Luxation Flashcards
what are the different types of luxation injuries?
- concussion
- subluxation
- lateral luxation
- intrustion
- extrustion
luxation: etiology and incidence
- permantent dentition: ages 9-10
- boys 3X more than girls
- most common for central incisors
- malocclusions perdispose teeth to more dental injuries, (severe over jet and open bite)
what are the three questions you should ask yourself with each injury?
- Was the tooth displaced?
- what happened to the neurovascular bundle?
- what happened to PDL and cementum?
if the tooth is diplaced, what is the likely treatment?
usually splint the teeth (flexible splint)
if the neurovascular bundle is torn….
-it will probably become necrotic, thus will need NSRCT
if the PDL and cementum are torn…
the tooth will be predisposed to complication of resorption
what is Concussion?
- PDL injury only
- hemorrhage and edema in PDL
- pain to percussion is only present feature
- normal radiograph
- no mobility and no bleeding from sulcus
- PDL injury only
- hemorrhage and edema in PDL
- pain to percussion is only present feature
- normal radiograph
- no mobility and no bleeding from sulcus
concussion
- No tooth displacement
- PDL: damage with loosening and/or bleeding from sulcus
- Pulp: minor rupture of neurovascular supply to the tooth
subluxation
subluxation
- No tooth displacement
- PDL: damage with loosening and/or bleeding from sulcus
- Pulp: minor rupture of neurovascular supply to the tooth
if patient has concussion/subluxation how do you assess and treat?
- Assessment: always canine to canine (periapicals, occlusal, “endo testing”)
- treatment: reassurance, prevention (ortho for malocc, or mouthguard), soft diet for two weeks
- complications are rare
- recall: 4, 6-8 weeks, and one year
root resorption
- surface heals with “wavey” lamina dura
- dentin and cementum replaced with bone
- cannot be reversed
- often results in ankylosis
what is ankylosis?
root dentin and cementum replaced with bone
immediately after luxation, what % of teeth respond to EPT?
more than 50% of teeth do NOT respond, cold testing more reliable
when is EPT unreliable?
- in children
- erupting permanent teeth
- teeth with open apicies
if there are discrepancies in cold and EPT testing….
pulps of traumatized teeth should be considered vital for up to a year if there are no RLs on PA, no sinus tracts, no discoloration and tooth remains asymptomatic
- Tooth is displaced laterally (usually with crown to lingual)
- Apex may protrude through buccal cortical plate and be “locked in”
- PDL&Cementum: injured
- Bone: fractured
- Pulp: neurovascular bundle often torn
lateral luxation
- Forces displace tooth out of socket (extruded)
- Only gingival fibers prevent tooth from avulsion
- PDL fibers and cementum torn
- Neurovascular bundle stretched or severed
extrusive luxation
- Tooth appears pushed into socket; clinical crown appears shortened visually and on x-ray
- May be locked into bone
intrusive luxation
intrusive luxation
- Extensive damage to bone and socket
- PDL and cementum remain intact
- Neurovascular bundle crushed
- Repositioning a challenge and will depend upon mm of intrusion
luxation general standards of treatment
-At least 4 PAs initially
-Sensitivity Testing and PAs at each recall visit
-If need to splint
– 2 weeks to 4 weeks depending upon whether alveolar fracture
– Physiologic splint always
-If require NSRCT place Ca(OH)2 as interim
medicament and leave in 2-4 weeks
-Refer to Endodontists always a good idea
splinting, how and how long?
- splint if mobile using at least one tooth mesial and distal to injured tooth
- usually two weeks
- if splinted more than two weeks may cause ankylosis
if the NV bundle is crushed, severed, or stretched…
– Monitor with sensibility test for necrosis
– May need NSRCT
– Do only if tooth repeatedly tests necrotic
– Do ASAP when necrosis occurs
**Luxation recall schedule
- 2 wks
- 4 wks
- 6-8 wks
- 6 months
- 1 year
- 5 years
- ADA code 0140 problem focused exam
- ADA code 0220 for PAs
what is the website for trauma?
www.dentaltraumaguide.org
recall schedule
2, 4, 6-8, 6, 1, 5
Calcific Metamorphosis
-Pulpal inflammation due to trauma that results in laying down of dentin to obliterate the pulp canal space.
– More common with open apex
-Less than 10% of teeth with calcific metamorphosis become necrotic
– Confirm vital with Cold and/or EPT
– Treat only if Pulp Necrosis & Symptomatic
-Prophylactic endodontic treatments not indicated
Luxation Standards of Treatment
At least 4 PAs initially
Sensitivity Testing and PAs at each recall visit
If need to splint
– 2 weeks to 4 weeks depending upon whether alveolar fracture
– Physiologic splint always
If require NSRCT place Ca(OH)2 as interim
medicament and leave in 2-4 weeks
Referral to Endodontists always a good idea
rules for repositioning an internally luxated tooth
Open apex -up to 7 mm: spontaneous -more than 7 mm: ortho and surgical Closed apex: -up to 3 mm: spontaneous -3-7 mm: ortho and surgical -more than 7 mm: surgical
