- Email: [email protected]
Spontaneous re-eruption of intruded permanent incisors: five case reports
Spontaneous re-eruption of intruded permanent incisors: five case reports Is¸ıl S¸arog˘lu, DMD, PhD,a Emine S¸en Tunç, DMD, PhD,b and Hayriye Sönmez, DMD, PhD,c Kırıkkale, Samsun, and Ankara, Turkey UNIVERSITY OF KIRIKKALE, UNIVERSITY OF ONDOKUZ MAYIS, AND UNIVERSITY OF ANKARA
This report presents 5 cases of intrusive luxation in immature permanent central incisors. The intruded incisors, with careful monitoring, were allowed to spontaneously re-erupt, which avoided the need to reposition the tooth either orthodontically or surgically. All of the teeth re-erupted spontaneously in a few months. The root development continued in all of the cases and all pulps remained vital. There were no other signs of pulpal and/or periapical pathology. It can be concluded that intruded immature permanent teeth can spontaneously re-erupt, conserve their vitality, and continue their root development without any surgical or orthodontic management. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:e60-e65)
Intrusive luxation injuries are axial displacements of the teeth into the supporting alveolar bone, which results in comminution or fracture of the socket and considerable injury to the periodontal ligament. Clinical signs are a reduced clinical crown length and expansion of the labial alveolar bone. Radiographically, the periodontal space is missing or reduced.1 Intrusive luxations have received relatively little attention in the literature compared with other types of trauma. Andreasen2 found that only 3% of permanent teeth injuries were intrusive luxation. The optimal treatment for intruded permanent teeth has not yet been determined.1 Management of an intruded permanent tooth may consist of 1. 2. 3. 4.
Observation for spontaneous eruption Surgical crown uncovering Orthodontic extrusion Partial surgical extrusion, immediately followed by orthodontic extrusion and surgical repositioning.3
Observation for spontaneous eruption is based on the empiric finding that intruded immature teeth frequently erupt spontaneously in a few months.4,5 This conservative management spares the child from overtreatment and enables periodontal healing.3 a
Assistant Professor, Department of Pediatric Dentistry, Faculty of Dentistry, University of Kırıkkale. b Assistant Professor, Department of Pediatric Dentistry, Faculty of Dentistry, University of Ondokuz Mayıs. c Professor, Department of Pediatric Dentistry, Faculty of Dentistry, University of Ankara. Received for publication Nov 8, 2005; returned for revision Nov 23, 2005; accepted for publication Nov 29, 2005. 1079-2104/$ - see front matter © 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2005.11.033
e60
The aim of this article was to report 5 spontaneously re-erupted immature permanent teeth without any sign of pulpal and/or periapical pathology. CASE REPORTS All of the cases reported here involved children who were referred to the Department of Pediatric Dentistry, University of Ankara, Turkey, for the management of intruded central incisors. In our clinic the main treatment principle of intruded immature permanent teeth is allowing for spontaneous reeruption if endodontic intervention is not deemed necessary. If the teeth do not show any sign of re-eruption in a few months or endodontic treatment is required, orthodontic repositioning is employed. Seven successive referrals of intruded immature permanent teeth have been followed for extended periods. In 2 cases spontaneous eruption did not occur because of severe crowding. These 2 teeth were repositioned with an orthodontic appliance and are not included in this report. Medical histories of the children were noncontributory. The children were instructed to rinse daily with 0.12% chlorhexidine gluconate. Standard clinical and radiographic examination procedures were used in all cases. The difference between the incisal edge of the intruded tooth and the adjacent incisor was noted. The roots of all of the intruded teeth were incompletely developed and there were no root or alveolar bone fractures noticed. It was decided not to reposition the teeth surgically at first but to allow some time for possible spontaneous re-eruption. The patients were then reviewed at 2, 4, and 8 weeks and every 3 months thereafter. At each recall visit, mobility, percussion, palpation, and vitality tests; measurement of the difference between the incisal edge of the teeth suffering from intrusion and the adjacent incisor (the amount of eruption); and radiographic controls of the related tooth were carried out. In the follow-up examinations, it was seen that the root development and the pulp vitality continued without any signs of pulpal and/or periapical pathology in all of the cases. All of the teeth fully re-erupted spontaneously in a few months (3 to 8 months).
