2014 Does Trauma in The Primary Dentition Cause Sequelae in Permanent Successors
2014 Does Trauma in The Primary Dentition Cause Sequelae in Permanent Successors
2014 Does Trauma in The Primary Dentition Cause Sequelae in Permanent Successors
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Michele Machado Lenzi1, Adılis Abstract – This systematic review sought scientific evidence (in the litera-
Kalina Alexandria1, Daniele ture) that trauma in the primary incisors cause sequelae in permanent suc-
Masterson T. P. Ferreira2, Lucianne cessors. Also this work verified whether there was a relation between the
Cople Maia1 presence and type of sequelae in permanent teeth with the child’s age at
1
Department of Pediatric Dentistry and the time of injury and type of trauma. Electronic databases, including the
Orthodontics, School of Dentistry, Federal PubMed, Scopus, The Cochrane Library, LILACS, and Web of Science
University of Rio de Janeiro; 2Central Library, were used to search for original articles up to June 2013. Prospective and
Health Science Center, Federal University of retrospective studies that assessed the association of trauma in deciduous
Rio de Janeiro, Rio de Janeiro, Brazil incisors and developmental disturbances in permanent successors were
selected. Two authors independently reviewed and extracted the data from
the included studies. A methodological quality assessment evaluation of
the selected studies was performed. The search retrieved 258 citations. Ini-
tially, 19 studies fulfilled the selection criteria; however, one (1) was
excluded, leaving 18 for the final selection. Despite some limitations in the
Key words: tooth injury; primary tooth; study designs were observed, especially the lack of a control group in most
permanent tooth; prevalence studies, the evidence found suggests that individuals with trauma in their
primary incisors have more developmental disorders in the permanent suc-
Correspondence to: Michele Lenzi, Disciplina
cessors than individuals without a previous trauma. Furthermore, the
de Odontopediatria da FO-UFRJ, Caixa
ria – CCS,
Postal: 68066, Cidade Universita younger the child is at the time of injury, the more frequent and more
CEP: 21941-971, Rio de Janeiro, RJ, Brazil severe are the sequelae to the permanent successor incisors. More severe
Tel./Fax: +55 21 25622098 traumas such as intrusion and avulsion are associated to more serious
e-mail: michelelenzi@hotmail.com developmental disorders. These results should be analyzed carefully
Accepted 10 October, 2014 because very few studies evaluated had a control group.
Trauma in the primary incisors is common, and its bances are some of the sequelae described in the
prevalence has been studied in several countries, show- literature (3, 11, 16–19).
ing a prevalence ranging from 11.0% to 47.0% (1, 2). Although there are studies in the literature on this
After trauma to primary incisors, it is essential to subject, there is still doubt whether other factors
consider the possible risks of sequelae in successor beyond a trauma could have led to these consequences.
teeth. The developmental disturbances of the perma- This systematic review aims to examine the scientific
nent teeth related to trauma to their predecessors have evidence that trauma in the primary incisors is associ-
a prevalence that ranges from 20% to 74% (3–10). ated with sequelae in permanent successors and to
This high prevalence is related to the close anatomical investigate the association between the presence and
relationship between the apices of the primary teeth type of sequelae in permanent teeth with the child’s age
and their developing permanent successors (10, 11). at the time of injury and type of trauma.
The distance between the apex of the primary central
incisor and the incisal edge of the permanent central
Methods
incisor ranges from 2.97 mm at age 3 to 1.97 mm at
age 6 (12). This systematic review was performed according to
The sequelae in permanent teeth after traumatic PRISMA (Preferred Reporting Items for Systematic
injury in primary incisors are related to the type of Review and Meta-Analysis) guidelines (http://www.
injury, the age of the child at the time of injury, as well prisma-statement.org) and was registered at Prospero
as the association with fractures of the alveolar bone under the number CRD42013004470.
(5, 10, 13). The intrusion and avulsion of primary inci-
sors were the types of injury that most commonly
Search strategy
caused sequelae in successors (2–4, 6, 7, 10, 14, 15).
