most of the injuries at early ages happen due to falling off when the kids learn to walk or run , as there is lack of motor abilities at that age .
one of the most common traumatic injuries happening in preschool children or kids is intrusive luxation which causes displacement of the tooth in the alveolus .
intrusive traumas are mostly experienced in the deciduous dentition with damage to anterior teeth ; this kind of trauma is more common at age 1 - 3 years due to the high resilience and flexibility of the surrounding tissues around the deciduous teeth .
preschool children have wide medullar spaced bones ; this situation leads to luxation and intrusion injuries instead of structural fractures .
the dentists should also avoid the permanent tooth disturbance in the anterior zone traumas since there is a probability of injuring the permanent teeth .
deciduous teeth traumas may present with several visual signs : color change of crown , pulp obliteration , pulp necrosis , resorption of root , inflammatory resorption , ankylosis , gingival recession , permanent displacement of the deciduous tooth , and pulp necrosis / premature loss .
general anesthesia ( ga ) may be indicated for pediatric dental patients with extensive restorative treatment or difficult treatment plans , uncooperative behavior , severe anxiety or fear , physical or mental challenges , or for patients who are very young . in case of tooth loss at the anterior region , to prevent the esthetic , phonetic , and space maintenance problems ,
the extracted natural teeth have been used for building up fixed apparels as temporary prosthetic treatment of preschool kids . in this case report , the management of an intruded deciduous maxillary right central incisor using its natural crown is presented .
a 3-year - old patient with no systemic problems had been brought to sifa university , pediatric dentistry clinic because of pain and swelling at the maxillary anterior incisor zone including the labial soft tissues .
the history of the patient included a trauma caused by falling off while running 40 days before referring to our clinic .
when the parents realized that there was no positive visual and feedback from their daughter , they decided to visit our clinic for examination and treatment . in the clinical examination
, there were no extraoral injuries like nose or head trauma . during intraoral examination , we observed a swelling at the maxillary anterior region , exactly at deciduous maxillary right incisors + ridge zone and labial sulcus [ figure 1 ] .
we found that the deciduous maxillary right central incisor was dislocated and intruded through labial sulcus soft tissue by observing the periapical radiograph [ figure 2a ] . due to the age of the patient
, we decided to remove it under ga with the permission of the family , as there could be lack of cooperation from the patient .
intraoral view of swelling at the maxillary anterior region ( a ) periapical radiograph showing severely intruded primary maxillary right incisor ; ( b ) surgically extracted deciduous tooth an impression ( 3 m espe ag , dental products , seefeld , germany ) was taken during ga to build up a removable partial prosthesis for the patient .
then , the intruded deciduous incisor tooth was surgically extracted [ figure 2b ] , and soft tissue ruptures were reformed and sutures were placed with 3 - 0 black braided silk ( ethicon ; johnson and johnson ltd . , somerville , nj , usa ) .
extra care was taken to avoid permanent teeth disturbance during surgery of the hard and soft tissues . also , we gave post - extraction instructions to the patient 's parents .
the crown of the extracted deciduous upper right central incisor was separated from the root .
the pulp chamber of the tooth was cleaned and then stored in sterile saline solution until use . before implementing the tooth to the removable appliance ,
flowable resin composite material ( 3 m espe , st paul , mn , usa ) was placed into the crown in increments and cured .
the removable partial prosthesis was completed by using the patient 's own extracted tooth [ figure 3 ] .
clinical and radiographic examinations [ figure 4 ] were undertaken and there was no problem found .
intraoral view of the removable appliance with natural crown ( 1 week after surgery ) intraoral view and periapical radiograph of the patient ( 3 months after surgery )
growing kids , in other words , preschool children , are much more vulnerable to fall ; as a result , they face injuries and traumas due to lack of their neuromuscular coordination .
most of the injuries in deciduous dentition are an intrusive luxation caused by face impact .
gondim et al . studied and followed up 16 patients with intrusion of the primary teeth , and 56.25% of the patients who suffered from tooth intrusion were males and in 91% , upper central incisors were the most intruded teeth .
