Intrusive luxation of permanent incisors in Norwegians aged 6–17 years: a retrospective study of treatment and outcome

Abstract – Background/Aim: External replacement resorption (ankylosis‐related) is a severe complication leading eventually to tooth loss. Little information exists regarding the influence of variables such as degree of intrusion or treatment method on the development of replacement resolution in intruded permanent incisors. The aim of this study was to report the most frequently involved age group, the preferred type of treatment, and the type and frequency of healing complications. Special attention was paid to the effect of treatment on the occurrence of replacement resorption. Material and Methods: Fifty‐one intruded permanent incisors were studied in 20 boys and 19 girls aged 6 to 17 years. Only three patients were over 12 years of age. Complete intrusion had occurred in 21 teeth, and 31 teeth were classified as immature. Re‐eruption was awaited for 37 teeth. The remaining teeth were repositioned orthodontically (7 teeth) or surgically (7 teeth). Results: Re‐eruption occurred in 35 out of 37 teeth over a period of 3–12 months. After a mean observation period of 4 years ranging from 1–12 years, retained pulp vitality was recorded in 22 teeth (43%). Pulp necrosis had developed in 57%, inflammatory resorption in 26% and replacement resorption in 12%. Whereas all inflammatory resorptions were arrested after long‐term calcium hydroxide treatment, replacement resorption always led to complete root resorption. In the analysis all orthodontic and surgical repositioned teeth were combined into an active treatment group. The non‐active treatment group consisted of teeth allowed to re‐erupt. The distribution of replacement resorption was significantly lower in teeth allowed to re‐erupt than in teeth repositioned actively. Conclusions: The best treatment of intruded incisors in 6–12 year‐old children is to await re‐eruption. Should endodontic treatment be required before re‐eruption has occurred, a gingivectomy can be performed to gain access to the root canal.     

Traumatically intruded permanent incisors: a study of treatment and outcome

Twenty-nine traumatically intruded permanent maxillary incisors from 20 patients were examined, treated and monitored for 2 years. There was a higher proportion of males than females. The teeth intruded furthest were more frequently extracted. Those which were surgically repositioned were more frequently retained and were associated with marginal bone loss significantly less frequently than those which were passively observed, while external root resorption occurred in similar proportions in both groups. A significantly higher proportion of those teeth that were delayed in presentation were subsequently extracted, and a similar trend was found for those with immature roots at the time of the initial examination.     

Outcomes for root-fractured permanent incisors: a retrospective study

PURPOSE: The objective of this study was to assess the outcomes for treated root-fractured permanent incisors with respect to pulp vitality, root tissue union, and tooth survival and to examine the effects of clinical and radiographic parameters and rigid splinting on the outcome. METHODS: Eighty-four teeth were identified and data extracted from case notes prior to transfer to an SPSS data base for analysis. The odds ratios for each factor were calculated and the significance of differences was determined. Tooth loss and relevant risk variables were examined using Cox's regression model and Kaplan-Meyer survival curves. RESULTS: Fourteen (17%) had fractures in the apical third, 47 (56%) in the middle third, and 23 (27%) in the coronal (gingival) third. Twenty-four (29%) also had crown fractures involving enamel and dentine. Crown fractures were identified as significant risk factors for pulp vitality. Loss of pulp vitality, horizontal displacement, and extrusive displacement of the coronal fragment were significant risk factors for hard root tissue union. Survival was poorest with gingival third fractures with 14 (61%) of these teeth being lost. Splinting rigidly had no significant effect on pulp vitality and type of root tissue healing. CONCLUSIONS: Loss of pulp vitality was significantly associated with enamel-dentine crown fracture. Hard root tissue union was significantly affected by pulp necrosis and luxation of the coronal fragment. Survival was poorest for root fractures within the gingival third of the root. Splinting with rigid fixation had no significant effect on pulp vitality and type of root tissue union.     

