History of the Dental Trauma Guide

In 1962 an important decision was made at the Trauma Center, Department of Oral and Maxillofacial Surgery at the University Hospital of Copenhagen: A periodic follow-up record would be made of all patients treated for traumatic dental and maxillofacial injuries. At that time the department had the sole responsibility for treatment of traumatic dental injuries in the eastern part of Denmark with a population of close to two million inhabitants.

The treatment principles followed at the time were based on the 1960 textbook “The Classification and Treatment of Traumatic Dental Injuries”, by R.G. Ellis (1) a book which relied on case reports and expert opinions. Because of the lack of good scientific material in the field of dental traumatology such low level of evidence provided the only basis for treatment decision making.

It soon became apparent from follow-up visits of trauma patients that treatment regiments based on these sources of information often led to serious healing complications. These complications were highlighted in a series of retrospective studies covering luxations injuries (7), avulsions with subsequent replantation (2, 3), root fractures (4, 5), alveolar fractures (6) and jaw fractures (6). The healing complications recognized in these clinical and radiographic follow-up examinations were pulp necrosis, pulp canal obliteration, progressive root resorption, loss of supporting bone and tooth loss.

An attempt to establish a cause-effect relationship between type and extent of trauma, treatment modality, and subsequent development of complications was seriously hampered by the incomplete data present in the patient records as well as insufficient initial radiographic documentation of the extent of injury. The first step to rectify this situation was to establish a classification system for dental trauma injuries covering all the possible injuries to the hard dental tissues, the periodontal tissues and the alveolar bone. As a model the WHO classification system was selected and a few missing trauma entities were added (concussion, subluxation and lateral luxation) to cover all the biologically distinguishable injury scenarios (147). This classification system has since gained a wide acceptance and has been used in all our subsequent trauma studies.

To improve the quality of the patients’ trauma records at the University Hospital and increase their value for research, a standardized trauma form was developed and implemented in 1966. This standardized patient record was quite comprehensive and contained all necessary details about the type and the extent of injury, patient characteristics (e.g. stage of root development, age and sex) as well as information about the treatment provided. Altogether 65 pieces of information about the trauma were collected for each patient. In 1969 a standardised radiographic examination procedure was developed using 4 radiographic projections of each traumatised tooth and in 1971 photographic documentation was added to include a facial photo of the oral region to register associated lip injuries as well as a frontal and an axial photos of the injured teeth (16). To complement the initial records, follow-up procedures were carried out at predetermined intervals, chosen based on experience as representing the optimum times for recognizing healing complications. Whenever treatment failed and teeth were removed they were examined at the Department of Oral Pathology at the Dental School which had strong ties to the University Hospital (the senior author having a dual appointment at both institutions). In the 1970s and 1980s sufficient standardized data had been accumulated to enable prospective clinical trauma studies and altogether 80 publications covering all trauma entities affecting the primary as well as the permanent dentition have now been completed (2-80, 156).

In the early 1970s a unique opportunity for doing experimental dental traumatology occurred when the senior author was allowed to do research on monkeys used at the Danish Serum Institute; these animal were used as kidney donors for polio vaccine production. The experiments conducted on these monkeys resulted in 65 experimental dental trauma studies including some in vitro studies (81-146).

In the following section the volume of clinical and experimental information available for each trauma type will be described. This information is essential as it shapes the approach used by the Dental Trauma Guide for each individual trauma entity in relation to diagnosis and treatment selection and prognosis estimation.

Luxation injuries

Concussion, subluxation, extrusive, lateral and intrusive luxations involving the permanent dentition were analyzed in a series of prospective studies (16, 17, 20, 21, 22, 66-69) and healing complications such as pulp necrosis, pulp canal obliteration (22), external and internal root resorption (29), transient and permanent marginal bone breakdown (16, 17) and transient apical bone breakdown were analyzed in detail (21-46). The etiology and pathogenesis of pulp necrosis was examined especially in relation to luxation type and stage of root development (17). The etiology and pathology of pulp canal obliteration (PCO) was another pulp healing complication studied and a strong relation was found between the occurrence of PCO and the initial displacement (severance of the apical blood supply) and the stage of root development (22). The long-term effect of pulp canal obliteration (i.e. up to 20 years) was analyzed in a joint study with Dr. A. Robertson from Gothenburg Dental School, Sweden and a slightly increased yearly risk of subsequent pulp necrosis was established for teeth with pulp canal obliteration (37).
Periodontal healing complications were analysed and a strong relations was found between root resorption events and the type of luxation (66-69). Furthermore, for intrusions a relationship was found between the choice of initial treatment and frequency of subsequent root resorption (51-53).

Avulsion injuries with subsequent replantation

The first clinical retrospective study of 110 replanted teeth was published in 1966 and showed a significant relationship between the length of the extraoral dry time and subsequent healing complications such as pulp necrosis and progressive root resorption (2, 3). A study of 22 extracted and histologically examined human teeth showed that root resorption events could be divided into surface resorption, inflammatory resorption and replacement resorption (2, 3); a terminology later changed to repair-related resorption, infection-related inflammatory resorption and ankylosis-related (osseus replacement) resorption.

A histological study demonstrated that infection-related resorption had its origin in the presence of bacteria located in the root canal and dentinal tubules (3) and a clinical study showed that conventional root canal treatment could prevent and arrest infection-related resorption in about 10% of the cases (2). A few years later it was discovered that calcium hydroxide was effective in preventing and arresting infection-related resorption in 90% of the cases (12).

In the early 1970s a series of experiments in monkeys were initiated to study the pathogenesis of the root resorption types subsequent to replantation (88-99), and to evaluate the effect of various treatment procedures on the outcome of replantation of permanent teeth. Among the procedures and factors tested were the effect of removing the coagulum before replantation (93), the detrimental effect caused by dry and wet extra oral time, the effectiveness of various storage media and their temperatures (95, 109, 116, 141), cleansing procedures of the root surface before replantation (104), exactness of repositioning (102, 113), splinting methods (rigid or flexible) and length of time of splinting (81, 110), occlusal overload during healing (101), and endodontic treatment before replantation (103, 106, 120, 121, 125-129). At that time a research collaboration concerning design of the experimental procedures and histological healing classifications was arranged between colleagues at the Dental School in Stockholm (Drs. L. Hammarström, L. Andersson, S. Lindskog, L. Blömlof) and Dr. M. Cvek at the Eastman Dental Institute in Stockholm (117, 118). Similarly a series of experiments concerning the effects of antibioticsupon healing of pulp and PDL after replantation was also carried out by these authors (143-146).

