Definition: Displacement of the tooth into the alveolar bone, damaging periodontal ligament and possibly the neurovascular bundle.
Clinical Findings: Tooth appears shorter or “missing”; immobile and firm; may have metallic percussion sound.
Radiograph: Periodontal ligament space absent; tooth apex may be displaced towards or through surrounding structures.
Treatment:
- Incomplete root formation:
- Intrusion <7 mm: Allow spontaneous eruption; assist orthodontically if no movement within 2-3 weeks.
- Intrusion >7 mm: Surgical or orthodontic repositioning.
- Complete root formation:
- Intrusion <3 mm: Allow spontaneous eruption.
- Intrusion 3-7 mm: Orthodontic or surgical repositioning.
- Intrusion >7 mm: Surgical repositioning.
- Begin root canal therapy within 2 weeks for mature teeth.
Follow-Up:
- 2 weeks: Clinical check and assess healing,
- 4 weeks: Splint removal, clinical and radiographic check.
- 6 months, 1 year, 5 years: Monitor for resorption, ankylosis, and pulp vitality.
Based on IADT guidelines. (Dent Traumatol 2012;28:2-12)
Clinical Note: Dental Trauma Assessment Intrusion Example
Chief Complaint: ______________________________
History of Trauma
- Date and Time: ______________________________
- Location of Injury: ___________________________
- Mechanism of Injury: (e.g., fall, sports, accident): ____________________________
- Initial Care Provided: ________________________
Medical History
- Allergies: _________________________________
- Medications: ______________________________
- Tetanus Status: ___________________________
- Relevant Medical History: ______________________
Dental History
- Previous Dental Injuries: ___________________________
Intraoral Findings
Soft Tissues:
- Lacerations: Yes (gingival lacerations adjacent to tooth #8).
- Bleeding: Mild localized gingival bleeding noted around tooth #8.
- Swelling: Mild localized swelling in the labial mucosa near the affected area.
Tooth Findings:
- Tooth #8:
- Displacement: Intruded by approximately 3 mm into the alveolar bone.
- Mobility: Firmly locked in position, immobile upon examination.
- Percussion: Metallic sound upon percussion, indicative of rigid ankylosis-like stability.
- Sensitivity Testing (cold, electric pulp test): No response, suggesting pulpal necrosis or temporary neural disruption.
Radiograph
- Periapical Radiograph:
- Tooth #8 displaced apically with loss of periodontal ligament space.
- Intact root structure with no visible fractures.
- No significant alveolar bone fractures were observed.
Plan
Immediate Management:
- Repositioning:
- Intrusion of approximately 3 mm managed with orthodontic repositioning using light forces over several weeks.
- Stabilization:
- Applied a flexible splint to stabilize the tooth after initial movement correction.
- Splint duration: 4 weeks.
- Pulp Therapy:
- Initiated root canal treatment within 2 weeks due to the high likelihood of pulpal necrosis in mature teeth.
- Oral Hygiene:
- Advised chlorhexidine rinse (0.12%) twice daily to prevent gingival infection.
- Recommended gentle brushing to maintain cleanliness around the affected area.
- Dietary Modifications:
- Advised a soft diet to avoid further trauma to the affected tooth.
- Medications:
- Prescribed analgesics for pain management (e.g., ibuprofen 400-600 mg every 6-8 hours as needed).
- Antibiotics prescribed if soft tissue trauma or significant risk of infection was present.
Follow-Up Schedule:
- 2 Weeks: Clinical evaluation of tooth position and healing progress.
- 4 Weeks: Splint removal. Clinical and radiographic examination.
- 6-8 Weeks: Radiographic assessment for resorption or other complications; continued orthodontic repositioning if needed.
- 6 Months, 1 Year, 5 Years: Long-term monitoring for complications such as ankylosis, root resorption, or delayed healing.
Warning About Risks Associated with Dental Trauma
Intrusive luxation carries significant risks, including pulp necrosis, root resorption, ankylosis, and delayed eruption. Regular follow-ups and prompt reporting of symptoms such as pain, discoloration, or increased mobility are critical for successful outcomes.