Intrusive luxation: a case report

Abstract –  Intrusive luxation is one of the most severe types of dental trauma. The occurrence of pulp necrosis in intruded teeth with open apices is 100%. The risk of development of inflammatory or replacement root resorptions is high. Thus, endodontic intervention is required soon after the occurrence of trauma, in an attempt to prevent or delay the appearance of such lesions. On the other hand, the access to the root canal is difficult, as the crown is intruded. A multidisciplinary approach comprising Surgery, Orthodontics and Endodontics is required to allow exposure of the crown, orthodontic extrusion and onset of endodontic therapy. The patient GCSA, aged 15 years, attended the community project 'Lugar de dente é na boca' ('teeth should be in the mouth') of the Federal University of Goiás, Brazil, 1 week after complete intrusion of the right maxillary central incisor. Radiographic examination revealed that the incisal edge of this tooth was at the level of the crown-root interface of the adjacent teeth. After surgical exposure of the crown, pulp sensitivity was evaluated and was found to be negative. After onset of endodontic therapy, the patient was referred for orthodontic extrusion of the intruded tooth. Successive changes of root canal dressing were performed and the root canal was definitely obturated at 3 years and 6 months after onset of treatment. The present paper reports on a case of severe intrusive luxation, discusses the different treatments recommended for repositioning of traumatically intruded teeth, and questions the ideal period of maintenance of calcium hydroxide dressing in the root canal, in an attempt to prevent the occurrence of root resorption and repair any existing resorption.     

Non-vital immature permanent incisors: factors that may infIuence treatment outcome

Finucane D, Kinirons MJ. Non-vital immature permanent incisors: factors that may influence treatment outcome. Endod Dent Traumatol 1999; 15: 273–277. © Munksgaard, 1999.
Abstract — This study examines the treatment of non-vital immature permanent incisors using the calcium hydroxide apexification tecnique. The objectives of the present study were to determine the speed and location of bamer formation and those factors discernible at presentation and during treatment which may be related to it. Forty-four non-vital immature incisors undergoing calcium hydroxide apexification were reviewed in detail. All cases were reviewed every 8–12 weeks for up to 18 months, or until apexification occurred. Details of the time and nature of the injuries and treatment were recorded. The degree of apical development prior to treatment was assessed, and barrier formation, location and time were noted. Mean time to barrier formation was 34.2 weeks (range 13–67 weeks). The strongest predictor of rapid barrier formation was the rate of change of calcium hydroxide and a barrier also formed more rapidly in cases with narrower initial apical width. There was evidence of displacement and a higher mean time for barrier formation in half of the cases. The presence of an abscess was the weakest predictor of rapid barrier formation and the effect was not significant (P=0.280). The barrier was located at the apex in 28 cases (63.6%) and the distance from the barrier to the apex for the remaining 16 (36.4%) varied from 1 mm to 5 mm. The number of placements of calcium hydroxide varied from 1 to 4 with a mean of 1.9, and there was a higher mean number of calcium hydroxide placements in the cases where the barrier was located at the apex.     

Non-vital immature permanent incisors: factors that may influence treatment outcome

This study examines the treatment of non-vital immature permanent incisors using the calcium hydroxide apexification technique. The objectives of the present study were to determine the speed and location of barrier formation and those factors discernible at presentation and during treatment which may be related to it. Forty-four non-vital immature incisors undergoing calcium hydroxide apexification were reviewed in detail. All cases were reviewed every 8-12 weeks for up to 18 months, or until apexification occurred. Details of the time and nature of the injuries and treatment were recorded. The degree of apical development prior to treatment was assessed, and barrier formation, location and time were noted. Mean time to barrier formation was 34.2 weeks (range 13-67 weeks). The strongest predictor of rapid barrier formation was the rate of change of calcium hydroxide and a barrier also formed more rapidly in cases with narrower initial apical width. There was evidence of displacement and a higher mean time for barrier formation in half of the cases. The presence of an abscess was the weakest predictor of rapid barrier formation and the effect was not significant (P = 0.280). The barrier was located at the apex in 28 cases (63.6%) and the distance from the barrier to the apex for the remaining 16 (36.4%) varied from 1 mm to 5 mm. The number of placements of calcium hydroxide varied from 1 to 4 with a mean of 1.9, and there was a higher mean number of calcium hydroxide placements in the cases where the barrier was located at the apex.     

