Original article
Emergency orthodontic treatment after the traumatic intrusive luxation of maxillary incisors

https://doi.org/10.1016/j.ajodo.2003.06.019Get rights and content

Abstract

Treatment of traumatically intruded teeth is based largely on empirical clinical experience rather than on scientific data. The aim of this qualitative meta-analysis was to provide an evidence base to evaluate the orthodontic repositioning approach. In a MEDLINE search of the literature in English, 14 reported patients involving 22 teeth were found to have been treated by this modality. Additionally, 3 new patients, involving 9 intruded teeth and presented herein, were combined to form a total study sample of 17 subjects (7 girls, 10 boys, aged 8.9 ± 1.2 years). Orthodontic extrusive forces were applied in the immediate posttrauma period (up to 3 months), with a variety of orthodontic appliances. Repositioning was achieved for 90.3% of the affected teeth but failed in 9.7% because of inflammatory resorption (2 teeth) or a misdiagnosis of root fracture (1 tooth). Early complications included loss of pulp vitality and external root resorption. All intruded teeth with closed root apices lost their vitality regardless of the degree of intrusion, whereas among those with incomplete apices, 45.5% that had been moderately intruded remained vital. External resorption was encountered in 54.8% of the teeth. Loss of marginal bone support was rarely encountered. Late complications included inflammatory root resorption in teeth with closed apices, in which endodontic treatment was not initially performed, and obliteration of the pulp tissue in teeth that remained vital. The results show that this method is superior to other treatment alternatives.

Section snippets

Patient 1

An 8-year-old, quadriplegic girl with cerebral palsy and mental retardation arrived at our department of oral and maxillofacial surgery 9 days after having traumatized her anterior teeth and severely lacerated her lips and gingivae (Fig 1). There was a previous history of trauma to the front teeth. Her overall malocclusion was Class II Division 1, with deep bite and impingement of the mandibular incisors on the palate.

The 4 maxillary incisors had all been severely intrusively luxated. The

Material and methods

A computerized MEDLINE literature search (from 1966 through November 2002) was performed to identify the maximum number of studies in which intrusive luxation was treated by the orthodontic repositioning approach. “Orthodontics” was searched in the subject heading and was crossed with various combinations of the terms “trauma,” “intrusion,” and “luxation.” A library search was also made of the articles cited in the bibliographies of the relevant case reports that were thus discovered.

The

Discussion

The current state of knowledge regarding treatment of intruded teeth is based largely on empirical clinical experience rather than on scientific data. In this qualitative meta-analysis, a thorough literature search sought published articles describing treatment of intruded maxillary incisors by orthodontic repositioning for evidence about this treatment approach. Because of the heterogeneity of the sample group, it was considered invalid to combine the data; nevertheless, some consistent

Conclusions

  • 1.

    The success rate of orthodontically generated extrusion of intruded teeth was high.

  • 2.

    Among the teeth with incomplete apices, those that had suffered severe intrusion lost their vitality, whereas almost half of the moderately intruded teeth remained vital.

  • 3.

    All teeth with completed apices lost their vitality.

  • 4.

    External root resorption affected more than half of the treated teeth.

  • 5.

    Loss of marginal bone support was rarely encountered.

  • 6.

    All teeth that had remained vital showed signs of pulp obliteration.

  • 7.

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