managementoftraumaticinjuryofprimarydentition.pptx

MANAGEMENT OF
TRAUMATIC INJURIES OF
PRIMARY DENTITION
Dr. Ruqaia Banu N
Department of paedodontics and preventive dentistry

CONTENTS
 Introduction
 Etiology
 Classification
 Objective of management
 Management of traumatic dental injury of the primary teeth
 Injuries to the hard dental tissues and the pulp
 Injuries to the hard dental tissues, the pulp, and the alveolar process
 Injuries to the periodontal tissues
 Sequelae of acute dental trauma in the primary dentition.
 Sequelae in permanent dentition after trauma in primary dentition.
 Conclusion
 Bibiliography

INTRODUCTION
 Traumatic injuries to the primary dentition present special problems and
the management is often different as compared with the permanent
dentition.
 Trauma to the oral region occurs frequently and comprises 5% of all
injuries for which people seek treatment .
 In preschool children, head and facial non-oral injuries make up as much
as 40% of all somatic injuries .
 In the age group 0–6 years, oral injuries are ranked as the second most
common injury covering 18% of all somatic injuries.

ETIOLOGY:
 Dental trauma is unpredictable and most commonly happens in the home, with school
being the second most common location.
 Injuries occur through direct or indirect impact, but the extent of the injury is directly
related to the energy of impact, shape of the impacting object, direction of the impact,
and the reaction of the tooth and surrounding tissue.
 Socioeconomic status and TDIs suggest those of high resources are at increased risk
due to easy access to leisure products and activities, while some report that children of
lesser means are at high risk due to behavior and environment.
 Gender was once thought to be a predisposing factor of TDIs, as boys were reported
to experience double the rate

 Other predisposing risk factors include individual anatomical features, such as
inadequate lip coverage of maxillary teeth, class II maxillary incisor protrusion,
and severe overjet.
 Children and adolescents with an overjet of 3 mm or greater are at a 5.4 times
higher risk of sustaining dental injuries than those with a less pronounced
overjet.
 Uncomplicated enamel fracture, followed by enamel-dentin fracture, are the
most frequent types of TDIs in the permanent dentition, while luxation injuries
are more common in the primary dentition.

CLASSIFICATION
Petti S, Andreasen JO, Glendor U, Andersson L. NA0D - The new Traumatic Dental Injury classification of the World Health
Organization. Dent Traumatol. 2022 Jun;38(3):170-174.

OBJECTIVES……
1. Recognize the various trauma entities.
2. Determine treatment option that will reduce the risk of
developmental disturbances of permanent dentition.
3. Determine risk profile for primary tooth that present a
significant risk for the permanent dentition.

The primary goal is to optimize periodontal and
pulpal healing in the primary dentition
provided that no further injury is transmitted to
the developing permanent successors.
Tsukibosi M. treatment planing for traumatize teeth 1st
edition , quintessence boo, 2000
Treatment principle
Factors influence on selection of treatment plan

Treatment
 No treatment necessary
Follow-up
 No follow-up is needed for infraction injuries unless they
are associated with a luxation injury or other fracture types
involving the same tooth.
 Andreasen J O, Andreasen F M, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th
ed. Munksgaard: Blackwell publication Co.
2007.

Treatment
 Smoothen sharp edges.
 In patients with lip or cheek lesions it is advisable to search
for tooth fragments or foreign material.
Follow-up
 No follow-up required.
Andreasen J O, Andreasen F M, Andersson L.Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th ed. Munksgaard:
Blackwell publication Co. 2007.

Treatment
 If possible, seal completely the involved dentin with glass
ionomer to prevent micro leakage.
 In case of large lost tooth structure, the tooth can be restored
with composite.
Follow-up
 Clinical control at 3-4 weeks.
Andreasen J O, Andreasen F M, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th
ed. Munksgaard: Blackwell
publication Co. 2007.

Enamel-dentin-pulp fracture
(Complicated crown fracture)

 Treatment
 If possible, preserve pulp vitality by partial pulpotomy.
 Calcium hydroxide is a suitable material for such procedures. 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.
 Follow-up
 Clinical after 1 week.
 Clinical and radiographic after 6-8 weeks and 1 year.
Andreasen J O, Andreasen F M, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th
ed. Munksgaard: Blackwell publication
Co. 2007.