Discoloration of enamel, enamel hypoplasia, crown dil- The following electronic databases were searched up
acerations, root dilacerations, and eruption distur- to and including June 2013: PubMed, Scopus, The
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1
2 Lenzi et al.
Cochrane Library, LILACS, and Web of Science. To up of the traumatized primary teeth until the complete
find additional studies, a hand search was done on the eruption of the successor. Textbooks, dissertations,
reference lists of the retrieved studies. case reports, case series, review articles, animal studies,
The search strategy included appropriate changes in editorials or opinions, and studies with insufficient data
the keywords and followed the syntax rules of each (age of children, type of trauma, prevalence of
database. Mesh terms, keywords, and other free terms sequelae) were excluded. There were no language
related to tooth injuries, primary dentition, permanent restrictions.
dentition, and sequelae were used with Boolean opera-
tors (OR, AND) to combine searches. The terms used
Quality assessment of studies and data extraction
were ‘tooth injuries’, ‘dental lesions’, ‘dental injuries’,
‘dental trauma’, traumatic injury*, ‘trauma dentoalveo- First, the titles and abstracts were analyzed to apply
lar’, ‘tooth avulsion’, exarticulation, ‘tooth dislocation’, the criteria for inclusion and exclusion. Then, the
‘tooth luxation’, ‘tooth movement’, ‘intrusive luxation’, selected studies were evaluated and judged by their full
‘dental intrusion’, ‘extrusive luxation’, ‘tooth extrusion’, texts.
‘lateral luxation’, ‘tooth subluxation’, concussion, The quality assessment and risk of bias of included
‘tooth fractures’, ‘primary dentition’, ‘deciduous denti- papers was applied following Fowkes and Fulton (21)
tion’, ‘deciduous tooth’, predecessors, ‘primary teeth’, for appraising research in the medical area. The check-
‘primary tooth’, ‘tooth abnormalities’, dental anomal*, list included questions on study design, study sample,
‘tooth malformation’, ‘tooth discoloration’, ‘dental control group, quality of measurements and outcomes,
enamel hypoplasia’, ‘enamel hypoplasia’, ‘crown dila- completeness, and distorting influences. When checking
ceration’, ‘root dilaceration’, odontoma, ‘compound the criteria for each paper, we assigned problems for
odontoma’, ‘tooth unerupted’, ‘tooth impacted’, ‘tooth each criterion as major (++) or minor (+) in terms of
eruption ectopic’, complications, sequelae, ‘permanent their expected effect on the results, and a decision was
dentition’, ‘adult dentition’, ‘secondary dentition’, suc- made as to whether the methods were adequate to pro-
cessors, ‘permanent tooth’, ‘permanent teeth’. duce useful information or not. The positive and nega-
Articles appearing in more than one database search tive aspects of the studies were weighted and implicitly
were considered only once. Two examiners (MML and judged. Inadequate study designs were considered a
AKA) independently performed the search process major problem (++). Assessing the quality was noted as
under the guidance of a librarian (DMTPF). Any dif- a minor problem (+) when the paper had a sample of
ferences between the two examiners were solved by a convenience; when the criteria for inclusion/exclusion
third investigator (LCM). was not defined adequately; when the sample size cal-
culations or a representative sampling of the popula-
tion was not included. Risk of bias was considered a
Inclusion criteria
major problem (++) when assessing the quality of
Figure 1 outlines the population, intervention/expo- papers that did not have a control group. Problems in
sure, comparison, and outcome—PICO/PECO format the quality of measurements and outcomes, complete-
(20). ness, and distorting influences when applicable were
Prospective and retrospective-controlled or not stud- considered a minor problem (+). Some aspects of the
ies conducted on children with dental trauma in pri- study design may have a greater influence than others.
mary dentition that were followed through until their For example, the absence of a control group would
permanent teeth had erupted were included in this probably be more important than the characteristics of
review. Traumatized primary teeth were compared to the sample.
non-traumatized ones (controls) and followed up until Points where the question was not applicable were
complete successor eruption. In case of the absence of marked ‘NA’. To make a judgment and to determine
a control group, the study should present a full follow the value of the study, we also posed three questions
Inclusion Criteria
P (participants) Children
E (exposition) Dental trauma in primary teeth
C (comparison) Non-traumatized primary teeth (control group). In the case of
the absence of a control group, the study should present a
full follow-up of the traumatized primary teeth until the
complete eruption of the successor.
