SEQUELAE OF THE INJURIES

TO THE ANTERIOR TEETH

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Reaction of the tooth to
trauma
• Reversible pulpitis
• Infection to periodontal ligament
• Irreversible pulpitis
• Pulp necrosis & infection
• Coronal discoloration
• Inflammatory resorption
i) Internal
ii) External
• Ankylosis (Replacement Resorption)
• Calcific metamorphosis of the pulp

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Reaction of permanent
tooth buds to injury

• Hypocalcification and hypoplasia

• Reparative dentin
• Dilaceration

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REVERSIBLE PULPITIS
• The pulp’s initial response to trauma is
pulpitis.
• Teeth with reversible pulpitis may be
tender to percussion, if the periodontal
ligament is inflammed (e.g. following a
luxation injury)

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INFECTION TO THE
PERIODONTAL LIGAMENT
A luxation injury to tooth
↓
Detachment of the gingival fibres
↓
Invasion of the microorganism from the oral cavity along
the root to infect the PDL
↓
Resulted in loss of alveolar bone

• Subsequently, increased tooth mobility accompanied by

exudation of pus from the gingival crevice will require
extaction of the injured tooth.

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IRREVERSIBLE PULPITIS
ACUTE/ CHRONIC
• Acute irreversible pulpits following a dental
injury can be painful if the exudates
accompanying the pulpal inflammation
cannot vent.
• Most frequently in children, inflammatory
exudates are quickly vented and the
pulpitis progress to a chronic, painful
condition.

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PULPAL NECROSIS &
INFECTION
A severe blow on the tooth
↓
Displacement
↓
Often results in pulpal necrosis
• Blow – severance of the apical vessels, in which case
the pulp undergoes autolysis and necrosis.
• Appears clinically and radiographically normal
• Loss of the pulp vitality due to traumatic injury at an early
stage of root development results in the arrest of dentin
apposition and cessation of root development.
• In later date, it may be infected so it should be extracted
or treated with endodontic procedures.

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INFECTION
• When pulp exposed by trauma, it may be considered
infected because microorganism gain access to it almost
immediately.
• First, infection is localized to a small area of the pulp.
• Pulp- inflammatory response
PMNL reach the area and prevents dissemination of
bacteria deeper into the pulp.
• If the inflammatory process is severe, it will extend
deeper into the pulp
• During the inflammatory reaction, tissue pressure is
increase, stasis occurs, with resulting necrosis of the
pulp.
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CORONAL
DISCOLORATION
• Crown discoloration is the external expression of
changes in the pulp-dentin complex that become visible
through the almost transparent enamel.
• As a result of trauma, the capillaries in the pulp
occasionally haemorrhage, leaving blood pigments
deposited in the dentinal tubules & discoloration of
crown of the tooth occurs.
• The variety of colours is traditionally divided in to three
main groups:
1. Pink-red
2. Yellow &
3. Dark (Gray-brown &black)
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• PINK DISCOLORATION-it is observed shortly after the
injury may represent intrapulpal haemorrhage. Rupture
of blood vessels in the pulp as a result of the injury
allows extravasation of red blood cells in to the
surrounding pulpal tissue, resulting in a reddish hue of
the crown.
• YELLOW DISCOLORATION- seen when the dentin is
thick and the pulp chamber narrower than usual This
condition is termed pulp canal obliteration(PCO).
PCO is a pathologic process, it has no known deleterios
effects and therefore does not necessitate any treatment
except follow-up.

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DARK DISCOLORATION – when the pulp becomes
necrotic or when pulpal hemorrhage occurs, red blood cells
undergo lysis and release heamoglobin.
Haemoglobin and it’s derivatives, such as hematin
molecules that contain iron ions, invade the dentin tubules
& stain the tooth dark.
If the pulp remains vital and eliminates the pigments, the
dark discoloration may fade with subsequent restoration of
the original color.
If the pulp loses its vitality and cannot eliminate the iron
containing molecules, the tooth may remain discoloured.

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INFLAMMATORY
RESORPTION
• It can occur either on the external root
surface or internally in the pulp chamber
or canal.
• It occurs subsequent to luxation injuries
and is related to a necrotic pulp and a
inflammed PDL.

