Permanent Trauma: Extrusion and lateral luxation Flashcards
Describe lateral luxation.
Horizontal forces displace the crown palatally and the apex labially.
PDL compression palatally.
Tooth is often locked into place by the fractured alveolus.
Describe extrusive luxation/extrusion.
Oblique forces displace the tooth out of its socket. Palatal PDL fibres prevent the tooth from complete avulsion.
What features do luxation and extrusion share?
Both PDL and neurovascular supply to the pulp are severed.
What type of teeth have a worse prognosis following these injuries?
Mature teeth
What are the radiographic features of a laterally luxated tooth?
Widened PDL space, best seen on eccentric bisecting angle or occlusal exposure.
What are the radiographic features of an extruded tooth?
Increased apical PDL space.
What noise will a laterally luxated tooth make when percussed?
High metallic percussion noise- indicating ankylosis (not recommended to routinely percuss traumatised teeth, very painful).
How should laterally luxated and extruded teeth be treated?
If treatment is sought soon after injury (ideally first 48 hours), teeth can be repositioned and splinted.
For a lateral luxation, the tooth must first be disengaged from the bone before it can be splinted and may required an extended splinting period (4 weeks instead of 2 weeks).
What antibiotics may be prescribed if a tooth has been badly displaced?
- 250mg phenoxymethylpenicillin QDS 5 days
- Clindamycin for patients with penicillin allergy
- Adjust doses for younger patients
What are the possible complications?
- Pulp necrosis (more common in mature teeth, particularly following severe luxation injuries)
- Pulp canal obliteration (more common in teeth with open apices)
What should be considered when deciding to root treat a traumatised tooth?
- Radiographic and clinical assessment required
- Sensibility tests are not reliable immediately following trauma
- Inflammatory resorption on a radiograph is always significant and requires prompt endo treatment
