Orthodontic repositioning of traumatically intruded permanent incisors - A report of three cases

Harpreet Singh,Ashok Kumar,Meenu Mittal,Poonam Sharma,Pranav Kapoor

doi:10.17159/2519-0105/2021/v76no1a2

Abstract

Intrusive luxation of permanent teeth is one of the most serious traumatic dental injuries involving damage to the gingival tissue, periodontal ligament, cementum, bone and to the neurovascular supply of the pulp. In addition to disruption of normal tooth development and eruption, it can also lead to pulpal necrosis, root resorption and marginal bone loss. Based on the extent/severity, intrusion maybe classified into mild (<3 mm), moderate (3-6mm) and severe (>6mm). Available techniques for managing intrusive luxation include a wait-and-watch approach to allow for spontaneous re-eruption, orthodontic traction and surgical repositioning. The type of treatment approach employed depends upon the stage of root development, severity of intrusive luxation and the presence or absence of alveolar fractures. It is difficult to predict reliable outcomes with these approaches, since the presence of variables such as the severity of intrusion, associated crown/root fracture, stage of root development and presence of alveolar fractures may alter the prognosis. The present article presents a series of three cases with intrusive luxation of permanent incisors successfully treated using an interdisciplinary approach involving orthodontic traction along with endodontic rehabilitation.

Highlights

Intrusive luxation of permanent teeth, comprising 0.3 to 2.0% of traumatic dental injuries in permanent dentition,[1] is a severe dental injury that may cause extensive damage to the tooth and periodontium leading to the disruption of pulpal blood supply, crushing of periodontal ligament (PDL) with stripping away of cementum & PDL, and trauma to the surrounding alveolar bone
Intrusion may result in a disruption in the normal tooth development and eruption, root resorption and marginal bone loss.[2,3,4,5]
The present article presents a series of three cases with intrusive luxation of permanent incisors successfully treated using an interdisciplinary approach involving orthodontic traction along with endodontic rehabilitation

Summary

INTRODUCTION

Intrusive luxation of permanent teeth, comprising 0.3 to 2.0% of traumatic dental injuries in permanent dentition,[1] is a severe dental injury that may cause extensive damage to the tooth and periodontium leading to the disruption of pulpal blood supply, crushing of periodontal ligament (PDL) with stripping away of cementum & PDL, and trauma to the surrounding alveolar bone. Spontaneous re-eruption following injury is unpredictable and relying on it can be over optimistic.[7] In case of severe intrusion, delayed repositioning leaves the root in close contact with the alveolar bone which facilitates replacement root resorption and ankylosis.[10,11,12] associated complications such as external root resorption and loss of marginal bone support may further complicate the treatment progress. A 9 year old female reported to the Department of Paediatric Dentistry, ESIC Dental College, Delhi with the chief complaint of pain in her upper front teeth (Fig. 10). Once the labial surface of the intruded incisors was sufficiently visible, MBT brackets were bonded on 11 & 21 and an improved superelastic 0.014-inch NiTi arch wire was ligated (Fig. 13B). Four years follow-up shows no further root resorption along with good occlusion & aesthetics (Fig. 22)

Findings

DISCUSSION

CONCLUSION