Management of intrusive luxation with immediate surgical repositioning

Abstract

Intrusive luxation is one of the most severe forms of traumatic injuries in which the affected tooth is forced to displace deeper into the alveolus. As a consequence of this type of injury, maximum damage occurs to the pulp and all the supporting structures. This report presents a case of severe intrusive luxation of mature maxillary central and lateral incisor in a 40-year-old male. The intruded tooth was immediately repositioned (surgical extrusion) and splinted within hours following injury. Antibiotic therapy was initiated at the time of repositioning and maintained for 5 days. Pulp removal and calcium hydroxide treatment of the root canal was carried out after repositioning. Splint was removed 2 months later. Definitive root canal treatment with Gutta percha was accomplished at a later appointment. Clinical and radiographic examination 6, 12 and 24 months after the surgical extrusion revealed satisfactory progressive apical and periodontal healing.

Surgical extrusion as a treatment option for crown–root fracture in permanent anterior teeth: a systematic review

“…Higher incidence of resorption was also observed in case of endodontic treatment being performed prior to extrusion due to contamination by serum, blood, and saliva . Various other case reports and case series have shown no signs of root resorption after an average follow up of 1 year . Periapical pathologies and marginal bone height:‐ Normal periapical healing and resolution of radiolucency was seen in almost all reported case reports and case series . A study showed a minor loss of marginal bone height in one out of the 20 teeth treated .…”

Management of luxation injuries in line with International Association of Dental Traumatology guidelines – Two case reports

“…Among all the types of luxation injuries, intrusion injury is the rarest one. [ 9 ] The treatment of intruded permanent incisors can be challenging. If the tooth is intruded 3–7 mm, surgical (preferably) or orthodontic repositioning is recommended.…”

Two intrusion cases applied at different times treated with surgical extrusion: one-year follow-up report

“…If root canal treatment is not initiated during these weeks, external root resorption may occur. The primary reason why we chose surgical extrusion as a treatment option was that it could allow rapid positioning ( 11 ) to initiate root canal treatment in which the tooth was totally embedded in the alveolar bone in late applied cases. Also, the second case was presented with teeth of multiple intrusion injuries and, re-positioning by surgical extrusion in the first three weeks after trauma is recommended.…”