Case Report/Clinical Techniques
Unusual Morphology of Permanent Tooth Related to Traumatic Injury: A Case Report Minji Kang, DDS,* and Euiseong Kim, DDS, MSD, PhD*† Abstract Root duplication, or multiple roots, is a very rare anatomy of the maxillary central incisor. This case report describes a permanent central incisor having 2 distinct roots as an assumed sequela of the avulsion and replantation of a primary incisor. The permanent successor might have had a disturbance of development because of the traumatic injury and discontinuity in the treatment after replantation. Conventional endodontic treatment followed by esthetic restoration was performed on the tooth. Clinicians should consider the potential prognoses and complications of traumatic injuries to primary teeth. (J Endod 2014;-:1–4)
Key Words Maxillary central incisor, traumatic injury, unusual morphology
From the *Department of Conservative Dentistry and Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea. Address requests for reprints to Dr Euiseong Kim, Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 120-752, South Korea. E-mail address: [email protected] 0099-2399/$ - see front matter Copyright ª 2014 American Association of Endodontists. http://dx.doi.org/10.1016/j.joen.2014.06.006 †
JOE — Volume -, Number -, - 2014
I
t is well-known that traumatic injuries of the primary dentition may interfere with the development of permanent teeth. Developmental disturbances in the permanent dentition after an injury to the primary dentition were reported in 12%–69% of cases in various clinical studies (1–5). Possible morphologic variations include the discoloration of the enamel, enamel hypoplasia, odontomalike malformations, crown or root dilacerations, root duplications, and partial or complete cessation of the root formation (2). Root duplication or multiple roots of the upper central incisors are very rare because the root canal anatomy of the maxillary central incisor usually has 1 root and 1 radicular canal system (6, 7). One case report (8) described root duplication of a permanent incisor as a result of an intrusive luxation of the primary teeth. The author speculated that the intrusion of the deciduous tooth into the follicle of the developing tooth germ caused an acute tilting of the permanent tooth germ and the formation of second root. The avulsion and replantation of a primary tooth has been mentioned in some clinical reports as a cause of damage to permanent teeth (2, 9, 10). Sakai et al (10) reported root dilacerations of a permanent tooth as a result of this type of traumatic injury. However, there is no report of a case describing the second root formation of a permanent incisor appearing after the avulsion of a primary tooth. The aims of this case report were to describe a permanent central incisor having 2 distinct roots as an assumed sequela of the avulsion and replantation of a primary incisor and to discuss the correlation between the trauma of primary teeth and the developmental anomaly of the permanent tooth.
Case Report A 14-year-old girl attended the Department of Conservative Dentistry of the Yonsei University Dental Hospital, Seoul, South Korea, with a chief complaint of a sinus tract on the upper front buccal gingiva. There was no contributable medical history. According to her parents, she fell forward and bumped her face on the table when she was 2 years old. Her right maxillary primary incisor was avulsed and replanted after 30 minutes at an emergency care center. Afterward, she did not attend the dental clinic, and no further follow-up of the primary incisor was done. The right maxillary central incisor was partially erupted and discolored, so it was treated with a tooth-colored restoration at a local clinic 5 years ago. An intraoral examination revealed a sinus tract close to the upper right central incisor, which was tilted distally with partial eruption (Fig. 1). There was a toothcolored restoration composing most of the crown. The tooth was not sensitive to palpation or percussion, but the probing depth on the mesial side was 6 mm. A radiographic examination, including cone-beam computed tomographic imaging, showed that it had 2 distinct roots: the mesial root surrounded by a radiolucency and the distal root positioned at the palatal side (Fig. 2A–C). When gutta-percha was probed into the sinus tract, it indicated the origin was a radiolucency of the mesial root. After clinical and radiographic examinations, the tooth was diagnosed with pulp necrosis and a chronic apical abscess. The treatment plan was a conventional root canal treatment followed by the replacement of the coronal restoration. After the application of local anesthesia with lidocaine hydrochloride (2% with epinephrine 1:100,000), the tooth was isolated with a rubber dam. The access opening was started from the palatal side of the coronal restoration with a high-speed no. 2
Unusual Morphology of Permanent Tooth
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Case Report/Clinical Techniques Sealapex (SybronEndo, Orange, CA) as a sealer. After the canal filling, the coronal restoration was removed completely, including the perforation site of the cervical dentin. A composite resin endocrown was delivered to the tooth as a final restoration (Fig. 3A and B). The patient was followed-up at 3 months, 6 months, and 1 year through clinical and radiographic examinations (Fig. 4). The tooth remained asymptomatic, and the probing depth was improved to normal.
