Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2009  |  Volume : 27  |  Issue : 2  |  Page : 125--130

Multidisciplinary approach on rehabilitation of primary teeth traumatism repercussion on the permanent successor: 6-year follow-up case report

ACV Mello-Moura1, GAVC Bonini1, SS Suga2, RS Navarro3, MT Wanderley4,  
1 Research and Clinical Center of Dental Trauma in Primary Teeth, Departamento de Ortodontia e Odontopediatria, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, Brazil
2 Professor of Certificate program on Pediatric Dentistry, FUNDECTO-FOUSP, Brazil
3 Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, Professor UNICASTELO, Collaborator of Special Laboratory of Lasers in Dentistry (LELO-FOUSP), Faculdade de Odontologia, Universidade de Sao Paulo, Brazil
4 Coordinator of Research and Clinical Center of Dental Trauma in Primary Teeth of the Pediatric Dentistry, Departamento de Ortodontia e Odontopediatria, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, Brazil

Correspondence Address:
M T Wanderley
Departamento de Ortodontia e Odontopediatria, da Faculdade de Odontologia da Universidade de Sao Paulo, Av. Prof. Lineu Prestes, 2227, CEP 05508-900 Sao Paulo, SP


Traumatic lesions in primary teeth are frequent in pediatric patients and can cause problems both to the deciduous tooth and permanent successor. The impact strength on deciduous tooth can reach the growing permanent tooth, affecting its morphology, structure and position, or even hampering its proper development. This report describes an aesthetic-functional rehabilitation process in an 8 year 10 month old boy during a multidisciplinary treatment held at the Clinical Center of Dental Trauma in Primary Teeth of the Pediatric Dentistry of Dental College of University of São Paulo, Brazil. The patient presented bilateral posterior cross bite and the permanent left upper central incisor with ectopic eruption and enamel hypoplasy, preceded by avulsion of element 61, occurred when the patient was 1.6 years old. After diagnosis and treatment planning, a quick expansion of jaws was recommended with Hass-type rapid expander and orthodontic leveling with fixed braces. Due to the ectopic eruption, the gingival contour had been altered and hypertrophia was found, compromising aesthetics and avoiding local hygienic procedures. Gingivoplasty was carried out with high-intensity Diode Laser, followed by aesthetic restoration with compound resin. It was concluded that after deciduous teeth traumatism it is important that the patient undergoes clinic and radiographic assistance until the permanent teeth erupt so that an adequate multidisciplinary treatment can be offered to the patient.

How to cite this article:
Mello-Moura A, Bonini G, Suga S S, Navarro R S, Wanderley M T. Multidisciplinary approach on rehabilitation of primary teeth traumatism repercussion on the permanent successor: 6-year follow-up case report.J Indian Soc Pedod Prev Dent 2009;27:125-130

How to cite this URL:
Mello-Moura A, Bonini G, Suga S S, Navarro R S, Wanderley M T. Multidisciplinary approach on rehabilitation of primary teeth traumatism repercussion on the permanent successor: 6-year follow-up case report. J Indian Soc Pedod Prev Dent [serial online] 2009 [cited 2019 Aug 20 ];27:125-130
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Full Text


Trauma in primary teeth can compromise permanent successors due to alterations in their developmental stages. [1] The literature shows a large range of after-effects in permanent teeth during these stages, varying between 12% and 69%. [2],[3],[4] Such effects are frequently associated with stronger impact traumas as intrusion and avulsion. [5],[6]

Type and severity of these effects are also related to other predisposing factors, such as child's age, proximity of primary teeth and permanent germ, stage of root formation or resorption of primary teeth, permanent teeth root formation, root inclination of primary teeth when trauma occurred, treatment conduct and deciduous tooth repair, among others. [1],[7],[8]

These factors justify the demand for carrying out immediate and long-term treatments to the affected deciduous teeth area after any kind of traumatic injury, as well as clinical and radiographic controls until permanent successor eruption and complete formation. In this way, possible permanent teeth repercussions can be diagnosed sooner, resulting in better outcomes.

In the event of repercussion on the permanent teeth, multidisciplinary treatment is the preferred approach. Global and integrated assistance to the patient by a crew of professionals from different areas will improve the treatment plan and prognosis. Pediatric dentistry, orthodontics, surgery, laser, restorative dentistry, endodontic, periodontics, and prosthodontics are some fields that comprise a multidisciplinary team seeking the best solution for rehabilitation. [9],[10],[11],[12],[13],[14],[15]


This report describes a 6-year follow-up of an aesthetic-functional rehabilitation of a school-age child, presenting permanent tooth malformation and ectopic eruption, a consequence of a dental trauma in primary tooth.

 Case Report

An 8-year and 10-month old boy came to the Clinical Center of Dental Trauma in Primary Teeth (Pediatric Dentistry Department, Dental School, University of São Paulo, Brazil), complaining that his "teeth were growing horribly and in the wrong place." Clinical examination revealed an upper left central incisor presenting ectopic eruption, yellow-brownish discolourations, and enamel hypoplasia [Figure 1].

