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Background: One of the primary concerns in the paediatric emergencies is traumatic dental injuries., Objective: This study aimed to create trauma in primary teeth and reveal its effects finite element analysis., Design: Three-dimensional models were created using cone-beam computed tomography images, representing a maxillary primary central incisor. An impact force moving at a speed of 10 m/s was simulated on the labial tooth surface in two directions: buccal and incisal., Results: The stress and deformation experienced in the adjacent tooth due to the primary tooth were higher than those generated in the permanent tooth. Forces applied in the incisal direction resulted in higher levels of stress and deformation in the permanent tooth germ. The difference between the stress and deformation values in primary teeth in the forces applied in the buccal and incisal directions is 21% and 75%, respectively; in the permanent tooth germ, this difference was 233% and 100%, respectively., Conclusions: Based on the findings of this study, it is crucial to thoroughly evaluate not only the affected primary tooth but also the adjacent teeth and the permanent tooth germ in traumatic dental injuries. This comprehensive examination allows for the anticipation and management of potential long-term problems., (© 2024 The Authors. International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd.)

A 3 year and 8 months old Chinese boy was referred for a consultation regarding his missing maxillary anterior teeth. He had a history of trauma to his primary maxillary anterior teeth due to a fall at the age of 16 months. Clinical examination of the patient indicated multiple carious lesions and inadequate oral hygiene. Radiographic examination revealed intrusion of the primary left lateral incisor, with evidence of damage to the permanent tooth germ. Subsequently, the patient was followed-up for almost six years during which his permanent maxillary left lateral incisor erupted exhibiting an unusual morphology. Clinically enamel hypoplasia and radiographically dens invaginatus were evident in affected tooth.

Mandibular fractures are one of the most common maxillofacial traumatic injuries. They are also reported to be associated with highest rate of post-operative infection. In mixed dentition, management of tooth buds in line of fracture present great challenge to the surgeon. Timely management and non-invasive techniques can help in alleviating complications associated with fractures in children. Such cases should be kept on long-term follow-up for evaluation of proper growth and development. This case report documents a child having a history of previous mandibular fracture and extra-oral sinus tract associated with infected dental follicle.

Introduction: Disturbances in forming of the hard tissue of teeth and bones can be a cause of their malformation and translocation. The impact of permanent teeth is one of them. It can occur with translocation of the tooth germ. The aim of the study was to present an atypical translocation of impacted permanent teeth in children., Material and Methods: 3.5 year clinical observation was carried out in 14 children (5 girls and 9 boys), aged between 9 and 12 years old. Patients were referred to our Department by orthodontists, paedodontists and General Dental Practitioners, due to impacted permanent teeth. According to the interview, in 8 cases children suffered from a trauma of a facial part of the skull, caused by a fall. On admitance patients were generally healthy. Basing on the clinical and radiological examination, translocation of the impacted permanent teeth has been diagnosed. In 9 cases it concerned medial maxillary incisors, whereas in remaining children--maxillary premolars. The extraction of such teeth has been performed as a part of the one day surgery procedures., Conclusion: In the cases where basing on the radiogram, the position of the tooth allows to predict the latter translocation, the germ has to be extracted.

Purpose: This study aims to review the literature regarding the evolution of current thoughts on the management of teeth in the line of mandibular fractures (MFs)., Methods: An electronic search in PubMed was undertaken in June 2012. The titles and abstracts from these results were read to identify studies within the selection criteria-studies reporting clinical series of MFs in which the management of teeth in the fracture line was analyzed., Results: The search strategy initially yielded 731 references. Twenty-seven studies were identified without repetition within the selection criteria. Additional hand searching yielded 12 additional papers., Conclusions: It is suggested that rigid fixation systems and the use of antimicrobial agents have reduced the incidence of infection in cases of teeth in the line of MFs. Tooth buds in the line of MFs should not be removed or replaced in the (alleged) proper position despite the degree of displacement, since studies showed that even tooth buds in the early stage of calcification and those involved in widely displaced fracture sites continued development and erupted. Its removal should be considered in cases of infection, which is a predictive factor of abnormality and/or impaction. Intact teeth in the fracture line should be left in situ if they show no evidence of severe loosening or inflammatory change. Permanent teeth maintained in the line of fracture should be followed up clinically and radiographically for at least 1 year to ensure that any unnecessary endodontic treatment is avoided. Teeth in the line of fracture that prevents reduction of fractures, teeth with fractured roots, a partially impacted wisdom tooth with pericoronitis, and a tooth with extensive periapical lesion should be removed. Teeth in the line of MFs should also be removed when located in sites where there is extensive periodontal damage, with broken alveolar walls, resulting in the formation of a deep pocket (making optimal healing doubtful).

