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Luxation Injuries. World Health Organization Classification. Great Threat to Pulp Vitality (Luxations). Traumatizes supporting structures of the periodontium Potentially severs pulpal blood supply entering the apical foramen WHO recognizes five main types of luxation injuries.
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Luxation Injuries World Health Organization Classification
Great Threat to Pulp Vitality(Luxations) • Traumatizes supporting structures of the periodontium • Potentially severs pulpal blood supply entering the apical foramen • WHO recognizes five main types of luxation injuries
Luxation Injuries • Concussion • Subluxation • Extrusive luxation • Lateral luxation • Intrusive luxation
Concussion • Clinical findings: tender to touch, not displaced no increased mobility. Sensitivity test are most likely positive • Radiographic findings: No abnormalities • Treatment: No treatment is need but it is essential to monitor pulpal condition for one year
Concussion: follow up • Follow up: clinical and radiographic examination at, 4 weeks, 8 weeks, 1 year with clinical and radiographic examination • Favorable outcome: Asymptomatic, positive pulp tests, can have false negative up to 3 months, continued root development, intact lamina dura • Unfavorable outcome: Symptomatic, negative pulp test, can have false neg for 3 months no continuing root development, signs of PAP, endo tx appropriate for stage of root development
Subluxation • Clinical findings: tender to touch or tap, increased mobility, not displaced. Bleeding from the gingival crevice. May have negative pulp test initially indicating transient pulpal damage. • Monitor pulpal response until a definitive pulpal diagnosis can be made • Radiographic findings: Abnormalities are usually not found • Treatment: no treatment is needed. Monitor pulpal status for one year
Subluxation: follow up • Follow up at 2 weeks, 4 weeks, 8 weeks 6 months and one year with clinical and radiographic examination • Favorable outcome: asymptomatic, positive pulp test. Can have false negative up to 3 months. Continued root development of immature teeth. Intact lamina dura. • Unfavorable outcome: Symptomatic, negative pulp tests, external inflammatory resorption, arrested root development, PAP, endo tx appropriate for stage of root development.
ExtrusiveLuxation • Clinical Findings: Tooth appears elongated and is excessively mobile. Sensitivity test give negative results • Radiographic findings: Increased periodontal ligament space apically • Treatment: Reposition tooth by gently re-inserting it into the socket. Stabilize for 2 weeks with a flexible splint. In mature tooth pulp necrosis is expected. With immature teeth watch for signs and symptoms of pulpal necrosis. Endodontic therapy indicated.
Extrusive Luxation: follow up • Remove splint in 2 weeks. Perform clinical and radiographic exam at 2 weeks, 4 weeks, 8 weeks, 6 months, then yearly • Favorable outcome: Asymptomatic, clinical and radiographic signs of healed periodontium, positive pulp tests (false neg up to 3 mos), marginal bone height maintained, continued root development • Unfavorable outcome: Symptoms and radiographic signs of apical periodontitis, negative response to pulp tests, if breakdown of marginal bone is noted splint for an additional 4 weeks, signs of external inflammatory root resorption, endodontic therapy appropriate for root development.
Lateral Luxations • Clinical findings: displacement usually palatal/lingual direction. Often immobile and percussion gives metallic sound. Fracture of alveolar process is present. Negative pulp tests. • Radiographic findings: widen PDL, best seen on occlusal exposure • Treatment: Reposition digitally to disengage from its boney lock and gently reposition to original location. Stabilize 4 weeks with flexible splint. Monitor vitality. If necrotic endodontic therapy is indicated to prevent root resorption
Lateral Luxation: follow up • Follow up: 2 weeks splint removal, 2-4-6weeks, 6-12 months and yearly for 5 years clinical and radiographic exam. • Favorable outcome: asymptomatic, clinical and radiographic signs of normal periodontium. Positive pulp tests. Potential false neg. for 3 months. No loss of marginal bone height. Continued root development in immature teeth. • Unfavorable outcome: Symptomatic with radiographic PAP. Negative vitality. (False negative up to 3 months) If marginal bone is breaking down splint for additional 4 weeks. External inflammatory root resorption or replacement resorption. Endodontic therapy appropriate for root development stage.
Intrusive Luxation • Clinical findings: tooth displaced axially into the alveolar bone. Immobile with metallic sound to percussion (ankylotic). Negative to vitality tests. • Radiographic findings: PDL absent. CEJ more apical then adjacent non-injured teeth. • Treatment: contingent on root development. Teeth with incomplete root development vs teeth with complete root formation
Intrusive Luxation: treatment • Incomplete root formation: Allow eruption with no intervention. If no movement within three weeks initiate orthodontic repositioning. If tooth was intruded more than 7 mm immediately reposition surgically or orthodontically. • Complete root formation: allow eruption if intruded less than 3 mm. If no movement in 3 weeks reposition surgically or orthodontically before ankylosis sets in. More extensive intrusions promptly reposition surgically. • Pulpal necrosis likely initiate endodontic therapy with CAOH 2 weeks after surgery. • Once repositioned surgically or orthodontically stabilize with flexible splint for 4-8 weeks
Intrusive Luxation: Follow up • 2 weeks splint removal. Clinical and radiographic exam. Then continue checking at 4 weeks 8 weeks 6 months and yearly for 5 years. • Favorable outcome: tooth erupting or in place. Intact lamina dura. No sign of resorption. Continued root development. • Unfavorable outcome: Tooth locked in place (ankylotic) Apical periodontitis. External inflammatory root resorption or replacement resorption. Endodontic therapy appropriate for stage of root development.