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Case 1 The first case report involved an 8-year-old girl who came to our clinic 2 weeks after having fallen in school. Intraoral examination revealed that right maxillary central incisor was intrusively luxated. The parents of the child informed us that she had an anterior open bite before the trauma. Radiographically the tooth appeared to have open apex and it had been intruded approximately 3 to 4 mm (Fig. 1A). The tooth was fully re-erupted at the 6-month follow-up. After 2 years follow-up the root development was completed without any signs of clinical or radiographic pathology (Fig. 1B).
Case 2 An 8-year-old boy was seen at our clinic 5 days after an automobile accident, which led to almost complete intrusion of his anterior tooth. The maxillary left central incisor was intruded 8 mm. The mesial edge was visible and had an enamel fracture. The maxillary right central incisor was slightly mobile and sensitive to percussion, and had an uncomplicated enamel-dentin fracture. Radiographs obtained did not show evidence of root fractures and confirmed the clinical diagnosis of intrusion and enamel fracture in the left maxillary central incisor, and concussion and enamel-dentin fracture in the right maxillary central incisor (Fig. 2A). Both teeth had incomplete root development. The left maxillary central incisor was fully re-erupted after 4 months. In the 2-year follow-up, it was noted that the root development had continued and the tooth gave a vital pulpal response on electric pulp testing (Fig. 2B).
Case 3 A healthy 8-year-old girl had fallen at home and injured herself 1 day earlier. The maxillary left central incisor was intruded with one third of the clinical crown below the free gingival margin (Fig. 3A). In the follow-up examinations the tooth was slowly re-erupting. The tooth was fully re-erupted in approximately 8 months. After 1-year follow-up it was noted that the root development was nearly completed. The clinical and radiographic examination showed that the tooth was clinically symptomless and the periodontal tissues were healthy (Fig. 3B).
Case 4 A 7-year-old girl slipped and fell on the ground at school. Her maxillary left central incisor suffered mild intrusive luxation and an enamel-dentin crown fracture. Radiographs confirmed an immature root (Fig. 4A). After 2.5-year follow-up the tooth was re-erupted and gave positive response to vitality test. The root development was completed without any signs of pathology (Fig. 4B).
Case 5 This case involved a 9-year-old boy who had fallen in school 2 days earlier. Intraoral examination revealed a red and swollen gingiva around the maxillary left central tooth. The maxillary central incisors were sensitive to percussion and the maxillary left central incisor was markedly intruded. Radiographic examination showed that the teeth had open apices
Fig. 1. Case 1. A, Initial radiograph. B, Periapical radiograph after 2 years.
e62 S¸arog˘lu et al.
Fig. 2. Case 2. A, Initial radiograph. B, Periapical radiograph after 2 years.
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Fig. 3. Case 3. A, Initial radiograph. B, Periapical radiograph after 1 year.
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S¸arog˘lu et al. e63 and no root fracture was evident (Fig. 5, A). Approximately 3 months later, the maxillary left central tooth was clinically fully re-erupted. In the 8-month follow-up electric pulp sensitivity tests resulted in positive responses. The tooth was asymptomatic and there was no sensitivity to percussion or palpation. Radiographic examination revealed that the root development continued without any sign of pathology (Fig. 5, B). No further follow-up was possible because the patient and his family moved to another town.
Fig. 4. Case 4. A, Initial radiograph. B, Periapical radiograph after 2.5 years.