In 1994 the first prospective study of 400 replanted human teeth with follow-up periods of up to 20 years after replantation was published. Due to the detailed information about the significant relation between extra-alveolar storage condition and later occurrence of pulp and periodontal healing complications a detailed survival analysis could be established for replanted teeth with a given set of extra-alveolar conditions (33-36). In a later study the influence of different factors such as age, splinting and endodontic techniques upon progression or arrest of a root resorption was described (64, 65).

Crown fractures with and without pulp exposure

We are currently working on a prospective study encompassing 853 permanent teeth including all five types of crown fractures (infractions, enamel, enamel-dentin and enamel-dentin-pulp fractures) as well as combinations with the abovementioned 5 luxation types (76-80). For all fractures types and their combination healing rates are documented in relation to pulpal and periodontal ligament healing.

In 1985 a new bonding system (Gluma®) was developed by Dr. Asmussen and Dr. Munksgaard at the Dental School in Copenhagen in coorperation with the ESPE® company and it was decided to use the system to rebond retrieved crown fragments (27, 28). In 1991 a Scandinavian multicenter study (Gothenburg, Sweden, Oslo, Norway and Copenhagen, Denmark) showed that the method had some promising long-term results (31) but debondings of glued fragments often occurred due to mastication or a new trauma both events indicating the necessity of further improvement in the bonding procedure, a fact which indicated a series of new in vitro studies (132-137).

Crown-root fractures

The two most common treatment strategies for uncomplicated and complicated crown-root fractures, namely restoration after gingivectomy ± ostectomy and orthodontic extrusion + gingivectomy, were analysed in a prospective long-term study. With regards to the stability of the restored tooth in the dental arch and the gingival health associated with the restored tooth, significant differences were found between the two methods, in favour of orthodontic extrusion in regard to long-term healing (70).

Root fractures

In 1967 the first retrospective clinical, radiographic and histologic study of 50 root fractured anterior permanent teeth revealed three main types of healing scenarios, namely healing with interfragment hard tissue, healing with interfragment periodontal ligament tissue and finally non-healing with interfragment development of granulation tissue due to pulp necrosis located in the coronal fragment (4). In 1989 a prospective study of 95 root-fractured permanent teeth was completed and a significant relationship between the healing outcome and the stage of root development and the extent of dislocation was demonstrated. (23). Furthermore, due to the periodic identical radiographic examinations, new healing variations could be described such as internal surface resorption andinternal tunnelling resorption (24).

In the early 1970s a research liaison was established with Dr. M. Cvek at the Eastman Dental Institute in Stockholm and identical recordings of variables in relation to root fractures was arranged. In 2005 a prospective study of 400 root-fractured teeth allowed a detailed analysis of preinjury factors (age, root development), injury factors (location of fracture, severity of dislocation of the fragment) and finally treatment factors (completeness of repositioning, splinting method and time of splinting and administration of antibiotics) (48, 49). Also the effects of various endodontic treatment procedures were analysed (50). Finally, the long-term fate of root-fractured teeth was published in 2008 (59) and 2009 (72).

Alveolar fractures

In a retrospective study in 1968 the outcome of 29 alveolar fractures involving 71 teeth were analysed and pulp necrosis and progressive root resorption were found to be very common (6). However, the treatment procedures used at that time have later been shown to be suboptimal. In 2009 a prospective study of 84 alveolar fractures with 197 involved teeth was conducted, a study which showed a significantly lower risk of complications than any previously reported study and specified a set of significant predictors for healing complications after alveolar fractures (62, 63). Furthermore, a clinical study of etiology and pathogenesis of 340 cases incorporating 800 teeth was published (61).

Jaw fractures with tooth involvement

In 1969 a series of 84 mandibular fractures were examined and a rather high frequency of alveolar bone loss in the fractures was found, a phenomenon primarily related to insufficient repositioning (9).

Primary tooth injuries

In two retrospective studies from the early 1970s the outcome of pulpal and periodontal healing complications were described for luxated primary teeth as well as the implications for the developing successors (10, 11). In a combined clinical and histologic study eight different complications involving the subjacent permanent successors were described. These encompassed enamel opacities, enamel hypoplasia with or without a cervically placed circumferential enamel hypoplasia, crown or root dilacerations, root angulation, arrested root formation andsequestration of infected tooth germs (10, 14).

Based on these studies it was decided to try to develop evidence based treatment for primary tooth injuries using a monkey model. In several experiments the effect of treatment procedures such as extraction or awaiting spontaneous eruption were examined (85, 86). Furthermore, the detrimental effects on the permanent successor caused by chronic inflammation in primary teeth due to an untreated pulp necrosis were analysed (87).

Based on these animal experiments a prospective study was started on 270 children with injured primary teeth. All children were followed with annual controls until the age of 6 where all healing complications affecting the injured primary teeth were analysed and related to the type of the luxation injury and stage of root development of the affected tooth at the time of injury (39). At the age of six eruption problems were analysed for the succedaneus successors. Finally, the patients were recalled at the age of 10 years where subsequent developmental changes to the permanent successor could be registered.

Making a unified database for all trauma types

Since systematic registration of all the various trauma types began in 1965, the trauma patients have been examined and followed-up using a standardized trauma record. Altogether 40,000 patient records exist and about 4,000 have been included in long-term follow-up studies. These 4,000 cases are now part of an extensive database covering all types of dental trauma injuries. In 2005 the Dental Trauma Guide project was started in order to use this valuable source of information for prognostic estimation of healing complications after dental trauma. The data makes it possible to calculate prognosis estimates for the various injury types and to make comparisons between competing treatment procedures. The aim and function of the Dental Trauma Guide will be described in a future publication.

Risk estimates are based on survival statistic carried out on a subselection of patients identified from the database as having a comparable trauma scenario. The underlying statistics are currently life table analysis but alternative approaches are being tested such cox regression and decision tree analysis in order to identify the most effective approach.