Revascularization of immature permanent incisors after severe extrusive luxation injury

Pulp necrosis is an uncommon sequel to extrusive luxation in immature teeth with incomplete apical closure. In this report, we describe the management of severely extruded immature maxillary incisors and the outcome of revascularization to treat subsequent pulp necrosis. An 8.5-year-old boy with severe dentoalveolar trauma to the anterior maxillary region as a result of a fall was provided emergency treatment consisting of reduction of the dislodged labial cortical bone and repositioning of the central incisors, which had suffered extrusive luxation. When he presented with spontaneous pain involving the traumatized incisors a week later, the teeth were treated via a revascularization protocol using sodium hypochlorite irrigation followed by 3 weeks of intracanal calcium hydroxide, then a coronal seal of mineral trioxide aggregate and resin composite. Complete periradicular healing was observed after 3 months, followed by progressive thickening of the root walls and apical closure. Follow-up observations confirmed the efficacy of the regenerative treatment as a viable alternative to conventional apexification in endodontically involved, traumatized immature teeth.     

Incisal overjet and traumatic injuries to upper permanent incisors: A retrospective study

Järvinen, S. Incisal ovejet and traumatic injuries to upper permanent incisors. A retrospective study.

The relationships between traumatic injuries to upper incisors and incisal overjet were studied in a sample of 1445 orthodontically untreated children aged 7 to 16 years. Traumatic injuries of the hard dental tissues and exarticulations of teeth were recorded. The frequency of injuries was 14.2 7% in children with normal ovejet (0–3 mm), 28.4 % in children with increased ovejet (3.1–6 mm), and 38.6% in children with extreme ovejet (>6 mm). The severity of injuries was also greater in children with extreme ovejet than in children with overjet ranging from 0 to 6 mm. Furthermore, the range of injuries increased in relation to the overjet. Two or more injured incisors were found in 19.2% of the children with normal overjet, in 22.2% of the children with increased overjet, and in 46.7 % of those with extreme ovejet.

Partly published in Finnish in Proc. Finn. dent. SOC. 73:Suppl. V, 1977.     

Traumatic injuries of the permanent incisors in children in southern Turkey: a retrospective study

Abstract –  The aim of this study is to investigate the incidence, etiologic factors and results of dental trauma and the effects of age and gender on the trauma in permanent incisors. Over a 3-year period, 514 permanent incisor teeth in 317 patients with trauma history, who applied to Süleyman Demirel University School of Dentistry, Department of Pedodontics from the southern cities of Turkey, were evaluated. Standardized trauma forms were filled for each patient. In all age groups, the most frequent cause of trauma was found to be unspecified falls (47.6%). Maxillary teeth (88.5%) and central incisors (87.5%) were the most affected teeth from dental trauma. Ellis class II crown fracture was the most frequently seen type of injury (43.8%). The percent of the patients who applied to a dental clinic in the first 3 days after the trauma occurred (22.8%) was less than the percent of the patients who applied after 3 months and more time period (45.1%). It reveals that it is important to inform the public about dental trauma and the importance of time in these cases.     

Eruption delay and sequelae in permanent incisors following intrusive luxation in primary dentition: a case report

Abstract – With respect to its consequences, intrusive luxation is one of the most severe form of dental traumatic injuries in primary dentition. This case report presents crown and root deformation of a permanent incisor together with its delayed eruption which have resulted from a traumatic injury to its predecessor.     

Fractured and avulsed permanent incisors in Finnish children. A retrospective study.

The frequency of traumatic injuries to permanent incisors was studied in a sample of 1614 children from the city of Lahti in Southern Finland. The children, 801 girls and 813 boys, ranged in age from 6 to 16 years. Injuries to hard dental tissues and exarticulations of teeth were recorded. The prevalence of injuries was 19.8%--14.6% in girls and 25.0% in boys. A rapid growth in the prevalence rates was found at the ages of 9--11 years, at which the estimated mean annual incidence was about 5% in girls and 7% in boys. In 78.4% of the children with injured incisors, one tooth only was injured. The teeth most commonly injured were the upper central incisors, 81.7%; and the most frequent type of injury was an uncomplicated crown fracture, 90.5%.     

