Sequelae of Intrusive Trauma to the Primary Predecessors: Odontoma Like Malformation and Enamel Hypoplasia

Case Report

Austin J Dent. 2014;1(1): 1005.

Sequelae of Intrusive Trauma to the Primary Predecessors: Odontoma Like Malformation and Enamel Hypoplasia

Rajni Nagpal1 and Naveen Manuja2*

1Department of Conservative Dentistry, Kothiwal Dental College, India

2Department of Pediatric Dentistry, Kothiwal Dental College, India

*Corresponding author: Naveen Manuja, Department of Paediatric Dentistry, Kothiwal Dental College, Moradabad, Uttar Pradesh, India

Received: May 22, 2014; Accepted: June 30, 2014; Published: July 01, 2014


Traumatic injury to the primary teeth can cause significant alteration of the underlying permanent dentition because of the close anatomic relationship between the developing permanent teeth and the apices of the overlying primary incisors. These developmental disturbances may range from white or yellow brown enamel discoloration with or without enamel hypoplasia, crown- root dilaceration, odontoma like malformation, root duplication or angulation, arrest of root development, germ sequestration and eruption disturbances. This case report describes a rare complication of odontoma-like malformation along with hypoplasia of the permanent teeth resulting from intrusive injury to primary predecessors at a very young age. The management along with esthetic considerations is discussed to achieve the physio-psychological rehabilitation of such patient.

Keywords: Odontoma like malformation; Penamel hypoplasia; Intrusive injury; Sequelae of trauma; Permanent maxillary incisor; Primary predecessors


The major concern with primary tooth trauma is the potential for damage to the underlying permanent successor [1]. This may occur directly from the injury or from the residual infection associated with the traumatized primary tooth [2]. The topographic relationship of the primary teeth to the permanent tooth germs explains the potential for possible developmental disturbances. Several developmental anomalies have been reported in the permanent dentition as sequelae of injuries to their primary predecessors [2-4]. These developmental defects may be simple or complex, extensive or local, affecting the crown, root, or the entire germ. In the coronal region, structural alterations may occur such as enamel hypoplasia, crown dilaceration and white, yellow or brown discoloration. Disturbances affecting the root region include root duplication, root dilaceration and partial or complete arrest of root formation. When the entire permanent tooth germ is affected, the following may be noted: alterations to the process of eruption of the permanent tooth, retention of the permanent tooth or malformation of the permanent tooth germ giving the appearance of an odontoma. Do Espírito Santo Jácomo DR et al. [5] in their longitudinal study of eight years reported that the most common developmental disturbances were discoloration of enamel and/or enamel hypoplasia (46.08%) and eruption disturbances (17.97%) due to the traumatic injury in their predecessors.

The extent of the disturbance of the developing tooth germ is related to the stage of germ development (the child's age at the time of injury), the spatial relationship of the involved teeth, the type of trauma, the severity, and the direction of impact [6-9]. Intrusion injuries which constitute 4.4-22% of traumatic injuries in the primary dentition have been reported to be associated with the highest likelihood of damage to the underlying permanent teeth [1,3,10-15]. An intrusive injury is the consequence of impact by a force in an axial direction that results in displacement of the tooth within the socket. Displacement of the primary tooth root may affect development of the permanent tooth by altering the secretary phase of the ameloblasts resulting in enamel hypoplasia or, in subsequent stages, changing the root formation process [16]. Sennhenn-Kirchner S et al.[13] reported that intrusion injuries are the most frequent cause of developmental disturbances in permanent teeth (47%). In half of the cases, a comparatively mild form of lesion like enamel discoloration was observed. Remaining cases showed other dental deformities like cessation of root formation or retention caused by ankylosis.

Altun C et al. [15] did a prospective 7-year study and observed developmental disturbances in 53.6% of permanent successors [enamel hypoplasia (28.3%), crown and/or root deformation (16.7%), and ectopic eruption (16.7%)] attributed to intrusive injury of their primary predecessors.

Malformation of the permanent tooth germ may be the result of severe intrusion by the primary tooth and invasion of the developing germ during the earliest phases of odontogenesis. Odontoma-like malformation of the permanent tooth is a rare developmental disturbance and only a few cases have been reported in the literature [4,17-20]. This anomaly is confined primarily to maxillary incisors when the time of injury occurs between ages 1 and 3 years, during the morphogenetic stages of the dental follicle, and results mainly from intrusive luxation or avulsion [17] This report presents a rare case of odontoma like malformation along with hypoplastic permanent maxillary incisors as sequelae of intrusive trauma to primary teeth.

Case Presentation

An eight year old girl visited the Department of Pediatric Dentistry, Kothiwal Dental College, Moradabad, India, with a complaint of discolored upper front teeth. Patient's mother gave a history of trauma to the upper front teeth at the age of 16 months due to fall which resulted in intrusion of primary maxillary incisors. She visited the local dentist who kept the patient on wait and watch. There was no regular follow up. The intruded teeth were surgically removed six months after trauma. Medical and family histories were non-contributory. The intraoral clinical examination revealed moderate oral hygiene with class I molar relationship. Only two permanent maxillary incisors were present which were severely deformed and discolored (Figure 1). Panoramic radiographic examination revealed impacted radiopaque calcified mass resembling odontoma like malformation in place of one permanent maxillary central incisor and other permanent maxillary central incisor was missing. Maxillary right permanent lateral incisor had erupted in the position of missing maxillary right permanent central incisor (Figure 2). Both erupted permanent maxillary lateral incisors showed severely hypo plastic crown with immature root. The impacted odontoma like malformation was surgically removed under local anesthesia (Figure 3 and 4). Esthetic composite resin build ups were performed on the hypo plastic crowns and missing teeth were restored with a removable prosthesis (Figure 5).