Extrusion and lateral luxation

 

  • Extrusive luxation = movement of the tooth in a coronal direction. This causes rupture of the periodontal ligament and severing of the pulp from the blood supply
  • Lateral luxation = movement of the tooth in a lateral direction (usually labial/palatal). Thus causes rupture of the periodontal ligament, severing of the pulp from the blood supply as well as an injury to the labial and/or palatal alveolar bone plates

Treatment:

Extrusive and lateral luxations require repositioning of the teeth by digital (finger) pressure and splinting

  1. Local anaesthesia is normally required, especially if there is an alveolar plate injury
  2. Hold the tooth between thumb and forefinger and apply firm, controlled pressure to ensure the tooth is moved back to its original position - confirm with the patient/family members that the appearance of tooth is the same as pre-injury
  3. Get the patient to bite on rolled up gauze to keep the tooth in the reduced position
  4. Non–rigid functional splint for 2—3 weeks, preferably with composite and wire
  5. Antibiotics may be required e.g. amoxicillin 250mg TDS 5/7
  6. Chlorhexidine 0.2% mouthwash twice daily while the splint is in position
  7. Soft diet 2 –3 weeks
  8. Radiographic examination after 2 –3 weeks prior to splint removal
  9. At no sign of marginal breakdown the splint can be removed

 

Prognosis:

  • Considerable risk of pulp necrosis, especially in teeth with mature root formation. 95% of extruded teeth lose vitality.


Intrusion