Traumatically intruded permanent incisors: a study of treatment and outcome

Critical appraisal of the 2020 IADT Guidelines: A personal commentary

The 2020 International Association of Dental Traumatology (IADT) Guidelines feature several important changes in the treatment recommendations for traumatic dental injuries (TDIs) from the previous 2012 iteration of these Guidelines. This evidence-based narrative review aims to provide a detailed appraisal of five specific changes incorporated in the 2020 IADT Guidelines, based on the available literature evidence that may have prompted these changes. The paper discusses three excellent additions/changes to the new Guidelines: (i) inclusion of a core outcome set for reporting TDIs; (ii) more conservative management of primary dentition TDIs including the changed recommendations for radiation exposure and managing primary dentition luxation injuries; and (iii) the changes in the treatment recommendations for permanent dentition avulsion injuries. The paper further debates whether two other changes made in the current IADT Guidelines for-(i) intrusion injuries in immature teeth; and (ii) complicated crown-root fractures in mature teeth-have sufficient evidence to support the changed recommendations.

Management of severe traumatic intrusion in the permanent dentition

Traumatic intrusion is considered one of the most severe luxation injuries to the permanent dentition. There are limited studies based on minimal evidence supporting suggested management protocols, owing to the rare occurrence of intrusion. The following case report details the multidisciplinary management and 18-month follow-up, in line with current UK guidelines, of a 23-year old adult male who sustained severe intrusion injuries to both permanent maxillary central incisor teeth. Timely, accurate diagnosis and subsequent appropriate management correlates with improved outcomes for traumatic injuries and it is therefore imperative those involved with the acute and long-term management of dentoalveolar trauma are aware of current guidelines.

A case-report of delayed repositioning of intruded permanent maxillary central incisors accompanied by complicated crown fractures: A 2-year follow-up

Intrusive luxation is the most severe type of dental injury with a complex healing sequence. Pulp necrosis, root resorption (surface, inflammatory and replacement resorption), and defects in marginal periodontal bone healing are the main complications. Treatment strategies can be either active, by repositioning (surgical or orthodontic extrusion), or passive, by spontaneous re-eruption based on the thorough evaluation of the case. This paper reports a case of delayed repositioning of severely intruded permanent maxillary central incisors accompanied by complicated crown fractures after 3 months. After thorough clinical and radiographic evaluations, and based on guidelines, the teeth were surgically repositioned and splinted for 6 weeks. One week after the initial intervention, the endodontic treatment for both permanent maxillary incisors were initiated using calcium hydroxide. 6 months later, the teeth were ready for MTA plug and gutta-percha root canal filling. During the follow-up period, the teeth had remained functional and esthetically acceptable. Further yearly observations are planned at least for 5 years.

Challenges in treating traumatically intruded and ankylosed permanent incisors: a case report with a multidisciplinary approach

This report discusses the challenges, complications and management of traumatic intrusion injuries affecting the permanent dentition. A case is described where trimming of the incisal edge of a severely intruded and ankylosed upper lateral incisor resulted in an unexpected re-eruption of the tooth. It is suggested that the vibrations from drilling may have disrupted the ankylosis, initiating spontaneous re-eruption and this approach could provide a minimally invasive and conservative pathway to treating ankylosed teeth. Clinical Relevance: To date no effective treatment has been described to reverse the development of replacement root resorption leading to the loss of the affected tooth. The hypothesis proposed here suggests that mechanical vibrations, if strong enough, may disturb the ankylosis and allow re-eruption of the intruded tooth.

Delayed replantation of avulsed teeth: two case reports

This case report presents two cases of delayed replantation of avulsed maxillary central incisors after an extended dry extra-alveolar period. Eight-year-old boy and 10-year-old boy presented with avulsed maxillary central incisors due to trauma occurring 27 and 7 hours earlier, respectively. Treatment guidelines for avulsed mature/immature permanent teeth with prolonged extra-oral time were carried out for the teeth and the extra-oral endodontic treatment was completed. After having been repositioned, the teeth were stabilized for 4 weeks and prophylactic antibiotic was prescribed. Clinical and radiographic controls were done after 18 months for Case I and 12 months for Case II. During the follow-up periods the teeth reported in these cases have remained in a stable, functional position but revealed clinical initial replacement resorption and ankylosis.