Dentofacial injuries that occur prior to the eruption of primary teeth can result in developmental disturbances not only in the primary but also in permanent dentition. Here we report a rare case of long term sequelae of trauma in a female child of 4 to 5 months of age which resulted in dilaceration and impaction of maxillary primary central incisors and subsequent enamel hypoplasia of the permanent maxillary central incisors.

Unlabelled: Trauma to the primary dentition is common. This injury may have an impact on the child and his/her parents. The examining dentist should take appropriate factors into consideration before providing the required treatment. This paper discusses the management of trauma to the primary teeth and describes the sequelae of injury to both the primary and secondary dentitions., Clinical Relevance: In cases of trauma to the primary teeth, diagnosis and appropriate management is necessary to alleviate the pain and discomfort for the child and to decrease the risk of damage to the permanent successor. It is important to prevent inducing fear and dental anxiety in children during the management of this injury.

Compared with the abundant literature on the replantation of avulsed permanent teeth, the literature on replantation of avulsed primary teeth is significantly more limited. A search of PubMed, using the terms: primary teeth, primary incisors, avulsion, exarticulation, replantation and reposition, and search in the reference list of the relevant articles, revealed 16 case reports of replantation of 31 primary incisors in 24 children. This article is a critical review of the arguments against replantation that have been presented in textbooks, review articles, and clinical guidelines., (© 2013 John Wiley & Sons A/S.)

Objective: To report the effects of a primary tooth trauma on the underlying permanent tooth germ., Clinical Presentation and Intervention: A 12-year-old girl was referred to our clinic with a complaint of poor aesthetic appearance. The crown of the permanent maxillary left central tooth exhibited an increased clinical crown height with an 'enamel hyperplasia' in the cervical third and had hypoplastic enamel with yellowish-brown discoloration extending from the middle third to the incisal edge. Radiographic examination revealed that the permanent maxillary left central tooth had abnormal root morphology with root dilaceration. The patient revealed a history of trauma at the age of 4 years. An aesthetic restoration with light-curing resin composite was performed on the vestibular surface of the maxillary left permanent central tooth., Conclusion: Sequelae of a primary tooth trauma on the permanent tooth were restored. We recommend that parents should be aware of the consequences of untreated trauma to a primary tooth. Educational and preventive programmes on dental trauma are required to educate parents about emergency knowledge and sequelae of dental trauma., (Copyright © 2013 S. Karger AG, Basel.)

Hypoplastic mandible related airway obstruction therapy may vary from non-surgical to surgical, depending on the severity of the obstruction. Since its introduction in 1992, distraction osteogenesis (DO) has been used to lengthen the mandible. A new intraoral device is presented here. It has no need of screw fixation, whilst placement and activation are intraoral, leading to simple placement and removal. Seven cases with hypoplastic mandible related airway obstruction were treated between 2001 and 2008 with intraoral DO at the authors' institution. Six patients had a tracheostomy and one received continuous positive airway pressure (CPAP). After the distraction phase, five patients could be decanulated and in one case CPAP was no longer required. In one case the desired effect was not achieved. The findings suggest that early mandibular DO leads to damage to the permanent tooth buds resulting in missing teeth. The effectiveness of mandibular DO regarding early discharge of the patient is shown, leading to an overall cost reduction. Knowledge of alternative modalities such as mandibular DO in case of hypoplastic mandible related airway obstruction in neonatal healthcare should lead to early referral to a dedicated maxillofacial surgeon, possibly avoiding long-term airway support or tracheotomy., (Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Trauma to the deciduous teeth may have severe consequences. Pulp necrosis is the commonly observed sequel in traumatized primary teeth and is one of the possible etiologic factors for the development of dentigerous cyst. Dentigerous cyst is more commonly seen in mandibular third molar and maxillary canine region and is rarely associated with other teeth. This article addresses a case of dentigerous cyst associated with the germ of upper permanent central incisor, an uncommon site of occurrence, which was impacted, dislodged from its natural site of eruption after trauma to the predecessor incisor.