DISCUSSION Intrusive luxation is defined as displacement of the tooth deeper into the alveolar bone.1 This common and very specific type of injury in the deciduous dentition occurs less frequently in permanent teeth6-8 and might result in unexpectedly severe complications, such as pulp necrosis, inflammatory root resorption, ankylosis, replacement resorption, and loss of marginal bone support.1,9 In the dental literature different treatment approaches have been suggested for the management of intrusive luxation injuries. However, disagreement exists regarding the most favorable approach to bring intruded teeth back to their normal position. Ellis10 stated that treatment of such cases was limited and recommended observation for re-eruption. Whereas Ellis considered it inadvisable to cause further disturbance to the apical and periodontal tissue, some authors recommend immediate surgical repositioning in most cases.11,12 On the other hand some authors suggest that surgical repositioning of intruded teeth may increase the risk of external root resorption and loss of marginal bone support.1,13 Surgical replacement might be indicated only when the tooth is displaced into the vestibule or through the floor of the nose.14 Although there is a lack of general agreement concerning the optimal treatment for traumatically intruded permanent incisor teeth, there is a general agreement that immature teeth normally will re-erupt spontaneously because of their high potential for eruption and for pulp and periodontal repair.1,4,15-17 Taintor et al.18 recommended that the injured tooth be left to re-erupt on its own and, in those instances in which it does not do so, that it be extruded orthodontically. Faria et al.19 stated that waiting for spontaneous re-eruption associated with gingivectomy and endodontic treatment is an alternative treatment for intrusive luxations even in mature permanent teeth. In the cases reported here, the more conservative option of observation was chosen, as endodontic intervention was not deemed necessary. The teeth were carefully monitored for continuing signs of vitality and if endodontics had been required gingival surgery or orthodontic repositioning may have been employed. All
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e64 S¸arog˘lu et al.
of the teeth reported here maintained their vitality and did not show any sign of periapical pathology during the follow-up periods. However Andreasen20 stated that severe healing complications could be seen as late as 5 to 10 years after trauma. Except the last case whose family moved to another town, all of the cases are still under observation in order to provide early diagnosis if any sign of complications occurs. CONCLUSION Careful monitoring for spontaneous re-eruption of the intruded immature permanent teeth is a more conservative treatment approach compared with surgical or orthodontic extrusion. The present case reports suggest that these teeth have a high potential of spontaneous eruption, while conserving their vitality and continuing root development. REFERENCES
Fig. 5. Case 5. A, Initial radiograph. B, Periapical radiograph after 8 months.
1. Andreasen JO, Andreasen FM. Textbook and colour atlas of traumatic injuries to the teeth. 3rd ed. Copenhagen: Munksgaard, Mosby; 1994. 2. Andreasen JO. Luxation of permanent teeth due to trauma. Scand J Dent 1970;78:273-86. 3. Sapir S, Mamber E, Slutzky-Goldberg I, Fuks AB. A novel multidisciplinary approach for the treatment of an intruded immature permanent incisor. Pediatr Dent 2004;26:421-5. 4. Shapira J, Regev L, Liebfeld H. Re-eruption of completely intruded immature permanent incisors. Endod Dent Traumatol 1986;2:113-6. 5. Alves LD, Donnely JC, Lugo A, Carter D. Re-eruption and extrusion of a traumatically intruded immature permanent incisor: Case report. J Endod 1997;23:246-8. 