Discussion
Figure 1. A preoperative photograph of the maxillary right central incisor with a sinus tract.
round bur, and the buccal side of the restoration was preserved. The mesial canal was easily detected. After pulp extirpation with K-files, the canal was debrided with 2.5% sodium hypochlorite. However, finding a distal canal was difficult because of its position. During the canal location, the cervical dentin under the coronal restoration was perforated. A resin-modified glass ionomer (Fuji II LC; GC Corporation, Tokyo, Japan) was used to repair the perforation site. After identifying the distal canal, extirpation and irrigation of the canal were performed in the same manner. The working length was determined with an apex locater (RootZX, Morita, Japan) and a periapical radiograph. Canals were prepared using the crown-down technique with the Profile System (Dentsply Maillefer, Ballaigues, Switzerland) up to file number 40/.06 for the mesial and 35/.06 for the distal canal system. The canals were dried with sterile paper points, and calcium hydroxide paste was placed in the root canals. The access cavity was sealed with a temporary sealing material (Caviton, GC Corporation). After a week, the tooth was asymptomatic, and the root canals were filled using a thermoplastic obturation technique (SuperEndo Alpha and Beta; B&L Biotech, Ansan, Korea) and
Andreasen and Ravn (9) reported developmental disturbances in 41% of 213 injured teeth. The lower the age at the time of an injury the higher the incidence of disturbances observed in permanent teeth is because the tooth germ is sensitive during early developmental stages. Intrusive luxation and avulsion appeared to be the types of injuries most often associated with disturbances in tooth development. The specific pathogenesis of the avulsion of primary teeth is responsible for this high frequency of disturbances (4). The slight rotating movement during an avulsion because of the root curvature may injure the hard or soft tissues separating the primary tooth from the developing permanent tooth germ. Textbooks and review articles about traumatic injuries of primary teeth have traditionally rejected the idea of replantation (11). The argument against replantation of primary incisors notes the risk of damage to the permanent tooth germ, which is in the process of development. The coagulum forced into the area of the follicle during replantation may impair the permanent successor (10–13). There were case reports describing impaction with a radicular cyst or dilacerations of a permanent incisor after the replantation of primary incisors (10, 12). Nevertheless, some clinicians perform replantation based on a few case reports that support this procedure (14, 15). According to the clinical opinion, the main benefit of the treatment is the maintenance of anterior dentition, an esthetic zone. Other reasons for replantation are the prevention of occlusion problems, space maintenance, and preservation of bone (15). After the replantation of
Figure 2. (A) A periapical radiograph of the maxillary right central incisor with gutta-percha tracing. (B) A reformatted axial view of the cone-beam computed tomographic scan of the maxillary right central incisor. The white arrow indicates the mesial root of the tooth, and the black arrow indicates the distal root of the tooth. (C) Three-dimensional reconstruction of the tooth.
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JOE — Volume -, Number -, - 2014
Case Report/Clinical Techniques
Figure 3. (A) A radiograph after root canal treatment and final restoration were done. (B) A postoperative photograph showing the final restoration of the tooth.
a primary tooth, following regular recall is essential to decide further treatment and detect inflammatory root resorption (13). In the present case, the permanent successor might have had a disturbance of development because of the injury in its early development stage. The crown of the permanent successor was not yet completely developed and was sensitive to damage at the time of injury. Moreover, the risk of pulp necrosis of the replanted primary incisor was increased because she did not have any further treatment of the replanted tooth, and subsequent inflammation may have affected the development of the permanent tooth germ (11). Root duplication is a rare complication after the injury of primary teeth. It occurs when half or less than half of the crown is formed at the time of injury (2). A traumatic division of the cervical loop occurs, resulting in the formation of 2 separate roots (1). Andreasen et al (2) reported only 4 teeth with this malformation when they analyzed 117 injured permanent teeth. The age at the time of injury appeared to be 2 years or less, the same age as in this case. However, all teeth with root duplication in this report appeared after intrusive luxation (not the avulsion of primary teeth).
