Management of luxation injuries

1. Presented By
Saeed Ahmed Bajafar
Rawda Sedi Mahmoud

2. Dental luxation :
group of clinical situations , that present
disruption between the tooth and its surrounding
tissues secondary to trauma.
with or without visible tooth displacement
Damage maybe in cementum, periodontal ligament
(PDL), and pulpal neurovascular supply

3.  In traumatology, luxations are
the most common
 Most commonly involved tooth
being the maxillary central
incisor
 Permanent dentition: 15% to
40% of dental injuries
 Primary dentition: 62-69% of
injuries
Luxation Trauma - 44%
– SUB-50%
– CON-19%
– LUX-17%
– INT-6%
– EXT=AVU-4%•

4. Concussion
Subluxation
Extrusive
Intrusive
Lateral
luxation
Avulsion

5. Especially note
1. Direction of dislocation
2. Amount of dislocation
3. Mobility
4. Percussion - response and sound
5. Response to pulp sensibility tests

6. Intrusive luxation
 Apical displacement of tooth into the alveolar
bone.
 The tooth is driven into the socket

7. displaced axially into the alveolar boneVisual signs
Usually high metallic (ankylotic) soundPercussion test
immobileMobility test
likely give negative Response
In immature, not fully developed teeth, pulpal revascularization may occur.
Sensibility test
As a routine: Occlusal, periapical exposure and lateral view from the
mesial or distal aspect of the tooth in question.
If the tooth is totally intruded a lateral exposure is indicated
Radiographs
recommended

8.  Administer local
anaesthesia.
 Whenever possible:
Reposition the tooth back
into its normal position.

9. 1. If intrusion less then 3 mm :
* allow the tooth to re erupt without
intervention .
if no movement is noticed after 2-4 weeks the
tooth may
*be repositioned orthodontically or surgically
before ankylosis
Closed Apex Root :

10.  2- If intrusion is 7 mm or more :
the tooth is repositioned surgically and stabilized for
4-8 weeks .
 in most cases the root will become necrotic , root
canal treatment is required
Closed Apex Root :
1. Allow eruption without intervention
2. Same treatment m only the endodontic
treatment differ .
Open Apex Root :

11. Favorable Outcome
 Tooth in place or
erupting.
 Intact lamina dura
 No signs of resorption.
 Continuing root
development in
immature teeth.

12. Unfavorable Outcome
 ankylosis (ankylotic tone
to percussion. )
 Radiographic signs of
apical periodontitis
 root resorption

14. • extract
If the apex is displaced into the
developing tooth germ
Follow Up
• 1 week C
• 3 - 4 weeks C +
R
• 6 - 8 weeks C
• 6 months C + R
• 1 year C+R and
(C*)

15. Favorable Outcome
 Tooth in place or erupting.
 No or transient
discoloration.
UnFavorable Outcome
 Tooth locked in place
 Radiographic signs of apical
periodontitis
 Persistent discoloration
 Damage to the permanent
successor

16. the tooth is displaced in an incisal direction, with or
without a concomitant lateral luxation
Extrusive luxation :

17. Appears elongatedVisual signs
TenderPercussion test
Excessively mobileMobility test
Usually lack of response except for teeth with minor displacements.Sensibility test
Increased periapical ligament spaceRadiographic
findings

18. Repositioning
The tooth is gently pushed back in to its
socket
Administer local anaesthesia
Applying splinting material
Polishing the splint

19. The finished splint
the splint allows optimal oral hygiene in
the gingival region
Suturing the gingival wound
The gingival wound is closed with
interrupted silk sutures.
Follow Up
• 2 Weeks S+, C++
• 4 Weeks C++
• 6-8 Weeks C++
• 6 Months C++
• 1 Year C++
• Yearly 5 years C++

20. Favorable Outcome
 Asymptomatic
 Clinical and radiographic of
healed periodontium.
 Positive response to pulp
testing
 Continuing root development
in immature teeth.
UnFavorable Outcome
 Symptoms and radiographic
sign consistent with apical
periodontitis.
 Negative response to pulp
testing
 External root resorption.

