What is an extrusion and how is it treated?
Partial displacement of the tooth out of its socket
An injury to the tooth characterized by partial or total separation of the periodontal ligament resulting in loosening and displacement of the tooth. The alveolar socket bone is intact in an extrusion injury as opposed to a lateral luxation injury. In addition to axial displacement, the tooth will usually have an element of protrusion or retrusion. In severe extrusion injuries the retrusion/protrusion element can be very pronounced. In some cases it can be more pronounced than the extrusive element.
- Visual signs: Appears elongated
- Percussion test: Tender
- Mobility test: Excessively mobile.
- Sensibility test: Usually lack of response except for teeth with minor displacements. The test is important in assessing risk of healing complications. A positive result to the initial test indicates a reduced risk of later pulp necrosis. In immature, not fully developed teeth, pulpal revascularization usually occurs. In mature teeth pulp revascularization sometimes occurs.
- Radiographic findings: Increased periapical ligament space.
- Radiographs recommended: As a routine: Occlusal, periapical exposure and view from the mesial or distal aspect of the tooth.
- The exposed root surface of the displaced tooth is cleansed with saline before repositioning.
- Reposition the tooth by gently re-inserting it into the tooth socket with axial digital pressure (local anesthesia is usually not necessary).
- Stabilize the tooth for 2 weeks using a flexible splint.
- Monitoring the pulpal condition is essential to diagnose associated root resorption.
Open apex: Revascularization can be confirmed radiographically by evidence of continued root formation and pulp canal obliteration and usually a return to a positive pulp response to sensibility testing.
Closed apex: A continued lack of pulp response to sensibility testing should be taken as evidence of pulp necrosis together with periapical rarefaction and sometimes crown discoloration.
- Soft food for 1 week.
- Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene. Brushing with a soft brush and rinsing with chlorhexidine 0.1 % is beneficial to prevent accumulation of plaque and debris.
- Clinical and radiographic control and splint removal after 2 weeks. Clinical and radiographic control at 4 weeks, 6-8 weeks, 6 months, and 1 year.
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