Patient's dental history, reported by his father, revealed avulsion of this tooth caused by a traumatic injury when the patient was 1 year and 6-months old. At this time, the father was informed of the importance of clinical and radiographic control until the complete eruption of the permanent tooth, as well the necessity of an aesthetic and functional spacer as soon as possible. However, these recommendations were not followed because his parents could not afford treatment.

After initial eruption of the hypoplastic region of tooth 21, a temporary restoration with photo-cured glass ionomer cement was carried out. The diagnosis and planning were based on orthodontic documentation. The treatment was divided into three stages: orthodontics, high intensity laser surgery, and aesthetic restoration with composite resin [Figure 2],[Figure 3],[Figure 4].

During the orthodontic treatment, two types of devices were used. Initially, to correct the bilateral posterior cross bite and to recover the lost space in the frontal region, a rapid expansion of the jaws was carried out using a modified Hass expander [16] [Figure 5] and [Figure 6]. After disjunction, the patient used a removable appliance with a Hawley arc to train the left upper central incisor until its complete eruption [Figure 7] and to maintain post-disjunction. After the complete root formation of tooth 21, this stage ended with fixed apparatology for a 4 × 2 leveling (with Nitinol 0.012", 0.014", 0.016" and 0.018" thread, in teeth 16-12-11-21-22-26) of the upper front region [Figure 8] and [Figure 9].

In the second stage, due to ectopic eruption, the irregular gingival contour was corrected using a high-intensity diode laser [Figure 10] and [Figure 11]. This type of laser can cut and coagulate soft tissues due to its pigmentation affinity. This procedure was accomplished with the 810-nm diode laser (GaAlAs) (ZAP Lasers, Soft Lase, CA, USA) performed with output power of 1.5W, in a continuous mode, using 400-µm quartz optical fiber in contact with tissue. [17],[18],[19],[20],[21],[22],[23] This technique provided a better postoperative and faster healing, allowing the beginning of the next stage 1 week after surgery.

The last stage consisted of removal of temporary restoration followed by aesthetic rehabilitation with compound resin. The angles and proximal surfaces were restored with nanoparticle composite (Z250, 3M ESPE, USA) using A1, A2, and I shades. Occlusal adjustment was made immediately after using high-speed multiblade drills (45 blades) and the excesses at proximal contours were removed with abrasive straps of sandpaper. After 48 hours, the finishing was made with abrasive disks (FGM, Brazil) and polished with abrasive diamond paste (FGM, Brazil) [Figure 12].


Despite the directions given to the patient's father about the importance of clinical and radiographic controls of traumatized region until the total eruption of permanent tooth successor and the use of a spacer to maintain the aesthetic functional space, none were followed. These procedures would have facilitated an earlier diagnosis and, therefore, a treatment with better outcomes (i.e., the maintenance of necessary space for permanent left upper central incisor eruption and preventive correction of posterior crossbite during deciduous dentition).

If all procedures were made earlier, aesthetic rehabilitation would be easier, done immediately after the complete eruption of the permanent left upper central incisor and before his pre-adolescence (a delicate time of physical and behavioral changes when an aesthetic problem can deeply affect the psychological structure of the patient).

The treatment was divided into three stages, each corresponding to one specialist's area. Each stage of this multidisciplinary approach was closely followed by a pediatric dentist, who participated in all stages of the case.

As the eruption of the left upper central incisor was ectopic and, therefore, the tooth was wrongly positioned, the authors opted for a prior temporary restoration with a glass ionomer cement followed by a gingivoplasty and then a final rehabilitation with compound resin.

The overall gingival situation grew worse during orthododontic treatment (increased hypertrophy and irregularity of gingival contour). Despite constant encouragement of careful oral hygiene, the patient was reluctant to cooperate.

Pediatric dentistry laser was used to perform clinical procedures in substitution associated with and/or complementary to conventional procedures, resulting in more comfort and acceptance of infant patients and parents, reduction of psychological trauma, and fear during dental appointment. [22],[23] Laser procedures require less operating time, promote blood clotting, need a smaller amount of anesthetic, frequently dispenses with sutures, and results in a post-surgical period with less pain and swelling compared to conventional surgical techniques. [19],[21],[22],[23]

After repairing gingival contour and providing constant encouragement of careful buccal hygiene, the patient moved on to the final treatment stage, aesthetic rehabilitation. Since every dental trauma in primary teeth can result in after-effects for the permanent successors, it is extremely important to have clinical and radiographic controls during its formation. Therefore, in cases of after-effects, the comprehensive approach of a multidisciplinary team is the best way to solve the problem.


Clinical and radiographic follow-up is very important after any type of trauma in primary teeth until the permanent successor has totally erupted and the root is totally formed.

The professional must be aware and concerned about the necessity to offer multidisciplinary assistance to patients presenting dento-alveolar traumatic injuries for the rehabilitation of repercussion of trauma of deciduous teeth in permanent teeth.


The authors would like to thank the support of all colleagues of Certificate program on Pediatric Dentistry of the FUNDECTO-FOUSP, Prof. Márcia Baptista for orthodontic support. Special thanks to Professor Célia Regina Martins Delgado Rodrigues, from Pediatric Dentistry of Dental College of University of São Paulo ( in memoriam ).


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