A short slideshow covering the basics of Intrusive luxation and total avulsion, from an endodontic point of view.. Highlight are the photographs chosen with care to explain the points well. Ideal for under-graduate and Post-graduate students. Based on Grossman's Endodontic Practice, 13th Edition.

1. TREATMENT OF
TRAUMATIZED TEETH
Intrusive Luxation and Avulsion

2. INTRUSIVE LUXATION
 Defined as the
intrusion or
displacement of the
tooth into the alveolar
bone along the long
axis of the tooth and is
accompanied by
fracture of the alveolar
socket.
 It is one of the most
severe forms of dental

3. The depth of intrusion can vary from a few mm to an almost complete
burial of the tooth into the socket.
INTRUSIVE LUXATION

4. DIAGNOSIS OF INTRUSIVE
LUXATION
 When the tooth is intruded
only a small portion of the
crown may be visible in the
oral cavity.
 This can be because of
swelling and amount of
tooth intrusion.
 Frequency of intrusion in
primary teeth > Permanent
teeth
 Intruded teeth are stable,
while extruded teeth are
mobile.
 Diagnosis on basis of

5. MANAGEMENT OF INTRUSIVE
LUXATUION
 Emergency Management:
 Cold application to alleviate
pain and swelling.
 Stopping bleeding.
 Wait and Watch
Management:
 Unless a permanent tooth
bud is damaged, no
immediate treatment is
required.
 Spontaneous re-eruption is
the treatment of choice,
especially for teeth with
incomplete root formation.
 This is a slow process: takes
2 to 14 months to complete.
On Incident Day
2 months follow-up
6 months follow-up

6.  Surgical Management:
 Surgical extrusion for
multiple teeth intrusions.
 Endodontic Management:
 Indicated if the pulp of the
intruded tooth dies.
 Frequent vitality tests done
 RCT done to forestall
inflammatory root
resorption.
 Orthodontic management:
 If the eruption is slow, the
tooth may be actively
erupted with an orthodontic
MANAGEMENT OF INTRUSIVE
LUXATUION
Surgical Re-positioning
Orthodontic Re-positioning

7. AVULSION
 Also called
exarticulation or total
luxation.
 It is defined as the
complete and total
displacement of the
tooth from its socket.

8. ETIOLOGY OF AVULSION
 Incidence of Avulsion:
 Primary teeth: 7 to 13%
of Traumatic Injuries
 Permanent teeth: 0.5 to
3% of Traumatic Injuries
 Sports and fight
injuries.
 Maxillary centrals most
commonly avulsed.

9. AVULSION AND EMOTION
 Avulsed/luxated teeth are a
dental and an emotional
problem.
 The shock and pain of the
injury and the loss of a tooth
needed for eating, speaking
and smiling leads to an
emotional upheaval in both
patients and parents.
 The situation is compounded
by need of an emergency
treatment to enhance
prognosis.
 The longer the tooth remains
out of its socket, the less
likely it is to regain a healthy

10. EMERGENCY TREATMENT AT SITE
OF AVULSION
 Instructions to be given to
patient/parent as soon as
dentist has been informed:
 Wash the tooth in running
water without any brushing or
cleaning. Check that the tooth
is intact.
 Avoid touching or scraping the
root surface.
 Have the patient rinse his/her
mouth.
 Replace the tooth with gentle,
steady finger pressure. If the
patient can ask to gently close
the mouth to push the tooth
back into its original position.
 Take the patient to the dentist

11. TRANSPORTING AVULSED
TEETH
 The choice of storage media is
for preserving the tooth is
extremely important to the
success or failure of
reimplantation.
 Suggested storage media are:
 HBSS (Hank’s Balanced Salt
Solution)
 Coconut water
 Patients’ own saliva
 Patient’s vestibule
 A container patient spits into
 Milk
 Physiological Saline
 Water
 Viaspan
 CPP-ACP (Casein

12. MANAGEMENT OF TEETH WITH
EXTRA-ORAL DRY TIME OF LESS

13. MANAGEMENT OF TEETH WITH
EXTRA-ORAL DRY TIME OF MORE

14. PULPAL HEALING
 Prognosis depends on
pulp exposure, degree of
damage, age of patient
etc.
 Pain continuous/
intermittent/ pain-free.
 In older patients pulpal
recession may protect
against external stimuli. In young patients dentinal exposure can cause sensitivity as pulp
horns are high and the dentinal tubules are wide and open.
 Developing tooth may revasularize – direction: from the apex
coronally.
 Short roots + large apical foramen = favorable prognosis.

15. PULPAL NECROSIS
 Follows severance of
blood supply.
 Liquifactive/coagulative/
gangrenous depending
on the presence of
bacteria.
 Easily treated with RCT
in fully formed teeth.
 Loss of vitality = weak
roots in developing teeth.
 May be accompanied by
external resorption/
internal resorption.

16. PUPLP CANAL
OBLITERATION
 Calcific
metamorphosis
 Small but probable
incidence.
 Observed in luxation
associated with
dislocation.
 Such teeth remain
symptomless except
for radiograph and
crown discoloration.
 Results from tooth
being stimulated to
lay down dentin.

17. EFFECT OF TRAUMA ON SUPPORTING
TISSUES
 Root resorption may be
seen
 3 possible ways of
reaction of bone and PDL
to trauma:
 Surface resorption (repair-
related resorption)
 External Surface Resorption
 Internal Surface Resorption
 Inflammatory Resorption
(infection-related
resorption)
 External Inflammatory
Resorption