Unlabelled: The traumatized primary teeth have a great clinical significance because it not only have consequences on itself but also on its succedaneous developing permanent teeth due to its close anatomical relationship. The extent of severity is adjudged by the type of trauma and the age of the child at the time of trauma. For instance, avulsion and intrusive injuries present with high percentage of developmental disturbances in permanent teeth than subluxation and extrusive injuries. When considering the age of the child at the time of trauma, consequences are less severe in children over 4 years of age than in the younger age group., Clinical Significance: It highlights the sequelae of trauma to primary teeth with the aim of aiding in detection of probable alterations in the traumatized primary teeth and its succedaneous permanent teeth.

Introduction: Dilaceration of the permanent teeth usually occurs because of trauma to their deciduous predecessors. Dilaceration in the crown is rare compared with that in the root and is more common in the maxillary and mandibular incisors. Generally, surgical exposure of the tooth followed by orthodontic traction or extraction of the tooth is the the choice of treatment., Methods: This article highlights a surgical-endodontic approach to the management of the left permanent maxillary central incisor with dilaceration of the crown., Results: The 1-year follow-up showed good stability of the prosthesis and good periodontal health., Conclusions: Surgical resection of the crown followed by endodontic treatment and restoration is a viable and rapid option for the management of crown dilaceration., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Electrical burns range from 4 to 7% of the total burn accidents and many of them affect primarily children biting on a live wire. Great confusion exists in the literature about the proper management of electrical burns to the mouth in the acute and late phases., Case Report: 14 year results are shown in a severe electrical burn sustained in a 1 year 2 months old girl, involving 90% of the lips and commissures, tongue, alveolar ridges and teeth (primary central incisors and permanent dental germs). Two weeks after she was out of danger, an active splint expansion device was built and used for 8 months to prevent secondary microstomia. Later a new active splint device was used for a year after lip plastic surgery. At age 13, orthopedics and orthodontics were accomplished with a lip tattoo completed at age 15., Conclusion: No matter how good the final esthetic and occlusal results are, prevention is always the best option.

The main purpose of this review is to present the aetiological factors and the mechanism that cause dilaceration of the maxillary central incisors. In early developmental stages, the permanent tooth germ of the maxillary incisor is situated palatally and superiorly to the apex of the primary incisor and gradually changes direction in a labial direction with its crown coming closer to the resorbing primary root. For reasons of this close relationship between the permanent tooth germ and the apex of the primary incisor, it is believed that an acute trauma to the primary predecessor can cause dilaceration of the long axis of the permanent successor. Clinically, dilaceration can be revealed by palpation high in the labial sulcus or in the hard palate, while its radiographic view is characteristic. The therapeutic approach to the dilacerated maxillary central incisors has to be carefully planned and needs the cooperation of several specialities to attain the final objective., (© 2010 John Wiley & Sons A/S.)

Objective: This study investigated the effects of trauma to primary teeth, related by age at the time of injury and type of injury sustained, to the frequency and type of developmental disturbances in the permanent successor teeth in a representative population of Maltese children., Method and Materials: Thirty-two children with 67 traumatized primary teeth were examined and any developmental disturbances of the corresponding permanent teeth recorded., Results: Altogether, 52.2% of the permanent teeth exhibited developmental disturbances following trauma to their primary predecessors. The highest frequency of malformations was found following subluxation injuries. Intrusion injuries were associated with the most severe malformations. Age at the time of trauma to the primary dentition was a principal factor in the risk and severity of malformations developing in the permanent successors., Conclusion: The extent of malformation of the developing tooth germ was highly related to its developmental stage and to the severity and type of trauma sustained by the primary incisor.

