Delayed tooth eruption as a result of trauma.

A tooth displaced down into alveolar bone is an intrusive luxation. This injury usually is accompanied by comminution of alveolar fracture. The dislocation is frequently axial and radiographic examination reveals absence of periodontal space. The primary site for luxation injuries is the maxillary anterior region in the primary and permanent dentition with frequency higher in the primary dentition. The optimal treatment for intruded permanent teeth has not been determined, but Andreasen suggests the tooth should be allowed to re-erupt or be moved into position via orthodontic measures. Immediate replacement of intruded teeth into their normal position frequently is followed by resorption of the crest of the alveolar bone. An unusual case of intrusive luxation of two permanent central incisors is described in which tooth emergence into the oral cavity was delayed and some keratinized gingiva altered. ten-year-old male presented with the complaint that both permanent maxillary central incisors had failed to erupt. The right central incisor crown was covered completely by an adherent elastic mucosa, and the left central incisor crown was exposed only at the distoincisal edge. The anatomical crowns of the teeth could be palpated (Figure 1). There was lack of attached gingiva adjacent to the maxillary central incisors with an absence of the anterior vestibular fornix. Oral hygiene was poor and severe gingival inflammation was present in the vestibular area adjacent to the lateral incisors. Inflammation of gingival tissue was most evident mesial to the maxillary lateral incisors where tissue folds entrapped plaque and food debris. The maxillary right lateral incisor showed an area of hypocalcification on the labial surface with subsequent demineralization due to inadequate plaque removal. A band of intrinsic strain of unknown etiology was evident on the incisal half of the four mandibular permanent incisors. Figure 1. Note the lack of eruption of the right central incisor and partial emergence of the left central incisor. Note also the lack of fornix and the plaque accumulation on the labial surfaces of the maxillary lateral incisors. Radiographic examination revealed root dilaceration of the right permanent central incisor; root development on all other permanent teeth was normal (Figure 2). The maxillary right first permanent molar was lost prematurely due to caries and as a result the maxillary right second permanent molar erupted in mesial version. The maxillary left central incisor appeared to be erupting into a true crossbite. In addition, there was a functional anterior crossbite due to forward thrusting of the mandible. This motion avoided lacerating soft tissue covering the incisor edges of the maxillary central incisors. It appeared that there would be sufficient space available for the eruption of both maxillary incisors. A severe traumatic injury at age two resulted in fracture and intrusion of the maxillary primary central and lateral incisors, with probable displacement of the developing maxillary right permanent central incisor. This traumatic episode may have resulted in the root dilaceration of the right permanent incisor and delayed eruption. The child sustained another trauma to the same 150 DELAYED TOOTH ERUPTION DUE TO TRAUMA: Shey et al. Figure 2. In this panorex radiogram showing the developing dentition, note the root dilaceration of the maxillary right central incisor. Mesial migration of the maxillary left first permanent molar is considered to be a result of premature loss of second primary molar. Figure 3. After four months of conservative treatment since the initial visit, the left central incisor erupted into crossbite. Figure 4. One week postoperatively, the surgical area shows adequate healing. Note the poor oral hygiene in the mandibular incisor area. region of the mouth at age eight in a bicycle accident, causing severe laceration of soft tissue and intrusion of both erupting permanent central incisors. The oral wound was not treated and healing may have occurred by fusion of labial and palatal fibrous connective tissue and oral epithelium. This accident may have resulted in loss of attached gingiva and delayed eruption of the permanent central incisors. The amount of gingiva may have been minimal or not present prior to the trauma and severe laceration of the labial frenum may have occurred with simultaneous intrusive luxation of the teeth resulting in the fusion of labial and palatal soft tissues.