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CASE REPORT

Year : 2011 | Volume: 29 | Issue: 2 | Page: 161-164

MULTIPLE ABNORMALITIES IN PERMANENT MAXILLARY INCISORSFOLLOWING TRAUMA TO THE PRIMARY ENTITION

Abstract

Diverse conseqences to t!e tra"a to #ri"ar$ %entition are so"eti"es %i&&ic't to e(#'ain) T!is

re#ort %escribes a rare case o& seqe'ae to #ri"ar$ toot! tra"a) T!e tra"atic e#iso%e *!ic!

occrre% at t!e a+e o& , $ears res'te% in abnor"a''$ 'ar+e cro*ns o& 11 an% 21 *it! $e''o*is!-bro*n %isco'oration an% ena"e' !$#er#'asia) t a'so 'e% to %i'aceration in t!e root o& 21 an%

ena"e' !$#o#'asia *it! %isco'oration in 12 an% 22)

!e"#or$s%Di'aceration. ena"e' !$#o#'asia. ena"e' !$#er#'asia. '(ation. "esio%ens

ntro%ction

T!e tra"a to t!e #ri"ar$ %entition is a'"ost a niversa' occrrence *!i'e +ro*in+ #) /'ores

esti"ate% t!e #reva'ence o& #ri"ar$ toot! tra"a to be 11-,0) 1An%reasen an% Ravn

estab'is!e% its #ea3 o& inci%ence to be 2-4 $ears) 2(ation in5ries es#ecia''$ intrsion an%av'sion are t!e "ost co""on t$#e o& #ri"ar$ toot! tra"a) 1.2.,

T!e c'ose #ro(i"it$ o& roots o& #ri"ar$ incisors. es#ecia''$ in t!e "a(i''ar$ arc!. "a3es t!e

%eve'o#in+ #er"anent toot! +er"s v'nerab'e to t!e in5r$ a&ter tra"a to #ri"ar$ incisors)

4

on Ar( i%enti&ie% a #reva'ence rate o& 2, &or t!e %eve'o#"enta' %e&ects in #er"anent teet!

&o''o*in+ tra"a to #ri"ar$ teet!) T!e !i+!est #reva'ence *as &on% a&ter intrsive in5ries),

An%reasen et al) %escribe% t!e "ost co""on seqe'ae to #ri"ar$ toot! tra"a as $e''o* or

*!ite ena"e' %isco'oration. *!ite-$e''o*is! bro*n %isco'oration o& ena"e' *it! !$#o#'asia.

cro*n %i'aceration. o%onto"a-'i3e "a'&or"ation. root %#'ication. vestib'ar root an+'ation.'atera' root an+'ation or %i'acerations. #artia' or co"#'ete arrest o& root &or"ation. seqestration

o& entire toot! +er" an% ecto#ic. #re"atre or %e'a$e% er#tion or i"#action)4

An nsa' case o& seqe'ae to #ri"ar$ toot! tra"a co"#risin+ "'ti#'e abnor"a'ities in t!e

#er"anent "a(i''ar$ centra' an% 'atera' incisors !as been #resente% !ere)

Case Re#ort

A 1,-$ear-o'% bo$ re#orte% to t!e ot-#atient %e#art"ent *it! t!e c!ie& co"#'aint o& #ain in

##er &ront teet! a'on+ *it! t!eir "a'a'i+n"ent) T!e "e%ica' !istor$ *as noncontribtor$) T!e#atient revea'e% a !istor$ o& a severe tra"atic e#iso%e at an a+e o& , $ears) T!ere *ere no
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recor%s o& t!e inci%ent. t!o+! t!e #arents a&&ir"e% t!at t!e #atient !a% &a''en into a *e'' 7abot

,0 &eet %ee#8 'ea%in+ to av'sion o& 1. 61 an% intrsion o& 2 an% 62) T!ere *as no associate%

"a(i''ar$ &ractre or nero'o+ica' abnor"a'ities an% t!e in5r$ *as "ana+e% *it!ot an$ &rt!er%isco"&ort) ot! 2 an% 62 re-er#te%. bt !a% to be e(tracte% 'ater at 9 $ears o& a+e)

t *as &rt!er re#orte% t!at 11 an% 21 !a% er#te% at ; $ears *!i'e 12 an% 22 at 10 $ears o& a+e*it! no abnor"a'it$ in er#tion o& ,1. ,2. 41. an% 42) T!e #atient state% t!at initia''$ t!ere *as

no #ain associate% *it! 11 an% 21 t!o+! !e 'ater %eve'o#e% sensitivit$ to co'% an% s*eets abot

6 "ont!s a+o)