Developmental disturbances of permanent teeth can result from trauma to primary teeth because of the proximity of the root of the primary teeth to their permanent successors. We describe the case of a 14-month-old boy who was referred to the baby clinic of the School of Dentistry, Universidad Estadual Paulista, Araçatuba, Brazil, after sustaining a severe trauma that led to intrusion of the right primary central incisor. Radiographic examination 4 years after the trauma showed a developing morphological change in the germ of the permanent successor. On eruption of the permanent central incisor, a crown malformation along with enamel hypoplasia was observed. We conclude that radiographic follow-up is indicated after trauma to monitor possible sequelae in the permanent successors even before their eruption

Odontogenic cysts are classified into 2 main types based on their formation mechanism: inflammatory and developmental. Radicular cysts are the most common inflammatory cysts, while dentigerous cysts are developmental cysts. We report 2 radicular cysts that developed at the apices of nonvital primary teeth and 2 dentigerous cysts. All 4 patients were young girls who experienced swelling in the mandibular molar region. Panoramic radiographs revealed a large cyst under the primary second molar, displacing the permanent second premolar or first molar to near the mandible's lower border. The treatment plan was begun with conservative decompression. Patients were followed up for several years. The process is described.

The aim of this study was to determine the prevalence of sequelae in the permanent anterior teeth following trauma in their predecessors, and also to verify the existence of association between the sequelae in the permanent teeth and the type of injury in their predecessors according to the age group at the time of injury. This study was performed based on data from the records of 169 boys and 138 girls who received assistance at the dental clinic of the State University of Rio de Janeiro from March 1996 to December 2004. The sample was collected from 753 traumatized deciduous teeth of children aged 0-10 years. The number of boys and girls with dental trauma corresponded to 55.0% and 45.0%, respectively. The more affected age period was between 1 and 4 years (75.3%). The most common type of traumatic injury was the intrusion (29.3%), followed by avulsion (14.1%). Concerning permanent dentition, the most common developmental disturbances were discoloration of enamel and/or enamel hypoplasia (46.08%) and eruption disturbances (17.97%) due to the traumatic injury in their predecessors. It was not possible to find an association between the type of injury in primary teeth and sequelae in their successors in the studied age groups (P

Objective: Owing to the anatomic proximity between the root of the primary tooth and its permanent successor, trauma to primary dentition may cause developmental disturbances in unerupted permanent teeth., Study Design: This report presents the findings of a prospective 7-year study examining developmental disturbances of permanent teeth attributed to intrusive injury of their primary predecessors based on initial patient records and clinical observation. Intrusive injuries were diagnosed and grouped according to World Health Organization classifications, as modified by Andreasen et al., Results: A total of 78 children (aged 12-48 months) presenting with intrusive trauma to 138 primary incisors were available for follow-up examinations. The most frequently intruded primary teeth were maxillary incisors (93.47%), with the right central primary incisor representing 41.3% of all intruded teeth. In 23 patients, 36 teeth were scheduled for extraction during the first visit. During the course of follow-up, 41 of the remaining teeth exhibited post-traumatic consequences, including pulp necrosis (78.0%), internal and/or external root resorption (14.6%), ankylosis (4.9%), and obliteration of the pulp canal (2.5%). In 74 permanent successors (53.6%), >or=1 of the following developmental disturbances were observed: enamel hypoplasia (28.3%), crown and/or root deformation (16.7%), and ectopic eruption (16.7%)., Conclusion: There was no significant correlation between age of intrusion and frequency of subsequent developmental disturbances (P > .05).

Dens invaginatus is a clinically relevant malformation of teeth resulting from an infolding of enamel and dentine into the dental structure during tooth formation, hence the former denomination "dens in dente". The dens invaginatus shows multiple morphological variations of crown and root formation. This frequently leads to caries, pulpal and periodontal involvement with necrosis and loss of attachment. Therefore, early diagnosis and prevention are of utmost importance. Due to the complexity of the malformation, treatment options in former days were limited. This article presents a profound review of the literature regarding etiology, epidemiology and histology. It discusses clinical appearance and diagnosis and it provides guidelines for decision-making and treatment of invaginated teeth.

Intrusive luxation of primary teeth carries a high risk of damage to underlying permanent tooth germs. Ectopic eruption of permanent incisors is an unusual outcome of traumatic injury to their predecessors. In this case report, we describe the multidisciplinary management of the consequences of a primary tooth intrusion that led to severe ectopic eruption of the permanent left central incisor in a horizontal position at the level of the labial sulcus.