Radiograph of the maxillary primary
incisors of a 3-year-old child, 3 hours
after injury.
Three-month follow-up radiograph
showing the development of a dentin
bridge at the site of the partial pulpotomy.
Two-year follow-up

Clinical photograph of a 27-month-old child who had
sustained a complicated crown fracture that was not treated.
The child appeared 6 weeks later with a parulis above the
involved tooth. The tooth was extremely mobile.
McTigue DJ.
Managing injuries to the primary dentition. Dent Clin North Am. 2009 Oct;53(4):627-38.

Crown-root fracture without
pulp involvement

 Localization of fracture line
 The fracture involves the crown and root of the tooth and is in a
horizontal or diagonal plane.
 A radiographic examination usually only reveals the coronal part of the
fracture and not the apical portion
 Treatment
 Depending on the clinical findings, two treatment scenarios may be
considered. Most of these may be deferred to later treatment.
 Fragment removal only
If the fracture involves only a small part of the root and the stable
fragment is large enough to allow coronal restoration, remove the mobile
fragment.
 Extraction
Extraction in all other instances.
Kupietzky A, Holan G Treatment of crown fractures with pulp exposure in primary incisors. Pediatr Dent.2003 May-Jun;25(3):241-7

 Patient instructions
 Soft food for 10-14 days.
Good healing following an injury to the teeth and oral tissues depends,
in part, on good oral hygiene. Brush with a soft brush after every meal
and apply chlorhexidine 0.1 % topically to the affected area with cotton
swabs twice a day for one week.
 This is beneficial to prevent accumulation of plaque and debris along
with recommending a soft diet.
 Parents should be further advised about possible complications that may
occur, like swelling, increased mobility or fistula.
 Children may not complain about pain; however, infection may be
present and parents should watch for signs of swelling of the gums and
bring the child in for treatment.

 Follow-up
 In case of fragment removal only: Clinical :after 1 week.
 Clinical and radiographic :after 3-4 weeks.
 Clinical : after 1 year.
In case of tooth extraction: Clinical and radiographic control
at 1 year and every year until eruption of the permanent
successor.

Crown-root fracture with pulp
involvement (Complicated crown-
root fracture)

 Treatment
 Depending on the clinical findings, two treatment scenarios may
be considered.
 Fragment removal only if the fracture involves only a small part
of the root and the stable fragment is large enough to allow
coronal restoration.
 Extraction in all other instances.
 Follow-up
 In case of fragment removal only: Clinical and radiographic
control at 1 year and every year until eruption of the permanent
successor.
In case of tooth extraction: Clinical and radiographic control at 1
year and every year until eruption of the permanent successor.

 In the primary dentition, root fractures are as rare as about 2-4% ,
due to the plasticity of the developing alveolar bone.
 They are most frequent at the age of 3-4 years where physiologic
root resorption has begun, thereby weakening the root.
Treatment
 No treatment
If the coronal fragment is not displaced no treatment is required.
 Extraction
If the coronal fragment is displaced, repositioning and splinting
might be considered.
 Otherwise extract only that fragment.
 The apical fragment should be left to be resorbed.
Götze GD, Barreira AK, Maia LC. Crown root fracture of a lower first primary molar: report of an unusual case. Dental Traumatology. 2008 Jun
‐
1;24(3):e377-80.

‐
1;24(3):e377-80.
These root fractures occurred at the age of
4 years. Due to severe displacement, both
coronal fragments were extracted. The
root tips remained in situ and were
resorbed normally

 Follow-up
 Clinical control after 1 week. Clinical and radiographic
control after 6-8 weeks and 1 year.
In case of tooth extraction: Clinical and radiographic control
at 1 year and every year until eruption of the permanent
successor.
‐
1;24(3):e377-80.

Title Conservation of root-fractured primary teeth--report of a case.
Author Liu X1
, Huang J, Bai Y, Wang X, Baker A, Chen F, Wu LA.
Journal Dent Traumatol. 2013 Dec;29(6):498-501.
abstract A 3.5-year-old girl presented to our clinic experiencing pain in her maxillary
central incisors following traumatic injury during a fall. Radiographic
examination revealed both primary maxillary central incisors with mid-root
and apical third horizontal root fractures, respectively. Splinting with
orthodontic brackets and stainless steel wire was performed. At 2 weeks,
resorption of the apical fragments in both injured teeth was observed, and
after 3 months, almost complete resorption was noted on radiographs. Tooth
mobility at this point was back to physiologic levels and the splint was
removed. After 2.5 years, the primary maxillary incisors were replaced by
permanent incisors demonstrating normal tooth color, position, and root
development. Although this case illustrated the favorable prognosis of two
primary teeth with root fractures and severely mobile coronal fragments by a
conservative approach, more scientific evidences are needed and frequent
recalls are necessary when primary root fractures are attempted to be
managed with splinting.