The illustrations used in the Dental Trauma Guide originate from a series of trauma textbooks published from the Department of Oral and Maxillofacial Surgery at the University Hospital in Copenhagen (147-155).

It is the hope of the authors that the Dental Trauma Guide project will help practitioners choose safe and effective treatments and enable them to give the patient accurate information about the risk profile of the traumatized tooth.

References

  • ELLIS RG. The classification and treatment of injuries to the teeth of children. 4. ed. Year Book Publishers Inc., Chicago 1960.
  • ANDREASEN JO, HJØRTING-HANSEN E. Replantation of teeth. I. Radiographic and clinical study of 110 human teeth replanted after accidental loss. Acta Odont Scand 1966;24:287-306.
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  • ANDREASEN JO, HJØRTING-HANSEN E. Intraalveolar root fractures: radiographic and histologic study of 50 cases. J Oral Surg 1967;25:414-426.
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  • ANDREASEN JO, BORUM MK, JACOBSEN HL, ANDREASEN FM. Replantation of 400 traumatically avulsed permanent incisors. 4. Factors related to periodontal ligament healing. Endod Dent Traumatol 1995;11:59-89.
  • ROBERTSON A, ANDREASEN FM, BERGENHOLTZ G, ANDREASEN JO, NORÉN JG. Incidence of pulp necrosis subsequent to pulp canal obliteration from trauma of permanent incisors. J Endod 1996;22:557-60.
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  • GLENDOR U, HALLING A, ANDERSSON L, ANDREASEN JO, KLITZ I. Type of treatment and estimation of time spent on dental trauma. A longitudinal and retrospective study. Swed Dent J 1998;22:47-60.
  • KAWANAMI M, ANDREASEN JO, BORUM MK, SCHOU S, HJØRTING-HANSEN E, KATO H.Infraposition of ankylosed permanent maxillary incisors after replantation related to age and sex. Endod Dent Traumatol 1999;15:50-6.
  • ROBERTSON A, ANDREASEN FM, ANDREASEN JO, NORÉN JG. Long-term prognosis of crown-fractured permanent incisors. The effect of stage of root development and associated luxation injury. Int J Paed Dent 2000;10:191-9.
  • CVEK M, ANDREASEN JO, BORUM MK. Healing of 208 intra-alveolar root fractures in patients aged 7 to 17 years. Dent Traumatol 2001;17:53-62.
  • BORUM MK, ANDREASEN JO. Therapeutic and economic implications of traumatic dental injuries in Denmark: an estimate based on 7549 patients treated at a major trauma centre. Int J Paediat Dent 2001;11:249-58.
  • ANDREASEN JO, ANDREASEN FM, SKEIE A, HJØRTING-HANSEN E, SCHWARTZ O. Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries – a review article. Dent Traumatol 2002;18:116-28.
  • ANDREASEN FM. Transient root resorption after dental trauma: The clinician’s dilemma. J Esthet Restor Dent 2003; 15: 80-92.
  • CVEK M, MEJÀRE I, ANDREASEN JO. Healing and prognosis of teeth with intra-alveolar fractures involving the cervical part of the root. Dent Traumatol 2002;18:57-65.
  • ANDREASEN JO, ANDREASEN FM, MEJÀRE I. CVEK M. Healing of 400 intra-alveolar root fractures. 1. Effect of pre-injury and injury factors such as sex, age, stage of rot development, fracture type, location of fractures and severity of dislocation. Dent Traumatol 2004;20:192-202.
  • ANDREASEN JO, ANDREASEN FM, MEJÀRE I, CVEK M. Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period of antibiotics. Dent Traumatol 2004;20:203-11.
  • CVEK M, MEJÀRE I, ANDREASEN JO. Conservative endodontic treatment of teeth fractures in the middle or apical part of the root. Dent Traumatol 2004;20:261-9.
  • ANDREASEN JO, BAKLAND LK, MATRAS R, ANDREASEN FM. Traumatic intrusion of permanent teeth. Part 1. An epidemiological study of 216 intruded permanent teeth. Dent Traumatol 2006;22:83-9.
  • ANDREASEN JO, BAKLAND LK, MATRAS R, ANDREASEN FM. Traumatic intrusion of permanent teeth. Part 2. A clinical study of the effect of preinjury and injury factors (such as sex, age, stage of root development, tooth location and extent of injury including number of intruded teeth) on 140 intruded permanent teeth. Dent Traumatol 2006;22:90-8.
  • ANDREASEN JO, BAKLAND LK, MATRAS R, ANDREASEN FM. Traumatic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay, method of repositioning, type of splint, length of splinting and antibiotics in 140 teeth. Dent Traumatol 2006;22:99-111.
  • ANDREASEN JO, VINDING TR, AHRENSBURG SS. Predictors for healing complications in the permanent dentition after dental trauma. A review. Endod Topics 2006; 14; 20-27.
  • ANDREASEN JO, MALMGREN B, SAE-LIM V, BAKLAND L. Tooth avulsion in children, to replant or not. A survey article. Endod Topics 2006, 14; 28-34.
  • ANDREASEN JO, JENSEN L. AHRENSBURG SS. Relationship between calcium hydroxide pH levels in the root canals and periodontal healing after replantation of avulsed teeth. Endod Topics 2006;14:93-101.
  • MALMGREN B, MALMGREN O, ANDREASEN JO. Alveolar bone development after decoronation of ankylosed teeth. Endod Topics 2006;14:35-40.
  • ANDREASEN JO, JENSEN SS, SAE-LIM V. The role of antibiotics in preventing healing complications after traumatic dental injuries. A literature review. Endod Topic 2006;14:80-92.
  • CVEK M, TSILINGARIDIS G, JO ANDREASEN. Survival of 534 incisors after intra-alveolar root fracture in patients aged 7-17 years. Dent Traumatol 2008;24;379-387.