However, another possibility is that the tooth was the fusion of a permanent incisor with a supernumerary tooth. Fusion occurs because of the union of 2 separated tooth germs and forms a joint tooth with a confluence of dentin. Although the exact etiology of fusion is unknown, a possible cause reported is pressure or a physical force providing close contact between 2 developing tooth buds (16). In the present case, the force produced when the primary tooth was rotated or replanted might have affected the tooth germs or displaced them close enough to develop fusion. There was a large restoration covering most of the crown, and it was difficult to distinguish fusion and root duplication in this case. Regarding treatment, defining the pathogenesis of this present case was not critically important, and a root canal treatment was definitely needed. Finding the distal canal was a challenge during treatment because it was positioned at the palatal side. If the existing restoration had been removed completely, detecting the distal canal would have been easier and would have had a lower risk of perforation. The bone healing of the periapical area is still incomplete after a year, but the tooth was asymptomatic and showed no pathologic signs. The
Figure 4. Recall radiographs at 1 year after the treatment.
JOE — Volume -, Number -, - 2014
Unusual Morphology of Permanent Tooth
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Case Report/Clinical Techniques prognosis of the tooth is expected to be fine. There is potential for the contraction of a periodontal problem because of a long buccal groove between the 2 roots, which may hamper the healing of bone around the mesial root. Hence, long-term follow-up is important for this tooth. In conclusion, it can be assumed that the traumatic injury of the primary teeth played a role in the formation of the abnormal root morphology in this case. Clinicians should consider the potential prognoses and complications of traumatic injuries to primary teeth and inform the patients and their guardians about the clinical importance of dental management and further periodic follow-up.
Acknowledgments The authors deny any conflicts of interest related to this study.
References 1. Wilson CF. Management of trauma to primary and developing teeth. Dent Clin North Am 1995;39:133–67. 2. Andreasen JO, Sundstrom B, Ravn JJ. The effect of traumatic injuries to primary teeth on their permanent successors. I. A clinical and histologic study of 117 injured permanent teeth. Scand J Dent Res 1971;79:219–83. 3. Selliseth NE. The significance of traumatised primary incisors on the development and eruption of permenent teeth. Rep Congr Eur Orthod Soc 1970;443–59.
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4. Ravn JJ. Sequelae of acute mechanical traumata in the primary dentition. A clinical study. ASDC J Dent Child 1968;35:281–9. 5. Andersson L. Epidemiology of traumatic dental injuries. J Endod 2013;39(3 Suppl): S2–5. 6. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589–99. 7. Rao Genovese F, Marsico EM. Maxillary central incisor with two roots: a case report. J Endod 2003;29:220–1. 8. Kaufman AY, Keila S, Wasersprung D, Dayan D. Developmental anomaly of permanent teeth related to traumatic injury. Endod Dent Traumatol 1990;6:183–8. 9. Andreasen JO, Ravn JJ. The effect of traumatic injuries to primary teeth on their permanent successors. II. A clinical and radiographic follow-up study of 213 teeth. Scand J Dent Res 1971;79:284–94. 10. Sakai VT, Moretti AB, Oliveira TM, et al. Replantation of an avulsed maxillary primary central incisor and management of dilaceration as a sequel on the permanent successor. Dent Traumatol 2008;24:569–73. 11. Holan G. Replantation of avulsed primary incisors: a critical review of a controversial treatment. Dent Traumatol 2013;29:178–84. 12. Al-Khayatt AS, Davidson LE. Complications following replantation of a primary incisor: a cautionary tale. Br Dent J 2005;198:687–8. 13. Zamon EL, Kenny DJ. Replantation of avulsed primary incisors: a risk benefit assessment. J Can Dent Assoc 2001;67:386. 14. Friedlander LT, Chandler NP, Drummond BK. Avulsion and replantation of a primary incisor tooth. Dent Traumatol 2013;29:494–7. 15. Kinoshita S, Mitomi T, Taguchi Y, Noda T. Prognosis of replanted primary incisors after injuries. Endod Dent Traumatol 2000;16:175–83. 16. Shafer WG, Hine M, Levy BM. Developmental disturbances of oral and papraoral structures. In: A Textbook of Oral Pathology, 4th ed. Philadelphia: WB Saunders; 1993:38–9.