Radiograph taken 2 weeks after injury showing
root resorption of the apical fragments After 10 month

Treatment
 No treatment is needed only observation.
Patient instructions
 Soft food for 1 week.
Soporowski NJ, Allred EN, Needleman HL. Luxation injuries of primary anterior teeth ^
prognosis and related correlates. Pediatr Dent 1994;16:96^101

Unfavorable Outcome
 Dark discoloration of crown.
 No treatment is needed unless apical periodontitis develops

 Meadow et al. reported subluxations to occur at an incidence of
40% of all trauma.
Andreasen noted this type of injury to occur at a frequency of 12%
in all traumatized primary teeth.
Treatment objective
 No treatment is needed.
 Unfavorable Outcome
 Transient red/ gray discoloration or yellow discoloration
indicates pulp obliteration and has a good prognosis

Treatment
 Spontaneous repositioning
If there is no occlusal interference, as is often the case in anterior
open bites, the tooth should be allowed to reposition
spontaneously.
 Repositioning
When there is occlusal interference local anesthesia should be
applied where after the tooth should be repositioned by gentle
combined labial and palatal pressure.
 Extraction
For teeth with severe displacement in a labial direction, extraction
is the treatment of choice. Extraction is indicated in these cases
because of the collision between the primary tooth and the
permanent tooth germ.
 Slight grinding
In cases with minor occlusal interference, slight grinding is
indicated.

managementoftraumaticinjuryofprimarydentition.pptx

 From a prospective study of 104 lateral Luxated teeth,99%were
realigned within the 1st
year.
 In an observational study, it was found that of 52 teeth that were
left for spontaneous reposition, almost 60%did not disclose any
complication.
 However, repositioning of lateral luxation was associated with an
increased risk of developing pulp necrosis.
 Follow-up
 Clinical control after 1 and 2-3 weeks. Clinical and radiographic
control at 6-8 weeks and 1 year.

 Intrusion comprises 8–22% of all luxation injuries of primary anterior teeth
(Andreasen and Ravn, 1972).
 Other authors have reported prevalence rates as 15.3% (Soporowski et al.,
1994), 21% (Onetto et al., 1994), 34% (Garcia-Godoy et al., 1987), and 54%
(Robertson et al., 1997).
The degree of intrusion can be divided into 3 grades (Von Arx, 1995)
 Grade I. Mild partial intrusion in which more than 50% of the crown is
visible.
 Grade II. Moderate partial intrusion in which less than 50% of the crown is
visible.
 Grade III. Severe or complete intrusion of the crown
prognosis and related correlates. Pediatr Dent 1994;16:96^101.

 Management of an intruded primary incisor depends on the
following variables:
1.Direction of intrusion,
2. Degree of intrusion,
3.Presence of alveolar bone fracture.
 In a retrospective study of 172 intruded teeth, the apices of more
than 80% of the teeth were pushed labially.
 It was found that most of them re-erupted and survived with no
complications for more than 36months post trauma, even in cases
of complete intrusion and fracture of the labial bone plate.

 Whenever the intrusion is moderate or severe (grade II or
III), the tooth rarely reerupts and may become necrotic,
indicating the need for extraction (Ravn, 1968; Wilson,
1995).
 If signs of re-eruption are not evident after 4–8 weeks,
ankylosis should be suspected, and extraction should be
considered (Harding and Camp, 1995; Borum and
Andreasen, 1998).

(A)Complete intrusion of tooth 61in a1-year-old girl.
(B) The intruded tooth appears shorter than its contralateral in the periapicalX-ray.
(C) In the lateralX-ray, the apex of the intruded tooth is displaced
through the labial bone plate.
(D) Clinical appearance 1month later.
(E) Re-eruption at 3months. (F) One year later.

Extrusion
 Partial displacement of the tooth out of its socket. An injury
to the tooth characterized by partial or total separation of the
periodontal ligament resulting in loosening and
displacement of the tooth.
 The alveolar socket bone remains intact. In addition to axial
displacement, the tooth usually will have some protrusive or
retrusive orientation.

