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Fahimeh VaziriDENTAL TRAUMA TO PRIMARY TEETHExtrusion & Intrusion

Primary Teeth: ExtrusionPartial displacement of the tooth out of its socketpartial or total separation of the periodontal ligament loosening and displacement of the tooth. The alveolar socket bone remains intact. axial displacementprotrusive or retrusive orientation

Primary Teeth: ExtrusionEtiology

Primary Teeth: ExtrusionEtiology

Primary Teeth: ExtrusionEtiology

Primary Teeth: ExtrusionDiagnostic signs

Primary Teeth: ExtrusionDiagnostic signsRadiographs recommended occlusal exposure: evaluate the size of the displacement rule out the presence of a root fracture.

Primary Teeth: ExtrusionTreatment GuidelinesThe treatment choice should be based on the:Degree of displacementMobilityRoot formation Ability of the child to cope with the emergency situation.

Primary Teeth: ExtrusionTreatment GuidelinesFor minor extrusion (< 3mm) in an immature developing tooth, either careful reposition the tooth or leave the tooth for spontaneous alignment.

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment GuidelinesExtraction is the treatment of choice for severe extrusion in a fully formed primary tooth.

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionTreatment Guidelines

Primary Teeth: ExtrusionPatient instructionsSoft food for 1 week.Good oral hygiene. Brush with a soft brush after every meal and apply chlorhexidine 0.1 % topically to the affected area with cotton swabs twice a day for one week. Parents should be further advised about possible complications that may occur, like swelling, dark discoloration of the crown, increased mobility or fistula. Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment.

Primary Teeth: ExtrusionFollow-up

Clinical control after 1 weeks. Clinical and radiographic control at 6-8 weeks, 6 months, and 1 year.

Primary teeth: IntrusionDisplacement of the tooth into the alveolar bone. This injury is accompanied by comminution or fracture of the alveolar socket.

Primary teeth: IntrusionEtiology

Primary teeth: IntrusionEtiology

Primary teeth: IntrusionEtiology

Primary teeth: IntrusionVisual signsDisplaced axially into the alveolar bone

The tooth may disappear completely in the tissues

Penetration of the tooth into the nasal cavity can be diagnosed by bleeding from the nose or simple observation of the nostril.

Primary teeth: IntrusionDiagnostic signs

Primary teeth: Intrusion

Primary teeth: Intrusion

Primary teeth: IntrusionDiagnostic signsRadiographs recommended: An occlusal or periapical exposure If the tooth is totally intruded an extra-oral lateral exposure may be indicated to make sure that the tooth has not penetrated the nasal cavity

Primary teeth: IntrusionTreatmentSpontaneous eruptionIf the apex is displaced toward or through the labial bone plate, the tooth should be left for spontaneous repositioning. In order to evaluate re-eruption, the degree of intrusion should be assessed by measuring the distance between the incisal edge of the intruded tooth and that of adjacent unaffected teeth.

ExtractionIf the apex is displaced into the developing tooth germ the tooth should be extracted to minimize the damage done to the permanent successor.

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionTreatment

Primary teeth: IntrusionPatient instructions

Soft food for 10-14 days.

Good oral hygiene. Brush with a soft brush after every meal and apply chlorhexidine 0.1 % topically to the affected area with cotton swabs twice a day for one week.

Parents should be further advised about possible complications that may occur, like swelling, dark discoloration of the crown, increased mobility or fistula. Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment.

Inform the parent about possible complications in the development of the permanent successor, especially following intrusion injuries sustained in children under 3 years of age.

Primary teeth: IntrusionFollow-up

Clinical control after 1 week. Clinical and radiographic control at 3-4 weeks, 6-8 weeks, 6 month, 1 year and yearly clinical and radiographic control until eruption of the permanent successor.

Referencehttp://www.dentaltraumaguide.org/