  • ANDREASEN JO, LAURIDSEN E, AHRENSBURG SS, TSILINGARIDIS G. Tooth mobility changes subsequent to root fractures. A longitudinal clinical study of 47 permanent teeth. Dent Traumatol 2009, 25. In preparation.
  • ANDREASEN JO, AHRENSBURG SS, HILLERUP S, KOFOED T, SCHWARTZ O. Alveolar fractures in the permanent dentition. Part 1. Epidemiology, etiology and pathogenesis. An Analysis of 340 cases involving 800 teeth. Dent Traumatol 2009, 25. In preparation.
  • ANDREASEN JO, AHRENSBURG SS, HILLERUP S, KOFOED T, SCHWARTZ O. Alveolar fractures in the permanent dentition. Part 2. A clinical prospective study of 83 cases involving 197 teeth. Effect of preinjury and injury factors upon healing complications. Dent Traumatol 2009;25. In preparation.
  • ANDREASEN JO, AHRENSBURG SS, HILLERUP S, KOFOED T, SCHWARTZ O. Alveolar fractures in the permanent dentition. Part 3. A clinical prospective study of 83 cases involving 197 teeth. Effects of treatment factors upon healing complications. Dent Traumatol 2009, 25. In preparation.
  • ANDREASEN JO, BORUM MK, JACOBSEN HL, AHRENSBURG SS, ANDREASEN FM. Replantation of 400 traumatically avulsed permanent incisors V – Preinjury and injury factors related to progression of root resorption. Dent Traumatol 2009;25. In preparation.
  • ANDREASEN JO, BORUM MK, AHRENSBURG SS, ANDREASEN FM. Replantation of 400 traumatically avulsed permanent incisors VI – Endodontic procedures related to periodontal healing or progression of root resorption. Dent Traumatol 2009;25. In preparation.
  • HERMAN NV, ANDREASEN JO, ANDREASEN F, AHRENSBURG SS. Periodontal healing complications following concussion injury in the permanent dendition. Dent. Traumatol 2009; 25. In preparation.
  • HERMAN NV, ANDREASEN JO, ANDREASEN F, AHRENSBURG SS. Periodontal healing complications following subluxation injury in the permanent dentition. Dent Traumatol 2009; 25. In preparation.
  • HERMAN NV, ANDREASEN JO, ANDREASEN F, AHRENSBURG SS. Periodontal healing complications following lateral luxation injury in the permanent dentition. Dent Traumatol 2009; 25. In preparation.
  • HERMAN NV, ANDREASEN JO, ANDREASEN F, AHRENSBURG SS. Periodontal healing complications following lateral extrusion injury in the permanent dentition. Dent Traumatol 2009; 25. In preparation.
  • BESSERMAN M, ANDREASEN JO, AHRENSBURG S, SELMER U. Long term prognosis of anterior crown-root fractured teeth treated by orthodontic and/or surgical exposure of the fracture site. Dent Traumatol 2009; 25. In preparation.
  • ANDREASEN JO, LAURIDSEN E, AHRENSBURG SS, HILLERUP S, KOFOD T. Timing of healing complications after traumatic dental injuries. Dent Traumatol 2009, 25. In preparation.
  • ANDREASEN JO, TSILIANGARIDIS G, CVEK M. Root fractures, treatment considerations after healing / non-healing in humans. Dent Traumatol 2009, 25. In preparation.
  • ANDREASEN JO, LAURIDSEN E, ANDREASEN FM. Contradictions in the treatment of traumatic dental injuries – and ways to proceed in dental trauma research. Dent Traumatol 2009, 25. In preparation.
  • ANDREASEN JO, LAURIDSEN E, DAUGAARD-JENSEN J. Dental traumatology: an orphan in pediatric dentistry? Pediatric Dent 2009; 31: 153-156.
  • ANDREASEN JO, LAURIDSEN E, AHRENSBURG SS. Development of an interactive dental trauma guide. Pediatric Dent 2009; 31: 133-136.
  • LAURIDSEN EF, GERDS TA, HERMANN NV, CHRISTENSEN SA, ANDREASEN JO. Crown fractures Part1 -healing complications of the pulp following crownfractures in permanent incisors. Dent Traumatol 2009, 25. In preparation.
  • LAURIDSEN EF, GERDS TA, HERMANN NV, CHRISTENSEN SA, ANDREASEN JO. Crown fractures Part 2 – development of pulp necrosis in permanent incisors following crownfractures and concussion injury. Dent Traumatol 2009, 25. In preparation.
  • LAURIDSEN EF, GERDS TA, HERMANN NV, CHRISTENSEN SA, ANDREASEN JO. Crown fractures Part 3 – development of pulp necrosis in permanent incisors following crownfractures and subluxation injury. Dent Traumatol 2009, 25. In preparation.
  • LAURIDSEN EF, GERDS TA, HERMANN NV, CHRISTENSEN SA, ANDREASEN JO. Crown fractures Part 4-development of pulp necrosis in permanent incisors following crownfractures with concurrent extrusion or lateral luxation injury. Dent Traumatol 2009, 25. In preparation.
  • LAURIDSEN EF, GERDS TA, HERMANN NV, CHRISTENSEN SA, ANDREASEN JO. Prediction of pulp necrosis following trauma in permanent incisors. Dent Traumatol 2009, 25. In preparation.
  • ANDREASEN JO. The effect of splinting upon periodontal healing after replantation of permanent incisors in monkeys. Acta Odont Scand 1975;33:313-323.
  • ANDREASEN JO. Influence of traumatic intrusion of primary teeth on their permanent successors in monkeys. Int J Oral Surg 1976;5:207-219.
  • SØDER P-Ø, OTTESKOG P, ANDREASEN JO, MODEER T. The effect of drying on the viability of the periodontal membrane. Scand J Dent Res 1976;84:164-168.
  • REINHOLDT J, ANDREASEN JO, SØDER P-Ø, OTTESKOG P, DYBDAHL R, RIIS I. Cultivation of periodontal ligament fibroblasts on extracted monkeys’ incisors. A histological study of three culturing methods. Int J Oral Surg 1977;7:215-225.
