(1) occlusal relief;
(2) soft diet for 7 days;
(3) immobilization with a splint if teeth have fully formed apices or if t.t.p. is
significant;
(4) chlorhexidine 0.2% mouthwash, twice daily.
Figures for pulpal survival 5 years after injury (731HTable 12.2) show that there is minimal
risk of pulpal necrosis. In addition, in over 97% of cases there is no evidence of any
resorption.
Extrusive luxation
There is a rupture of p.l. and pulp.
Lateral luxation
There is a rupture of p.l, pulp, and the alveolar plate (732HFig. 12.36 (a)). The treatment
for both these injuries is:
(1) atraumatic repositioning with gentle but firm digital pressure (733HFig. 12.36 (b));
(2) local anaesthetic is required if there is an alveolar plate injury;
(3) non-rigid functional splint for 2-3 weeks (734HFig. 12.36 (c));
(4) antibiotics, for example, amoxycillin 250 mg three times daily (<10 years old 125
mg three times daily) for 5 days;
(5) chlorhexidine 0.2% mouthwash twice daily while splint is in position;
(6) soft diet 2-3 weeks.
Antibiotics may have a beneficial effect in promoting repair of the p.l. They do not
appear to affect pulpal prognosis.
After 2-3 weeks the teeth are radiographed. If there is no evidence of marginal
breakdown the splint can be removed. If marginal breakdown is present then it should
be retained for a further 2-3 weeks.
For both these injuries the decision whether to progress to endodontic treatment
depends on the combination of clinical and radiographic signs at regular review (735HFig.
12.7). Five-year pulpal survival figures (736HTable 12.2) show that prognosis is
significantly better for open apex teeth but nevertheless a proportion of mature closed
apex teeth will retain vitality. In addition, over 4% of mature teeth involved in
luxation injuries will exhibit on radiographs a natural healing phenomenon known as
'transient apical breakdown' (t.a.b.) which can mimic apical inflammation.
Ambivalent clinical and radiographic signs should be given the 'benefit of the doubt'
until the next review.
With more significant damage to the p.l. in both extrusive and lateral luxation injuries
there is an increased risk of root resorption. Thirty-five per cent of mature teeth that
have undergone lateral luxation show subsequent evidence of surface resorption.
In some cases of lateral luxation the displacement cannot be reduced with gentle