O (outcomes) Primary outcome: The presence of sequela in a permanent
tooth.
Secondary outcomes: Types of sequelae in permanent Fig. 1. Inclusion criteria based on the
teeth, child's age at time of injury and type of injury. PECO format following Maia and
Antonio (20).
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Does trauma in the primary dentition cause sequelae in successors? 3
about bias (‘Are the results erroneously biased in a cer- (2–8, 10, 14, 16–18, 22–28) were assessed. Among these
tain direction?’), confounding (‘Are there any serious studies, one study (17) evaluated a sample of cases
confusing or other distorting influences?’), and chance reported in a previous article and literature cases and
(‘Is it likely that the results occurred by chance?’). was excluded. A total of 18 articles were screened for
Here, the answer to each question could be ‘YES’ or the final analysis. Table 1 shows the quality assessment
‘NO’. If the answers to the three questions were ‘No’, of the included studies.
then the paper could be considered sound. The summary details and characteristics of the final
Data extraction was performed by two researchers selected studies are recorded in Table 2. Of the 18 stud-
(MML; AKAF) and was based on methods, partici- ies included, duration of the study ranged from 5 to
pants, type of injury, prevalence of sequelae, most fre- 10 years. Regarding the type of trauma observed, eight
quent sequelae, time of follow up, and statistical studies (2–4, 10, 14, 23, 26, 27) included children with
analysis. Any differences between the two examiners dislocations and fractures, three studies (5, 7, 16) were
were solved by a third investigator (LCM). performed in patients who had only sustained disloca-
tions, five studies (18, 22, 24, 25, 28) included only
patients with intrusions and two studies (6, 8) avul-
Results
sions. Dental injuries were assessed according to crite-
A total of 258 titles/abstracts were identified or ria of Andreasen and Andreasen (11) in all studies
retrieved by database search and one by hand search. reviewed. The sample size ranged from 30 to 487 chil-
Most were found in PubMed (n = 107), followed by dren and from 44 to 620 traumatized primary teeth.
Scopus (n = 82), Web of Science (n = 49), Cochrane The age of patients ranged from 0 to 10 years old. All
library (n = 16), and Lilacs (n = 4). Figure 2 summa- studies included both genders. In relation to the pres-
rizes the study selection process. Of these, 94 were ence of sequelae in permanent successors, the results
duplicated; therefore, counted only once. All unique showed that the prevalence ranged from 20.2% (7) to
titles and abstracts (n = 165) were analyzed according 74.1% (6) and in all studies, dental enamel defects were
to the inclusion and exclusion criteria, and 146 were the most prevalent sequelae. Five articles (4, 5, 7, 8,
excluded. The full texts of the remaining 19 studies 23) found a statistically significant association between
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
4
Table 1. Checklist for appraising a medical article following Fowkes and Fulton (21)
Altun Andreasen & Andreasen & Assuncß~ao Ben Bassat Carvalho Christophersen De Amorim
Guideline Ckecklist et al. (25) Ravn (3) Ravn (5) et al. (7) et al. (16) et al. (18) et al. (8) et al. (4)
Lenzi et al.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Table 1. Continued
Jacomo & Ishikawa Scerri Sennhenn-Kirchner Sleiter & Von Spinas von
Guideline Ckecklist Campos (2) Innes (24) et al. (26) Ravn (6) Ravn (28) et al. (23) & Jacobs (14) Arx (27) et al. (22) Arx (10)
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Quality control 0 0 0 0 0 0 0 0 0 0
Completeness? Compliance 0 0 0 0 0 0 0 0 0 0
Drop outs NA NA NA NA NA NA NA NA NA NA
Deaths NA NA NA NA NA NA NA NA NA NA
Missing data + 0 0 0 0 0 0 0 0 0
Distorting influences? Extraneous treatments NA NA NA NA NA NA NA NA NA NA
Contamination NA NA NA NA NA NA NA NA NA NA
Changes over time + + + 0 0 + + + + 0
Confounding factors 0 0 0 0 0 0 0 0 0 0
Distortion reduced by analysis 0 0 0 0 0 0 0 0 0 0
Summary questions Bias: YES YES YES YES YES NO YES YES YES YES
Are the results erroneously
biased in a certain direction?
