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Management of luxation injuries

Management of luxation injuries

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Management of luxation injuries

  1. 1. Presented By Saeed Ahmed Bajafar Rawda Sedi Mahmoud
  2. 2. Dental luxation : group of clinical situations , that present disruption between the tooth and its surrounding tissues secondary to trauma. with or without visible tooth displacement Damage maybe in cementum, periodontal ligament (PDL), and pulpal neurovascular supply
  3. 3.  In traumatology, luxations are the most common  Most commonly involved tooth being the maxillary central incisor  Permanent dentition: 15% to 40% of dental injuries  Primary dentition: 62-69% of injuries Luxation Trauma - 44% – SUB-50% – CON-19% – LUX-17% – INT-6% – EXT=AVU-4%•
  4. 4. Concussion Subluxation Extrusive Intrusive Lateral luxation Avulsion
  5. 5. Especially note 1. Direction of dislocation 2. Amount of dislocation 3. Mobility 4. Percussion - response and sound 5. Response to pulp sensibility tests
  6. 6. Intrusive luxation  Apical displacement of tooth into the alveolar bone.  The tooth is driven into the socket
  7. 7. displaced axially into the alveolar boneVisual signs Usually high metallic (ankylotic) soundPercussion test immobileMobility test likely give negative Response In immature, not fully developed teeth, pulpal revascularization may occur. Sensibility test As a routine: Occlusal, periapical exposure and lateral view from the mesial or distal aspect of the tooth in question. If the tooth is totally intruded a lateral exposure is indicated Radiographs recommended
  8. 8.  Administer local anaesthesia.  Whenever possible: Reposition the tooth back into its normal position.
  9. 9. 1. If intrusion less then 3 mm : * allow the tooth to re erupt without intervention . if no movement is noticed after 2-4 weeks the tooth may *be repositioned orthodontically or surgically before ankylosis Closed Apex Root :
  10. 10.  2- If intrusion is 7 mm or more : the tooth is repositioned surgically and stabilized for 4-8 weeks .  in most cases the root will become necrotic , root canal treatment is required Closed Apex Root : 1. Allow eruption without intervention 2. Same treatment m only the endodontic treatment differ . Open Apex Root :
  11. 11. Favorable Outcome  Tooth in place or erupting.  Intact lamina dura  No signs of resorption.  Continuing root development in immature teeth.
  12. 12. Unfavorable Outcome  ankylosis (ankylotic tone to percussion. )  Radiographic signs of apical periodontitis  root resorption
  13. 13. • extract If the apex is displaced into the developing tooth germ Follow Up • 1 week C • 3 - 4 weeks C + R • 6 - 8 weeks C • 6 months C + R • 1 year C+R and (C*)
  14. 14. Favorable Outcome  Tooth in place or erupting.  No or transient discoloration. UnFavorable Outcome  Tooth locked in place  Radiographic signs of apical periodontitis  Persistent discoloration  Damage to the permanent successor
  15. 15. the tooth is displaced in an incisal direction, with or without a concomitant lateral luxation Extrusive luxation :
  16. 16. Appears elongatedVisual signs TenderPercussion test Excessively mobileMobility test Usually lack of response except for teeth with minor displacements.Sensibility test Increased periapical ligament spaceRadiographic findings
  17. 17. Repositioning The tooth is gently pushed back in to its socket Administer local anaesthesia Applying splinting material Polishing the splint
  18. 18. The finished splint the splint allows optimal oral hygiene in the gingival region Suturing the gingival wound The gingival wound is closed with interrupted silk sutures. Follow Up • 2 Weeks S+, C++ • 4 Weeks C++ • 6-8 Weeks C++ • 6 Months C++ • 1 Year C++ • Yearly 5 years C++
  19. 19. Favorable Outcome  Asymptomatic  Clinical and radiographic of healed periodontium.  Positive response to pulp testing  Continuing root development in immature teeth. UnFavorable Outcome  Symptoms and radiographic sign consistent with apical periodontitis.  Negative response to pulp testing  External root resorption.
  20. 20. the tooth is displaced labially, lingually, distally, or mesially, with or without an associated apical displacement Lateral luxation :
  21. 21. Displaced, usually in a palatal/lingual or labial directionVisual signs Usually gives a high metallic (ankylotic) soundPercussion test Usually immobileMobility test Sensibility tests will likely give negative resultSensibility test The widened periodontal ligament spaceRadiographic findings A steep occlusal radiographic exposure reveals, as expected, more displacement than the bisecting angle technique. A lateral radiograph reveals the associated fracture of the labial bone plate Radiographs recommended