A case is presented of a 10-year-old girl, referred for consultation for failure of the maxillary central incisor to erupt. At 18 months, the patient underwent intrusion of the right central primary incisor, which re-erupted several months later. Radiographic examination revealed a complex odontoma-like malformation located next to the floor of the nose, away from the permanent incisors. Clinical examination revealed space loss of the corresponding permanent incisor and severe hypoplasia of the permanent right lateral incisor. Because of its deep location, it was decided not to remove the odontoma, but to recommend yearly radiographic follow up to rule out the development of a dentigerous cyst. This case describes a very rare complication of intrusion of primary incisors and emphasizes the importance of follow up until eruption of the corresponding permanent teeth.

Turner's hypoplasia usually manifests as a portion of missing or diminished enamel, generally affecting one or more permanent teeth in the oral cavity. A case report of 8 year old girl who met with trauma at 2 years of age leading to primary incisors being knocked out, reported after 6 years with complaint of pain and discharge in her anterior malformed teeth is discussed in this article. The permanent incisors erupted with dilacerated crown, root malformations and missing enamel. Further, patient developed sinus, lateral root pathology, tooth mobility and malocclusion in relation to affected teeth which were managed by esthetic, functional, endodontic and surgical procedure. Root canal treatment along with palatal contouring and esthetic restoration by light cure composite was performed on the tooth with crown dilaceration and sinus, where as surgical management was considered for the tooth with root malformation.

Objective: To observe the effect of mandibular distraction osteogenesis (DO) on developing molars., Design: Descriptive clinical study., Setting: University hospital setting. Seventeen children (mean age 7.6 years) with various syndromes (hemifacial/craniofacial microsomia, Goldenhar syndrome, Treacher Collins syndrome, Nager syndrome and Pyle-Bakwin-Krida syndrome) participated. experimental variable - Severely retrognathic lower jaws were distracted (mean 30 days) with an extraoral bicortically fixed DO device., Outcome Measure: Consecutive panoramic tomograms were analysed after a mean follow-up period of 3.6 years, range 1-6.9 years., Results: The mandibular molars were affected by DO in 13 of the 17 patients which included 18 of 63 mandibular molars studied. Structural changes included root malformations, hindered tooth development and the destruction of tooth follicles. Positional changes such as shifted and tilted teeth were also found. Three injured teeth failed to erupt. These changes were because of splitting of the tooth follicle during the osteotomy (22%), piercing of the tooth follicle by the pin (39%) or migration of tooth germ towards the newly created bone (39%). Fifteen per cent of first molars, 43% of second molars and 31% of third molars were affected during the distraction process. Of all dental injuries, 44% were noticed while the appliance was in place. A further 17% of injuries were noted between 3 months and 1 year postoperatively and 33% during the second postoperative year., Conclusions: Although dental injuries are a minor disadvantage compared with the vast benefits offered by DO, focusing on these drawbacks might lead to re-consideration of the type of the device as well as the timing of DO.

The guiding principle in managing trauma to the primary dentition is potential sequelae to the permanent tooth. If the risk to the permanent tooth is great, the primary tooth should be removed. If esthetics are a concern to the parent, a number of appliances can be fabricated to temporarily manage this issue. It is important that parents realize that the desire to maintain optimum esthetics by maintaining a significantly injured primary tooth can, in many cases, cause more damage to the permanent tooth. Where avulsions have occurred, the old adage "when in doubt, leave it out" is still perhaps the most reliable advice.

Traumatic injury to a primary tooth has a potential to damage the underlying permanent tooth germ. It may lead to developmental disturbance of permanent dentition. The impaction of the permanent maxillary central incisor because of the root dilaceration in children is rare. The purpose of this paper is to report a developmental disturbance of a permanent right maxillary lateral incisor in a 12-year-old girl with a history of trauma at an early age.

A 2-year 6-month male presented after an intrusive injury sustained at 15 months of age. Intra-oral radiographs showed coronal dilaceration of the germ of the permanent central incisor and the presence of a calcified tissue mass in the area of the trauma which was identified after surgical removal as the permanent upper left lateral incisor. Immediate treatment and long-term options are discussed.

