Delayed tooth eruption as a result of trauma - Clinical case management

Sep 5, 2026

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Delayed eruption of permanent maxillary central incisors is presented as a consequence of traumatic injuries involving intrusion and displacement of primary teeth. The case describes delayed emergence with abnormal gingival conditions, root dilaceration on one side, and related occlusal factors such as functional anterior crossbite. Treatment prioritized improving gingival health through hygiene instruction and staged conservative measures, followed by surgical exposure and periodontal care, with monitoring of eruption over months.

LanguageEnglish

CategoryHealthcare

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Delayed tooth eruption as a result of trauma

Case presentation

Treatment

# Delayed tooth eruption as a result of trauma Zia Shey,DMD,MSPatricia Leach,DMDRichard T.Vogel,DMD ## Abstract A tooth displaced down into alveolar bone is anintrusive luxation.This injury usually is accompaniedby comminution of alveolar fracture.¹The dislocationis frequently axial and radiographic examinationreveals absence of periodontal space. The primary site for luxation injuries is themaxillary anterior region in the primary andpermanent dentition with frequency higher in theprimary dentition.²The optimal treatment forintruded permanent teeth has not been determined,but Andreasen suggests the tooth should be allowedto re-erupt or be moved into position via orthodonticmeasures.Immediate replacement of intruded teethinto their normal position frequently is followed byresorption of the crest of the alveolar bone.1 Figure 1.Note the lack of eruption of the right central incisorand partial emergence of the left central incisor.Note also thelack of fornix and the plaque accumulation on the labial sur-faces of the maxillary lateral incisors. An unusual case of intrusive luxation of twopermanent central incisors is described in which toothemergence into the oral cavity was delayed and somekeratinized gingiva altered. Radiographic examination revealed root dilacerationof the right permanent central incisor;root developmenton all other permanent teeth was normal(Figure 2).Themaxillary right first permanent molar was lost premature-ly due to caries and as a result the maxillary right secondpermanent molar erupted in mesial version.The max-illary left central incisor appeared to be erupting into atrue crossbite.In addition,there was a functional anteriorcrossbite due to forward thrusting of the mandible.Thismotion avoided lacerating soft tissue covering the incisoredges of the maxillary central incisors.It appeared thatthere would be sufficient space available for the eruptionof both maxillary incisors. # A ten-year-old male presented with the complaintthat both permanent maxillary central incisors had fail-ed to erupt.The right central incisor crown was coveredcompletely by an adherent elastic mucosa,and the leftcentral incisor crown was exposed only at the distoin-cisal edge.The anatomical crowns of the teeth could bepalpated(Figure 1).There was lack of attached gingivaadjacent to the maxillary central incisors with an absenceof the anterior vestibular fornix.Oral hygiene was poorand severe gingival inflammation was present in thevestibular area adjacent to the lateral incisors.Inflam-mation of gingival tissue was most evident mesial to themaxillary lateral incisors where tissue folds entrapped pla-que and food debris.The maxillary right lateral incisorshowed an area of hypocalcification on the labial surfacewith subsequent demineralization due to inadequateplaque removal.A band of intrinsic strain of unknownetiology was evident on the incisal half of the four man-dibular permanent incisors. A severe traumatic injury at age two resulted in frac-ture and intrusion of the maxillary primary central andlateral incisors,with probable displacement of thedeveloping maxillary right permanent central incisor.This traumatic episode may have resulted in the rootdilaceration of the right permanent incisor and delayederuption.The child sustained another trauma to the same Figure 2.In this panorex radiogram showing the developing den-tition,note the root dilaceration of the maxillary right centralincisor.Mesial migration of the maxillary left first permanentmolar is considered to be a result of premature loss of secondprimary molar. Figure 4.One week postoperatively,the surgical area showsadequate healing.Note the poor oral hygiene in the mandibularincisor area. region of the mouth at age eight in a bicycle accident,causing severe laceration of soft tissue and intrusion ofboth erupting permanent central incisors.The oral woundwas not treated and healing may have occurred by fu-sion of labial and palatal fibrous connectiv

FAQs

What injury mechanism is linked to the delayed eruption described in the case?

A history of traumatic injury caused intrusion and displacement of the maxillary primary incisors, with probable effects on developing permanent incisors and resulting delay in eruption.

What clinical findings were observed in the affected maxillary central incisors?

The right incisor crown was fully covered by adherent elastic mucosa, while the left was exposed only at the distoincisal edge, with poor oral hygiene and severe gingival inflammation and reduced attached gingiva.

How was treatment planned to accelerate eruption and manage gingival health?

Oral hygiene instruction and a conservative regimen were used first to stimulate eruption, followed by surgical uncovering of the covered crown, gingivectomy, use of a periodontal pack, gentle debridement, and ongoing observation of eruption.

Sep 5, 2026

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