according to the histories taken from the patients who had intrusive luxation , the injuries were found to be due to fall during ordinary walking or running ( 62.5% ) or during riding a bicycle or tricycle ( 12.5% ) .
generally , the anterior teeth , and mostly , the maxillary central incisors are affected because of their anatomical location , where they are directly exposed to any kind of physical trauma . this paper reports a 3-year - old female child who suffered from trauma to the primary central incisor and was misdirected about the treatment . for the success of the treatment , in the diagnosis and treatment planning , expert 's advice is very important . in situations of injuries and/or traumas including intrusive luxations
if the apex is displaced toward or through the labial bone plate , the tooth should be considered to be left in place for spontaneous repositioning and re - eruption .
when the crown is completely intruded , the tooth rarely re - erupts and may become necrotic , indicating the need for extraction . also , if the apex is displaced through the tooth germ , tooth extraction is suggested to avoid possible damage to the permanent successor .
ankylosis should be suspected if visual signs of re - eruption are not present after 12 months , so extraction should be considered .
also , a child with a thumb habit or swallowing disorder may apply force , avoiding the intruded tooth from re - erupting . in the case
presented here , the tooth was intruded through the labial of maxillary ridge and the root was displaced distally at an angle . with the impact force of trauma ,
intrusive tooth was completely embedded into the bone and the labial alveolar bone was broken .
for this reason , it should have been considered for extraction immediately after the patient referred to the clinic . in the case
presented here , an impression was taken during ga to build up a removable partial prosthesis and the extraction was carried out immediately after the impression was taken . in normal conditions , for a better prosthesis and impression , the wound of extraction area should heal and soft tissue should be in final shape . due to younger age of the patient and lack of cooperation from her , we did not take the risk of second ga only for impression . in tooth losses , both esthetics and functions should be considered .
that is why , the condition of the preschool patient was considered as an esthetic and functional problem in her developing dentition . as a consequence , to avoid bone loss of the alveolar process and as a temporary solution till final permanent treatment could be done , space management procedure with an esthetic concept was applied .
anterior tooth loss results in difficulty in speech development , especially in a young child .
it is also a setback for a child to have lost a tooth at an early age , and it may lead to the development of tongue habits .
while some of these cases were treated with esthetic fixed maintainers , others were treated with glass fiber reinforced cement to fix the patient 's own tooth as a pontic which is the permanent central incisor . despite the advantages of these fixed restorations in comparison to removable partial prosthesis , the fixed appliances have limiting effects on the maxillary growth in preschool growing kids .
the other reason for using removable esthetic partial prosthesis in this case was the crown lengths of the deciduous molars , for which occluso - cervically , the lengths were short ; therefore , we were not able to prefabricate an anterior esthetic fixed space maintainer by molar bands .
acrylic teeth can be used for building removable esthetic partial prosthesis after traumatic tooth loss in the anterior region , but they do not provide the contour or size that a natural tooth does .
reported using patient 's own tooth to make the patient feel comfortable about size , shape , and color .
for the reason mentioned earlier , we had to build a removable partial prosthesis with the patient 's own tooth . to conclude
, we can say that using patient 's own tooth instead of prefabricated teeth on a fixed appliance renders psychological satisfaction for the patient and his / her family , and can be better tolerated because of its shape , size , and color .
 tooth intrusion is the most common trauma during early infancy . 
 primary maxillary central incisors are the most affected teeth . 
 there are a few treatment approaches which depend upon the severity of the trauma , and the treatment must be managed professionally . in this case report , a 3-year - old girl with a history of trauma 40 days before referring to our pediatric clinic is presented . 
 deciduous maxillary right central incisor was intruded through labial and alveolar socket and completely covered with soft tissue . 
 the intruded deciduous incisor tooth was surgically extracted and impression was taken under general anesthesia . 
 the removable partial prosthesis was completed by using the patient 's own extracted tooth . 
 using natural crown on removable prosthesis gives psychological satisfaction to the patient and his / her family , and can be better tolerated since its shape , size , and color are exactly in harmony . 
INTRODUCTION
CASE REPORT
DISCUSSION