Confounding: NO NO NO NO NO NO NO NO NO NO
Are there any serious confusing
or other distorting influences?
Chance: NO NO NO NO NO NO NO NO NO NO
Is it likely that the results
occurred by chance?
++, major problem; +, minor problem; 0, no problem; NA, not applicable.
Does trauma in the primary dentition cause sequelae in successors?
5
6 Lenzi et al.
the age of the child at the time of the trauma and the important to verify whether other etiologic factors
prevalence of sequelae in permanent dentition. Three are associated with teeth malformations besides den-
articles (5, 7, 23) found an association between the type tal trauma in primary teeth. There are other possible
of injury and prevalence of sequelae. The association causes for malformation of permanent teeth, such as
between type of injury and type of defects was found molar-incisor hypoplasia, imperfect amelogenesis, and
in three studies (5, 23, 28). fluorosis (23). We detected few studies with a control
For the quality assessment, the articles were classi- group, and this was a major limitation of the
fied according to the risk of bias, confounding, and assessed papers. Risk of bias was considered a major
chance. Susceptibility to bias was observed in 15 of the problem when assessing the quality of papers that
18 studies analyzed (Table 1). did not have a control group. Andreasen and Ravn
(5) found in their study a high frequency of develop-
mental disturbances recorded in the non-trauma
Discussion
group. That high frequency indicated that non-trau-
The literature suggests that traumatic dental injuries matic factors were involved in the etiology of the
that occur during odontogenesis can cause changes in observed changes. On the other hand, Scerri et al.
the primary incisors and their successors (3, 5, 6, 17, (23) found 52.2% of the cases in the study group
28). The aim of this systematic review was to find evi- with sequelae in permanent successors while only
dence in the literature that trauma in deciduous denti- 10% of disturbances were found in the control
tion causes alterations in the developing permanent group.
teeth and to show that there is an association between The criteria for inclusion and exclusion of studies
the presence and type of sequelae in permanent teeth differed in some approaches. Most of the papers
with the child’s age at time of injury and type of included only traumatic injuries of the periodontal tis-
trauma. sue (5, 7, 16), other studies only included intrusion (18,
Epidemiological studies of dental injuries provide 22, 24, 25, 28) or avulsion (6, 8). The literature shows
important data concerning the prevalence and associ- that the severity of the sequelae depends on the child’s
ated factors of such injuries. Epidemiological data can age at the time of the injury, the type and extent of the
provide a basis for the development of preventive and injury, and the stage of development of the successor
clinical procedures (11). There are tools that are at the moment of trauma (6, 10, 11, 13, 23). For some
designed and developed specifically to assess the quality authors (1–3, 6, 7, 10, 12, 23, 25) regardless of the
of evidence from epidemiological studies (29). The criti- stage of development of the successor, the types of
cal appraisal of the methods and results of these studies trauma that cause the most sequelae are luxations,
was conducted using a detailed checklist with an addi- mainly intrusion and avulsion. Andreasen & Ravn (5),
tional summary judgment (21) After reviewing all arti- Assuncß~ao et al. (7) and Scerri et al. (23) found a signif-
cles identified in the search, we determined that 18 icant association between the type of trauma and the
papers met the inclusion criteria. The problems found prevalence of sequelae. In the Andreasen & Ravn (5)
in these articles were mainly due to an inadequate and Assuncß~ ao et al. (7) studies, intrusion luxation and
description of the efforts to address potential sources avulsion were the types of trauma that were more asso-
of bias, such as sample size, source of sample, control ciated with the presence of alterations in the permanent
group, and missing data. These problems influenced teeth. Scerri et al. (23) found the highest prevalence of
the quality of the evidence found, and further studies malformations following subluxation of primary inci-
should be carried out paying greater attention to these sors. An association between the type of injury and
methodological factors. type of defects was also found. For Ravn (28), the
The design of the selected studies did not include more serious disturbances such as enamel hypoplasia,
sample size calculations or a representative sampling of crown, or root malformation are more common in
the population. Most studies were conducted in dental cases of avulsion. A possible explanation for this may
schools (4–7, 23, 28) or dental trauma centers (2, 10, be found in the anatomic relationship of the primary
14, 18, 27), and samples of convenience were obtained tooth to the permanent tooth germ. The root curvature
in these cases. Assessing the quality was noted as a of the primary tooth provokes a slight rotary move-
minor problem (+) when the paper had a sample of ment during avulsion, which can injure the bud of the
convenience. None of the articles reviewed explained permanent successor tooth (5, 28). Scerri et al. (23) and
how the sample size was determined, possibly suggest- Andreasen & Ravn (5) found a statistically significant
ing a lack of representativeness of sample, and as a result between intrusion and enamel discoloration with
consequence a compromised external validity. How- enamel hypoplasia.
