Intrusion injuries of primary incisors. Part I: Review and management

Department of Pediatric Dentistry

Resident’s Name: Jessica Wilson

Program: Lutheran Medical Center - Providence

Article title: Intrusion injuries of primary incisors. Part I: Review and management

Author(s): Diab, M et al.

Journal: Quintessence Intl

Year. Volume (number). Page #’s: 2000. 31(5). 327-334.

Major topic: Intrusion Injuries

Overview of method of research: Literature review

Findings:
Males have significantly higher incidence of primary tooth injuries after the first year.
Peak incidence of intrusion injuries between 1 and 3 years of age (root tips are fully formed) and rarely occurs after the age of 4 (root tips begin to resorb).
Primary incisors are highly susceptible as the alveolar bone contains large marrow spaces and high crown to root ratio.
Grade I (mild) intrusions: more than 50% of the crown is visible
Grade II (moderate) intrusions: less than 50% of the crown in visible
Grade III (severe) intrusions: complete intrusion of the crown
Although gingival bleeding and edema may be present, palpation and percussion sensitivity are rare.
Although one study on monkeys demonstrated there was less damage to permanent teeth if the intruded incisor is removed, other studies show there is no significant difference in frequency or
degree of damage to the permanent tooth.

Key points/Summary:
History of the accident as well as medical history is very important (antibiotics for endocarditis/tetanus immunization).
Diphtheria, pertussis, tetanus (DPT) vaccine given before 18 mo, then boosters given at 6 and every 10 years after. If child‘s injury has been exposed to soil and the child has not received vaccine in last 5 years, a booster is recommended.
It is not advised to separate young children from their parents at this time. Knee to knee and tell show do techniques may be indicated.
Neurological assessment is essential and if positive signs appear, hospitalization a must.
Extraoral and intraoral exams are to be performed. Although both upper and lower lip injuries are often present, contusions of the chin and lower lip are more prevalent.
Must take radiograph (PA & occlusal) to determine position orientation and integrity of intruded tooth as well as the alveolar bone surrounding it. The PDL is absent in the case of intrusion.
Labial crown inclination indicated palatal intrusion toward the unerupted permanent tooth. This appears elongated in the occlusal radiograph.
Less commonly seen, palatal crown inclination is indicative of labial intrusion away from the developing permanent tooth. This appears as a foreshortened root.
An anterolateral exposure may be indicated to determine the exact position of the intruded primary tooth. An occlusal film is taped to the child’s cheek, the x-ray beam is oriented from the opposite side and the exposure time is doubled.
Spontaneous re-eruption may occur within 1-6 months IF primary tooth is labially intruded or it is a class I intrusion. However, pulpal necrosis and pathologic root resorption may occur at a later time. Some authors recommend a 1 week dose of antibiotics to help prevent complications. If signs of re-eruption are not evident in 4-8 weeks, this may be indicative of ankylosis and extraction should be considered. Digit sucking may also be grounds for failure to re-erupt.
If signs or symptoms of infection at the site of trauma or pulpal infection/necrosis
All other circumstances such as a palatally intruded tooth, grade II or III intrusions, perforations of the buccal plate and alveolar bone fractures, extraction is indicated.
Whether or not to splint primary teeth is still controversial.
It is important to note that despite our best efforts to protect the developing permanent dentition, damage may still have occurred at the time of injury.
Recommendations to parents should include a soft diet, cleaning teeth with moist swab in alcohol-free mouthwash, and anticipating and signs or symptoms of infection in addition to follow up exams
Follow up appointments are indicated at 1 week post trauma, every 2 weeks for a month, then every 1 month for the next three months and finally every 6 months. A follow-up radiograph should be taken 1-2 months post trauma to verify proper healing.

Assessment of Article: Great summary of recommendations and the research backing them.