Intrusion - Treatment Guidelines


Get Adobe Flash player


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 permanent teeth with incomplete root formation with minor or moderate intrusion. In teeth with mature root development it is only recommended for teeth with minor intrusion.This treatment seems to lead to fewer healing complications than orthodontic and surgical repositioning. If no movement within a few weeks, initiate orthodontic or surgical repositioning before ankylosis can develop.
  • 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 (more than 7 mm) 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. A temporary filling with calcium hydroxide is recommended.

Treatment choice

Factors determining treatment choice are stages of root development, age and intrusion level.

Degree of intrusion Repositioning
Spontaneous Orthodontic Surgical
OPEN APEX Up to 7 mm x
More than 7 mm x x
CLOSED APEX Up to 3 mm x
3-7 mm x x
More than 7 mm   x

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.

follow-up

Control after 2 weeks. Splint removal and control after 4 weeks, 6-8 weeks, 6 months, 1 year and yearly for 5 years

Dental Trauma Guide 2010 - produced in cooperation with the Resource Centre for Rare Oral Diseases and Department of Oral and Maxillo-Facial Surgery
at the University Hospital of Copenhagen - Last edited the 07-01-2014.