JOE — Volume -, Number -, - 2014
Unusual Morphology of Permanent Tooth Related to Traumatic Injury: A Case Report Minji Kang, DDS,* and Euiseong Kim, DDS, MSD, PhD*† Abstract Root duplication, or multiple roots, is a very rare anatomy of the maxillary central incisor. This case report describes a permanent central incisor having 2 distinct roots as an assumed sequela of the avulsion and replantation of a primary incisor. The permanent successor might have had a disturbance of development because of the traumatic injury and discontinuity in the treatment after replantation. Conventional endodontic treatment followed by esthetic restoration was performed on the tooth. Clinicians should consider the potential prognoses and complications of traumatic injuries to primary teeth. (J Endod 2014;-:1–4)
Key Words Maxillary central incisor, traumatic injury, unusual morphology
From the *Department of Conservative Dentistry and Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea. Address requests for reprints to Dr Euiseong Kim, Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 120-752, South Korea. E-mail address: [email protected] 0099-2399/$ - see front matter Copyright ª 2014 American Association of Endodontists. http://dx.doi.org/10.1016/j.joen.2014.06.006 †
JOE — Volume -, Number -, - 2014
I
t is well-known that traumatic injuries of the primary dentition may interfere with the development of permanent teeth. Developmental disturbances in the permanent dentition after an injury to the primary dentition were reported in 12%–69% of cases in various clinical studies (1–5). Possible morphologic variations include the discoloration of the enamel, enamel hypoplasia, odontomalike malformations, crown or root dilacerations, root duplications, and partial or complete cessation of the root formation (2). Root duplication or multiple roots of the upper central incisors are very rare because the root canal anatomy of the maxillary central incisor usually has 1 root and 1 radicular canal system (6, 7). One case report (8) described root duplication of a permanent incisor as a result of an intrusive luxation of the primary teeth. The author speculated that the intrusion of the deciduous tooth into the follicle of the developing tooth germ caused an acute tilting of the permanent tooth germ and the formation of second root. The avulsion and replantation of a primary tooth has been mentioned in some clinical reports as a cause of damage to permanent teeth (2, 9, 10). Sakai et al (10) reported root dilacerations of a permanent tooth as a result of this type of traumatic injury. However, there is no report of a case describing the second root formation of a permanent incisor appearing after the avulsion of a primary tooth. The aims of this case report were to describe a permanent central incisor having 2 distinct roots as an assumed sequela of the avulsion and replantation of a primary incisor and to discuss the correlation between the trauma of primary teeth and the developmental anomaly of the permanent tooth.
Case Report A 14-year-old girl attended the Department of Conservative Dentistry of the Yonsei University Dental Hospital, Seoul, South Korea, with a chief complaint of a sinus tract on the upper front buccal gingiva. There was no contributable medical history. According to her parents, she fell forward and bumped her face on the table when she was 2 years old. Her right maxillary primary incisor was avulsed and replanted after 30 minutes at an emergency care center. Afterward, she did not attend the dental clinic, and no further follow-up of the primary incisor was done. The right maxillary central incisor was partially erupted and discolored, so it was treated with a tooth-colored restoration at a local clinic 5 years ago. An intraoral examination revealed a sinus tract close to the upper right central incisor, which was tilted distally with partial eruption (Fig. 1). There was a toothcolored restoration composing most of the crown. The tooth was not sensitive to palpation or percussion, but the probing depth on the mesial side was 6 mm. A radiographic examination, including cone-beam computed tomographic imaging, showed that it had 2 distinct roots: the mesial root surrounded by a radiolucency and the distal root positioned at the palatal side (Fig. 2A–C). When gutta-percha was probed into the sinus tract, it indicated the origin was a radiolucency of the mesial root. After clinical and radiographic examinations, the tooth was diagnosed with pulp necrosis and a chronic apical abscess. The treatment plan was a conventional root canal treatment followed by the replacement of the coronal restoration. After the application of local anesthesia with lidocaine hydrochloride (2% with epinephrine 1:100,000), the tooth was isolated with a rubber dam. The access opening was started from the palatal side of the coronal restoration with a high-speed no. 2
Unusual Morphology of Permanent Tooth
1
Case Report/Clinical Techniques Sealapex (SybronEndo, Orange, CA) as a sealer. After the canal filling, the coronal restoration was removed completely, including the perforation site of the cervical dentin. A composite resin endocrown was delivered to the tooth as a final restoration (Fig. 3A and B). The patient was followed-up at 3 months, 6 months, and 1 year through clinical and radiographic examinations (Fig. 4). The tooth remained asymptomatic, and the probing depth was improved to normal.