C'inica' e(a"ination revea'e% no e(tra-ora' s*e''in+) ntra-ora''$. t!e 'abia' +in+iva' "ar+ins in

re'ation to 11 an% 21 a##eare% in&'a"e%) T!e "a(i''ar$ centra' incisors *ere b'bos *it! 'ar+er

"esio%ista' %ia"eter)

&ro" t!e %isto-'abia' re+ion to t!e "i%%'e o& t!e 'abia' sr&ace) Rotation *as seen in 11 a'on+

*it! cross bite /i+re 1)

/i+re 1: Cro*n abnor"a'ities an% %isco'oration in 11. 21. 12. an% 22

*it! ena"e' !$#er#'asia in 21 an% ena"e' !$#o#'asia in 12 an% 22

Cl&'( )ere *o +&e#

T!e "a(i''ar$ 'atera' incisors. *it! nor"a' "esio%ista' %i"ensions. !a% a "ar3e% constriction at

t!e "i%%'e t!ir% o& t!e 'abia' sr&ace) Cro*n o& 12 !a% ena"e' !$#o#'asia *it! bro*n

%isco'oration e(ten%in+ &ro" "i%%'e t!ir% to t!e incisa' e%+e) Ena"e' !$#o#'asia *as 'ess"ar3e% in 22. t!o+! $e''o*is!-bro*n %isco'oration *as #resent /i+re 1)ot! 11 an% 21

*ere ten%er on #ercssion *!i'e 12 an% 22 *ere nor"a') P'# vita'it$ tests #rove% 11 an% 21 to

be nonvita' *!i'e 12 an% 22 *ere vita')

Ra$&ogra,)&' -&.$&.gs

Ort!o#anto"o+ra#! revea'e% abnor"a' root "or#!o'o+$ o& 21: root %i'acerations) 4T!e

ano"a'os cro*n "or#!o'o+$ o& 11. 21. 12. an% 22 co'% a'so be a##reciate%/i+re 2) An

intraora' #eria#ica' ra%io+ra#! e(!ibite% t!at t!e root o& 21 *as %i'acerate% *it! an i""atrea#e() T!e root o& 11 a'so !a% an o#en a#e() T!e abnor"a' ra%io-o#acit$ in t!e cro*ns o& 11. 21.

12. an% 22 e"#!asi>e% t!eir ano"a'os "inera'i>ation) Anot!er ver$ interestin+ &in%in+ *as t!e

#resence o& an inverte% "esio%ens. in c'ose #ro(i"it$ to "i%%'e an% a#ica' t!ir% o& t!e root o&

21) T!e s!a#e o& root o& 21 see"e% to &o''o* t!e "or#!o'o+$ o& t!e s#ern"erar$ toot!/i+re,)
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/i+re 2: Ort!o#anto"o+ra#! s!o*in+ root %i'acerations in 21

Cl&'( )ere *o +&e#

/i+re ,: ntraora' #eria#ica' ra%io+ra#! s!o*in+ root %i'acerations in 21 an% an

inverte% "esio%ens in c'ose #ro(i"it$ to 21

Cl&'( )ere *o +&e#

Trea*me.*

A&ter a t!oro+! eva'ation o& t!e #atient?s c'inica' recor%s. a treat"ent #'an co"#risin+ root

cana' treat"ent o& 11 an% 21. e(traction o& t!e "esio%ens. an% 'ater t!e #rost!o%onticre!abi'itation o& 11. 12. 21. an% 22 *ere &or"'ate%) A#e(i&ication o& 11 an% 21 *as carrie% ot

sin+ t!e ca'ci" !$%ro(i%e #aste) A&ter &or"ation o& an a#ica' barrier. t!e root cana's *ere

obtrate% *it! +tta#erc!a sin+ 'atera' con%ensation)

Sr+ica' e(traction o& t!e "esio%ens *as ta3en ot a&ter , *ee3s) A&ter e'evation o& t!e &'a#. t!e

!$#er#'astic ena"e' "a'&or"ation co'% be ver$ c'ear'$ seen in t!e cervica' t!ir% o& 21 an%

s#ec3s o& ena"e' in t!e cervica' t!ir% o& 11) T!is ano"a'os ena"e' *as s"oot!e% sin+ a

steri'e co"#osite &inis!in+ bt on a s'o* s#ee% !an% #iece) T!e &'a# *as stre% an% t!e #atientreca''e% a&ter a *ee3 &or re"ova' o& stres /i+re 4a-c)

/i+re 4: 7a8 @$#er#'astic ena"e' "a'&or"ation in cervica' t!ir% o& 21.s#ec3s o& ena"e' in t!e cervica' t!ir% o& 11. an% e(traction soc3et o&

"esio%ens) 7b8 Posto#erative #!oto+ra#! a&ter s"oot!in+ o& t!e cervica'

ena"e' "a'&or"ations in 11 an% 21) 7c8 E(tracte% s#ern"erar$ toot!