6. Altay N, Güngör HC. A retrospective study of dento alveolar injuries of children in Ankara, Turkey. Dent Traumatol 2001;17:201-4. 7. Kırzıog˘lu Z, Özay Ertürk S, Karayılmaz H. Traumatic injuries of the permanent incisors in children in southern Turkey: a retrospective study. Dent Traumatol 2005;21:20 –5. 8. S¸arog˘lu I, Sönmez H. The prevalence of traumatic injuries treated in the pedodontic clinic of Ankara University, Turkey, during 18 months. Dent Traumatol 2002;18:299-303. 9. Chan AWK, Cheung GSP, Ho MWM. Different treatment outcomes of two intruded permanent incisors: a case report. Dent Traumatol 2001;17:275-80. 10. Ellis RG. The classification and treatment of injuries to the teeth of children. 2nd ed. Chicago: Year Book Publishers, Inc; 1948. 11. Skieller V. The prognosis for young teeth loosened after mechanical injuries. Acta Odontol Scand 1960;18:171-81. 12. Kinirons MJ, Sutcliffe J. Traumatically intruded permanent incisors: a study of treatment and outcome. Brit Dent J 1991;170:144-6. 13. Saad AY, Abdellatief EM. Surgical repositioning of unerupted anterior teeth. J Endod 1996;22:376-9. 14. Jacobsen I. Traumatic injuries to the teeth. In: Magnusson BO. Pedodontics: a systemic approach. Copenhagen: Munksgaard; 1981. 15. Jacobsen I. Clinical follow-up study of permanent incisors with intrusive luxation after acute trauma. J Dent Res 1983;62:486 (abstract no. 37). 16. Tronstad L, Trope M, Bank M, Barnett F. Surgical access for
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17. 18. 19.
20.
endodontic treatment of intruded teeth. Endod Dent Traumatol 1986;2:75-8. Holan G, Rom D. Sequelae and prognosis of intruded primary incisors: a retrospective study. Pediatr Dent 1999;21:242-7. Taintor JF, Bonness PW, Biesterfeld RD. The intruded tooth. Dent Survey 1977;55:30-4. Faria G, Silva RAB, Fiori-Junior M, Nelson-Filha P. Re-eruption of traumatically intruded mature permanent incisor: case report. Dent Traumatol 2004;20:229-32. Andreasen FM. Pulpal healing after luxation injuries and root
S¸arog˘lu et al. e65 fracture in the permanent dentition. Endod Dent Traumatol 1989;5:111-31. Reprint requests: Is¸ıl S¸arog˘lu, DMD, PhD ¨ niversitesi Kırıkkale U Dis¸ Hekimlig˘i Fakültesi Pedodonti ABD Kırıkkale Türkiye [email protected]
This report presents 5 cases of intrusive luxation in immature permanent central incisors. The intruded incisors, with careful monitoring, were allowed to spontaneously re-erupt, which avoided the need to reposition the tooth either orthodontically or surgically. All of the teeth re-erupted spontaneously in a few months. The root development continued in all of the cases and all pulps remained vital. There were no other signs of pulpal and/or periapical pathology. It can be concluded that intruded immature permanent teeth can spontaneously re-erupt, conserve their vitality, and continue their root development without any surgical or orthodontic management. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:e60-e65)
Intrusive luxation injuries are axial displacements of the teeth into the supporting alveolar bone, which results in comminution or fracture of the socket and considerable injury to the periodontal ligament. Clinical signs are a reduced clinical crown length and expansion of the labial alveolar bone. Radiographically, the periodontal space is missing or reduced.1 Intrusive luxations have received relatively little attention in the literature compared with other types of trauma. Andreasen2 found that only 3% of permanent teeth injuries were intrusive luxation. The optimal treatment for intruded permanent teeth has not yet been determined.1 Management of an intruded permanent tooth may consist of 1. 2. 3. 4.