Multidisciplinary treatment for a patient with traumatically intruded permanent canine and premolar

When selecting treatment for traumatically intruded teeth, various factors should be evaluated including the degree of intrusion, pulp vitality, patient's age and maturity of the tooth. Treatment options consist of surgical repositioning, orthodontic extrusion and spontaneous re-eruption. This study describes a case of a 22-year-old male with traumatically intruded maxillary canine and first premolar that was treated comprehensively by an orthodontist, endodontist and prosthodontist two months after injury.

Management of traumatically intruded young permanent tooth with 40-month follow-up

BACKGROUND

Intrusive luxation injuries often result in severe damage to the tooth, periodontal ligament and pulpal tissue. Furthermore, treatment outcome is often unpredictable because of the large number of injury related variables which influence choice of treatment and prognosis. This report presents the case of a 9-year-old boy with a 6 mm intruded permanent maxillary central incisor with an open apex.

METHODS

The treatment option chosen was to wait and watch for 'spontaneous re-eruption'. At the end of two weeks, the tooth showed signs of pulp necrosis and external root resorption. A palatal mucoperiostal flap was reflected and endodontic access was established, following which an intracanal medicament of calcium hydroxide was applied. By the end of the fifth month, there was radiographic evidence of apical barrier formation and by the tenth month, the tooth had re-erupted to the level of the adjacent central incisor. Root canal treatment was completed at the end of 24 months and the root was reinforced using a glass fibre post.

RESULTS

At the last follow-up visit (40 months after trauma), the tooth was asymptomatic and radiographic examination showed satisfactory periapical and periodontal healing.

CONCLUSIONS

Spontaneous re-eruption is possible, even in severely intruded teeth with open apices.

Interventions for treating traumatised permanent front teeth: luxated (dislodged) teeth

BACKGROUND

Dental trauma is common especially in children and young adults. One group of dento-alveolar injuries is classified as luxation. This group includes a subgroup of severe injuries where the tooth is displaced from its original position. These injuries are classified further by the direction in which the tooth has been displaced, namely: intrusion, extrusion and lateral luxation.

OBJECTIVES

To evaluate the effects of a range of interventions for treating displaced luxated permanent front teeth.

SEARCH METHODS

Search strategies were developed for MEDLINE via OVID and revised appropriately for the following databases: Cochrane Oral Health Group's Trials Register (to 20 August 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 8), MEDLINE via OVID (1966 to August 2012), EMBASE via Elsevier (1974 to August 2012), and LILACS via BIREME (1982 to August 2012). Dissertations, Theses and Abstracts were searched as were reference lists from articles. There were no language restrictions.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials of treatment interventions for displaced luxated permanent front teeth. Included trials had to have a minimum follow-up period of 12 months.

DATA COLLECTION AND ANALYSIS

Two review authors independently and in duplicate assessed the eligibility of all reports identified in the searches. Authors were contacted for additional information where required.

MAIN RESULTS

No randomised or quasi-randomised controlled trials were found.

AUTHORS' CONCLUSIONS

We found no randomised or quasi-randomised trials of interventions to treat displaced luxated permanent front teeth. Current clinical guidelines are based on available information from case series studies and expert opinions. Randomised controlled trials in this area of dental trauma are required to robustly identify the benefits of different treatment strategies.

Multidisciplinary trauma management: a case report

This case report documents the dental management of two permanent maxillary central incisors with a severe intrusive labial luxation injury in conjunction with one complicated and one uncomplicated crown fracture. Additionally, there was a fracture of the labial cortical plate which remained attached to the overlying soft tissue. The two affected teeth and fractured labial plate of bone were surgically repositioned and splinted. Endodontic therapy was completed on the two incisors and the two crown fragments, which had been maintained wet, were re-attached. The report describes a multidisciplinary approach to trauma management and case progress over a 20-month period.

Late term complications of intruded permanent incisors: 2 case reports

This report describes 2 cases of intrusive luxation injuries of maxillary immature permanent central incisors. In both cases, intruded teeth were left for spontaneous re-eruption. During periodic follow-ups for up to 2 years the teeth did not show any sign, clinically or radiographically, of pulp necrosis with apical periodontitis. However, in the first case tenderness to percussion and periapical radiolucency developed after 2.5 years and endodontic treatment was started. In the second case, the patient returned after 2 years 9 months with complaint and periapical radiolucency was observed radiographically. Endodontic therapy was performed. These late-term complications highlight the need for regular long-term follow-up in cases of intrusive luxation in permanent teeth.