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 INTERNAL RESORPTION
• I.R. is a destructive process generally caused by
odontoclastic action; it may be observed radiographically in
the pulp chamber or canal within a few weeks or months
after an injury.
• The destructive process may progress slowly or rapidly.
• If progression is rapid, it may cause a perforation of the
crown or root within a few weeks.
• Mummery described this condition as ‘PINK SPOT’
because when the crown is affected, the vascular tissue of
the pulp shines through the remaining thin shell of the tooth.
• If a perforation occurred, he referred to as ‘PERFORATING
HYPERPLASIA OF THE PULP’.
• If detected early, the tooth may treated with endodontic
procedure.

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EXTERNAL RESORPTION

• In nontraumatized primary teeth, external

root resorption is part of the physiological
process of replacing the primary dentition
with permanent teeth.
• In primary incisors sustaining traumatic
injuries, external root resorption may
appear as an accelerated unfavourable
pathological reaction.

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• External inflammatory root resorption ,as
in permanent teeth, is a rapid process
characterized clinically by increased
mobility of the tooth, sensitivity to
percussion, and often a fistula or swelling
in the gums above the tooth.
• Radiographically the PDL space is
widened and the root surface is irregular.
• This condition may develop within a few
weeks of the injury.

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ANKYLOSIS(REPLACEMENT
RESORPTION)
• Injury to periodontal membrane and subsequent
inflammation associated with invasion by
osteoclastic cells.
• Results in irregular resorbed areas on the
peripheral root surface.
• In histologic section repair can be seen that may
cause a mechanical lock or fusion b/w alveolar
bone and root surface.
• The adjacent teeth continue to erupt, whereas
the ankylosed tooth remain fixed in relation to
surrounding structures.

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• The ankylosed anterior primary tooth should be
removed if there is evidence of its causing
delayed or ectopic eruption of the permanent
successor.
• If ankylosis of a permanent tooth occurs during
active eruption, eventually a discrepancy b/w the
position of this tooth and its adjacent ones will
be obvious.
• The injured teeth will continue to erupt and may
drift mesially with a loss of arch length.
• Therefore the removal of a permanent tooth that
becomes ankylosed is often necessary.

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CALCIFIC METAMORPHOSIS
OF DENTAL PULP
• A frequently observed reaction to trauma is the
partial or complete obliteration of the pulp
chamber and canal.
• Patterson and Mitchell identified calcific
metamorphosis as a pathologic deviation from
the normal pulp and surrounding dentin.
• The crown of teeth that have undergone this
reaction may have a yellowish opaque color.

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• Primary teeth demonstrating calcific
metamorphosis will usually undergo normal root
resorption.
• Permanent teeth will often be retained
indefinitely.
• However, a permanent tooth showing signs of
calcific changes as a result of trauma should be
regarded as a potential focus of infection.
• For this reason endodontics recommend that
root canal therapy be instituted as soon as
diminution of the pulp canal becomes apparent.

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REACTION OF PERMANENT
TOOTH BUDS TO INJURY
• Injury to the anterior primary teeth may
have possibility of damage to the
underlying developing permanent teeth.
• Because anatomically the permanent
anterior teeth develop in close proximity to
the apices of primary incisors.

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HYPOCALCIFICATION AND
HYPOPLASIA
• Cutrights experiments-
• He observed small areas that showed
destruction of the ameloblasts and a pitted area
where a thin enamel layer had been laid down
before the injury.
• In other teeth there was evidence of destruction
of the ameloblasts before any enamel had been
laid down resulting in Hypoplasia that clinically
appeared as deep pitting.
• A small pigmented hypoplastic area has been
referred to as TURNER TOOTH.
• Small hypoplastic defects may be restored by
the resin bonding www.FourthMolar.com
technique.
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REPARATIVE DENTIN
• If the injury to the developing permanent
tooth is severe enough to remove the thin
covering of developing enamel or cause
destruction of the ameloblasts, the
subjacent odontoblasts have been
observed to produce a reparative type of
dentin.

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DILACERATION
• Occasionally, occurs after the intrusion or
displacement of an anterior primary tooth.
• The developed portion of the tooth is
twisted or bent on itself and in this new
position growth of the tooth progresses.

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 References
1. Pediactric dentistry infancy through
adolescence, 4th Edition, Pinkham,
Casamassimo, Fields, Mctigue, Nowak
2. Dentistry for the child and adolescent, 6th
Edition, Ralph E.Mcdonald, David
R.Avery
3. Text book of Pedodontics, 1st Edition,
Shobha Tondon
4. www.google.co.in
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