Intrusive luxation
INTRUSIVE LUXATION
Consideration between spontaneous re-eruption and either orthodontic or surgical repositioning:
* It appears that with immediate surgical repositioning there is a high risk of both external root resorption and loss of marginal bone support. Surgical repositioning should therefore be avoided unless the tooth is driven up into the floor of the nose or out in the soft tissue of the vestibulum.
* Most intruded teeth should either be moved into position orthodontically or allowed to re-erupt spontaneously. The choice between the two treatment methods depends upon the degree of intrusion, since external inflammatory root resorption frequently develops and endodontic treatment often has to be started as soon as 2-3 weeks after the accident. If it is thought possible to gain access to the root canal with the tooth in its intruded position, spontaneous re-eruption is awaited. Otherwise, the eruption is helped by orthodontic forces in order to make the endodontic treatment possible.
Follow-up:
All traumatized teeth are carefully observed for clinical and radiographic signs of complications. The intervals between
re-examinations should be individualised depending upon the severity of traume, the expected type of complication and the
age of the patient. When external inflammatory root resorption is an expected complication, a clinical and radiographic
control should be taken every 14 days until the situation is clear.
In mature teeth where the apex is closed, intrusion results in pulpal necrosis. Therefore, endodontic treatment is optimally started 7 - 10 days after trauma, if this is technically possible. Waiting longer is not recommended because of the risk of external inflammatory root resorption, if/when the pulp becomes infected. When no signs of external inflammatory root resorption can be detected, endodontic therapy can be done either with short (1 - 4 weeks) or long term (12 months or until PDL returns 'normal') calcium hydroxide treatment. When external inflammatory root resorption is present, long term (12 months or until PDL returns 'normal') calcium hydroxide treatment is always used.
