Intrusive luxation: a case report

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.

Endodontic and orthodontic management of traumatically intruded teeth with horizontal root fracture: a case report

This report describes the case of an 8-year-old boy that was referred to endodontic and orthodontic treatment after suffering an injury that led to intrusion of the maxillary right permanent central incisor, palatal displacement of the upper right lateral incisor, and root fracture of both central incisors. Both injured teeth were immature and had open apices. The intruded tooth was repositioned by endodontic and orthodontic management. Endodontic therapy was performed in both teeth with periodical changes of calcium-hydroxide-based paste as root canal dressing and introduction of MTA as an apical barrier. The postoperative course was uneventful with clinical and radiographic success up to 3 and 1/2 years of follow up. In the present case, orthodontic repositioning combined with endodontic therapy constitued a viable alternative treatment for intrusive luxations in immature permanent teeth.