Effect of luxation type on pulpal blood flow measurements: a long-term follow-up of luxated permanent maxillary incisors

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood-flow (PBF). Dental injury has been associated with significant PBF reduction. The purpose of this study was to assess whether (i) the type of luxation trauma may affect PBF measurements and (ii) whether luxation type-related measurements may show short- and long-term changes of PBF values. In 41 trauma patients, 69 maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous tooth were investigated by LDF to assess local PBF values. Perfusion units were recorded in four sessions, on the day of splint removal, and 12, 24 and 36 weeks after splint removal. Statistical analysis consisted of univariate analysis of variance for repeated measurements. For the LDF measurements, the main effect of the variable 'session' was not significant (P = 0.119). However, there was a significant 'session'/'luxation type' interaction (P = 0.000). Analysis of simple session-within-luxation type effects revealed intrusive luxations to be associated with a significant decrease in PBF values (P = 0.000), while subluxations (P = 0.568), lateral luxations (P = 0.980), extrusive luxations (P = 0.910), and avulsions (P = 0.996) showed no significant difference between session-related values. The PBF measurements did not change over time for the contralateral incisors (P = 0.996). The LDF may become useful in the detection of pulpal ischaemic episodes in luxated maxillary incisors after repositioning and splinting. Further studies are warranted to assess the validity of the diagnosis of post-traumatic 'ischaemic episodes' by comparing it with histological tooth pulp changes, and by determining how well it may predict course and response to treatments in clinical trials.     

Incisal overjet and traumatic injuries to upper permanent incisors. A retrospective study.

The relationships between traumatic injuries to upper incisors and incisal overjet were studied in a sample of 1445 orthodontically untreated children aged 7 to 16 years. Traumatic injuries of the hard dental tissues and exarticulations of teeth were recorded. The frequently of injuries was 14.2% in children with normal overjet (0--3 mm), 28.4% in children with increased overjet (3.1-6mm), and 38.6% in children with extreme overjet (greater than 6 mm). The severity of injuries was also greater in children with extreme overjet than in children with overjet ranging from 0 to 6 mm. Furthermore, the range of injuries increased in relation to the overjet. Two or more injured incisors were found in 19.2% of the children with normal overjet, in 22.2% of the children with increased overjet, and in 46.7% of those with extreme overjet.     

Intrusive luxation of primary teeth.

Traumatic injuries caused by intrusion account for 4-22% of the damage in anterior primary teeth and are generally related to axial impact. They are more frequent in children aged 1-3 years because of the additional high resilience and flexibility of the primary teeth supporting structures. The treatment decision will depend on the magnitude of the trauma and on the displacement position. In most cases, radicular displacement occurs towards the labial bone plate. The clinical decision of spontaneous re-eruption and observation were adopted. This study aims at presenting a literature review illustrated with two case reports of patients having intrusive luxation injuries of the primary incisors.     

Sequelae and prognosis of intruded primary incisors: a retrospective study.

PURPOSE: This study was designed to assess the sequelae and prognosis of intruded primary incisors. METHODS: Of 196 children who visited the emergency clinic due to intrusion of 310 maxillary primary incisors, 110 children (172 teeth) were available for follow-up examination (study group). Eighty-six children (138 teeth) did not show for the follow-up examination (non-respondents group). Male/female ratio was 1.7:1. Age range of children at time of injury was 12-72 months (mean 28). Follow-up time ranged between 0 and 59 months (mean 27). RESULTS: Fifty-seven percent of all teeth were completely intruded. In 80%, the root was pushed labially. All but two ankylosed teeth re-erupted, and 37% of these re-erupted into an ectopic position. Completely intruded incisors re-erupted into an ectopic position in a higher percentage (45%) than partially intruded teeth (30%). Fifty-two percent of the teeth presented pulp canal obliteration (PCO). Sixty-four percent of the completely intruded incisors presented PCO compared to 40% of partially intruded teeth. Arrest of dentin apposition was found in 15% of the teeth, and was not affected by the degree of intrusion. Twenty-three teeth were extracted shortly after the injury due to suspect of contact with the developing permanent successor (19 teeth) and severe caries (4 teeth). Sixty-eight percent of the intruded teeth survived more than 36 months after the injury. Twenty-three percent were extracted due to periodontal breakdown and 5% due to repeated trauma. Antibiotic therapy did not have any effect on the survival rate. CONCLUSION: The majority of intruded primary incisors may re-erupt and survive with no complications after more than 36 months post trauma even in cases of complete intrusion and fracture of the labial bone plate.