Restoration of an intruded maxillary central incisor with a uniquely designed dowel and core restoration: a case report

This article describes the restoration of an intruded root using a custom-made metal dowel and metal-ceramic veneer core restoration. The treatment plan for this patient consisted of restoring the missing esthetics and eliminating psychological trauma by utilizing the root of the intruded maxillary left central incisor to replace both missing central incisor crowns. This treatment will preserve space and bone until the patient is old enough for another prosthodontic restoration to be considered.

CLINICAL SIGNIFICANCE

As the lost fragments were not recovered, we considered this restoration of the intruded root to be the best therapeutic option, considering the effect on the patient's psyche. The patient was satisfied with the final result.

Intrusive luxation: a case report

Intrusive luxation is one of the most severe types of dental trauma. The occurrence of pulp necrosis in intruded teeth with open apices is 100%. The risk of development of inflammatory or replacement root resorptions is high. Thus, endodontic intervention is required soon after the occurrence of trauma, in an attempt to prevent or delay the appearance of such lesions. On the other hand, the access to the root canal is difficult, as the crown is intruded. A multidisciplinary approach comprising Surgery, Orthodontics and Endodontics is required to allow exposure of the crown, orthodontic extrusion and onset of endodontic therapy. The patient GCSA, aged 15 years, attended the community project 'Lugar de dente é na boca' ('teeth should be in the mouth') of the Federal University of Goiás, Brazil, 1 week after complete intrusion of the right maxillary central incisor. Radiographic examination revealed that the incisal edge of this tooth was at the level of the crown-root interface of the adjacent teeth. After surgical exposure of the crown, pulp sensitivity was evaluated and was found to be negative. After onset of endodontic therapy, the patient was referred for orthodontic extrusion of the intruded tooth. Successive changes of root canal dressing were performed and the root canal was definitely obturated at 3 years and 6 months after onset of treatment. The present paper reports on a case of severe intrusive luxation, discusses the different treatments recommended for repositioning of traumatically intruded teeth, and questions the ideal period of maintenance of calcium hydroxide dressing in the root canal, in an attempt to prevent the occurrence of root resorption and repair any existing resorption.

Immediate surgical repositioning following intrusive luxation: a case report and review of the literature

This report presents a case of severe intrusive luxation of mature maxillary lateral incisor in a 10-year-old boy. The intruded tooth was immediately repositioned (surgical extrusion) and splinted within 2 h following injury. Tetracycline therapy was initiated at the time of repositioning and maintained for 10 days. Pulp removal and calcium hydroxide treatment of the root canal was carried out after repositioning. Splint was removed 1 month later. Definitive root canal treatment with gutta percha was accomplished at the second month recall. Clinical and radiographic examination 28 months after the surgical extrusion revealed satisfactory apical and periodontal healing.

Spontaneous re-eruption of intruded permanent incisors: five case reports

This report presents 5 cases of intrusive luxation in immature permanent central incisors. The intruded incisors, with careful monitoring, were allowed to spontaneously re-erupt, which avoided the need to reposition the tooth either orthodontically or surgically. All of the teeth re-erupted spontaneously in a few months. The root development continued in all of the cases and all pulps remained vital. There were no other signs of pulpal and/or periapical pathology. It can be concluded that intruded immature permanent teeth can spontaneously re-erupt, conserve their vitality, and continue their root development without any surgical or orthodontic management.

Surgical repositioning of traumatically intruded permanent incisor: case report with a 10-year follow up

This report describes the case of a 10-year-old boy that was referred to the pediatric dentistry clinic 15 days after sustaining a severe traumatism that led to complete intrusion of the maxillary left mature permanent central incisor. The intruded tooth was repositioned by using surgical extrusion. Endodontic therapy was performed with calcium hydroxide-based paste as root canal dressing and root canal filling was performed with a calcium hydroxide-based root sealer and gutta-percha points. The postoperative course was uncomplicated, with both clinical and radiographic success up to 10 years of follow up. In this case surgical repositioning combined with endodontic therapy constituted a viable alternative treatment for intrusive luxations in mature permanent teeth.

The role for 'reminders' in dental traumatology: 3. The minimum data set that should be recorded for each type of dento-alveolar trauma - a review of existing evidence

The aim of this study was to establish the prognostic factors recorded at the time of diagnosis or initial treatment that affect pulp and periodontal healing and tooth survival. A search strategy and quality assessment method was established to review the literature. The significant factors identified are listed for each type of dento-alveolar injury. These factors identified are the gold standard against which quality assessments of dento-alveolar trauma records can be compared and all new computer or paper-based methods for recording any type of dento-alveolar trauma should aim to record this minimum information.