Purpose: The goal was to suggest guidelines for the treatment of developing tooth buds located on the fracture line of mandibular fractures., Patients and Methods: The long-term radiographic follow-up records of 28 patients with mandibular fractures involving 66 tooth buds were examined for the occurrence of abnormalities in development or eruption. The fates of the involved teeth were compared according to the fracture conditions and other factors, and the cause of the abnormalities was surveyed., Results: Abnormal findings were observed in 30 of 66 developing teeth (45%); these included deficient root formation, abnormal bend of the root, nodule formation on the root, partial obliteration of the pulp cavity, impaction, growth arrest, and external resorption. No relationship was found between the presence of abnormalities and the condition of the fracture or the developmental stage of the tooth buds. However, infection, rotation of the tooth bud, and a surgical wire passing through the follicular space were associated with arrested growth and impaction., Conclusions: The tooth buds present on the fracture line should be preserved except in cases of infection, and careful attention should be paid to avoiding further injury to the tooth bud and the soft tissues of the follicle at the time of surgery.

Primary teeth and the permanent successors must be understood as interdependent units, where each one of them interacts with and depends on each other. Pulpal inflammation/infection of a primary tooth and the spread of this condition over the periradicular tissues can lead to alterations in the dental germ of the permanent successor and to the surrounding structures if no therapy is done, i.e. endodontics or extraction. This work will present cases of permanent teeth that showed alteration in eruption and / or in development, as a consequence of inflammation / infection of the preceding primary teeth, such as: hypoplasia, morphological alteration on the dental crown or total arrest of. radicular formation. The teeth analysed in this study belong to patients who attended the Universidade Federal de Santa Catarina Children's Dentistry Clinic. The earlier these lesions are diagnosed, the less were the destructive effects and the consequences on the primary tooth/permanent germ unit.

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., (Copyright Blackwell Munksgaard, 2004)

Objective: Clinical and histopathological evaluation of mechanical trauma on the development of maxillary first molar with Scanning Electron Microscope., Design: Experimental study with four newborn Wistar rats. Trauma induced on 1st, 3rd, 7th and 10th postnatal days with dental K file. Right first molar region of the maxilla was the experimental side and the left side as control. Animals were sacrificed on the 42nd Postnatal day when the teeth came into functional occlusion. Teeth were evaluated clinically and SEM study of the crown was performed., Results: Marked disfigurement of cusps, roughened defective, enamel, crown dilacerations and enamel hypoplasia were observed. Damage was less severe to the tooth subjected to trauma on the 10th postnatal day.

The traumatisms of the temporary teeth are very frequent. They are bound to the acquirement of the march, to the games, to the sport and to the accidents of the public way. Favoured by the presence one improved proalveoly, they constitute a dental emergency of makes some important risks of complications. Indeed, these traumatisms, in case of belated conference and/or of maladjusted treatment or conducted pain, could induce some complications and have some aesthetic and functional after effects on the dental germ underlying. Some of these complications observed in some patients are stakes in evidence by some iconographic illustrations.

The efficacy of a modified cast-metal resin-bonded splint was evaluated after 14 years in service. The splint was used to immobilize the root-compromised maxillary central and lateral incisors of a teenage male following relapsed orthodontic treatment. The affected teeth were indirectly traumatized, before their eruption, in a bicycle accident that resulted in avulsion of their primary predecessors. The rationale for selecting this treatment modality rather than the alternatives is discussed. The clinical protocol employed during the treatment and subsequent follow-up is described.

It has been reported in the literature that some rural populations of Sub-Saharan and Eastern Africa and other isolated areas around the world, practise gouging or enucleation of primary tooth buds to cure childhood illnesses. The unerupted primary canine tooth bud is believed to be the cause of febrile illness, diarrhoea, and vomiting; prevalent in infants in these areas of the world. Tooth bud gouging has implications for the developing dentition, and is a potential risk to the health and life of the child. Reported prevalence ranges from 22%-90%. From the information in this case report, the practise of tooth bud gouging is no longer confined to rural areas and may well be performed by communities that have emigrated to the UK. The three sisters described, now resident in the UK, suffered tooth gouging in a city clinic in Uganda. The damage caused to the primary and permanent dentition is described and treatment planning and options are suggested for each case to restore structure and function. Appropriate provision of healthcare and education could avoid the potential long-term damage to the health of the child and their developing dentition by the practise of tooth bud gouging, whether it occurs in the developing or developed world.

