7.1: Concussion and subluxation

(b) Fig7.1.2.eps (c) Fig7.1.3.eps

Diagnosis and treatment planning

The diagnoses (Tables 7.1.1 and 7.1.2) were:

  • Upper left central incisor (21) – Tooth concussion.
  • Upper left lateral incisor (22) – Subluxation.

Table 7.1.1 Clinical and radiographic features of concussion injuries

  • Mobility and periodontal probing depths are within normal limits.
  • Sensibility tests at the time of injury are generally normal.
  • The tooth may be tender to percussion or mastication.
  • There are no radiographic signs of injury initially.
  • Pulp canal obliteration may occur in the future, but is unlikely.

Table 7.1.2 Clinical and radiographic features of subluxation injuries

  • Mobility may be slightly increased.
  • There may be mild bleeding from the gingival sulcus.
  • Periodontal probing depths are within normal limits.
  • Sensibility tests at the time of injury may be negative, but this often indicates only a transient loss of pulpal response. Further tests will be necessary at review appointments for a conclusive diagnosis.
  • The tooth will generally be tender to percussion or mastication.
  • There may or may not be widening of the periodontal ligament space.
  • Further radiographic follow-up may show pulp canal obliteration.

The treatment plan was to provide symptomatic treatment and monitor the pulpal responses to the injury (Table 7.1.3).

Table 7.1.3 Treatment of concussion and subluxation injuries

  • Relief of occlusal interferences for patient comfort, if necessary.
  • Implementation of soft diet for up to 2 weeks.
  • Splinting of affected teeth for up to 2 weeks for patient comfort, only if necessary.
  • Often no treatment is necessary.

What are the types of luxation injuries?

There are five types of luxation injuries:

Concussion

The tooth is sensitive to biting and percussion, but there is no increased mobility and the tooth has not been displaced. The impact of injury has affected the PDL, and there can be some slight damage to the neurovascular supply to the pulp.

Subluxation

In addition to increased sensitivity to biting and percussion, there is also increased mobility. The tooth, however, has not been displaced. There is damage to the PDL and the alveolar socket; in addition, there may be injury to the neurovascular supply to the pulp.

Extrusive luxation

The tooth has been displaced out of the socket, often severing the neurovascular supply to the pulp. The tooth is very mobile, and there can be a concomitant alveolar fracture. Sensibility testing is usually negative.

Lateral luxation

The tooth has been displaced laterally into the adjacent bony support. Typically, the crown has been displaced palatally/lingually, and the root has shifted toward the labial cortical plate. The tooth is usually very firmly embedded in its new position and has an ankylotic sound when percussed.

Intrusive luxation

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Related posts:

  1. 1.3: Chronic periapical periodontitis with suppuration
  2. 3.1: Apexification
  3. 3.2: Apexogenesis
  4. 1.4: Chronic periapical periodontitis with an extraoral sinus
  5. 5.4: Surgical management of a perforation
  6. 4.5: Working length determination

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Mar 13, 2015 | Posted by in Endodontics | Comments Off on 7.1: Concussion and subluxation

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