Cl&'( )ere *o +&e#

A&ter a%eqate +in+iva' !ea'in+ at t!e si(t! *ee3 #osto#erative #erio%. inter"e%iate

#rost!o%ontic re!abi'itation sin+ an acr$'ic bri%+e *as carrie% ot /i+re )A s++estionre+ar%in+ t!e %e&initive #orce'ain cro*ns. to be carrie% ot a&ter 1; $ears o& a+e. *as a'so "a%e)
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/i+re : nter"e%iate #rost!o%ontic re!abi'itation sin+ an acr$'ic

bri%+e

Cl&'( )ere *o +&e#

Discssion

T!e severit$ o& t!e %a"a+e to t!e #er"anent teet! %e#en%s #on t!e %irection an% intensit$ o&

i"#actin+ &orce. a+e o& t!e c!i'%. sta+e o& t!e %eve'o#"ent o& #er"anent toot! +er". an% t!e

a"ont o& %issi#ation o& t!e i"#actin+ &orce) 1.,.4T!e severe natre o& tra"a in t!e #resent

case. 'ea%in+ to av'sion o& 1 an% 61 an% intrsion o& 2 an% 62. an% t!e a+e o& i"#act 7, $ears8

e(#'ains t!e c'inica' "ani&estation in 11. 12. 21. an% 22 to so"e e(tent)

/or"ation o& t!e #er"anent "a(i''ar$ centra' incisor be+ins at 20 *ee3s in tero) ts ena"e'

&or"ation be+ins at ,-4 "ont!s o& a+e an% is co"#'ete% b$ 4- $ears) T!e i"#act o& t!e

tra"a. t!o+! %issi#ate% b$ t!e #'iabi'it$ o& s3e'eton an% av'sion o& 1 an% 61. "i+!t !ave

res'te% in %istrbance in a"e'o+enesis *!ic! *as sti'' not co"#'ete) T!is co'% !ave 'e% to

abnor"a' s!a#e an% %isco'oration o& t!eir cro*n),.4T!e ena"e' !$#er#'asia in t!e cervica'

t!ir% o& t!e 'abia' sr&ace is an nsa' &in%in+ an% can a'so be attribte% to in5re% a"e'ob'asts)

T!e i"#act *as severe eno+! to case ena"e' !$#er#'asia an% increase% %i"ensions o& 11 an%

21 bt %i% not #ro+ress to ano%onto"a-'i3e "a'&or"ation)

T!e !$#o#'astic constriction an% %isco'oration in t!e "i%%'e t!ir% o& 12 an% 22 can be e(#'aine%

b$ %irect in5r$ to t!e ena"e' "atri( b$ t!e intr%in+ roots o& 2 an% 62) ,.4.6Since t!e

intr%e% toot! !a% er#te% an% t!e ena"e' "atri( o& t!e cervica' t!ir% o& 12 an% 22 &or"e% at a

'ater a+e. it *as s#are%)4

Di'aceration o& t!e root o& 11 an% 21 can be attribte% to t!e scar tisse &or"ation as e(#'aine%

b$ e$er. since root &or"ation o& #er"anent "a(i''ar$ centra' incisors is not starte% be&ore 4-

$ears o& a+e an% t!e tra"a in t!e #resent case *!ic! occrre% at , $ears co'% not !ave case% a

%irect i"#act on t!e root an+'ation)4Anot!er #ossib'e e(#'anation can be t!e #resence o& aninverte% "esio%ens in c'ose #ro(i"it$ to t!e root o& 21) A't!o+! t!ere is a !i+! inci%ence o&

con+enita''$ #resent s#ern"erar$ teet! in t!is re+ion. a #ossibi'it$ o& #ri"ar$ toot! tra"a

'ea%in+ to #artia' %ivision o& t!e ena"e' or+an an% ori+in o& t!e inverte% "esio%ens cannot be

tota''$ ne+ate%) B.9

T!e treat"ent #'an invo'vin+ a#e(i&ication sin+ ca'ci" !$%ro(i%e !as been a%vocate% b$
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5/6

n"ber o& researc!ers);T!e e(traction o& t!e i"#acte% s#ern"erar$ toot! *as carrie% ot

%e to its #ro(i"it$ *it! t!e root o& 21 an% as it *as a #ossib'e case o& t!e #ain) 9T!e %ecision

&or sin+ t!e inter"e%iate acr$'ic bri%+e *as base% on %e'a$in+ t!e %e&initive re!abi'itation ti''

+in+iva' "ar+ins !ave a%eqate'$ estab'is!e% an% #'# !orns !ave rece%e% in 12 an% 22)