 Treatment
The treatment choice should be based on the degree of
displacement, mobility, root formation and the ability of the child
to cope with the emergency situation.
For minor extrusion (< 3mm) in an immature developing tooth,
either careful reposition the tooth or leave the tooth for
spontaneous alignment.
Extraction is the treatment of choice for severe extrusion in a
fully formed primary tooth.
 Follow-up
 Clinical control after 1 weeks. Clinical and radiographic control
at 6-8 weeks, 6 months, and 1 year.
Soporowski NJ, Allred EN, Needleman HL. Luxation injuries of primary anterior teeth ^ prognosis and related correlates. Pediatr Dent
1994;16:96^101.

 Replacement of avulsed tooth…
 May displace a coagulum in to the follicular space of
developing incisor.
 Periapical inflammation
 External root resorption
Sakai VT, Moretti AB, Oliveira TM, Silva TC, Abdo RC, Santos CF, Machado MA. Replantation of an avulsed maxillary
primary central incisor and management of dilaceration as a sequel on the permanent successor. Dental Traumatology.
2008 Oct 1;24(5):569-73

 Treatment
 It's not recommended to replant avulsed primary teeth.
At the initial examination make sure that all avulsed teeth
are accounted for.
 If not it is highly recommended to make a radiographic
examination in order to ensure that the missing tooth is not
a case of complete intrusion or root fracture with loss of the
coronal fragment.
 If the avulsed tooth has not been found refer the child to the
paediatrician to exclude aspiration.
Sakai VT, Moretti AB, Oliveira TM, Silva TC, Abdo RC, Santos CF, Machado MA. Replantation of an avulsed maxillary
primary central incisor and management of dilaceration as a sequel on the permanent successor. Dental Traumatology.
2008 Oct 1;24(5):569-73

Tsukibosi M. treatment planing for traumatize teeth 1st
edition , quintessence boo, 2000.

Title Replantation of an avulsed maxillary primary central incisor and management
of dilaceration as a sequel on the permanent successor.
Author Sakai VT1
, Moretti AB, Oliveira TM, Silva TC, Abdo RC, Santos CF, Machado MA
.
Author information
Journal Dent Traumatol. 2008 Oct;24(5):569-73.
Abstract This case report outlines the sequel and possible management of a permanent tooth
traumatized through the predecessor, a maxillary right primary central incisor that
was avulsed and replanted by a dentist 1 h after the trauma in a 3-year-old girl.
Three years later, discoloration and fistula were present, so the primary tooth was
extracted. The patient did not come to the scheduled follow-ups to perform a
clinical and radiographic control of the succeeding permanent incisor, and only
returned when she was 10 years old. At that moment, the impaction and dilaceration
of the maxillary right permanent central incisor were observed through radiographic
examination. The dilacerated permanent tooth was then surgically removed, and an
esthetic fixed appliance was constructed with the crown of the extracted tooth.
Positive psychological influence of the treatment on this patient was also observed.

 A fracture of the alveolar process which may or may not
involve the alveolar bone socket.
 Teeth associated with alveolar fractures are characterized by
mobility of the alveolar process; several teeth typically will
move as a unit when mobility is checked.
 Occlusal interference is often present.
Andreasen JO, Bakland LK, Flores MT , Andreasen FM, Andersson L. Traumatic dental
injuries –A manual. Third Edition. Wiley bleckwell 2011

Radiographic findings:
 The vertical line of the fracture may run along the PDL or in the
septum.
 The horizontal line may be located apical at the apex or coronal to
the apex.
 An associated root fracture may be present. The horizontal fracture
line may run at any level in regard to the permanent tooth germs.
Treatment:
 Treatment of fracture of the alveolar process includes reduction and
immobilization
 After administration of local anesthesia, the alveolar fragment is
repositioned with digital pressure.
Andreasen JO, Bakland LK, Flores MT , Andreasen FM, Andersson L. Traumatic dental injuries –A manual. Third Edition. Wiley bleckwell
2011

 Splinting of alveolar fracture can be achieved by means of acid-
etch/ resin splint or arch bars.
 Inter-maxillary fixation is not required provided that a stable splint
is used.
 Fixation period of 4 week is usually recommended.
In child this period can be reduced to 3 weeks.
Follow-up
 Splint removal and clinical and radiographic control after 4 weeks.
 Clinical control after 1 week.
 Clinical and radiographic control and splint removal after 3-4
weeks.
 Clinical and radiographic control after 6-8 weeks and
 1 year then yearly until exfoliation.
Andreasen J O, Andreasen F M, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth.
4th
ed. Munksgaard: Blackwell publication Co. 2007.

