An analysis of 58 traumatically intruded and surgically extruded permanent teeth

Department of Pediatric Dentistry

Lutheran Medical Center

Resident’s Name: Kris Hendricks Date: September 4, 2009

Article title: An analysis of 58 traumatically intruded and surgically extruded permanent teeth

Author(s): K Ebeleseder, G Santler, K Glockner, H Hulla, C Perti, F Quehenberger

Journal: Endodontica and Dental Traumatology

Volume (number): 16: 34-39

Month, Year: 2000

Major topic: Trauma

Minor topic(s): Traumatically intruded teeth

Type of Article: Follow-up of traumatically intruded teeth

Main Purpose Analyze prognosis and sequelae of traumatically intruded teeth, some of which were surgically extruded

Overview of method of research: Traumatized teeth were treated and data was collected upon treatment, and at subsequent follow-up appointments. 29 teeth were followed for 9 months (short-term group), and 29 teeth were followed for 3 years 4 months.

Findings: Teeth in this study had varying degrees of trauma. Some were merely displaced, and others had crown fractures, alveolar bone fractures and gingival lacerations. Interestingly, the primary cause of intrusion luxated teeth in this study is the use of waterslides (cause #2 was cycling). Average age of patients was 11, and more males than females had injuries that met the criteria of the study. 48 of the 58 teeth were surgically repositioned (9 were inadvertently completely exarticulated), and 9 teeth with shallow intrusion depth and immature apices were left to spontaneously re-erupt. Orthodontic extrusion was done in one case. Of note, 54% of the teeth in the mid-term group showed discoloration and 9% of the short-term group, showing that discoloration increases with time lapsed since the injury. Teeth deeply intruded have poorer prognosis than those only slightly intruded. This study shows that immaturity of the root (e.g. open apex) had a positive influence on pulpal healing. Also, increasing surgical manipulation leads to increased incidence of ankylosis, but had no influence on pulpal healing or initial alveolar bone loss. The end of this study is a discussion on recommendations on treatment of intruded teeth. From other studies, Jacobsen recommends spontaneous re-eruption, Andreasen & Vestergaard-Pedersen recommend orthodontic repositioning, and Kinirons & Sutcliffe suggesst careful surgical repositioning.

Key points/Summary : In traumatically intruded teeth, talk to parents about discoloration, as it is common. Also, especially if deeply intruded, pulpal necrosis requiring endodontic treatment, and the possibility of ankylosis and marginal bone loss should be discussed. Possible need for future extraction should be mentioned as well.

Assessment of article: Good food for thought. Interestingly, this article cites its rationale for surgical reposition as “practical reasons.” Although in many cases it may be practical to surgically reposition teeth, the expectations of a good prognosis in dental traumatology are ever changing, and as ankylosis was the goal in years past, a healthy PDL and lack of ankylosis is the goal today. With that in mind, we should definitely consider other treatment options including spontaneous re-eruption, and orthodontic extrusion.