Intrusive luxation of permanent teeth: what are the important factors for treatment decision-making? A systematic review

This summary is based on the article published in Dental Traumatology: Intrusive luxation of permanent teeth: a systematic review of factors important for treatment decision‐making (June 2014)

Jasem Dawood AlKhalifa, Abdulaziz A. AlAzemi

Context

Intrusive luxation (intrusion) is the displacement of the tooth into the alveolar bone along the axis of the tooth and is accompanied by comminution or fracture of the alveolar socket (1). Intrusion of permanent teeth is one of the most severe dental injuries and usually occurs in
children aged 6–12 years (2).

Traumatic intrusion often affects a single tooth, especially the central or lateral incisor, and is usually caused by falls where the tooth is hit and displaced into the bone (2). The pulp immediately loses its vascular supply, and the periodontal ligament is severely injured. The prognosis of this injury is poor, and severe complications predominate in the long term (1). However, there are reports that intruded teeth can heal and function normally, without leading to eventual tooth loss.

Treatment for this type of trauma can be performed either actively, by repositioning (surgical or orthodontic extrusion), or passively, by spontaneous re-eruption. However, the choice of treatment is controversial in the literature, and recommendations are often contradictory
or unclear.

Purpose of the Review

1. To conduct a literature review of the topic ‘intrusive luxation of permanent teeth’ and assess the current strength and level of evidence of the available studies;
2. To investigate the risks of complications of different treatment methods; and
3. To assess other important factors taken into consideration for the choice of treatment.

Key Findings

1. Currently, all studies for the treatment of traumatically intruded permanent teeth have limitations. Guidelines for treatment are currently not based on strong evidence.
2. The three most important factors affecting the prognosis of intrusive luxation were root development, degree of intrusion, and age (3). Deeper
3. degrees of intrusion significantly increased the risk of root resorption (RRR, IRR, and surface root resorption) (3) and RRR (4).
4. Root development was strongly correlated with pulp survival (5, 4, 3); chances of revascularization increased in roots with open apices. Age was also correlated with pulp survival; however, this may be  confounded by the fact that, by definition, young people have immature roots (6).
5. Age was more strongly related to marginal bone loss than to root development, with more bone loss identified in older people, perhaps because their bone is more dense and they have fewer healing capabilities compared with young individuals (3).
6. Given that infection can be controlled by endodontic therapy, it seems that spontaneous eruption results in the fewest complications in immature teeth, regardless of the degree of intrusion.
7. There is no sufficient evidence for the superiority of either surgical or orthodontic repositioning in terms of the fewest complications.

References

1. Andreasen JO, Andreasen FM. Intrusive luxation. In: Andreasen JO, Andreasen FM, Andersson L, editors. Textbook and color atlas of traumatic injuries to the teeth, 4th edn. Oxford, UK: Wiley-Blackwell; 2007. p. 428–43.
2. Andreasen JO, Bakland LK, Matras RC, Andreasen FM. Traumatic intrusion of permanent teeth. Part 1. An epidemiological study of 216 intruded permanent teeth. Dent Traumatol 2006;22:83–9.
3. Andreasen JO, Bakland LK, Andreasen FM. Traumatic intrusion of permanent teeth. Part 2. A clinical study of the effect of preinjury and injury factors, such as sex, age, stage of root development, tooth location, and extent of injury including number of intruded teeth on 140 intruded permanent teeth. Dent Traumatol 2006;22:90–8.
4. Tsilingaridis G, Malmgren B, Andreasen JO, Malmgren O. Intrusive luxation of 60 permanent incisors: a retrospective study of treatment and outcome. Dent Traumatol 2012; 28:416–22.
5. Wigen TI, Agnalt R, Jacobsen I. Intrusive luxation of permanent incisors in norwegians aged 6–17 years: a retrospective study of treatment and outcome. Dent Traumatol 2008; 24:612–8.
6. Andreasen JO, Bakland LK, Andreasen FM. Traumatic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay, method of repositioning, type of splint, length of splinting and antibiotics on 140 teeth. Dent Traumatol 2006;22:99–111.

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