Sequele Of Acute Dental Trauma In
The Primary Dentition

PULPITIS:
 Pulpitis is the initial response of the tooth to trauma and it
accompanies almost every injury.
 Signs include sensitivity to percussion and capillary
congestion, which may be clinically apparent from the
lingual surface of the tooth using transillumination.
 Pulpitis may be reversible in minor injuries or may
progress to irreversible pulpitis and pulp necrosis.
BorumMK, AndreasenJO. Sequelae of traumato primary maxillary incisors. Part I.
Complications in the primary dentition. Endod DentTraumatol 1998;14:31^44.

PULP NECROSIS:
 Injured pulps may lose their vitality either because of damage
to the vascular tissue at the apex and the resulting ischemia or
because of necrosis of exposed coronal pulp tissue.
 If the necrotic pulp becomes infected with oral
microorganisms either because of luxation of the root and
ingress through the lacerated PDL or via an exposed pulp,
pain and root resorption can occur.
McTigue DJ.
Managing injuries to the primary dentition. Dent Clin North Am.
2009 Oct;53(4):627-38.

TOOTH DISCOLORATION:
 Injuries to the primary incisors frequently cause tooth discoloration .
 Blood vessels within the pulp chamber can rupture, depositing blood
pigment in the dentinal tubules.
 This blood may desorbed completely or can persist to some degree
throughout the life of the tooth.
 Teeth that discolor are not necessarily necrotic, particularly when the
color change occurs within a few days of the injury.
 A yellowish discoloration of both primary and permanent teeth may
occur if they undergo pulp canal obliteration
McTigue DJ.
Managing injuries to the primary dentition. Dent Clin North Am. 2009 Oct;53(4):627-38.

PULP CANAL OBLITERATION:
 The entire pulp chamber and canal appear radiopaque in
radiographs and the crown may have a yellowish color.
 The process of accelerated dentinal apposition in PCO is not well
understood, but primary teeth with PCO tend to resorb normally.
 Pulp necrosis is rare in teeth with PCO and root canal treatment is
rarely indicated in either the primary or permanent dentitions.
McTigue DJ.
Managing injuries to the primary dentition. Dent Clin North Am. 2009
Oct;53(4):627-38.

Sequelae In Permanent Dentition
After Trauma In Primary Dentition.

Enamel hypoplasia:
 This includes discoloration of the enamel and or defects of the
enamel surface.
 Discoloration usually ranges from white to yellowish-brown
staining.
 The hypoplasia normally affects the labial crown surface and
ranges from tiny spots to large areas.
BorumMK, AndreasenJO. Sequelae of traumato primary maxillary incisors. Part I.
Complications in the primary dentition. Endod DentTraumatol 1998;14:31^44.

Fig. 1.-Enamel discoloration of 31 and 32 in a 9-year-old boy after trauma to their predecessors at 2.5 years of age.
Fig. 2.-Buccal enamel defect of 1 1 in an 8-year-old boy after partial luxation of 51 at 1.5 years of age.
Fig. 3.-Combined enamel defect and discoloration of 12 in a 9-year-old boy after partial luxation of 52 at 2 years of
age.
Fig. 4.-Extended enamel hypoplasia of 41 in a 7-year-old boy after partial luxation of 81 at 11 months of age.
form

Crown Dilaceration:
 A traumatic displacement of already formed hard tooth substance
in relation to the developing soft tissues leads to a deviation of the
crown in relation to the long axis of the tooth.
 A minor dilaceration consists of a circular enamel defect.
 The severe type includes a complete palatal deviation of the crown
with additional enamel hypoplasia
Sakai VT, Moretti AB, Oliveira TM, Silva TC, Abdo RC, Santos CF, Machado MA. Replantation of an avulsed maxillary primary central
incisor and management of dilaceration as a sequel on the permanent successor. Dental Traumatology. 2008 Oct 1;24(5):569-73.
Fig. 5a.-Crown dilacerations of 21 and 22 in a 9-year-old boy after partial luxations of 61 and 62 at 2
years of age.
Fig. 5b.-Palatal deviations of the crowns of 21 and 22.

Odontome-like teeth
 Heavy trauma to the permanent tooth germ
at an early stage of odontogenesis may lead
to complete tooth deformation.
 Odontome-like disturbances of permanent
teeth may develop especially after intrusive
or luxation of primary teeth.
 On radiographs such malformed teeth
present as a conglomeration of hard tissues
resembling a complex odontome.
 As a rule such malformed teeth do not
erupt and must be removed surgically.