Discussion
Figure 1. A preoperative photograph of the maxillary right central incisor with a sinus tract.
round bur, and the buccal side of the restoration was preserved. The mesial canal was easily detected. After pulp extirpation with K-files, the canal was debrided with 2.5% sodium hypochlorite. However, finding a distal canal was difficult because of its position. During the canal location, the cervical dentin under the coronal restoration was perforated. A resin-modified glass ionomer (Fuji II LC; GC Corporation, Tokyo, Japan) was used to repair the perforation site. After identifying the distal canal, extirpation and irrigation of the canal were performed in the same manner. The working length was determined with an apex locater (RootZX, Morita, Japan) and a periapical radiograph. Canals were prepared using the crown-down technique with the Profile System (Dentsply Maillefer, Ballaigues, Switzerland) up to file number 40/.06 for the mesial and 35/.06 for the distal canal system. The canals were dried with sterile paper points, and calcium hydroxide paste was placed in the root canals. The access cavity was sealed with a temporary sealing material (Caviton, GC Corporation). After a week, the tooth was asymptomatic, and the root canals were filled using a thermoplastic obturation technique (SuperEndo Alpha and Beta; B&L Biotech, Ansan, Korea) and
Andreasen and Ravn (9) reported developmental disturbances in 41% of 213 injured teeth. The lower the age at the time of an injury the higher the incidence of disturbances observed in permanent teeth is because the tooth germ is sensitive during early developmental stages. Intrusive luxation and avulsion appeared to be the types of injuries most often associated with disturbances in tooth development. The specific pathogenesis of the avulsion of primary teeth is responsible for this high frequency of disturbances (4). The slight rotating movement during an avulsion because of the root curvature may injure the hard or soft tissues separating the primary tooth from the developing permanent tooth germ. Textbooks and review articles about traumatic injuries of primary teeth have traditionally rejected the idea of replantation (11). The argument against replantation of primary incisors notes the risk of damage to the permanent tooth germ, which is in the process of development. The coagulum forced into the area of the follicle during replantation may impair the permanent successor (10–13). There were case reports describing impaction with a radicular cyst or dilacerations of a permanent incisor after the replantation of primary incisors (10, 12). Nevertheless, some clinicians perform replantation based on a few case reports that support this procedure (14, 15). According to the clinical opinion, the main benefit of the treatment is the maintenance of anterior dentition, an esthetic zone. Other reasons for replantation are the prevention of occlusion problems, space maintenance, and preservation of bone (15). After the replantation of
Figure 2. (A) A periapical radiograph of the maxillary right central incisor with gutta-percha tracing. (B) A reformatted axial view of the cone-beam computed tomographic scan of the maxillary right central incisor. The white arrow indicates the mesial root of the tooth, and the black arrow indicates the distal root of the tooth. (C) Three-dimensional reconstruction of the tooth.
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JOE — Volume -, Number -, - 2014
Case Report/Clinical Techniques
Figure 3. (A) A radiograph after root canal treatment and final restoration were done. (B) A postoperative photograph showing the final restoration of the tooth.
a primary tooth, following regular recall is essential to decide further treatment and detect inflammatory root resorption (13). In the present case, the permanent successor might have had a disturbance of development because of the injury in its early development stage. The crown of the permanent successor was not yet completely developed and was sensitive to damage at the time of injury. Moreover, the risk of pulp necrosis of the replanted primary incisor was increased because she did not have any further treatment of the replanted tooth, and subsequent inflammation may have affected the development of the permanent tooth germ (11). Root duplication is a rare complication after the injury of primary teeth. It occurs when half or less than half of the crown is formed at the time of injury (2). A traumatic division of the cervical loop occurs, resulting in the formation of 2 separate roots (1). Andreasen et al (2) reported only 4 teeth with this malformation when they analyzed 117 injured permanent teeth. The age at the time of injury appeared to be 2 years or less, the same age as in this case. However, all teeth with root duplication in this report appeared after intrusive luxation (not the avulsion of primary teeth).
