Dental intrusion

Dental intrusion is an apical displacement of the tooth into the alveolar bone. This injury is accompanied by extensive damage to periodontal ligament, cementum, disruption of the neurovascular supply to the pulp, and communication or fracture of the alveolar socket.[1]

Intrusive traumas have been found to comprise 0.3-1.9% of the traumas affecting permanent dentition.

Diagnosis

In most cases of intrusion with fully erupted permanent dentition, diagnosis can be made by comparing incisal height of teeth next to the injured one.  In cases with mixed dentition, a percussion test must be performed as an intruded tooth can mimic an erupting tooth.

Clinical and radiographical presentation

Clinical findings show shortened crown length to various degree and up to no visible crown in severe cases. Tooth is immobile, and percussion gives high, metallic sound. Bleeding around crown margins can be observed.[2]

Radiographical findings shows dislocation of root in an apical direction, and periodontal ligament space is not continuous or can disappear completely.[2]

Management

Management of intrusion depends on several factors such as whether the tooth has a closed or open apex, type of teeth (primary or permanent dentition) and how much the tooth is intruded in mm. This type of dental trauma is complex and is commonly associated with pulpal necrosis and inflammatory ankylosis. Management is focused on reducing this effect and is commonly achieved by root canal treatment.

Primary teeth[3]
Primary teeth presentation on examination Treatment options
Tooth displaced labially Leave for spontaneous reposition
Tooth intruded horizontally with apex displaced into developing tooth germ Extract

Permanent teeth[4]
Teeth with incomplete root formation Treatment options
Intrusion of up to 7mm Allow eruption without intervention. If no movement is seen within few weeks, must be repositioned orthodontically
Intrusion more than 7mm Must be repositioned using surgical or orthodontic approach.
Teeth with complete root formation Treatment options
Intrusion less than 3mm Allow time for spontaneous eruption
  • If no movement within 2–4 weeks, surgical or orthodontic reposition required to avoid ankylosis
Intrusion between 3-7mm Surgical or orthodontic reposition required
Intrusion more than 7mm Surgical reposition required

Intruded teeth with closed apex will likely become necrotic. Recommended root canal therapy within 2–3 weeks after repositioning. Where surgical or orthodontic reposition required, after repositioning tooth must be stabilize with a flexible splint for 4 weeks.

Follow-up

Frequent follow up appointments are required to monitor healing process clinically and radiographically:

  • 2 weeks → 4 weeks→ 6–8 weeks→ 6 months→ 1 year → Yearly for 5 years

See also

Dental trauma

References
  1. O., Andreasen, J. (2000). Essentials of traumatic injuries to the teeth : a step-by-step treatment guide. Andreasen, F. M. (Frances M.), Wiley InterScience (Online service) (2nd ed.). Copenhagen: Munksgaard. ISBN 9780470698822. OCLC 232612072.
  2. Traumatic dental injuries : a manual. Andreasen, J. O. (3rd ed.). Chichester, West Sussex, U.K.: Wiley-Blackwell. 2011. ISBN 9781118713211. OCLC 842929965.CS1 maint: others (link)
  3. Flores, Marie Therese; Malmgren, Barbro; Andersson, Lars; Andreasen, Jens Ove; Bakland, Leif K.; Barnett, Frederick; Bourguignon, Cecilia; DiAngelis, Anthony; Hicks, Lamar (August 2007). "Guidelines for the management of traumatic dental injuries. III. Primary teeth". Dental Traumatology. 23 (4): 196–202. doi:10.1111/j.1600-9657.2007.00627.x. ISSN 1600-4469. PMID 17635351.
  4. Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander; Ahrensburg, Søren Steno (2012-01-25). "Dental Trauma Guide: A source of evidence-based treatment guidelines for dental trauma". Dental Traumatology. 28 (2): 142–147. doi:10.1111/j.1600-9657.2011.01059.x. ISSN 1600-4469. PMID 22272918.


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