Complicated crown fracture of an unerupted permanent tooth--a case report

Crown Fracture of an Unerupted Incisor in a Young Child: Case Report and Restorative Protocol

Aim

This case report describes a protocol for restoring a crown fracture of an unerupted permanent incisor in a child.

Background

Crown fractures are an important concern in pediatric dentistry due to the negative impact on oral health-related quality of life (OHRQoL) in children and adolescents resulting from functional limitations as well as consequences related to social and emotional well-being.

Case description

An enamel and dentin fracture of the crown of unerupted tooth 11 due to direct trauma is being presented in a 7-year-old girl. The restorative treatment involved minimally invasive dentistry, including computer-aided design (CAD)/computer-aided manufacturing (CAM) technology and direct resin restoration.

Conclusion

The treatment decision was essential for maintaining pulp vitality and continued root development, as well as ensuring esthetic and functional results.

Clinical significance

Crown fracture of an unerupted incisor may occur in childhood, requiring a long-term clinical and radiographic follow-up. Predictable, positive, and reliable esthetic outcomes can be achieved using CAD/CAM technology combined with adhesive protocols.

How to cite this article

Kamanski D, Tavares JG, Weber JBB, et al. Crown Fracture of an Unerupted Incisor in a Young Child: Case Report and Restorative Protocol. Int J Clin Pediatr Dent 2022;15(5):636-641.

Developmental dental alterations in permanent teeth after intrusion of the predecessors: clinical and microscopic evaluation

This case report describes the management of developmental dental alterations in permanent dentition as a consequence of severe intrusive luxation in its predecessors in a child of 2 years. At 10 years of age, this patient was referred for consultation due to lack of permanent maxillary right central and lateral incisors. Radiographic examination revealed impaction of hypoplasic permanent maxillary central incisor, absence of the lateral incisor and compound odontoma in region of the permanent maxillary lateral incisor. The odontoma was surgically removed and unerupted central incisor was placed in orthodontic traction over a period of 8 months. The central incisor presented with abnormal shape and was restored with composite resin. Odontoma histologic analysis was carried out through Hematoxylin and Eosin coloration and Scanning Electron Microscopy. Cement and osteocement formations were found in soft tissue, as well as some irregularly distributed dentine islands of tooth-like structures, indicative of compound odontoma. We followed up this patient for 5 years and orthodontic management was successfully performed for correct alignment of the maxillary right central incisor impacted by compound odontoma.

Tooth displacement and root dilaceration after trauma to primary predecessor: an evaluation by computed tomography

This case report illustrates the relationship between trauma to a deciduous tooth and the consequences to the permanent dentition. The patient suffered an injury to the central incisors at the age of four with resultant pulpal necrosis. The permanent dentition was affected by displacement from its original position and a severe dilaceration at the crown/root junction.

An unusual developmental disturbance of an unerupted permanent incisor due to trauma to its predecessor - a case report

Developmental disturbances of unerupted permanent tooth result from trauma to primary tooth as there is a close proximity between the root of the primary tooth and its permanent successor. The damage to the unerupted permanent tooth occurs by the transmission of traumatic forces to the permanent tooth germ. In the present case, however, a developmental disturbance on the permanent maxillary central incisor resulting from a direct effect of the inversely intruded primary maxillary central incisor is presented. The intruded tooth was extracted under general anesthesia. Upon eruption of the permanent central incisor, a localized crown malformation along with enamel hypoplasia which was not classified as a developmental disturbance before was observed. The damaged sites were restored with a light-cured composite resin.

Avulsion of primary teeth and sequelae on the permanent successors

The purpose of the present study was to determine the frequency of avulsion of primary teeth and the location of the avulsed tooth in a representative population of Danish children. Also, the frequency and the type of developmental disturbances in the permanent successors were assessed and related to age at the time of injury. The material included dental records of 4238 children from three clinics in Municipal Dental Health Services near Copenhagen, Denmark. The children were born between 1 January 1983 and 31 December 2000. Thirty-five children (0.8%) were identified as having avulsed in all 44 primary teeth most frequently the maxillary incisors (89%). Thirty-three fully erupted permanent successors were included in the study, the prevalence of developmental disturbances was 30% (10 teeth). The results showed the risk of developmental disturbances in the permanent successors to be more frequent the younger the age at the time of injury (P = 0.04). Discolouration affected all 10 permanent teeth, but also hypoplasia and horizontal enamel hypoplasia were found.

Odontoma-like malformation in a permanent maxillary central incisor subsequent to trauma to the incisor predecessor

This report describes a case of a patient (1 year and 8 months old) with traumatic avulsion of the maxillary right primary central incisor and morphological changes in the germ of the permanent successor. One year after the trauma, an odontoma-like malformation developed. This malformation was removed 6 years after trauma and orthodontic treatment was started. Clinical follow-up and periodic radiographs are necessary after traumatic avulsion of primary teeth to monitor possible sequelae in the permanent successor. An odontoma-like malformation requires a multidisciplinary approach.

Pulp canal obliteration in an unerupted permanent incisor following trauma to its primary predecessor: a case report

Trauma to a primary tooth may result in damage to the underlying developing permanent tooth bud because of the close proximity between the root of the primary tooth and its permanent successor. We report an unusual case where injury to the primary dentition resulted in pulp canal obliteration (PCO) of a permanent maxillary central incisor prior to its eruption. The other permanent maxillary central incisor was diagnosed as malformed because of trauma to the primary dentition at an earlier age. The occurrences of PCO or crown malformation dose not routinely disrupt the eruption of those teeth. Periodic assessment is required to determine the need for endodontic intervention.

Traumatic injuries in the primary dentition

As a support for the guidelines published in 2001, a review of the literature was carried out using the evidence-based approach in order to update the state of the art regarding epidemiology and treatment of traumatic dental injuries in the primary dentition. An online search in Medline, and a review of expert literature, lead to the conclusion that most luxation injuries heal spontaneously, and unless more conclusive evidence is available, conservative treatment of acute dental trauma for preschool children is suggested. Pain control, the dentist's ability to cope with the child's anxiety, and follow-up instructions in oral hygiene techniques will allow many primary teeth that are currently lost at the time of injury to be saved.

The forensic evaluation of dental injuries in Istanbul, Turkey

When a person is wounded in Turkey, he first attends hospital for treatment. The hospital is responsible for a report describing his injuries and their treatment and prognosis. The patient is then scanned by a specialist in forensic medicine who provides a final official report. In that report the lesions, the prognosis (including whether the injuries are life threatening or not) and the projected days away from daily activity are shown. In this study 18,317 cases which were examined in the second and the third Specialization Board of the Council of Forensic Medicine during 1996 were analyzed. Among them 112 cases were dental injuries. Dental injuries are reviewed according to their sex, causation, detail of injury, and they are compared to other studies.