Intrusion - Treatment Guidelines
Treatment
Tooth intrusion is associated with a potential risk of tooth loss due to progressive root resorption (ankylosis or infection related resorption). The following three methods are only partly evidence based.
- Spontaneous eruption
This is the treatment of choice for deciduous/primary teeth and for permanent teeth with incomplete root formation. This treatment has been shown to lead to significantly fewer healing complications than orthodontic and surgical repositioning.
- Orthodontic repositioning
This treatment may be preferred for patients coming in for delayed treatment. This treatment method enables repair of marginal bone in the socket along with the slow repositioning of the tooth.
- Surgical repositioning
This treatment technique is preferable in the acute phase. Intrusion with major dislocation of the tooth (approximately more than half a crown length) may be an indication for surgical repositioning.
Common for all treatments
Endodontic treatment can prevent the necrotic pulp from initiating infection-related root resorption. This treatment should be considered in all cases with completed root formation where the chance of pulp revascularization is unlikely. Endodontic therapy should preferably be initiated within 3-4 weeks post-trauma.
Treatment choice
Factors determining treatment choice are stages of root development, age and intrusion level.
|
AGE |
|
Repositioning |
|
|
|
Spontaneous |
Orthodontic |
Surgical |
| OPEN APEX |
6-11 years |
Up to 7 mm |
xxx |
|
|
| More than 7 mm |
xxx |
|
|
| CLOSED APEX |
12-17 years |
Up to 7 mm |
xx |
|
|
| More than 7 mm |
|
x |
x |
| More than 17 years |
Up to 7 mm |
|
x |
x |
| More than 7 mm |
|
x |
x |
xxx The treatment procedure is significantly better than the other options
xx The treatment procedure has a tendency for better healing than the other options
x The surgical repositioning procedure may be more practical to use compared to the orthodontic repositioning. Surgical repositioning impose a slightly increased risk of late complications compared to orthodontic extrusion
Teeth with open apex
- Allow spontaneous repositioning to take place.
- If no movement is noted within 4 weeks, undertake orthodontic repositioning.
Teeth with closed apex
- The teeth should be repositioned either orthodontically or surgically as soon as possible.
- The pulp will most likely be necrotic and root canal treatment using a temporary filling with calcium hydroxide is recommended. The treatment can be completed after the tooth have been repositioned.
Patient instructions
- 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.