Intrusive luxation injuries of permanent teeth are quite uncommon, making up 0.5% to 1.9% of all dental traumas. It is considered one of the most severe types of dental injuries, and healing complications such as infection-related, ankylosisa-related, and replacement resorption, pulp necrosis and marginal bone loss are frequent (Figure 1). There has been much debate about the optimal treatment of intruded permanent teeth.
Three treatment protocols are currently in use for the treatment of intrusive luxations:
- waiting for spontaneous re-eruption
- orthodontic repositioning
- immediate surgical repositioning
Due to the absence of high-quality studies with sufficiently large patient numbers, this debate has persisted. Tsilingaridis et al from Karolinska lnstitutet, Sweden, combined 3 Scandinavian studies to evaluate the survival of intruded permanent teeth related to treatment protocols in a large number of patients, with special focus on development of pulp necrosis and replacement resorption. The 168 patients (230 intruded permanent teeth) ranged in age from 5 to 18 years (107 boys, 61 girls; mean age, 9.6 years).
Figure 1. (Left) Periapical radiograph of tooth #9 following intrusion injury. (Right) Periapical radiograph at 1 month with inflammatory root resorption on the distal surface of tooth #9. (Images courtesy of Dr. Frederic Barnett.)
Standardized protocols were used for documentation and included
- degree of intrusion
- stage of root development
- type of treatment
- pulp and periodontal condition
- crown fracture
- bone loss
- systemic antibiotic administration
- splinting time and type
Overall, replacement resorption was found less frequently in teeth awaiting re-eruption than in teeth with active treatment (orthodontic or surgical repositioning). This indicated that leaving the teeth to re-erupt diminishes the risk of replacement resorption because of additional damage to the periodontal ligament during treatment. ‘
For mature teeth with an intrusion depth 7 mm, the International Association for Dental Traumatology guidelines recommend orthodontic or surgical repositioning. The results from this study supported this recommendation. Although orthodontic repositioning seemed to have had a slightly better healing outcome, there was no significant difference between orthodontic and surgical repositioning. When combined with the practicality of endodontic access, financial issues, number of visits and quality of life for the patient, surgical repositioning becomes the preferred treatment.
The results from this study indicated that choice of treatment, root development and degree of intrusion play arole in the development of replacement resorption. Awaiting re-eruption of intruded permanent teeth appeared to be the most favorable treatment, especially in immature teeth with mild intrusion.
Tsilingaridis G, Malmgren B, Andreasen JO, et al. Scandinavian multicenter study on the treatment of 168 patients with 230 intruded permanent teeth—a retrospective cohort. Dent Traumatol 2016;doi:10.1111/edt. 12266.