Traumatic intrusion of permanent teeth. Part 2. A clinical study of the effect of preinjury and injury factors, such as sex, age, stage of root development, tooth location, and extent of injury including number of intruded teeth on 140 intruded permanent teeth

A prospective study of 140 intruded permanent teeth was done to evaluate the following healing complications: pulp necrosis (PN), root resorption (surface, inflammatory and replacement resorption) (RR) and defects in marginal periodontal healing (MA). These complications were related to various preinjury and injury factors. Age appeared to be related to all three healing complications in that patients younger than 12 years had the lowest complication rate. Stage of root formation at the time of the injury was very strongly related to PN and MA, with immature root formation (i.e. incomplete root formation or completed root formation with wide open apex) having better prognosis than more mature root development. Lateral incisors showed significantly more defects in MA, a finding possibly explained by the observation that lateral incisors were more often involved in multiple intrusions compared to other teeth and noting that multiple intrusions had a significantly higher frequency of MA. An associated crown fracture with exposed dentin resulted in more frequent PN, a finding possibly related to bacterial invasion through dentinal tubules into an ischemic pulp. The presence of a gingival laceration added to both PN and MA. The extent of intrusion (in mm) showed some relation to both RR with intrusion 1-3 mm having the lowest frequency of RR, whereas PN and MA showed no significant relation to the extent of intrusion. Finally, multiple adjacent intruded teeth were more frequently involved in a significantly greater loss of interproximal marginal bone (MA) than single intrusions. In conclusion, the relationship between healing complications and preinjury and injury factors could generally be explained by better healing possibilities in teeth with immature root formation. A possible explanation for that could be the softer bone surrounding the tooth, whereby trauma to the periodontium might be diminished.

Traumatic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay, method of repositioning, type of splint, length of splinting and antibiotics on 140 teeth

A prospective study of 140 intruded permanent teeth was examined for the following healing complications: pulp necrosis (PN), root resorption (RR; surface, inflammatory and replacement resorption), and defects in marginal periodontal bone healing (MA). The occurrence of these healing complications was related to various treatment factors such as treatment delay, method of repositioning (i.e. expecting re-eruption, orthodontic reposition and surgical reposition), type of splint (rigid, semirigid and flexible), length of splinting (days) and the use of antibiotics. Treatment delay, i.e. before and after 24 h, had no effect upon healing. Active repositioning in individuals with incomplete root formation (surgical or orthodontic) had a negative effect upon the three healing parameters compared with spontaneous eruption. In teeth with complete root formation and an age of 12-17 no repositioning was still the best treatment in regard to MA. In individuals older than 17 years of age, cases were not anticipated to spontaneously erupt and in these cases, the general choice of treatment was either active orthodontic or surgical repositioning. The former procedure appeared in this treatment scenario to slightly reduce the risk of MA complications. However, this treatment procedure was also found to be more time demanding (an average of 22 consultations for orthodontic repositioning compared with 17 consultations for surgical repositioning). If a surgical repositioning was performed, the type of splint (i.e. flexible, semirigid or rigid) appeared to have no significant effect on the type of healing. The same applied to the length of splinting time (shorter or longer than 6 weeks). No effect of dentin covering procedures for associated crown fractures (enamel-dentin fractures) could be demonstrated. Likewise, antibiotics had no apparent effect upon healing. In conclusion, in patients with intruded teeth with incomplete root formation, spontaneous eruption should be expected. In patients with completed root formation and with an age of 12-17 spontaneous eruption can still occur, but must be monitored very carefully. In older patients (i.e. >17 years) with completed root formation, either surgical or orthodontic extrusion should be attempted. The latter procedure appeared to lead to a slight reduction (not significant) in the risk of MA complications. The extent and direction of the intrusion may however favour surgical repositioning.

Traumatic intrusion of permanent teeth. Part 1. An epidemiological study of 216 intruded permanent teeth

An epidemiological study of traumatic intrusion of permanent teeth was performed on 216 teeth in 151 patients treated over a 50-year period at a major trauma center in Denmark (Copenhagen). This analysis showed that intrusion of permanent teeth was of rare injury only affecting 1.9% of traumatic injuries involving permanent teeth. The main etiologic factor appeared to be falling which resulted in axial impacts on maxillary or mandibular teeth. The most common injury patterns were intrusion without additional injuries (33.5%) and intrusion with crown fractures (60.5%). A few cases were combinations of intrusion and either crown/root-fractures or root fractures (6%). Most often one tooth was intruded (46.3%), followed by two teeth (32.4% ) and three or more teeth (21.3%). The majority of intruded teeth were displaced 2-8 mm. The age group of 6-12 years of age was most frequently involved and boys appeared to experience intrusion injuries more frequently than girls, and at an earlier age. Maxillary central and lateral incisors are the primary victims of intrusions and this seems to be identical to other trauma types and is possibly related to the known exposure to impacts of maxillary incisors. The reliability of clinical findings, such as lack of mobility (81.8%), metallic percussion tone (72.5%), and no pain to percussion (66%) was reasonably high, whereas a radiographic feature such as the obliteration of the periodontal ligament space appeared to be only a partly reliable diagnostic tool (52%).

