IADT treatment guidelines for intrusion

intrusive-luxation4

Clinical findings

  • The tooth is displaced axially into the alveolar bone.
  • It is immobile and percussion may give a high, metallic (ankylotic) sound.
  • Sensibility tests will likely give negative results.

Radiographic findings

  • The periodontal ligament space may be absent from all or part of the root.
  • The cemento-enamel junction is located more apically in the intruded tooth than in adjacent non-injured teeth, at times even apical to the marginal bone level.

Treatment

Teeth with incomplete root formation:

  • Allow eruption without intervention.
  • If no movement within few weeks, initiate orthodontic repositioning.
  • If the tooth is intruded more than 7 mm, reposition surgically or orthodontically.

Teeth with complete root formation:

  • Allow eruption without intervention if the tooth is intruded less than 3 mm. If no movement after 2-4 weeks, reposition surgically or orthodontically before ankylosis can develop.
  • If the tooth is intruded 3-7 mm, reposition surgically or orthodontically.
  • If the tooth is intruded beyond 7 mm, reposition surgically.
  • The pulp will likely become necrotic in teeth with complete root formation. Root canal therapy using a temporary filling with calcium hydroxide is recommended and treatment should begin 2-3 weeks after repositioning.
  • Once an intruded tooth has been repositioned surgically or orthodontically, stabilize with a flexible splint for 4 weeks.

Follow-up

  • 2 weeks – Clinical and radiographic examination.
  • 4 weeks – Splint removal, clinical and radiographic examination.
  • 6-8 weeks – Clinical and radiographic examination.
  • 6 months – Clinical and radiographic examination.
  • 1 year – Clinical and radiographic examination.
  • Yearly for 5 years – Clinical and radiographic examination.