Introduction: A malformed mandible and an abnormally positioned mandibular foramen make it difficult to plan an ideal osteotomy line for mandibular distraction. In addition, there have been reports of such complications as nonunion, damage and stretch injury of the inferior alveolar nerve and tooth germ damage when conventional osteotomy or corticotomy are used for mandibular distraction. The authors utilized the original sagittal split ramus osteotomy for mandibular distraction., Patients and Methods: Five patients (three unilateral hemifacial microsomia, one bilateral hemifacial microsomia, and one mandibular retrusion) were included in this study of distraction osteogenesis using the sagittal split ramus osteotomy. Extraoral distraction devices were applied to the first four patients. An intraoral device with mono-cortical screw fixation was used for the fifth patient., Result: In all five cases, the results of the distraction were satisfactory. Complications (as listed) of conventional osteotomy when used for distraction were avoided. Satisfactory results were achieved and these were also well maintained postoperatively (mean follow up: 36 months)., Conclusion: The authors believe that sagittal osteotomy for mandibular distraction osteogenesis makes it possible, to avoid injury to the inferior alveolar nerve during operation and stretching injury during distraction and to prevent tooth germ injury. It is also possible to diversify the osteotomy line for various force vectors to enlarge the bony contact surface area. Therefore, we suggest that sagittal split ramus osteotomy should be used as a preferred modification of osteotomy for mandibular distraction.

Background: The melanotic neuroectodermal tumor of infancy is a rare and so far as being classified neoplasm with a high rate of recurrence for one year after diagnosis. Since Krompecher described 1918 the tumor at first, only about 200 cases are reported until today, mostly with manifestation in the maxillary region., Case-Reports: The authors present two infants at the age of six and eight weeks with first clinical manifestation of the tumor in the maxillary region. Although there were no other common signs, the tumor destroyed wide areas of the mid-face. In spite of a treatment with radical surgery, recurrences occur rapidly in the first living year., Conclusions: Our clinical and histological findings show characteristics of local malignant growth. For these facts the radical resections of the primary tumor and its recurrences are individually the therapeutical consequences. A follow up of seven years of one infant shows a hypoplasm of the mid-face as a result of the inhibition of further growth by the loss of germs after maxillary hemisection.

This article describes a case where during an extraction of a primary molar's root remnant, the successor permanent tooth was accidentally extruded. The extruded tooth was immediately repositioned to its right position in the socket and it erupted normally after a short time. After 2 years, a routine clinical examination revealed normal appearance of the premolar in the dental arch. A radiograph demonstrated an obliterated coronal part of the pulp, normal root length, a slightly open apex and no periapical inflammation.

This report describes a rare case of crown dilaceration of the mandibular first premolar caused by trauma during extraction of the precedent primary first molar. The mandibular first primary molar had been extracted at the age of 4 years 7 months. Compared to the pre-operative radiograph, the post-operative film showed that the direction of the first premolar tooth germ had changed, suggesting that crown dilaceration had been induced by the surgical procedures during tooth extraction. From radiographic examinations, the premolar was considered to have erupted spontaneously.

Intrusive trauma was experimentally applied to the tooth germ at different developmental stages in the rat first molar. The tooth germ at the earliest (postnatal day 1, initiating stage of enamel matrix formation) and the latest (postnatal day 10, calcifying stage of preformed enamel matrix) developmental stages studied showed localized enamel hypoplasia as a direct sequela of trauma. The tooth germs in which enamel matrix was rapidly thickening (postnatal days 3, 5, 7) and had not yet started to calcify showed the most intense and extensive injuries to the formation and structural organization of both enamel and dentin. As for indirect effects secondary to trauma, tooth germ dislocation was observed chiefly in tooth germs at the same developmental stages, frequently resulting in ankylosis. The present experimental model may be helpful for clarifying the histogenesis of traumatic changes in the developing tooth germ.

Trauma to a primary mandibular central incisor resulted in a rare case of dilaceration and duplication of crown with hypercementosis of the root in the permanent successor. This tooth was extracted. This article highlights the consequences of trauma to a primary tooth for a developing permanent successor.

A complication that occurred during the extraction of mandibular right second primary molar is presented. The clinical and radiographic examinations were done; however, the germ of the second premolar came out with the primary tooth. In the same session, replantation was done and monitored very often for two years. The tooth erupted normally into occlusion without any abnormality in dental arch.