Observation for spontaneous eruption Surgical crown uncovering Orthodontic extrusion Partial surgical extrusion, immediately followed by orthodontic extrusion and surgical repositioning.3
Observation for spontaneous eruption is based on the empiric finding that intruded immature teeth frequently erupt spontaneously in a few months.4,5 This conservative management spares the child from overtreatment and enables periodontal healing.3 a
Assistant Professor, Department of Pediatric Dentistry, Faculty of Dentistry, University of Kırıkkale. b Assistant Professor, Department of Pediatric Dentistry, Faculty of Dentistry, University of Ondokuz Mayıs. c Professor, Department of Pediatric Dentistry, Faculty of Dentistry, University of Ankara. Received for publication Nov 8, 2005; returned for revision Nov 23, 2005; accepted for publication Nov 29, 2005. 1079-2104/$ - see front matter © 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2005.11.033
e60
The aim of this article was to report 5 spontaneously re-erupted immature permanent teeth without any sign of pulpal and/or periapical pathology. CASE REPORTS All of the cases reported here involved children who were referred to the Department of Pediatric Dentistry, University of Ankara, Turkey, for the management of intruded central incisors. In our clinic the main treatment principle of intruded immature permanent teeth is allowing for spontaneous reeruption if endodontic intervention is not deemed necessary. If the teeth do not show any sign of re-eruption in a few months or endodontic treatment is required, orthodontic repositioning is employed. Seven successive referrals of intruded immature permanent teeth have been followed for extended periods. In 2 cases spontaneous eruption did not occur because of severe crowding. These 2 teeth were repositioned with an orthodontic appliance and are not included in this report. Medical histories of the children were noncontributory. The children were instructed to rinse daily with 0.12% chlorhexidine gluconate. Standard clinical and radiographic examination procedures were used in all cases. The difference between the incisal edge of the intruded tooth and the adjacent incisor was noted. The roots of all of the intruded teeth were incompletely developed and there were no root or alveolar bone fractures noticed. It was decided not to reposition the teeth surgically at first but to allow some time for possible spontaneous re-eruption. The patients were then reviewed at 2, 4, and 8 weeks and every 3 months thereafter. At each recall visit, mobility, percussion, palpation, and vitality tests; measurement of the difference between the incisal edge of the teeth suffering from intrusion and the adjacent incisor (the amount of eruption); and radiographic controls of the related tooth were carried out. In the follow-up examinations, it was seen that the root development and the pulp vitality continued without any signs of pulpal and/or periapical pathology in all of the cases. All of the teeth fully re-erupted spontaneously in a few months (3 to 8 months).
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S¸arog˘lu et al. e61
Case 1 The first case report involved an 8-year-old girl who came to our clinic 2 weeks after having fallen in school. Intraoral examination revealed that right maxillary central incisor was intrusively luxated. The parents of the child informed us that she had an anterior open bite before the trauma. Radiographically the tooth appeared to have open apex and it had been intruded approximately 3 to 4 mm (Fig. 1A). The tooth was fully re-erupted at the 6-month follow-up. After 2 years follow-up the root development was completed without any signs of clinical or radiographic pathology (Fig. 1B).
Case 2 An 8-year-old boy was seen at our clinic 5 days after an automobile accident, which led to almost complete intrusion of his anterior tooth. The maxillary left central incisor was intruded 8 mm. The mesial edge was visible and had an enamel fracture. The maxillary right central incisor was slightly mobile and sensitive to percussion, and had an uncomplicated enamel-dentin fracture. Radiographs obtained did not show evidence of root fractures and confirmed the clinical diagnosis of intrusion and enamel fracture in the left maxillary central incisor, and concussion and enamel-dentin fracture in the right maxillary central incisor (Fig. 2A). Both teeth had incomplete root development. The left maxillary central incisor was fully re-erupted after 4 months. In the 2-year follow-up, it was noted that the root development had continued and the tooth gave a vital pulpal response on electric pulp testing (Fig. 2B).
Case 3 A healthy 8-year-old girl had fallen at home and injured herself 1 day earlier. The maxillary left central incisor was intruded with one third of the clinical crown below the free gingival margin (Fig. 3A). In the follow-up examinations the tooth was slowly re-erupting. The tooth was fully re-erupted in approximately 8 months. After 1-year follow-up it was noted that the root development was nearly completed. The clinical and radiographic examination showed that the tooth was clinically symptomless and the periodontal tissues were healthy (Fig. 3B).