23. the tooth is displaced labially, lingually, distally, or
mesially, with or without an associated apical
displacement
Lateral luxation :

24. Displaced, usually in a palatal/lingual or labial directionVisual signs
Usually gives a high metallic (ankylotic) soundPercussion test
Usually immobileMobility test
Sensibility tests will likely give negative resultSensibility test
The widened periodontal ligament spaceRadiographic
findings
A steep occlusal radiographic exposure reveals, as expected, more
displacement than the bisecting angle technique.
A lateral radiograph reveals the associated fracture of the labial bone
plate
Radiographs
recommended

25. Repositioning
 forcing the displaced apex
 Axial pressure apically will bring the
tooth back to its original position
 If the palatal aspect of the marginal bone
has also been displaced at the time of
impact. This must be repositioned with
digital pressure .
Administer Local Anaesthesia

26. Verifying Repositioning And
Splinting With The Acid-etch
Technique
 Occlusion is checked and a radiograph
taken .
 The incisal one-third of the labial aspect
of the injured and adjacent teeth is acid
etched (30 seconds) with phosphoric acid
gel.
Preparing The Splinting Material
 The etchant is removed with a 20
seconds water spray.
 The labial enamel is dried with
compressed air

27. Applying The Splinting
Material
Tow weeks after injury
a radiograph is taken to evaluate
periodontal and pulpal healing

28. Splint Removal
The splint is removed using fissure burs,
by reducing the splinting material
interproximally and thereafter thinning the
splint uniformly across its total span.
Once, thinned out, the splint can be
removed by using sharp explorer.

29. Favorable Outcome
 Asymptomatic
 Clinical and radiographic
signs of normal or healed
periodontium.
 Positive response to pulp
testing (false negative
possible up to 3 months).
 Marginal bone height
corresponds to that seen
radiographically after
repositioning.
 Continuing root
development in immature
teeth.
Unfavorable Outcome
 Symptoms and radiographic
sign consistent with apical
periodontitis.
 Negative response to pulp
testing (false negative
possible up to 3 months).
 If breakdown of marginal
bone, splint for an additional
3-4 weeks.
 External inflammatory root
resorption.
 Endodontic therapy
appropriate for stage of root
development is indicated.

30. • The Tooth Is Allowed To Reposition
Spontaneously
No Occlusal Interference
• Slight Grinding Is Indicated
Minor Occlusal Interference
• The Tooth Can Be Gently
Repositioned
Severe Occlusal
Interference
• Extraction
Severe Displacement
Follow Up
• 1 week C
• 2 - 3 weeks C
• 6 - 8 weeks C +
R
• 1 year C + R

31. Favorable Outcome
 Asymptomatic
 Clinical and radiographic
signs of normal or healed
periodontium.
 Transient discoloration
might occur
UnFavorable Outcome
 Symptoms and radiographic
sign consistent with
periodontitis.
 Grey persistent discoloration

32. 2-year-, 7-month-old
male
• Mother stated, “ Child was running in home, fell and
hit cement stairs three hours ago
Chief Complaint and History of Present
Injury
Soft tissue injuries: Bruising noted on lip
No other significant findings
Extra-oral Exam
Maxillary left primary central incisor: Intruded to
gingival margin
Maxillary left primary lateral incisor: Slight mobility,
brown discoloration noted middle third
Intra-oral Exam

33. Radiographs not possible due to very
poor patient cooperation
Vitality tests deferred
Diagnostic Tools
Maxillary left primary central incisor:
Intrusion
Diagnosis

34. No treatment is indicated at this
time
Discharge instructions
Watch for clinical signs such as
presence of parulis or fstula
Follow-up treatment
Treatment
The overall prognosis for this tooth
is based on the observation that it
did re-erupt. The four-month post-
op radiograph demonstrated no
periapical resorption or
radiolucency.
Prognosis and Discussion

35. 12-year-, 7-month-old male
• Foster dad reports, “He fell while running
and
• pushed his tooth up”
Chief Complaint and History of Present
Injury
No other significant findings
Extra-oral Exam
Attached gingiva lacerated adjacent to
intruded maxillary right permanent central
incisor
Intra-oral Exam

36. Intra-oral periapical radiographs of maxillary
anterior area:
 Demonstrate mature root formation of
anterior teeth and closed apices
 The maxillary right permanent central incisor
is intruded approximately 10mm and labially
luxated with concomitant fracture of alveolar
plate
 The periodontal ligament (PDL) space is
obliterated on the occlusal radiographic image
Percussion tests
 Maxillary right permanent lateral incisor:
Positive
 Maxillary right permanent central incisor:
Negative, high metallic sound
Diagnostic Tools

37.  Maxillary right permanent central incisor:
Surgically reposition as soon as possible and splint .
 light orthodontic wire three to four weeks
 Maxillary left permanent central incisor: Apply
glass ionomer or composite resin temporary
restoration on fracture to cover exposed dentin
Follow-up Treatment
 Maxillary right permanent central incisor:
Complete pulpectomy within three weeks of injury.
Fill canal with Ca(OH)2 for two to four weeks.
Because this tooth is likely to ankylose and undergo
replacement resorption, do not place Gutta Percha
unless healing is indicated by presence of lamina
dura and no signs of resorption. Remove splint after
four weeks and complete final composite restoration
 Maxillary left permanent central incisor: Complete
final composite restoration after splint is removed
Treatment