  • THYLSTRUP A, ANDREASEN JO. The influence of traumatic intrusion of primary teeth on their permanent successors in monkeys. A macroscopic, polarized and scanning electron microscopic study. J Oral Path 1977;6:296-306.
  • ANDREASEN JO, REINHOLDT J, RIIS I, DYBDAHL R, SØDER P-Ø, OTTESKOG P. Periodontal and pulpal healing of monkey incisors preserved in tissue culture before replantation. Int J Oral Surg 1978;7:104-12.
  • ANDREASEN JO, RIIS I. Influence of pulp necrosis and periapical inflammation of primary teeth on their permanent successors. Combined macroscopic and histological study in monkeys. Int J Oral Surg 1978;7:178-87.
  • BARBAKOW FH, CLEATON-JONES PE, AUSTIN JC, ANDREASEN JO, VEIERA E. Changes in tooth mobility after experimental replantation. J Endod 1978;4:256-72.
  • SØDER P-Ø, OTTESKOG P, FRITHIOF L, BLOMLÖF L, ANDREASEN JO. Cultivation of fibroblasts on human teeth. Ultrastructural observations of cells cultivated in multilayers. Int J Oral Surg 1979;8:234-240.
  • ANDREASEN JO. A time-related study of periodontal healing and root resorption activity after replantation of mature permanent incisors in monkeys. Swed Dent J 1980;4:101-10.
  • ANDREASEN JO. Analysis of topography of surface and inflammatory root resorption after replantation of mature permanent incisors in monkeys. Swed Dent J 1980;4:135-44.
  • ANDREASEN JO. Analysis of pathogenesis and topography of replacement resorption ankylosis after replantation of mature permanent incisors in monkeys. Swed Dent J 1980;4:231-40.
  • ANDREASEN JO. The effect of removal of the coagulum in the alveolus before replantation upon periodontal and pulpal healing of mature permanent incisors in monkeys. Int J Oral Surg 1980;9:458-61.
  • ANDREASEN JO. Delayed replantation after submucosal storage in order to prevent root resorption after replantation. In J Oral Surg 1980:9:394-403.
  • ANDREASEN JO. Relationship between cell damage in the periodontal ligament after replantation and subsequent development of root resorption. Acta Odont Scand 1981;39:15-25.
  • ANDREASEN JO. Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys. In J Oral Surg 1981;1:43-53.
  • ANDREASEN JO, KRISTERSON L. The effect of limited drying or removal of the periodontal ligament upon periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odont Scand 1981;39:1-13.
  • ANDREASEN JO. The effect of pulp extirpation or root canal treatment on periodontal healing after replantation of permanent incisors in monkeys. J Endod 1981;7:245-52.
  • ANDREASEN JO. Interrelation between alveolar bone and periodontal ligament repair after replantation of mature permanent incisors in monkeys. J Perio Dent Res 1981;16:228-35.
  • TRONSTAD L, ANDREASEN JO, HASSELGREN G, KRISTERSON L, RIIS I. pH changes in dental tissue after root canal filling with calcium hydroxide. J Endod 1981;7:17-22.
  • ANDREASEN JO. The effect of excessive occlusal trauma upon periodontal healing after replantation of mature permanent incisors in monkeys. Swed Dent J 1981;5:115-22.
  • ANDREASEN JO. Periodontal healing after replantation and autotransplantation of incisors in monkeys. Int J Oral Surg 1981;10:54-61.
  • ANDREASEN JO, KRISTERSON L. The effect of extra-alveolar root filling with calcium hydroxide on periodontal healing after replantation of permanent incisors in monkeys. J Endod 1981;7:349-54.
  • WEINSTEIN FM, WORSAAE N, ANDREASEN JO. The effect on periodontal and pulpal tissues of various cleaning procedures prior to replantation of extracted teeth. Acta Odont Scand 1981;39:251-5.
  • ANDREASEN JO, KRISTERSON L. Repair processes in the cervical region of replanted and transplanted teeth in monkeys. In J Oral Surg 1981;10:128-36.
  • ANDREASEN JO. Relationship between surface and inflammatory resorption and changes in the pulp after replantation of permanent incisors in monkeys. J Endod 1981;7:294-301.
  • ANDREASEN JO, KRISTERSON L. Evaluation of different types of autotransplanted connective tissues as potential periodontal ligament substitutes. An experimental replantation study in monkeys. Int J Oral Surg 1981;10:189-201.
  • CVEK M, CLEATON-JONES PE, AUSTIN JC, ANDREASEN JO. Pulp reactions to exposure after experimental crown fractures or grinding in adult monkeys. J Endod 1982;8:391-7.
  • MATSSON L, ANDREASEN JO, CVEK M, GRANATH L. Ankylosis of experimentally reimplanted teeth related to extra-alveolar period and storage environment. Ped Dent 1982;4:327-9.
  • KRISTERSON L, ANDREASEN JO. The effect of splinting upon periodontal and pulpal healing after autotransplantation of mature and immature permanent incisors in monkeys. Int J Oral Surg 1983;12:239-49.
  • SCHWARTZ O, ANDREASEN JO. Cryopreservation of mature teeth before replantation in monkeys. Int J Oral Surg 1983;12:425-36.
  • KRISTERSON L, ANDREASEN JO. Influence of root development on periodontal and pulpal healing after replantation of incisors in monkeys. Int J Oral Surg 1984;13:313-23.
  • KRISTERSON L, ANDREASEN JO. Autotransplantation and replantation of tooth germs in monkeys. Effect of damage to the dental follicle and position of transplant in the alveolus. Int J Oral Surg 1984;13:324-33.
