Title	Primary Tooth Trauma Is Associated With A High Incidence Of Developmental Defects In The Permanent Successor
Clinical Question	What is the likelihood that a traumatic injury to a primary tooth will cause some type of developmental sequelae with the permanent successor?
Clinical Bottom Line	Trauma to the primary dentition will result in some type of developmental defect of the permanent successor 22% of the time. This is increased if the traumatic injury is intrusion of the primary incisors (54%).
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 21199335 de Amorim/2011 148 children with 241 injured primary teeth Prospective cohort study Key results A total of 148 children with 241 injured primary teeth were included in the study. The patients were categorized as to gender, type of trauma, and age at trauma. 83% of traumatized teeth were maxillary incisors, 11% maxillary lateral incisors, 4% mandibular central/lateral incisors, 2% canines/molars. Subjects were followed until the time of eruption of the permanent successor. and any developmental defects were noted. 78% had no defects in permanent successor, 22% did. 74% had enamel discoloration or hypoplasia, 26% had eruption disorders. Based on logistic regression analysis, traumas that occurred between 1-3 years of age showed a higher prevalence of permanent tooth sequelae. 19121957 Altun/2009 78 children with 138 primary incisors with intrusive trauma injuries Prospective cohort study Key results A total of 78 children with 138 traumatically intruded primary incisors were followed from time of injury until eruption of the permanent successor. Demographic data and type of trauma were collected. Maxillary primary incisors accounted for 93% of all intruded teeth. Most injuries (77%) occurred between 13-36 months of age. 54% of permanent teeth had some type of developmental sequelae. 28% had enamel hypoplasia, 17% crown deformation, 17% ectopic eruption. This study did not find any significant correlation of age at time of trauma and frequency of development sequelae.
Evidence Search	traumatic[All Fields] AND ("tooth, deciduous"[MeSH Terms] OR ("tooth"[All Fields] AND "deciduous"[All Fields]) OR "deciduous tooth"[All Fields] OR ("primary"[All Fields] AND "tooth"[All Fields]) OR "primary tooth"[All Fields]) AND ("injuries"[Subheading] OR "injuries"[All Fields] OR "wounds and injuries"[MeSH Terms] OR ("wounds"[All Fields] AND "injuries"[All Fields]) OR "wounds and injuries"[All Fields]) AND ("dentition, permanent"[MeSH Terms] OR ("dentition"[All Fields] AND "permanent"[All Fields]) OR "permanent dentition"[All Fields] OR ("permanent"[All Fields] AND "tooth"[All Fields]) OR "permanent tooth"[All Fields]) AND ("abnormalities"[Subheading] OR "abnormalities"[All Fields] OR "defects"[All Fields])
Comments on The Evidence	The two studies presented here have larger sample size and good follow up. Both studies showed that maxillary incisors are the most commonly traumatized primary tooth. There was percentage difference in the frequency of permanent tooth sequelae between the studies. This is not surprising since the first study (22%) was looking at all primary tooth types and the 2nd study (54%) at only primary incisors. Since both studies found maxillary primary incisors as the most commonly injured tooth, it isn’t surprising the percentage is higher.
Applicability	Any dentist that would possibly treat children for traumatic primary tooth injury.
Specialty	(General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords	Primary tooth trauma, developmental sequelae
ID#	2161
Date of submission	10/07/2011
E-mail	dietrichm@livemail.uthscsa.edu
Author	Matthew Dietrich
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Peter T. Gakunga, BDS, MS, PhD
Faculty mentor e-mail	GAKUNGA@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Andrea Le and Christopher Adams (San Antonio, TX) on 12/01/2017 The PubMed database was searched for the above terms in November 2017. The articles addressed in this CAT were confirmed as the highest level of evidence published on this topic. Additional minor support for this CAT conclusion was provided by two case study reports: one published in 2017 (PMID: 28475088) and the other published in 2014 (PMID: 25115661). Both case studies describe a rare case of primary central incisor trauma that led to developmental sequelae. There are still no new primary or secondary studies that include statistics on traumatic injury to a primary tooth leading to a developmental sequelae with the permanent successor.