Root malformation
 Trauma to the epithelial root sheath of Hertwig during root
development may lead to root dilaceration or to an arrest
of root formation
 In the latter case a very short root may develop and tooth
eruption will be delayed or completely disturbed.
Sakai VT, Moretti AB, Oliveira TM, Silva TC, Abdo RC, Santos CF, Machado MA. Replantation of an avulsed maxillary primary central incisor and
management of dilaceration as a sequel on the permanent successor. Dental Traumatology. 2008 Oct 1;24(5):569-73.

Day PF, Flores MT, O’Connell AC, et al. International Association of Dental Traumatology guidelines for the management of
traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol 2020;36(4):343-359.
A summary of the management of TDIs in the primary dentition includes
the following:
• A child’s maturity and ability to cope with the emergency situation, the
time for shedding of the injured tooth, and the occlusion are all
important factors that influence treatment.
• It is critical that parents are given appropriate advice on how best to
manage the acute symptoms to avoid further distress. The use of
analgesics is recommended when pain is anticipated.
• Minimizing dental anxiety is essential. Various behavioral approaches
are available and have been shown to be effective for managing acute
procedures in an emergency situation.
• Where appropriate and the child’s cooperation allows, options that
maintain the child’s primary dentition should be the priority.
• Discussions with parents about the different treatment options should
include the potential for further treatment visits and consideration for
how best to minimize the impact of the injury on the developing
permanent dentition.

CONCLUSION:
 Pediatric dental trauma is most common among younger children
who are still developing coordination, as well as adolescents
involved in sports.
 The resulting orofacial injuries can result in pain, tooth loss,
dysfunction, and diminish the patient’s quality of life.
Understanding the risk for TDIs and performing trauma first aid
when they occur will help contribute to successful management of
these events.
 In addition, educating parents/caregivers, coaches and athletes
about TDI prevention can increase the use of mouthguards in high-
risk sports.
 Finally, dental professionals who seek regular training and
continuing education in dental trauma will be best positioned to
provide care that supports optimal outcomes.

BIBLIOGRAPHY
 Andreasen JO, Bakland LK, Flores MT , Andreasen FM, Andersson L.
Traumatic dental injuries –A manual. Third Edition. Wiley bleckwell 2011
 Andreasen J O, Andreasen F M, Andersson L. Textbook and Color Atlas of
Traumatic Injuries to the Teeth. 4th
ed. Munksgaard: Blackwell publication
Co. 2007.
 Tsukibosi M. treatment planing for traumatize teeth 1st
edition ,
quintessence boo, 2000.
 McTigue DJ Managing injuries to the primary dentition. Dent Clin North
Am. 2009 Oct;53(4):627-38.
 Malmgren B, Andreasen JO, Flores MT, Robertson A, DiAngelis AJ,
Andersson L, Cavalleri G, Cohenca N, Day P, Hicks ML, Malmgren O.
International Association of Dental Traumatology guidelines for the
management of traumatic dental injuries: 3. Injuries in the primary
dentition. Dental Traumatology. 2012 Jun 1;28(3):174-82

 Kupietzky A, Holan G Treatment of crown fractures with pulp exposure in
primary incisors. Pediatr Dent.2003 May-Jun;25(3):241-7
 John SA, Anandaraj S, George S. Biologic restoration of a traumatized maxillary
central incisor in a toddler: A case report. Journal of Indian Society of Pedodontics
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 Götze GD, Barreira AK, Maia LC. Crown root fracture of a lower first primary
‐
molar: report of an unusual case. Dental Traumatology. 2008 Jun 1;24(3):e377-80.
 Liu X, Huang J, Bai Y, Wang X, Baker A, Chen F, Wu LA. Conservation of root‐
fractured primary teeth—report of a case. Dental Traumatology. 2013 Dec
1;29(6):498-501.
 Sakai VT, Moretti AB, Oliveira TM, Silva TC, Abdo RC, Santos CF, Machado
MA. Replantation of an avulsed maxillary primary central incisor and
management of dilaceration as a sequel on the permanent successor. Dental
Traumatology. 2008 Oct 1;24(5):569-73.
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‐
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 BorumMK, AndreasenJO. Sequelae of traumato primary maxillary
incisors. Part I. Complications in the primary dentition. Endod
DentTraumatol 1998;14:31^44.
 Soporowski NJ, Allred EN, Needleman HL. Luxation injuries of
primary anterior teeth ^ prognosis and related correlates. Pediatr Dent
1994;16:96^101.
 Glendor U, Andersson L. Public health aspects of oral diseases and
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