7.3: Intrusive luxation

(b) Fig7.4.2.eps

Table 7.3.1 Clinical and radiographic signs of intrusion injuries

Clinical features of intrusion injuries
  • The intruded tooth looks like a partially erupted tooth, and part or all of the crown may be submerged beneath the gingiva.
  • The tooth is firmly bound in the alveolar bone.
  • Percussion of the exposed crown elicits an ankylotic tone.
  • The lip is generally oedematous.
  • There may be a haematoma of the lip and adjacent sulcus.
Radiographic features of intrusion injuries
  • The intruded tooth will occupy a more apical position than the adjacent tooth.
  • There will typically be complete disappearance of the periodontal ligament space.

Given the nature of the injury, no sensibility tests were performed. A radiograph (Figure 7.3.1b) of the maxillary incisor region revealed erupting lateral and central incisor teeth. The 21 was positioned more apical to the adjacent the 11. All the incisors were at a very early stage of development, commensurate with the patient’s age. There were no signs of any root fractures.

Diagnosis and treatment planning

The diagnosis was intrusive luxation of the 21. The treatment plan was to monitor the intruded tooth for spontaneous re-eruption.

Do all traumatically intruded teeth spontaneously re-erupt?

Intruded teeth have the potential for spontaneous re-eruption in patients up to the age of 17 years. This is the desired outcome, although it is not always predictable (Table 7.3.2).

Table 7.3.2 Treatment protocols for luxation injuries

Intrusive luxation ’ treatment of teeth with incomplete root formation (up to the age of 15 years)
  • Allow at least 3 weeks for signs of spontaneous re-eruption to take place.
  • If there are no signs of re-eruption after 3–6 weeks, surgically or orthodontically re-position the tooth.
  • Carry out endodontic treatment only if the pulp becomes necrotic or if infection-related inflammatory resorption develops.
Intrusive luxation ’ treatment of teeth with complete root formation (after the age of 15 years)
  • Spontaneous re-eruption cannot be expected, reposition the tooth surgically or orthodontically as soon as possible.
  • Pulpal necrosis is likely, carry out endodontic treatment using calcium hydroxide as an inter-appointment dressing.

How often should the patient be reviewed?

It is important to monitor the response to the injury with periodic review visits. The first follow-up should be at about 2 weeks, and then the tooth should be reviewed at 2–3, 6 and 12 months and annually thereafter, for at least 5 years.

What is considered to be the most desirable outcome?

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Mar 13, 2015 | Posted by in Endodontics | Comments Off on 7.3: Intrusive luxation
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