Intrusion
Intrusion is caused by an axial, apical impact and results in extensive damage to pulp and periodontal ligament
Immature root formation:
- Mild intrusion (less than 3mm), leave to re-erupt and review
- Moderate intrusion ( 3mm to 6mm) may re-erupt or require orthodontic repositioning
- Severe intrusion (6mm+) consider surgical repositioning under LA. Bony impactions may require release of impediment prior to repositioning the labial plate and soft tissue closure and suturing.
- Monitor radiographically at 3, 4 and 6 weeks.
Mature root formation:
- Mild intrusion (<3mm) may be orthodontically repositioned over a period of about 2 weeks
- Moderate intrusion (3—6mm) reposition orthodontically
- Severe intrusion (6mm+) surgical repositioning and appropriate tissue repair carried out at a specialist centre.
- Extirpate the pulp 2 weeks after injury, using calcium hydroxide as an interim dressing to inhibit root resorption
- RCT once periodontal healing established. The optimum time for this is 2 weeks after injury.
Prognosis:
- The nature of the crush injury to the periodontal membrane and root surface is quite severe and progressive root resorption is commonly seen. Figures vary from 38% to 52%.
- It is important that the tooth should be sufficiently repositioned within 3 weeks to allow treatment of necrotic pulps and thus minimise the risk of inflammatory root resorption.