ever, a statement in the methods section that the sam- When the sequelae of the successors were analyzed
ple size was chosen in order to have sufficient power to in relation to the child’s age at the time of the trauma,
detect a meaningful result would be adequate evidence the results of the studies showed that the developmen-
that steps had been taken to ensure an appropriate tal disturbances tended to be more severe and had a
sample size (21). higher ratio when traumatic injuries occurred at a
The most-striking finding when this systematic younger age (4, 6, 8, 14, 16, 18, 23, 26). Five articles
review was conducted was the high number of papers (4, 5, 7, 8, 23) found a statistically significant associa-
that lacked a control group. Only four articles (3, 5, tion between the age of the child at the time of the
16, 23) reported control groups. A control group is trauma and the prevalence of sequelae in permanent
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Table 2. Characteristics of the sample and data collection of the included studies
Participants Most frequent sequelae
Author/Country/Year/ Injury types on on permanent Duration of the
Study design Source of sample Sample size primary teeth successors Sequelae prevalence study (years) Statistical analysis/P value
Altun et al. (25) Hospital pediatric n = 78 children Intrusion Enamel hypoplasia 53.6% (n = 74) 7 Chi-squared tests/
Turkey/2009/ dentistry clinic n = 138 traumatized teeth Correlation between age and
Prospective frequency of sequelae
P = 0.442
Andreasen & Ravn Main material: Main material: Luxations and Enamel hypoplasia Main material: – Fisher’s test.
(3) Denmark/1973/ 5 public schools in 487 children (147–30% fractures 57.8%(trauma group) The difference in frequency of
Retrospective Conpenhagen where children with history of trauma) 45.3% (non-trauma group) enamel changes in the trauma
had been under regular dental Control Material: and non-trauma group was
care. 111 children (17–15.3% with found to be significant
Control Material: history of trauma) (P < 0.01)
5 public schools in
Conpenhagen where children
were not being treated for
dental care regularly
Andreasen & Ravn Dental Department, University Trauma group: Luxations Enamel discoloration, Trauma group 10 Multivariate analysis described
(5) Denmark/1971/ Hospital, Conpenhagen n = 103 children Enamel hypoplasia 41.3% by Larsen and Chi-squared
Retrospective n = 213 traumatized teeth (n = 88) tests/
Control group: Correlation between age and
Contralateral permanent frequency of sequelae
successors (n = 26 children (P = 0.001), type of injury
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
n = 33 teeth) (P = 0.002)
Assuncß~ao et al. (7) Baby Clinic Londrina State n = 389 children Luxations Enamel discoloration, 20.2% (n = 126) 10 Proportion and Chi-squared
Brazil/2009/ University, Brazil n = 620 traumatized teeth enamel hypoplasia, test/
Retrospective crown dilaceration Association between age and
sequelae (P = 0.000325).