Case 4 A 7-year-old girl slipped and fell on the ground at school. Her maxillary left central incisor suffered mild intrusive luxation and an enamel-dentin crown fracture. Radiographs confirmed an immature root (Fig. 4A). After 2.5-year follow-up the tooth was re-erupted and gave positive response to vitality test. The root development was completed without any signs of pathology (Fig. 4B).
Case 5 This case involved a 9-year-old boy who had fallen in school 2 days earlier. Intraoral examination revealed a red and swollen gingiva around the maxillary left central tooth. The maxillary central incisors were sensitive to percussion and the maxillary left central incisor was markedly intruded. Radiographic examination showed that the teeth had open apices
Fig. 1. Case 1. A, Initial radiograph. B, Periapical radiograph after 2 years.
e62 S¸arog˘lu et al.
Fig. 2. Case 2. A, Initial radiograph. B, Periapical radiograph after 2 years.
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Fig. 3. Case 3. A, Initial radiograph. B, Periapical radiograph after 1 year.
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S¸arog˘lu et al. e63 and no root fracture was evident (Fig. 5, A). Approximately 3 months later, the maxillary left central tooth was clinically fully re-erupted. In the 8-month follow-up electric pulp sensitivity tests resulted in positive responses. The tooth was asymptomatic and there was no sensitivity to percussion or palpation. Radiographic examination revealed that the root development continued without any sign of pathology (Fig. 5, B). No further follow-up was possible because the patient and his family moved to another town.
Fig. 4. Case 4. A, Initial radiograph. B, Periapical radiograph after 2.5 years.
DISCUSSION Intrusive luxation is defined as displacement of the tooth deeper into the alveolar bone.1 This common and very specific type of injury in the deciduous dentition occurs less frequently in permanent teeth6-8 and might result in unexpectedly severe complications, such as pulp necrosis, inflammatory root resorption, ankylosis, replacement resorption, and loss of marginal bone support.1,9 In the dental literature different treatment approaches have been suggested for the management of intrusive luxation injuries. However, disagreement exists regarding the most favorable approach to bring intruded teeth back to their normal position. Ellis10 stated that treatment of such cases was limited and recommended observation for re-eruption. Whereas Ellis considered it inadvisable to cause further disturbance to the apical and periodontal tissue, some authors recommend immediate surgical repositioning in most cases.11,12 On the other hand some authors suggest that surgical repositioning of intruded teeth may increase the risk of external root resorption and loss of marginal bone support.1,13 Surgical replacement might be indicated only when the tooth is displaced into the vestibule or through the floor of the nose.14 Although there is a lack of general agreement concerning the optimal treatment for traumatically intruded permanent incisor teeth, there is a general agreement that immature teeth normally will re-erupt spontaneously because of their high potential for eruption and for pulp and periodontal repair.1,4,15-17 Taintor et al.18 recommended that the injured tooth be left to re-erupt on its own and, in those instances in which it does not do so, that it be extruded orthodontically. Faria et al.19 stated that waiting for spontaneous re-eruption associated with gingivectomy and endodontic treatment is an alternative treatment for intrusive luxations even in mature permanent teeth. In the cases reported here, the more conservative option of observation was chosen, as endodontic intervention was not deemed necessary. The teeth were carefully monitored for continuing signs of vitality and if endodontics had been required gingival surgery or orthodontic repositioning may have been employed. All
OOOOE October 2006
e64 S¸arog˘lu et al.
of the teeth reported here maintained their vitality and did not show any sign of periapical pathology during the follow-up periods. However Andreasen20 stated that severe healing complications could be seen as late as 5 to 10 years after trauma. Except the last case whose family moved to another town, all of the cases are still under observation in order to provide early diagnosis if any sign of complications occurs. CONCLUSION Careful monitoring for spontaneous re-eruption of the intruded immature permanent teeth is a more conservative treatment approach compared with surgical or orthodontic extrusion. The present case reports suggest that these teeth have a high potential of spontaneous eruption, while conserving their vitality and continuing root development. REFERENCES
Fig. 5. Case 5. A, Initial radiograph. B, Periapical radiograph after 8 months.