  • ANDREASEN JO, SCHWARTZ O, ANDREASEN FM. The effect of apicoectomy before replantation on periodontal and pulpal healing in teeth in monkeys. Int J Oral Surg 1985;14:176:83.
  • SCHWARTZ O, ANDREASEN JO, GREVE T. Cryopreservation before replantation of mature teeth in monkeys (II). Effect of preincubation, different freezing and equilibration rates and endodontic treatment upon periodontal healing. Int J Oral Surg 1985;14:350-61.
  • ANDREASEN JO, SCHWARTZ O. The effect of saline storage before replantation upon dry damage of the periodontal ligament. Endod Dent Traumatol 1986;2:67-70.
  • ANDREASEN JO. Review article. Experimental dental traumatology. Development of a model for external root resorption. Endod Dent Traumatol 1987;3:269-87.
  • ANDERSSON L, JONSSON BG, HAMMERSTRÖM L, BLOMLÖF L, ANDREASEN JO, LINDSKOG S.Evaluation of statistics and desirable experimental design of a histomorphometrical method for studies of root resorption. Endod Dent Traumatol 1987;3:288-95.
  • ANDREASEN JO, KRISTERSON L, ANDREASEN FM. Effect of damage to the Hertwig’s epithelial root sheath upon root growth after autotransplantation of teeth in monkeys. Endod Dent Traumatol 1988;4:145-51.
  • ANDREASEN JO. Review of root resorption systems and models. Etiology of root resorption and the homeostatic mechanisms of the periodontal ligament. In: Davidovitch Z (ed). The Biological Mechanisms of Tooth Eruption and Root Resorption. EBSCO Media, Birmingham 1988, pp.9-21.
  • SCHWARTZ O, ANDREASEN JO. Allotransplantation and autotransplantation of mature teeth in monkeys. The influence of endodontic treatment. J Oral Maxillofac Surg 1988;46:672-81.
  • GROISMAN M, SCHWARTZ O, ANDREASEN JO, ATTSTRÖM R. Supraalveolar periodontal healing of auto- and allotransplanted teeth in monkeys. Endod Dent Traumatol 1989;5:229-33.
  • SCHENDEL KU, SCHWARTZ O, ANDREASEN JO, HOFFMEISTER B. Re-innervation of autotransplanted teeth. A histological investigation in monkeys. Int J Oral Maxillofac Surg 1990;19:247.
  • SCHWARTZ O. GROISMAN M, ATTSTRÖM R. ANDREASEN JO. Transmission electron microscopy of supraalveolar periodontal healing of auto- and allotransplanted teeth in monkeys. Endod Dent Traumatol 1990;6:26-32.
  • ANDREASEN JO, PITT FORD TR. A radiographic study of the effect of various retrograde fillings on periapical healing after replantation. Endod Dent Traumatol 1994;10:276-81.
  • PITT FORD TR, ANDREASEN JO, KARIYAWASAM SP. Effect of IRM root end filling on healing after replantation. J Endod 1994;20:381-5.
  • PITT FORD TR, ANDREASEN JO, DORN SO, KARIYAWASAM SP. Effect of super-EBA as a root end filling on healing after replantation. J Endod 1995;21:13-5.
  • PITT FORD TR, ANDREASEN JO, DORN SO, KARIYAWASAM SP. Effect of various zinc oxide materials as root-end fillings on healing after replantation. Int Endod J 1995;28:273-8.
  • PITT FORD TR, ANDREASEN JO, DORN SO, KARIYAWASAM SP. Effect of various sealers with gutta-percha as root-end fillings on healing after replantation. Endod Dent Traumatol 1996;12:33-7.
  • OIKARIENEN KS, STOLZE K, ANDREASEN JO. Influence of conventional forceps extraction and extraction with and extrusion instrument on cementoblast loss and external root resorption of replanted monkey incisors. J Periodont Res 1996;31:337-44.
  • ROBERTSON A, LUNDGREN T, ANDREASEN JO, DIETZ W, HOYER I, NORÉN JG. Pulp calcifications in traumatized primary incisors. A morphological and inductive analysis study. Eur J Oral Sci 1997;196-206.
  • FARIK B, MUNKSGAARD EC, KREIBORG S, ANDREASEN JO. Adhesive bonding of fragmented anterior teeth. Endod Dent Traumatol 1998;14:119-123.
  • FARIK B, MUNKSGAARD EC, SUH BI, ANDREASEN JO, KREIBORG S. Adhesive bonding of fractured anterior teeth: effect of wet technique and rewetting agent. Am J Dent 1998;11:251-253.
  • FARIK B, MUNKSGAARD EC, ANDREASEN JO, KREIBORG S. Drying and reweetting anterior crown fragments prior to bonding. Endod Dent Traumatol 1999;15:113-16.
  • FARIK B, MUNKSGAARD EC, ANDREASEN JO. Fracture strength of fragment-bonded teeth. Effect of calcium hydroxide lining before bonding. Am J Dent 2000;13:98-100.
  • FARIK B, MUNKSGAARD EC, ANDREASEN JO. Impact strength of teeth restored by fragment-bonding. Endod Dent Traumatol 2000;16:151-3.
  • FARIK B, MUNKSGAARD EC, ANDREASEN JO. Strength of fragment-bonded teeth. In: Roulet J-F, Degrange M, (ed.). Adhesion. The Silent Revolution in Dentistry. Quintessenz Publishing Co, Inc. 2000;197-200.
  • ROBERTSON A, ANDREASEN FM, BERGENHOLTZ G, ANDREASEN JO, MUNKSGAARD C. Pulp reactions to restoration of experimentally induced crown fractures. J Dent 1998;26:409-416.
  • ANDREASEN JO, FARIK B, MUNKSGAARD EC. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol 2002;18:134-7.
  • SCHWARTZ O, ANDREASEN JO. Allo- and autotransplantation of mature teeth in monkeys: a sequential time-related histoquantitative study of periodontal and pulpal healing. Dent Traumatol 2002;18:246-61.
  • SCHWARTZ O, ANDREASEN FM, ANDREASEN JO. Effects of temperature, storage time and media on periodontal and pulpal healing after replantation of incisors in monkeys. Dent Traumatol 2002;18:1-6.
  • ANDREASEN JO, MUNKSGAARD EC, BAKLAND LK. Comparison of fracture resistance of immature sheep teeth after root canal calcium hydroxide or MTA. Dent Traumatol 2006;22:154-6.
