finger pressure. It is not advisable to use more force as this can further damage the
periodontal ligament. Orthodontic appliances, either a removable or a sectional fixed
appliance can be used to reduce the displacement over a period of a few weeks (737HFig.
12.37(a-c)).
Intrusive luxation
These injuries are the result of an axial, apical impact and there is extensive damage
to p.l, pulp, and alveolar plate(s).
Two distinct treatment categories exist: the open and closed apex. Both categories can
be discussed depending on whether the intrusive injury is: mild(<3 mm); moderate (3-
6 mm); or severe (>6 mm).
OPEN APEX
- Mild intrusion <3 mm. Excellent eruptive potential. Treat conservatively and
review. If no movement in 2-4 months move orthodontically. - Moderate Intrusion 3-6 mm. Disimpact (with forceps if necessary) and either allow
to erupt spontaneously for 2-4 months before extruding orthodontically or apply
orthodontic forces early. - Severe intrusion >6 mm. Orthodontic repositioning may be impossible and
disimpaction followed by surgical repositioning under either LA, LA/sedation, or GA
is appropriate. Functional splint for 2-3 weeks.
Monitor pulpal status clinically and radiographically at regular intervals during the
first 6 months after injury, and then 6 monthly, and start endodontics if necessary:
Non-setting calcium hydroxide in root canal does not preclude against orthodontic
movement. Once apexification has occurred and orthodontic movement has ceased
(738HFig. 12.38(a-c)) obturate canal with gutta percha.
CLOSED APEX
- Mild intrusion <3 mm. Orthodontic extrusion is probably indicated straight away
although some authors have advocated conservative treatment. The danger of a tooth
ankylosing in an intruded position should always be borne in mind and in this respect
active treatment is preferable to a conservative approach. - Moderate intrusion 3-6 mm. Orthodontic extrusion is indicated straight away.
- Severe intrusion >6 mm. Surgical repositioning. Functional splint for 2-3 weeks.
Elective pulp extirpation will be necessary for all significant intrusive luxation
injuries in closed apex teeth (739HTable 12.3) at about10 days.
Maintain non-setting calcium hydroxide in root canal during orthodontic movement
before obturation with gutta percha (740HFig. 12.39 (a-d)).
If endodontic treatment is commenced within 2 weeks after any injury to the p.l. then
the initial intracanal dressing should be with an antibiotic/steroid (Ledermix, Lederle)
paste. This may help to reduce the incidence of inflammatory resorption.
At the initial examination both open and closed apex teeth should receive antibiotics,
chlorhexidine mouthwash, and a soft diet.