seen radiographically
with the tooth appearing shorter than its
contralateral
 If the apex is displaced palatally towards
the permanent tooth germ, the apical
tip cannot be seen radiographically and
the tooth appears elongated.

25.  to allow spontaneous re-eruption except
when displaced into the developing
successor

26.  to reposition passively,
 actively
 or surgically
and then to stabilize the tooth with a splint
for up to 4 weeks

27.  For immature the objective is to allow for
spontaneous eruption
 In mature teeth, the goal is to reposition
the tooth with orthodontic or surgical
extrusion and initiate endodontic
treatment within the first 3 weeks of the
traumatic incidence

28.  The preference for intrusion into the
permanent maxillary central and lateral
incisor appears to be related to the
common fall direction in which these
teeth are generally the first to make
contact with extraoral objects.

29.  Depending on the vestibular curvature
of the primary teeth’s root and the
impact’s direction, the apexes of these
teeth are usually dislocated into the
vestibular.
 The most common initial treatment for
traumatically intruded primary teeth is to
wait for spontaneous re-eruption.

30.  timing of seeking care
 the family’s eagerness to maintain the
teeth, and
 the patient’s age

31.  Gondim et al, who evaluated 22 intruded
teeth and showed a total re-eruption in
43% of cases, partial re-eruption in 47% of
cases, and no re-eruption in 11% of cases.
Gondim JO, Moreira Neto JJS. Evaluation of intruded primary incisors. Dent
Traumatol 2005;21:131-3.

32.  In a follow-up study of 123 intruded
primary incisors, total re-eruption
occurred in 84% of the completely
intruded teeth and in 92% of those who
had suffered partial intrusion.
Borssén E, Holm A-K. Treatment of traumatic dental injuries in a cohort of 16-year-
olds in northern Sweden. Endod Dent Traumatol 2000;16:276-81.

33.  In addition, in a clinical study of 123
intruded teeth available for follow-up
evaluation, 88% re-erupted fully, 10% did
not return to the occlusal plane, and 2%
failed to re-erupt due to ankylosis
Holan G, Ram D. Sequelae and prognosis of intruded primary incisors: A
retrospective study. Pediatr Dent 1999;21:242-7.

34.  In a study of 11 cases of primary intruded
tooth Seven cases have been observed
satisfactory without surgical treatments such
as re-positioning and fixation, and all those re-
erupted to the occlusal level of the contra-
lateral side within 1.5 year. Otherwise, 4 cases
treated with re-positioning and fixation
revealed periapical periodontitis in
radiographic feature, alveolar abscess
formation, or discoloration.
Hirata et al. Management of Trauma of Primary Tooth: Report of Intrusion
Case. J.Hard Tissue Biology 2005;14(4):361-362.

35.  Diab et al described that when the tooth
was intruded completely, the tooth
should be extracted because re-
eruption could not be expected. On the
other hand, Holan et al reported 108 of
123 intruded teeth were re-erupted
spontaneously.
Diab M. and Elbadrawy H.E.: Intrusion injuries of primary incisors. Part :
Review and Management. Quintessennce Int 31:327-334, 2000

36.  Several studies support that the
permanent tooth germ’s malformation
may be the result of severe intrusion by
the primary tooth and invasion of the
developing germ during the earliest
phases of odontogenesis, when the child
is between 1 and 3 years old

37.  The type of traumatic primary tooth injury
combined with the child’s age at the
time of the injury can indicate the
probability of subsequent damages to
the primary tooth or permanent tooth
germ involved.
 The importance of regular follow-ups
should be emphasized to evaluate
healing, oral hygiene, infection control,
and evolution of the case

38.  In this case report, secondary damage
on the permanent maxillary right central
and lateral incisors’ germs was observed
radiographically.
 The extent and type of actual damage
was not definitively established.

40.  Ruviére, Costa, Cunha. Conservative Management of Severe
Intrusion in a Primary Tooth: A 4-year Follow-up. J Dent Child
2009;76:87-91.
 Guideline on Management of Acute Dental Trauma. AAPD
201;33(6): 220-28.
 Gondim JO, Moreira Neto JJS. Evaluation of intruded primary
incisors. Dent Traumatol 2005;21:131-3.
 Borssén E, Holm A-K. Treatment of traumatic dental injuries in
a cohort of 16-year-olds in northern Sweden. Endod Dent
Traumatol 2000;16:276-81.
 Holan G, Ram D. Sequelae and prognosis of intruded primary
incisors: A retrospective study. Pediatr Dent 1999;21:242-7.
 Diab M. and Elbadrawy H.E.: Intrusion injuries of primary
incisors. Part : Review and Management. Quintessennce Int
2000;31:327-334.
 Hirata et al. Management of Trauma of Primary Tooth: Report
of Intrusion Case. J.Hard Tissue Biology 2005;14(4):361-362.