TRAUMATIC INJURIES OF TEETHCONCUSSION
- Concussion refers to vascular structures at the tooth apex and periodontal ligament resulting in inflammatory edema
- No displacement, only minimal loosening of tooth occurs
- May result in mild avulsion of the tooth from its socket causing occlusal surface to make premature contact with an opposing tooth
- Tenderness on gentle horizontal or vertical percussion
- Tooth sensitive to biting forces
- Patients usually try to modify occlusion to avoid traumatized tooth
- Soft diet
- Relief of occlusal interferences
- Flexible splinting
- Periodic monitoring with repeated vitality testing and radiographs
- Pulp necrosis
- Root resorption is very rare
- Dislocation of the tooth from its socket after severing of the periodontal attachment
- Usually two or more teeth involved
- Teeth mostly affected: deciduous and permanent maxillary incisors
- Mandibular teeth seldom affected
- Vitality testing: temporarily decreased or undetectable
- Vitality may return after weeks or several months
- Depending on magnitude and direction of traumatic force
- Subluxation
- Extrusive luxation
- Lateral luxation
- Intrusive luxation
- Teeth are in normal location or limited elevation of tooth from its socket
- Abnormally mobile
- Extravasated blood emanating from gingival crevice depicts PDL damage
- Tenderness to percussion and masticatory forces
- Partial displacement of a tooth out of its socket
- Often found in deciduous teeth
- Tooth appears elongated
- Usually displaced palatally
- Bleeding from gingival sulcus
- Mobile
- Comminution or crushing of alveolar process accompany tooth dislocation
- Movement direction depends on:
- Orientation and magnitude of the force
- Root shape
- Tooth may be pushed through buccal or less commonly lingual cortical plate
- Root apex palpable insulcus area
- Restoring teeth to normal position by digital pressure under LA
- Comminuted pieces of alveolar bone to be repositioned by digital pressure
- Removal of occlusal interferences if necessary
- Immobilization for 2-3 weeks using flexible splints
- Root canal therapy prior to splint removal
- Extraction of the traumatized teeth should be the last resort
- Periodic follow up clinically and radiographically
- Pulp necrosis: Open apex -9%, Closed apex -55%
- Chances of surface resorption
- Inflammatory resorption can be seen in association with pulp necrosis
- Due to compression to the PDL, both inflammatory and replacement resorption may occur
Free for members
Keep reading — it's free
The rest of this article is open to DentalReach members. Create a free account, or sign in, and every article on the site opens in full.