T!e rarit$ o& t!is case can be e"#!asi>e% b$ t!e si"'taneos occrrence o& ena"e' !$#er#'asia

an% !$#o#'asia in t!e sa"e qa%rant o& t!e 5a*. a&ter t!e sa"e tra"atic e#iso%e) T!is c'inica'

#ictre. es#ecia''$ t!e cro*n abnor"a'ities in t!e #er"anent "a(i''ar$ centra' incisors. is a'so

%i&&ic't to c'assi&$ accor%in+ to t!e estab'is!e% criterion +iven b$ An%reasen et a')4an% on

Ar( ,&or t!e seqe'ae to #ri"ar$ toot! tra"a)

Sc! a case o& "'ti#'e abnor"a'ities in #er"anent teet! &o''o*in+ tra"a to t!e #ri"ar$

%entition e"#!asi>es t!e nee% &or creatin+ a*areness a"on+ t!e #b'ic an% t!e !ea't!care

#ro&essiona's not on'$ &or t!e a##ro#riate "ana+e"ent o& t!e i""e%iate tra"a bt a'so &or t!e

'on+-ter" &o''o*-# an% sbseqent "ana+e"ent o& its seqe'ae)

Re&erences

1) /'ores T) Tra"atic in5ries in t!e #ri"ar$ %entition) Dent Tra"ato' 20021;:2;B-9;)PED /TET

2) An%reasen FO. Ravn FF) E#i%e"io'o+$ o& tra"atic %enta' in5ries to #ri"ar$ an%

#er"anent teet! in a Danis! #o#'ation sa"#'e) nt F Ora' Sr+ 19B21:2,-9)PED

,) on Ar( T) Deve'o#"enta' %istrbances o& #er"anent teet! &o''o*in+ tra"a to t!e

#ri"ar$ %entition) Ast Dent F 199,,;:1-10)

PED4) An%reasen FO. Sn%stroG" .Ravn FF) T!e e&&ect o& tra"atic in5ries to t!e #ri"ar$ teet!

on t!eir #er"anent sccessors) ) A c'inica' an% !isto'o+ica' st%$ o& 11B in5re% #er"anent

teet!) Scan% F Dent Res 19B1B9:219-;,)

) an %er in%en /) So"e +enera' as#ects o& t!e nor"a' %eve'o#"ent o& t!e %entition) n:

Deve'o#"ent o& t!e %entition) C!ica+o: Hintessence Pb'is!in+ Co 19;,) #) 9-69)

6) Tr+t D. Te3cice3 . Cano+I' @) An nsa' %eve'o#"enta' %istrbance o& an

ner#te% #er"anent incisor %e to tra"a to its #re%ecessor - a case re#ort) Dent

Tra"ato' 200622:2;,-6)

B) Arenas . arberia E. cavec!i T. aroto ) Severe tra"a in t!e #ri"ar$ %entition

%ia+nosis an% treat"ent o& seqe'ae in #er"anent %entition) Dent Tra"ato' 200622:226-,0)

;) Ra&ter ) A#e(i&ication: A revie*) Dent Tra"ato' 20021:1-;)PED /TET

9) Rsse'' JA. /o'*arc>na A) esio%ens--%ia+nosis an% "ana+e"ent o& a co""on

s#ern"erar$ toot!) F Can Dent Assoc 200,69:,62-6)
http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ref8http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ref8http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ref9http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ref4http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ref4http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ref3http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft1http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12656861&dopt=Abstracthttp://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1600-4469&date=2002&volume=18&issue=6&spage=287http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft2http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4146883&dopt=Abstracthttp://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft3http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8447765&dopt=Abstracthttp://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft4http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft5http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft6http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft7http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft8http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15660748&dopt=Abstracthttp://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1600-4469&date=2005&volume=21&issue=1&spage=1http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft9http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft9http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft8http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft7http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft6http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft5http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft4http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft3http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft2http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft1http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#tophttp://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ref8http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ref9http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ref4http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ref3http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft1http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12656861&dopt=Abstracthttp://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1600-4469&date=2002&volume=18&issue=6&spage=287http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft2http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4146883&dopt=Abstracthttp://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft3http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8447765&dopt=Abstracthttp://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft4http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft5http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft6http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft7http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft8http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15660748&dopt=Abstracthttp://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1600-4469&date=2005&volume=21&issue=1&spage=1http://www.jisppd.com/article.asp?issn=0970-4388;year=2011;volume=29;issue=2;spage=161;epage=164;aulast=Tewari#ft9


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PED /TET
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12787472&dopt=Abstracthttp://www.cda-adc.ca/jcda/vol-69/issue-6/362.htmlhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12787472&dopt=Abstracthttp://www.cda-adc.ca/jcda/vol-69/issue-6/362.html

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