However, another possibility is that the tooth was the fusion of a permanent incisor with a supernumerary tooth. Fusion occurs because of the union of 2 separated tooth germs and forms a joint tooth with a confluence of dentin. Although the exact etiology of fusion is unknown, a possible cause reported is pressure or a physical force providing close contact between 2 developing tooth buds (16). In the present case, the force produced when the primary tooth was rotated or replanted might have affected the tooth germs or displaced them close enough to develop fusion. There was a large restoration covering most of the crown, and it was difficult to distinguish fusion and root duplication in this case. Regarding treatment, defining the pathogenesis of this present case was not critically important, and a root canal treatment was definitely needed. Finding the distal canal was a challenge during treatment because it was positioned at the palatal side. If the existing restoration had been removed completely, detecting the distal canal would have been easier and would have had a lower risk of perforation. The bone healing of the periapical area is still incomplete after a year, but the tooth was asymptomatic and showed no pathologic signs. The
Figure 4. Recall radiographs at 1 year after the treatment.
JOE — Volume -, Number -, - 2014
Unusual Morphology of Permanent Tooth
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Case Report/Clinical Techniques prognosis of the tooth is expected to be fine. There is potential for the contraction of a periodontal problem because of a long buccal groove between the 2 roots, which may hamper the healing of bone around the mesial root. Hence, long-term follow-up is important for this tooth. In conclusion, it can be assumed that the traumatic injury of the primary teeth played a role in the formation of the abnormal root morphology in this case. Clinicians should consider the potential prognoses and complications of traumatic injuries to primary teeth and inform the patients and their guardians about the clinical importance of dental management and further periodic follow-up.
Acknowledgments The authors deny any conflicts of interest related to this study.
References 1. Wilson CF. Management of trauma to primary and developing teeth. Dent Clin North Am 1995;39:133–67. 2. Andreasen JO, Sundstrom B, Ravn JJ. The effect of traumatic injuries to primary teeth on their permanent successors. I. A clinical and histologic study of 117 injured permanent teeth. Scand J Dent Res 1971;79:219–83. 3. Selliseth NE. The significance of traumatised primary incisors on the development and eruption of permenent teeth. Rep Congr Eur Orthod Soc 1970;443–59.
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4. Ravn JJ. Sequelae of acute mechanical traumata in the primary dentition. A clinical study. ASDC J Dent Child 1968;35:281–9. 5. Andersson L. Epidemiology of traumatic dental injuries. J Endod 2013;39(3 Suppl): S2–5. 6. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589–99. 7. Rao Genovese F, Marsico EM. Maxillary central incisor with two roots: a case report. J Endod 2003;29:220–1. 8. Kaufman AY, Keila S, Wasersprung D, Dayan D. Developmental anomaly of permanent teeth related to traumatic injury. Endod Dent Traumatol 1990;6:183–8. 9. Andreasen JO, Ravn JJ. The effect of traumatic injuries to primary teeth on their permanent successors. II. A clinical and radiographic follow-up study of 213 teeth. Scand J Dent Res 1971;79:284–94. 10. Sakai VT, Moretti AB, Oliveira TM, et al. Replantation of an avulsed maxillary primary central incisor and management of dilaceration as a sequel on the permanent successor. Dent Traumatol 2008;24:569–73. 11. Holan G. Replantation of avulsed primary incisors: a critical review of a controversial treatment. Dent Traumatol 2013;29:178–84. 12. Al-Khayatt AS, Davidson LE. Complications following replantation of a primary incisor: a cautionary tale. Br Dent J 2005;198:687–8. 13. Zamon EL, Kenny DJ. Replantation of avulsed primary incisors: a risk benefit assessment. J Can Dent Assoc 2001;67:386. 14. Friedlander LT, Chandler NP, Drummond BK. Avulsion and replantation of a primary incisor tooth. Dent Traumatol 2013;29:494–7. 15. Kinoshita S, Mitomi T, Taguchi Y, Noda T. Prognosis of replanted primary incisors after injuries. Endod Dent Traumatol 2000;16:175–83. 16. Shafer WG, Hine M, Levy BM. Developmental disturbances of oral and papraoral structures. In: A Textbook of Oral Pathology, 4th ed. Philadelphia: WB Saunders; 1993:38–9.
JOE — Volume -, Number -, - 2014
