DEPARTMENT OF PEDIATRIC

DENTISTERY
SEQUELAE OF TRAUMATIC
INJURIES TO PRIMARY TEETH

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INTRODUCTION
 Complications following traumatic injuries
to primary teeth may appear shortly after
injury or after several months.
 Most injury are prone in 2 to 4 years of
life when children learn to walk, play etc.
 Any injury to teeth of young child can
have serious and long term consequences.
 Most damaging sequelae of injuries to
primary teeth are their effect on
unerrupted developing permanent
dentition.
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SEQUELAE OF TRAUMA TO
PRIMARY TEETH
 Reversible pulpits
 Infection in periodontal ligament
 Irreversible pulpitis
 Pulp necrosis
 Pulpal obliteration
 Inflammatory resorption
 Ankylosis
 Coronal discolouration
 Complication following intrusion
 Complication following avulsion
 Injuries to developing permanent dentition.

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REVERSIBLE PULPITIS
 Initial response of pulp to trauma –
pulpitis
 Teeth – Tender on percussion
- PDL is inflammed
 May progress to an irreversible state
with necrosis of the pulp.

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INFECTION IN PERIODONTAL
LIGAMENT
 Detachment of gingival fibers from tooth in the injury.

 Invasion of micro organism from oral cavity along the root.

 Loss of alveolar bone support.

 Diminishes healing potential of supporting tissues

 Increase tooth mobility with exudation of pus.

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 Thus, if infection of PDL is their –
tooth should extracted

INFECTION OF PERIODONTAL LIGAMENT

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IRREVERSIBLE PULPITIS
 May be Acute

Chronic

Partial

Total

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 Acute:- Painful if the exudate accompaning the
pulpal inflammation can not vent.
 Chronic:- Inflammatory exudates are
quickly vented.

Pulpits progress to a chronic painless condition.

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PULP NECROSIS
 Commonest complication.
 Two mechanism explains how pulp of
injured teeth become necrotic.
 Infection of pulp in cases of untreated
crown fracture with pulp exposure.
 Interrupted blood supply to the pulp
leading to ischemia.
 Untreated teeth with exposed pulps
expected to develop swellings of fistula.
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 Loss of pulp vitality in early stage of
root development.
 Arrest in dentin appostion & cessation
of root development.
 Teeth with periapical inflammation
- Should be extracted
- To prevent possible damage to
successor.

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PULP OBLITERATION
 Result of intensified activity of
odontoblasts

Accelerated dentin apposition

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INFLAMMATORY RESORPTION
Inflammatory Resorption

Internal resorption External inflammatory

resorption
* Usually seen with * Usually seen
Luxation & sub after intrusive
Luxation injuries injuries.

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INTERNAL RESORPTION
 Inflammation of pulp

 Odontoblastic layer losses its integrity

 Exposure of dentin to odontoclastic activity.

 Eventually, this process leads to root perforation .

 If coronal dentin is completely resorbed, red colour

resorbing tissue is visible through enamel.

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 EXTERNAL RESORPTION

(1) External inflammatory root resorption

• Rapid process
• Characterized clinically
• Increased tooth mobility
• Sensitivity to percussion.
• Dull sound produced by
• percussion
• Fistula or swelling in the gums above the tooth.
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 Radiography
 PDL Widening
 Root surface is irregular
 Teeth with resorption
should be extracted
 RCT in the traumatized
tooth is highly correlated
with enamel defects in
permanent teeth.

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 External surface root resorption
 Characterized by- Gradual elimination of
root
dentin with preservation of PDL
 Affects the apex of the root only and
becomes rounded & progress until the
natural exfoliation or traumatic avulsion
occurs.
 As resorption progress:-
Bone replaces the space previously
occupied by the root
- Separates the primary tooth & its
permanent successor.
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 In such cases –
Root resorption may be associated with
Expansion of permanent tooth follicle
Dilated follicle

Follicle becomes Permanent tooth is

Infected deflected from its
normal alignment

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ANKYLOSIS
 K/a Replacement resorption
 Results after irreversible injury to PDL.
 Ankylosed primary teeth.
May cause delay in or ectopic
eruption of developing permanent
tooth.

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CORONAL DISCOLOURATION
 Results from changes in pulp- dentin
complex.
 Variety of discolouration is divided
into three groups.
1. Pink – Red – Due to intra – pulpal
haemorrhage
2. Yellow- Due to pulpal obliteratation
3. Dark (Grey, Brown, Black):-
Due to pulp necrosis & haemorrhage
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 Discolouration with
healthy buccal mucosa

Intense reddish brown

discolouration seen.

Yellow discolouration seen.www.FourthMolar.com

COMPLICATION FOLLOWING
INTRUSION
 PDL breakdown due to infection
Main reason for loss of primary teeth
following intrusion.
 Usually teeth do not errupt in their original
position, but reerupt into a rotated
alignments.
Cause:- of failure to reerupt
1. If root has been pushed out of alveolar bone
into the surrounding soft tissue.
2. Damage to PDL ligament – Ankylosis.
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INTRUSION OF TEETH DUE TO
TRAUMA
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 COMPLICATION FOLLOWING
AVULSION
 Delayed & Ectopic eruption of
permanent teeth.
Cause:1) Lack of guidence
2) Development of scar tissue
3) Deflection of the developing
permanent tooth bud by
injured
primary teeth.
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DAMAGE TO PERMANENT
DENTITION
 Most serious sequalae of injuries.
 Injuries have significant potential
for damage to permanent
successor.
 Periapical pathologies, intrusive
injuries, over instrumentation of
primary root canals – Cause
irreversible damage.
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Delayed Eruption of Teeth
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 Injury to permanent teeth –
( Percentage)
Intrusive luxation - 69%
Avulsion - 52%
Subluxation - 34%
Extussive luxation - 34%

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Injuries to developing teeth
are as follows:-
 White or yellow- brown discolouration
of enamel.
 White or yellow – Brown discolouration
of enamel with – Circular Enamel
Hypoplasia.
 Crown dilaceration
 Odontoma – like malformation
 Root duplicator
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 Vestibular or lateral root angulations &
dilacerations.
 Partial or complete arrest of root formation.
 Sequestration of permanent tooth germs
a) Disturbances in cruption
- Ectopic Eruption
- Delayed Eruption
 Alteration in path of developing tooth crown.

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ABBERENT ERRUPTION WITH ITS INCISAL
EDGE HIGH IN THE LABIAL SULCUS
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REFERENCES
 Pediatric Dentistry INFANCY Through
ADOLSENCE- PINKHAM
 Pediatric Dentistry- WELBERY
 Pediatric Dentistry-SHOBA TANDON
 Mc Donald RE, Avery DR, Dean JA-Dentistry for child
and adolescent
 Oral and dental trauma in children and adolescents-
GRAHAM,ROBERTS,PETER LONGHURST

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