  • ANDERSSON L, LINDSKOG S, BLOMLÖF L, HEDSTRÖM KG, HAMMERSTRÖM L. Effect of masticatory stimulation on dentoalveolar ankylosis after experimental tooth replantation. Endod Traumatol 1985; 1:13-16.
  • HAMMERSTRÖM L, BLOOMLÖF L, FEIGLIN B, LINDSKOG S. Replantation of teeth and antibiotic treatment. Endod Dent Traumatol 1986; 2:51-57.
  • CVEK M, CLEATON-JONES P, AUSTIN J, KLING M, LOWNIE J, FATTI P. Effect of topical application of doxycycline on pulp revascularization and periodontal healing in reimplanted monkey incisors. Endod Dent Traumatol 1990; 6:170-176.
  • CVEK M, CLEATON-JONES P, AUSTIN J, KLING M, LOWNIE J, FATTI P. Pulp revascularization in reimplanted immature monkey incisors – predictability and the effect of antibiotic systematic prophylaxis. Endod Dent Traumatol 1990; 6:157-169.
  • ANDREASEN JO. Traumatic injuries of the teeth. Textbook (1st ed.) Munksgaard, Copenhagen 1972.
  • ANDREASEN JO. Traumatic injuries of the teeth. (2nd ed.) Munksgaard, Copenhagen 1981.
  • ANDREASEN JO, ANDREASEN FM. Textbook and Color Atlas of Traumatic Injuries to the Teeth (3rd ed.). Copenhagen: Munksgaard, 1993; 13-64.
  • ANDREASEN JO, ANDREASEN FM. Textbook and Color Atlas of Traumatic Injuries to the Teeth (4th ed.). Oxford, Blackwell 2007. pp. 62-113.
  • ANDREASEN JO, ANDREASEN FM. Essentials of Traumatic Injuries to the Teeth (1st ed.). Munksgaard, Copenhagen 1990.
  • ANDREASEN JO, ANDREASEN FM. Essentials of Traumatic Injuries to Teeth (2nd ed.). Munksgaard, Copenhagen 1999.
  • ANDREASEN JO. Atlas of Replantation and Transplantation of Teeth. Mediglobe SA, Switzerland 1990; 111-138.
  • ANDREASEN JO, ANDREASEN FM, BAKLAND LK, FLORES MT. Traumatic Dental Injuries. A manual (1st ed.). Munksgaard, Copenhagen 1999.
  • ANDREASEN JO, ANDREASEN FM, BAKLAND LK, FLORES MT. Traumatic dental injuries. A Manual (2nd ed.). Oxford: Blackwell/Munksgaard Publishing Company. 2003;1-85.
  • ANDREASEN JO, LAURIDSEN E, AHRENSBURG SS. Dental Trauma Guide. A source of evidence based treatment guidelines for dental trauma. Dent Traumatol 2009, 25. In press.
  • HATIBOVIĆ-KOFMAN S, RAIMUNDO L, ZHENG L, CHONG L, FRIEDMAN M, ANDREASEN JO. Fracture resistance and histological findings of immature teeth treated with mineral trioxide aggregate. Dent Traumatol 2008;24:272-6.
  • HERMUND NU, HILLERUP S, KOFOD T, SCHWARTZ O, ANDREASEN JO. Effect of early or delayed treatment upon healing of mandibular fractures: a systematic literature review. Dent Traumatol 2008;24:22-6.
  • ANDREASEN JO, STORGÅRD JENSEN S, KOFOD T, SCHWARTZ O, HILLERUP S. Open or closed repositioning of mandibular fractures: is there a difference in healing outcome? A systematic review. Dent Traumatol 2008;24:17-21.
  • CVEK M, TSILINGARIDIS G, ANDREASEN JO. Survival of 534 incisors after intra-alveolar root fracture in patients aged 7-17 years. Dent Traumatol 2008;24:379-87.
  • ANDREASEN JO, LAURIDSEN E, ANDREASEN FM. Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research. Dent Traumatol 2010;26:16-22.
  • ANDREASEN JO, LAURIDSEN E, DAUGAARD-JENSEN J. Dental traumatology: an orphan in pediatric dentistry? Pediatr Dent 2009;31:153-6.
  • ANDREASEN JO, LAURIDSEN E, CHRISTENSEN SS. Development of an interactive dental trauma guide. Pediatr Dent 2009;31:133-6.
  • ANDREASEN JO, SCHWARTZ O, KOFOED T, DAUGAARD-JENSEN J. Transplantation of premolars as an approach for replacing avulsed teeth. Pediatr Dent 2009;31:129-32. Review.
  • TROPE M, ANDREASEN JO. Comments on routine systemic antibiotic prescription in the management of permanent avulsed teeth. Dent Traumatol 2010;26:302.
  • ANDREASEN JO. Pulp and periodontal tissue repair – regeneration or tissue metaplasia after dental trauma. A review. Dent Traumatol 2012;28:19-24.
  • ANDREASEN JO, BAKLAND LK. Pulp regeneration after non-infected and infected necrosis, what type of tissue do we want? A review. Dent Traumatol 2012;28:13-8.
  • BAKLAND LK, ANDREASEN JO. Will mineral trioxide aggregate replace calcium hydroxide in treating pulpal and periodontal healing complications subsequent to dental trauma? A review. Dent Traumatol 2012;28:25-32.
  • TSILINGARIDIS G, MALMGREN B, ANDREASEN JO, MALMGREN O. Intrusive luxation of 60 permanent incisors: a retrospective study of treatment and outcome. Dent Traumatol 2012;28:416-22.
  • ANDREASEN JO, ANDERSSON L. Critical considerations when planning experimental in vivo studies in dental traumatology. Dent Traumatol 2011;27:275-80.
  • ANDERSSON L, ANDREASEN JO. Important considerations for designing and reporting epidemiologic and clinical studies in dental traumatology. Dent Traumatol 2011;27:269-74.
  • OSTERGAARD BH, ANDREASEN JO, AHRENSBURG SS, POULSEN S. An analysis of pattern of dental injuries after fall accidents in 0- to 2-year-old children – does the use of pacifier at the time of injury make a difference? Int J Paediatr Dent 2011;21:397-400.
  • ANDREASEN JO, LAURIDSEN E, GERDS TA, AHRENSBURG SS. Dental Trauma Guide: a source of evidence-based treatment guidelines for dental trauma. Dent Traumatol 2012;28:345-50.
  • HERMANN NV, LAURIDSEN E, AHRENSBURG SS, GERDS TA, ANDREASEN JO. Periodontal healing complications following extrusive and lateral luxation in the permanent dentition: a longitudinal cohort study. Dent Traumatol 2012;28:394-402.