Eruption of teeth in the nose following trauma to the primary and permanent dentitions

Oro-facial trauma is common and forms a large component of any maxillofacial service workload. Even minor trauma can result in significant oro-facial and dental injury. This report reinforces the importance of a careful dental history and thorough examination, particularly when teeth remain missing after initial inspection. Other anatomical sites should be considered to ensure they do not contain traumatically displaced teeth. These two case reports show the late presentation of incisor teeth in the nasal cavity following dentoalveolar trauma.

Emergency orthodontic treatment after the traumatic intrusive luxation of maxillary incisors

Treatment of traumatically intruded teeth is based largely on empirical clinical experience rather than on scientific data. The aim of this qualitative meta-analysis was to provide an evidence base to evaluate the orthodontic repositioning approach. In a MEDLINE search of the literature in English, 14 reported patients involving 22 teeth were found to have been treated by this modality. Additionally, 3 new patients, involving 9 intruded teeth and presented herein, were combined to form a total study sample of 17 subjects (7 girls, 10 boys, aged 8.9 +/- 1.2 years). Orthodontic extrusive forces were applied in the immediate posttrauma period (up to 3 months), with a variety of orthodontic appliances. Repositioning was achieved for 90.3% of the affected teeth but failed in 9.7% because of inflammatory resorption (2 teeth) or a misdiagnosis of root fracture (1 tooth). Early complications included loss of pulp vitality and external root resorption. All intruded teeth with closed root apices lost their vitality regardless of the degree of intrusion, whereas among those with incomplete apices, 45.5% that had been moderately intruded remained vital. External resorption was encountered in 54.8% of the teeth. Loss of marginal bone support was rarely encountered. Late complications included inflammatory root resorption in teeth with closed apices, in which endodontic treatment was not initially performed, and obliteration of the pulp tissue in teeth that remained vital. The results show that this method is superior to other treatment alternatives.

Clinical outcomes for permanent incisor luxations in a pediatric population. I. Intrusions

A longitudinal outcome study was undertaken to identify variables that significantly influenced tooth survival as well as pulpal and periodontal outcomes for intruded permanent maxillary incisors of children and adolescents. All cases were treated between June 1988 and June 1998 in a teaching hospital clinic. Clinical and radiographic data were collected for 26 patients (19 males, 7 females) that represented 31 permanent maxillary incisors. Mean age at the time of injury was 9.3 years (range = 5.5-17.8 years). Mean time elapsed to follow up was 1380 days (range = 65-3394 days). Survival analysis was used to identify variables significantly related to the survival and pulp necrosis (PN) for these incisors. Proportional hazards regression yielded significant prognostic models for tooth survival and the diagnosis of PN (P < 0.05). Incisors intruded > 6 mm had significantly decreased survival compared with incisors intruded < 3 mm (5-year survival, 0.45 and 1.0, respectively, (P < 0.05)). Complex crown fractures were significantly related to the development of PN (P < 0.05). Logistic regression analysis showed that treatment method and severity of intrusion were related to the presence of replacement root resorption (P < 0.05). This study represents the largest sample of intruded permanent incisors examined in an outcome study of children and adolescents exclusively.

Influence of surgical repositioning of mature permanent dog teeth following experimental intrusion: a histologic assessment

The aim of this study was to evaluate, through histologic examination, the effect of surgical repositioning of intruded dog teeth upon the pulpal and surrounding tissues. Thirty teeth in 10 adult dogs, aged 2-3 years, were used. Fifteen teeth were intruded, surgically repositioned and fixed using orthodontics wire, composite resin, and enamel acid conditioning. All these teeth served as the experimental group. The remaining intruded teeth were not treated (control group). The animals were sacrificed to allow observations at 7, 15, and 30 post-operative days. The maxillary and mandibular arches were removed and processed for histologic exam. Based on the methodology and observed results, we concluded that: pulpal necrosis, external root resorption and ankylosis were common sequelae to severe traumatic intrusion; a careful immediate surgical repositioning of severed intruded permanent tooth with complete root formation has many advantages with few disadvantages.

Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries -- a review article

Based on an analysis of the literature concerning parameters influencing the prognosis of traumatic dental injuries, few studies were found to have examined possible relationships between treatment delay and pulpal and periodontal ligament healing complications. It has been commonly accepted that all injuries should be treated on an emergency basis, for the comfort of the patient and also to reduce wound healing complications. For practical and especially economic reasons, various approaches can be selected to fulfill such a demand, such as acute treatment (i.e. within a few hours), subacute (i.e. within the first 24 h), and delayed (i.e. after the first 24 h). In this survey the consequences of treatment delay on pulpal and periodontal healing have been analyzed for the various dental trauma groups. Applying such a treatment approach to the various types of injuries, the following treatment guidelines can be recommended, based on our present rather limited knowledge of the effect of treatment delay upon wound healing. Crown and crown/root fractures: Subacute or delayed approach. Root fractures: Acute or subacute approach. Alveolar fractures: Acute approach (evidence however questionable). Concussion and subluxation: Subacute approach. Extrusion and lateral luxation: Acute or subacute approach (evidence however questionable). Intrusion: Subacute approach (evidence however questionable). Avulsion: If the tooth is not replanted at the time of injury, acute approach; otherwise subacute. Primary tooth injury: Subacute approach, unless the primary tooth is displaced into the follicle of the permanent tooth or occlusal problems are present; in the latter instances, an acute approach should be chosen. These treatment guidelines are based on very limited evidence from the literature and should be revised as soon as more evidence about the effect of treatment delay becomes available.

Factors affecting resorption in traumatically intruded permanent incisors in children

There is a lack of consensus concerning the management of intruded permanent teeth. The objectives of the present study were to determine the prevalence of resorption for intruded permanent teeth and to establish the effect of factors on the timing, prevalence and rate of resorption and to examine the relationship between the timing of onset and the subsequent rate of resorption. Sixty-one intruded permanent incisors treated at the Paediatric Dentistry units in Belfast and Newcastle upon Tyne, during the period 1990-99 with a minimum follow-up period of 1.5 years, were studied. The timing and presence of resorption and its rate of occurrence over time were set as the principal outcomes. There was a significantly earlier onset and higher prevalence of resorption in more severely intruded teeth (P< 0.05). There was also a significant relationship between the degree of apical development and resorption with an increased prevalence in the more fully developed roots (P< 0.001). Resorption was detected significantly earlier in teeth with higher rates of resorption (P< 0.05). However, the treatment method did not significantly affect the prevalence or rate of resorption. In conclusion, the occurrence of root resorption after intrusive trauma appears to be related to the severity of the original injury and the stage of root development rather than the repositioning procedure.

Conservative management of an intruded immature maxillary permanent central incisor with healing complication of pulp bone

Traumatic intrusion injury of permanent teeth is serious with multiple complications possible associated with the pulp, periodontal ligament, alveolar bone and Hertwig's epithelial root sheath. The optimal treatment for the management of an intrusion injury has not yet been determined. A case is presented involving the conservative management of an immature maxillary permanent central incisor intrusively luxated by allowing for re-eruption and orthodontic extrusion two weeks later. After a follow-up period of ten months, the intruded tooth continued to show a mobility of grade one, without metallic percussion tone or infra-occlusion, which confirmed periodontal ligament healing. Although the intruded tooth failed to respond to dry ice testing, no other signs of pulp necrosis were evident and the colour of the intruded tooth was within normal limits throughout the follow-up period. However, complications of healing of Hertwig's epithelial root sheath occurred, causing in-growth of bone and periodontal ligament into the root canal.

Pulpal and periodontal reactions of immature permanent teeth in the dog to intrusive trauma

Pulpal and periodontal tissues of immature incisors of 10 dogs were radiographically and histopathologically evaluated immediately, 7, 15, 30 and 60 days after experimental intrusion induced by mechanical blows. Forty upper central and mesial lateral incisors showing incomplete root formation on radiographs were submitted to intrusive force. After the observation periods, the dogs were killed, two at a time. The hemi-maxilas were removed and processed for histopathologic examination. The traumatized teeth showed accelerated apical formation with reduced radicular length. Pulpal vitality was maintained and the subjacent tissues did not present irreversible changes. All traumatized teeth re-erupted spontaneously.