Luxation Injuries

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Luxation Injuries

• World Health Organization Classification

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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

• Concussion
• Subluxation
• Extrusive luxation
• Lateral luxation
• Intrusive luxation

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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

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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

6
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

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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.

8
Extrusive Luxations
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Extrusive Luxation

• 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.

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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.

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Inflammatory Root Resorption
12
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

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Lateral Luxations
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Lateral Luxations
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Lateral Luxations
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Lateral Luxations
17
Lateral Luxations
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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.

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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

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Intrusive Luxations
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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

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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.

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Intrusive Luxation Immature
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Re-erupting
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Replacement Resorption(Ankylosis)