  • ANDREASEN JO, AHRENSBURG SS. History of the Dental Trauma Guide. Dent Traumatol 2012;28:336-44.
  • GERDS TA, LAURIDSEN E, AHRENSBURG SS, ANDREASEN JO. The dental trauma internet calculator. Dent Traumatol 2012;28:351-7.
  • LAURIDSEN E, HERMANN NV, GERDS TA, KREIBORG S, ANDREASEN JO. Pattern on traumatic dental injuries in the permanent dentition among children, adolescents and adults. Dent Traumatol 2012;28:358-63.
  • HERMANN NV, LAURIDSEN E, AHRENSBURG SS, GERDS TA, ANDREASEN JO. Periodontal healing complications following concussion and subluxation injuries in the permanent dentition: a longitudinal cohort study. Dent Traumatol 2012;28:386-93.
  • ANDREASEN JO, AHRENSBURG SS, TSILINGARIDIS G. Root fractures: the influence of type of healing and location of fracture on tooth survival rates – an analysis of 492 cases. Dent Traumatol 2012;28:404-9.
  • ANDREASEN JO, AHRENSBURG SS, TSILINGARIDIS G. Tooth mobility changes subsequent to root fractures: a longitudinal clinical study of 44 permanent teeth. Dent Traumatol 2012;28:410-4.
  • LAURIDSEN E, HERMANN NV, GERDS TA, AHRENSBURG SS, KREIBORG S, ANDREASEN JO. Combination injuries 1. The risk of pulp necrosis in permanent teeth with concussion injuries and concomitant crown fractures. Dent Traumatol 2012;28:364-70.
  • LAURIDSEN E, HERMANN NV, GERDS TA, AHRENSBURG SS, KREIBORG S, ANDREASEN JO. Combination injuries 2. The risk of pulp necrosis in permanent teeth with subluxation injuries and concomitant crown fractures. Dent Traumatol 2012;28:371-8.
  • LAURIDSEN E, HERMANN NV, GERDS TA, AHRENSBURG SS, KREIBORG S, ANDREASEN JO. Combination injuries 3. The risk of pulp necrosis in permanent teeth with extrusion or lateral luxation and concomitant crown fractures without pulp exposure. Dent Traumatol 2012;28:379-85.
  • DIANGELIS AJ, ANDREASEN JO, EBELESEDER KA, KENNY DJ, TROPE M, SIGURDSSON A, ANDERSSON L, BOURGUIGNON C, FLORES MT, HICKS ML, LENZI AR, MALMGREN B, MOULE AJ, POHL Y, TSUKIBOSHI M; INTERNATIONAL ASSOCIATION OF DENTAL TRAUMATOLOGY. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol 2012;28:2-12. Erratum in: Dent Traumatol 2012;28:499.
  • ANDERSSON L, ANDREASEN JO, DAY P, HEITHERSAY G, TROPE M, DIANGELIS AJ, KENNY DJ, SIGURDSSON A, BOURGUIGNON C, FLORES MT, HICKS ML, LENZI AR, MALMGREN B, MOULE AJ, TSUKIBOSHI M; INTERNATIONAL ASSOCIATION OF DENTAL TRAUMATOLOGY. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2012;28:88-96.
  • MALMGREN B, ANDREASEN JO, FLORES MT, ROBERTSON A, DIANGELIS AJ, ANDERSSON L, CAVALLERI G, COHENCA N, DAY P, HICKS ML, MALMGREN O, MOULE AJ, ONETTO J, TSUKIBOSHI M; INTERNATIONAL ASSOCIATION OF DENTAL TRAUMATOLOGY. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol 2012;28:174-82.
  • ANDREASEN JO. Pulp and periodontal tissue repair – regeneration or tissue metaplasia after dental trauma. A review. Dent Traumatol 2012;28:19-24.
  • ANDREASEN JO, BAKLAND LK. Pulp regeneration after non-infected and infected necrosis, what type of tissue do we want? A review. Dent Traumatol 2012;28:13-8.
  • BAKLAND LK, ANDREASEN JO. Will mineral trioxide aggregate replace calcium hydroxide in treating pulpal and periodontal healing complications subsequent to dental trauma? A review. Dent Traumatol 2012;28:25-32.
  •  TSILINGARIDIS G, MALMGREN B, ANDREASEN JO, MALMGREN O. Intrusive luxation of 60 permanent incisors: a retrospective study of treatment and outcome. Dent Traumatol 2012;28:416-22.
  •  ANDREASEN JO, LAURIDSEN E, GERDS TA, AHRENSBURG SS. Dental Trauma Guide: a source of evidence-based treatment guidelines for dental trauma. Dent Traumatol 2012;28:142-7.
  •  ANDREASEN JO, LAURIDSEN E. Alveolar process fractures in the permanent dentition. Part 1. Etiology and clinical characteristics. A retrospective analysis of 299 cases involving 815 teeth. Dent Traumatol 2015;31:442-7.
  •  LAURIDSEN E, GERDS T, ANDREASEN JO. Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture. Dent Traumatol 2016;32:128-39.
  •  TSILINGARIDIS G, MALMGREN B, ANDREASEN JO, WIGEN TI, MASENG AAS AL, MALMGREN O. Scandinavian multicenter study on the treatment of 168 patients with 230 intruded permanent teeth – a retrospective cohort study. Dent Traumatol 2016;32:353-60.
  •  DIANGELIS AJ, ANDREASEN JO, EBELESEDER KA, KENNY DJ, TROPE M, SIGURDSSON A, ANDERSSON L, BOURGUIGNON C, FLORES MT, HICKS ML, LENZI AR, MALMGREN B, MOULE AJ, POHL Y, TSUKIBOSHI M. Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations of Permanent Teeth. Pediatr Dent 2016;38:358-368.
  •  ANDERSSON L, ANDREASEN JO, DAY P, HEITHERSAY G, TROPE M, DIANGELIS AJ, KENNY DJ, SIGURDSSON A, BOURGUIGNON C, FLORES MT, HICKS ML, LENZI AR, MALMGREN B, MOULE AJ, TSUKIBOSHI M. Guidelines for the Management of Traumatic Dental Injuries: 2. Avulsion of Permanent Teeth. Pediatr Dent 2016;38:369-376.
  •  MALMGREN B, ANDREASEN JO, FLORES MT, ROBERTSON A, DIANGELIS AJ, ANDERSSON L, CAVALLERI G, COHENCA N, DAY P, HICKS ML, MALMGREN O, MOULE AJ, ONETTO J, TSUKIBOSHI M. Guidelines for the Management of Traumatic Dental Injuries: 3. Injuries in the Primary Dentition. Pediatr Dent 2016;38:377-385.