dental trauma to permanent teeth

Permanent teeth Extrusion & Intrusion

Fahimeh VaziriDENTAL TRAUMA TO PERMANENT TEETHExtrusion & Intrusion

Permanent teeth: Extrusion

Permanent teeth: ExtrusionEtiology

Permanent teeth: ExtrusionDiagnostic signs





Permanent Teeth: ExtrusionTreatment Guidelines





Permanent Teeth: ExtrusionTreatment GuidelinesFLEXIBLE ACRYLIC SPLINT













Permanent Teeth: ExtrusionTreatment GuidelinesFLEXIBLE WIRE SPLINT















Permanent Teeth: ExtrusionTreatment GuidelinesThe exposed root surface of the displaced tooth is cleansed with saline before repositioning.

Reposition the tooth by gently re-inserting it into the tooth socket with axial digital pressure (local anesthesia is usually not necessary).

Stabilize the tooth for 2 weeks using a flexible splint.

Monitoring the pulpal condition is essential to diagnose associated root resorption.

Permanent Teeth: ExtrusionTreatment GuidelinesOpen apex: Revascularization can be confirmed radiographically by evidence of continued root formation and pulp canal obliteration and usually a return to a positive pulp response to sensibility testing.

Closed apex: A continued lack of pulp response to sensibility testing should be taken as evidence of pulp necrosis together with periapical rarefaction and sometimes crown discoloration.

Permanent Teeth: ExtrusionPatient instructions

Soft food for 1 week.

Good oral hygiene. Brushing with a soft brush and rinsing with chlorhexidine 0.1 %

Permanent Teeth: ExtrusionFollow-up

Clinical and radiographic control and splint removal after 2 weeks. Clinical and radiographic control at 4 weeks, 6-8 weeks, 6 months, 1 year and yearly for 5 years.

Permanent teeth: Intrusion

Permanent teeth: IntrusionEtiology

Permanent teeth: IntrusionDiagnostic signs







Permanent teeth: IntrusionTreatment GuidelinesTooth intrusion is associated with a potential risk of tooth loss due to progressive root resorption (ankylosis or infection related resorption). The following three methods are only partly evidence based.

Permanent teeth: IntrusionTreatment GuidelinesSpontaneous eruptionThis is the treatment of choice for permanent teeth with incomplete root formation with minor or moderate intrusion. In teeth with mature root development it is only recommended for teeth with minor intrusion. This treatment seems to lead to fewer healing complications than orthodontic and surgical repositioning. If no movement within a few weeks, initiate orthodontic or surgical repositioning before ankylosis can develop.

Orthodontic repositioningThis treatment may be preferred for patients coming in for delayed treatment. This treatment method enables repair of marginal bone in the socket along with the slow repositioning of the tooth.

Surgical repositioning This treatment technique is preferable in the acute phase. Intrusion with major dislocation of the tooth (more than 7 mm) may be an indication for surgical repositioning.

Permanent teeth: IntrusionTreatment GuidelinesCommon for all treatmentsEndodontic treatment can prevent the necrotic pulp from initiating infection-related root resorption. This treatment should be considered in all cases with completed root formation where the chance of pulp revascularization is unlikely. Endodontic therapy should preferably be initiated within 3-4 weeks post-trauma. A temporary filling with calcium hydroxide is recommended.

Permanent teeth: IntrusionTreatment Guidelines


Spontaneous eruption
















Orthodontic repositioning

































Permanent teeth: IntrusionTreatment GuidelinesOrthodontic repositioning


Surgical repositioning























Permanent teeth: IntrusionTreatment GuidelinesSurgical repositioning











Permanent teeth: IntrusionTreatment GuidelinesFactors determining treatment choice are stages of root development and intrusion level.

Permanent teeth: IntrusionPatient instructions

Soft food for 1 week.Good oral hygiene. Brushing with a soft brush and rinsing with chlorhexidine 0.1 %

Permanent teeth: Intrusionfollow-upControl after 2 weeks. Splint removal and control after 4 weeks, 6-8 weeks, 6 months, 1 year and yearly for 5 years

Referencehttp://www.dentaltraumaguide.org/

dental trauma to permanent teeth

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