Crown dilaceration of a permanent tooth constitutes 3% of traumatic injuries to developing teeth. It usually involves the maxillary incisors and less frequently their mandibular counterparts. This report concerns a patient, whose primary mandibular central incisors, following a fall at the age of 14 months, sustained partial avulsion with displacement. The teeth were repositioned by the father, with the aid of a pediatrician, and without the assistance of a dentist. The patient presented at the age of 8 years, and, following clinical and radiographic examination, a diagnosis was made of crown dilaceration with lingual displacement of the incisal third of the permanent mandibular central incisors, and hypoplastic enamel on all but the gingival third of their crowns. In addition to this, a supernumerary tooth was discovered labial to and between the mandibular right permanent central incisor and the mandibular right primary lateral incisor. After a brief review of the literature, the treatment of this patient is described and the restoration of the dilacerated teeth, followed by a discussion on crown dilaceration and issues concerning the restoration of such teeth.

A case of multiple fractures of the mandible following a car accident in a five-year-old patient is reported. The fracture line passed distal to the first molar tooth bud. The fracture was treated by wire osteosynthesis and skeletal fixation. During the ensuing 18 months, a gradual arrest of the development of the first molar tooth bud was radiologically observed. The eruption process had not been disturbed, and the tooth erupted at the age of 6 1/2 years. Since the distal root had completely failed to develop and the mesial roots showed a diminished size, the tooth was extracted. Histopathological examination revealed disturbed dentin apposition, there was almost complete obliteration of the pulp chamber by globular dentin, and evidence of root resorption.

This report documents two patients with inversion and impaction of the second premolar tooth. Family and personal histories of both patients were unremarkable with no abnormalities in general growth and development nor any history of trauma. Patient 1 was a 10-year-old female with inversion and impaction of the mandibular right second premolar. Fifteen months previously, pre-operative radiographic examination prior to extraction of the mandibular right second primary molar revealed a normal direction and eruptive pattern of the tooth in question. However, following extraction of the mandibular right second primary molar, the developing succedaneous premolar was seen to be inverted. This was suggestive of inversion resulting from an iatrogenic force during tooth extraction. The second patient was a 9-year-old male with inversion and impaction of the maxillary right second premolar. Radiographic examination 3 months prior to the initial visit at our hospital showed an existing inversion of this tooth. This pointed to a developmental abnormality in the location of the original tooth bud.

Traumatic dental injuries to the young child can present both diagnostic and therapeutic challenges. Luxation injuries to the primary dentition are the most common injuries. Yet, they are the most controversial with regard to definitive treatment, prognosis, and sequelae. Damage to the developing teeth subsequent to primary tooth injury is often unavoidable and has permanent effects on the dentition. Diagnostic criteria, treatment options, and outcomes are presented in this article; however, treatment decisions are often based on patient behavior.

A six-year-old boy presented with extraoral eruption of a mandibular permanent canine and a loosely attached lateral incisor in the labial vestibule, 3 months following trauma to the chin. The trauma not only caused displacement of the permanent tooth buds, but also resulted in transposition of the lateral incisor and canine with subsequent ectopic eruption. The case is presented to demonstrate one of the infrequent complications of trauma involving the unerupted tooth buds of permanent teeth and its unusual clinical presentation.

The arrest of a premolar bud was observed in an animal experiment that was designed to study the influence of endodontic treatment in dogs' temporary teeth on the eruption of their permanent successors. A chemical irritation was induced by the burst of ZOE (zinc oxide and eugenol) into the dental follicle. Moreover, a mechanical trauma on the temporary molar was promoted by the dog's biting on its cage metallic bars. The devitalization effects were studied in thick undecalcified ground sections which were subjected to microradiographic analysis, to UV light microscopy in order to detect the fluorescent indicators of calcification, and finally to methylene blue staining. The arrest of the bud development was noted in fluorescent microscopic examination. Cellular cementum was formed on the pulpal surface of the dentine, while cementum, chondroid tissue, woven bone and lamellar bone developed in the pulpal tissue. These observations advise caution during root canal therapy of temporary teeth, especially those that are exposed to mechanical trauma. Such as the upper incisors.