  22. 22. Repositioning  forcing the displaced apex  Axial pressure apically will bring the tooth back to its original position  If the palatal aspect of the marginal bone has also been displaced at the time of impact. This must be repositioned with digital pressure . Administer Local Anaesthesia
  23. 23. Verifying Repositioning And Splinting With The Acid-etch Technique  Occlusion is checked and a radiograph taken .  The incisal one-third of the labial aspect of the injured and adjacent teeth is acid etched (30 seconds) with phosphoric acid gel. Preparing The Splinting Material  The etchant is removed with a 20 seconds water spray.  The labial enamel is dried with compressed air
  24. 24. Applying The Splinting Material Tow weeks after injury a radiograph is taken to evaluate periodontal and pulpal healing
  25. 25. Splint Removal The splint is removed using fissure burs, by reducing the splinting material interproximally and thereafter thinning the splint uniformly across its total span. Once, thinned out, the splint can be removed by using sharp explorer.
  26. 26. Favorable Outcome  Asymptomatic  Clinical and radiographic signs of normal or healed periodontium.  Positive response to pulp testing (false negative possible up to 3 months).  Marginal bone height corresponds to that seen radiographically after repositioning.  Continuing root development in immature teeth. Unfavorable Outcome  Symptoms and radiographic sign consistent with apical periodontitis.  Negative response to pulp testing (false negative possible up to 3 months).  If breakdown of marginal bone, splint for an additional 3-4 weeks.  External inflammatory root resorption.  Endodontic therapy appropriate for stage of root development is indicated.
  27. 27. • The Tooth Is Allowed To Reposition Spontaneously No Occlusal Interference • Slight Grinding Is Indicated Minor Occlusal Interference • The Tooth Can Be Gently Repositioned Severe Occlusal Interference • Extraction Severe Displacement Follow Up • 1 week C • 2 - 3 weeks C • 6 - 8 weeks C + R • 1 year C + R
  28. 28. Favorable Outcome  Asymptomatic  Clinical and radiographic signs of normal or healed periodontium.  Transient discoloration might occur UnFavorable Outcome  Symptoms and radiographic sign consistent with periodontitis.  Grey persistent discoloration
  29. 29. 2-year-, 7-month-old male • Mother stated, “ Child was running in home, fell and hit cement stairs three hours ago Chief Complaint and History of Present  Injury Soft tissue injuries: Bruising noted on lip No other significant findings Extra-oral Exam Maxillary left primary central incisor: Intruded to gingival margin Maxillary left primary lateral incisor: Slight mobility, brown discoloration noted middle third Intra-oral Exam
  30. 30. Radiographs not possible due to very poor patient cooperation Vitality tests deferred Diagnostic Tools Maxillary left primary central incisor: Intrusion Diagnosis
  31. 31. No treatment is indicated at this time Discharge instructions Watch for clinical signs such as presence of parulis or fstula Follow-up treatment Treatment The overall prognosis for this tooth is based on the observation that it did re-erupt. The four-month post- op radiograph demonstrated no periapical resorption or radiolucency. Prognosis and Discussion
  32. 32. 12-year-, 7-month-old male • Foster dad reports, “He fell while running and • pushed his tooth up” Chief Complaint and History of Present  Injury No other significant findings Extra-oral Exam Attached gingiva lacerated adjacent to intruded maxillary right permanent central incisor Intra-oral Exam
  33. 33. Intra-oral periapical radiographs of maxillary anterior area:  Demonstrate mature root formation of anterior teeth and closed apices  The maxillary right permanent central incisor is intruded approximately 10mm and labially luxated with concomitant fracture of alveolar plate  The periodontal ligament (PDL) space is obliterated on the occlusal radiographic image Percussion tests  Maxillary right permanent lateral incisor: Positive  Maxillary right permanent central incisor: Negative, high metallic sound Diagnostic Tools
  34. 34.  Maxillary right permanent central incisor: Surgically reposition as soon as possible and splint .  light orthodontic wire three to four weeks  Maxillary left permanent central incisor: Apply glass ionomer or composite resin temporary restoration on fracture to cover exposed dentin Follow-up Treatment  Maxillary right permanent central incisor: Complete pulpectomy within three weeks of injury. Fill canal with Ca(OH)2 for two to four weeks. Because this tooth is likely to ankylose and undergo replacement resorption, do not place Gutta Percha unless healing is indicated by presence of lamina dura and no signs of resorption. Remove splint after four weeks and complete final composite restoration  Maxillary left permanent central incisor: Complete final composite restoration after splint is removed Treatment

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