1. Andreasen JO, Andreasen FM. Textbook and colour atlas of traumatic injuries to the teeth. 3rd ed. Copenhagen: Munksgaard, Mosby; 1994. 2. Andreasen JO. Luxation of permanent teeth due to trauma. Scand J Dent 1970;78:273-86. 3. Sapir S, Mamber E, Slutzky-Goldberg I, Fuks AB. A novel multidisciplinary approach for the treatment of an intruded immature permanent incisor. Pediatr Dent 2004;26:421-5. 4. Shapira J, Regev L, Liebfeld H. Re-eruption of completely intruded immature permanent incisors. Endod Dent Traumatol 1986;2:113-6. 5. Alves LD, Donnely JC, Lugo A, Carter D. Re-eruption and extrusion of a traumatically intruded immature permanent incisor: Case report. J Endod 1997;23:246-8. 6. Altay N, Güngör HC. A retrospective study of dento alveolar injuries of children in Ankara, Turkey. Dent Traumatol 2001;17:201-4. 7. Kırzıog˘lu Z, Özay Ertürk S, Karayılmaz H. Traumatic injuries of the permanent incisors in children in southern Turkey: a retrospective study. Dent Traumatol 2005;21:20 –5. 8. S¸arog˘lu I, Sönmez H. The prevalence of traumatic injuries treated in the pedodontic clinic of Ankara University, Turkey, during 18 months. Dent Traumatol 2002;18:299-303. 9. Chan AWK, Cheung GSP, Ho MWM. Different treatment outcomes of two intruded permanent incisors: a case report. Dent Traumatol 2001;17:275-80. 10. Ellis RG. The classification and treatment of injuries to the teeth of children. 2nd ed. Chicago: Year Book Publishers, Inc; 1948. 11. Skieller V. The prognosis for young teeth loosened after mechanical injuries. Acta Odontol Scand 1960;18:171-81. 12. Kinirons MJ, Sutcliffe J. Traumatically intruded permanent incisors: a study of treatment and outcome. Brit Dent J 1991;170:144-6. 13. Saad AY, Abdellatief EM. Surgical repositioning of unerupted anterior teeth. J Endod 1996;22:376-9. 14. Jacobsen I. Traumatic injuries to the teeth. In: Magnusson BO. Pedodontics: a systemic approach. Copenhagen: Munksgaard; 1981. 15. Jacobsen I. Clinical follow-up study of permanent incisors with intrusive luxation after acute trauma. J Dent Res 1983;62:486 (abstract no. 37). 16. Tronstad L, Trope M, Bank M, Barnett F. Surgical access for
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17. 18. 19.
20.
endodontic treatment of intruded teeth. Endod Dent Traumatol 1986;2:75-8. Holan G, Rom D. Sequelae and prognosis of intruded primary incisors: a retrospective study. Pediatr Dent 1999;21:242-7. Taintor JF, Bonness PW, Biesterfeld RD. The intruded tooth. Dent Survey 1977;55:30-4. Faria G, Silva RAB, Fiori-Junior M, Nelson-Filha P. Re-eruption of traumatically intruded mature permanent incisor: case report. Dent Traumatol 2004;20:229-32. Andreasen FM. Pulpal healing after luxation injuries and root
S¸arog˘lu et al. e65 fracture in the permanent dentition. Endod Dent Traumatol 1989;5:111-31. Reprint requests: Is¸ıl S¸arog˘lu, DMD, PhD ¨ niversitesi Kırıkkale U Dis¸ Hekimlig˘i Fakültesi Pedodonti ABD Kırıkkale Türkiye [email protected]