Association between type of
trauma and sequelae
(P = 0.000001)
Ben Bassat et al. Not mentioned n = 36 children Luxations Enamel discoloration, 25% (n = 27) – Not mentioned
(16) Israel/1985/ n = 76 traumatized teeth enamel hypoplasia
Retrospective
Carvalho et al. (18) Dental Trauma Center of the n = 307 children Intrusion Enamel discoloration, 68.8% (n = 84) 8 Chi-squared tests/
Brazil/2010/ Pediatric Dentistry Clinic of n = 221 traumatized teeth enamel hypoplasia Correlation between age and
Retrospective Rio de Janeiro State sequelae (P = 0.140)
University
Christophersen et al. Danish Municipal Dental Health n = 35 children Avulsion Enamel discoloration, 30% (n = 10) – Correlation between age and
(8) Denmark/2005/ Services in Lyngby-Taarbaek, n = 44 traumatized teeth enamel hypoplasia sequelae (P = 0.04)
Retrospective Hilleroed and Taarnby
De Amorim et al. (4) Private Pediatric Dental Clinic in n = 148 children Luxations and Enamel discoloration, 22.4% (n = 54) – Chi-squared test and multiple
Brazil/2011/ Goi^ania, Brazil n = 241 traumatized teeth fractures enamel hypoplasia logistic regression/
Retrospective Significant association
between age and frequency of
Does trauma in the primary dentition cause sequelae in successors?
sequelae (P = 0.03)
7
8
Table 2. Continued
Participants Most frequent sequelae
Author/Country/Year/ Injury types on on permanent Duration of the
Lenzi et al.
Study design Source of sample Sample size primary teeth successors Sequelae prevalence study (years) Statistical analysis/P value
Jacomo & Campos Dental Trauma Center of the n = 307 children Luxations and Enamel discoloration, 51.1% (n = 89) 8 Chi-squared tests/
(2) Brazil/2009/ Pediatric Dentistry Clinic of n = 753 traumatized teeth fractures enamel hypoplasia Correlation between age and
Retrospective Rio de Janeiro state University frequency of sequelae
(P < 1.00)
Innes (24) Scotland/ Paediatric clinic n = 78 children n = 138 Intrusions Enamel hypoplasia, 54.4% (n = 74) 7 Chi-squared tests not find any
2009/Retrospective traumatized teeth dilacerations, ectopic correlation between age and
eruption frequency of sequelae
Ishikawa et al. (26) Paediatric clinic in Japan n = 66 children n = 126 Luxations and Crown malformation 57.1% (n = 72) – Not mentioned
Japan/1990/ traumatized teeth fractures and calcification and
Retrospective discoloration in the
enamel and hypoplasia
Ravn (6) Denmark/ Institute of Pedodontics n = 77 children Avulsion Enamel hypoplasia 74.1% (n = 63) – Not mentioned
1975/Retrospective n = 85 traumatized teeth
Ravn (28) Denmark/ Department of Pedodontics n = 78 children Intrusions Enamel discoloration 54% (n = 54) 10 Association between type of
1976/Retrospective n = 100 traumatized teeth trauma and sequelae
(P < 0.001)
Scerri et al. (23) Dental Departament, St Lukes Study group: Luxations and Enamel discoloration Study group: – Chi-squared test/
Republic of Malta/ Hospital, Guardamangia and n = 32 children fractures 52.2% Association between type of
2010/Retrospective School Dental Clinic, Floriana n = 67 traumatized teeth (n = 35) trauma and sequelae
Control group: Control group: (P < 0.01)
n = 20 children 10% (n = 8)
n = 67 teeth
Sennhenn-Kirchner & Department of Oral Surgery in n = 106 children Luxation and Enamel discoloration, 25% (n = 20) 5 Not mentioned
Jacobs (14) the Center for Oral and n = 200 traumatized teeth fractures enamel hypoplasia
Germany/2006/ Maxillofacial Diseases of the
Retrospective University of Goetting
Sleiter & Von Arx Department of Oral and n = 30 children Luxations and Enamel discoloration 32.4% (n = 24) 5 Not mentioned
(27) Switzerland/ Maxillofacial Surgery, n = 74 traumatized teeth fractures
2002/Retrospective Switzerland
Spinas et al. (22) Dentoalveolar trauma study n = 85 children Intrusions Enamel hypoplasia 25% (n = 32) 15 Not mentioned
Italy/2006/ Centre of the University of n = 130 traumatized teeth
Retrospective Cagliari Dental Department
von Arx (10) Department of Oral and n = 114 children Luxations and Enamel hypoplasia and/ 23% (n = 33) 10 Not mentioned
Switzerland/1995/ Maxillofacial Surgery, n = 255 traumatized teeth fractures or enamel defects
Retrospective Kantosspital, Lucerne,
Switzerland
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Does trauma in the primary dentition cause sequelae in successors? 9
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