Authors: Torneck CD.
Title: Effects and clinical significance of trauma to the developing permanent dentition.
Journal: Dent Clin North Am
Date: Jul 1982
Citation: 26(3):481-504
Category: Pediatric Endodontics
Evidence-based Ranking: 5
Purpose/Objectives: To familiarize the practicing dentist with some of delayed effects that occurs when the developing permanent teeth are injured.

Discussion: The paper begins with a good review of normal development of the tooth. Overall injury to the apical odontogenic complex can occur in on of three ways: (1) directly through a crushing or tearing of the cells at the time of trauma, (2) indirectly, through interferences with the apical vasculature caused by thrombosis or hemorrhage, and (3) secondarily, subsequent to the establishment of an infective process in the periodontium. More specifically injury to the odontoblasts can result in arrest in function, or a stimulus as seen with pulp obliteration. Injury to HERS can result in changes to the quality and quantity of dentin, or result in a dilacerations of the apex. Some damage can be reversed with removal of the inflammation, while others cannot, and then it will be up to already differentiated Odbls to form a hard tissue barrier, which will be irregular at best. Injury to the dental supporting tissue can result in osteoclastic resorption of the cementum and dentin. In teeth with horizontal root fractures, repair has been reported in 77 % as long as the fracture is adequately reduced and stabilized. Injuries to developing crowns, such as primary teeth with intrusive injuries, can result in developmental defects to crown morphology and enamel matrix formation and calcification.

ReviewerÂ’s comments: Overview of the effects of trauma.