Tooth luxation with displacement

Lateral luxation: Definition and clinical appearance

Lateral eccentric displacement

Lateral luxation implies lateral eccentric displacement of the tooth in its socket. It is often accompanied by fracture of the alveolar bone plate.

Clinically, the tooth appears laterally displaced and is generally stable in its new position.

Response to pulp test is generally absent. Exceptions include cases with minimal displacement.

Lateral luxation: Clinical findings

Left central maxillary incisor with lateral luxation

Frontal and palatal view of left central maxillary incisor with lateral luxation. The tooth is only attached to the palatal mucosa, and it is displaced in palatal direction.

Lateral luxation: Radiographic findings

Axially dislocated tooth out of its socket with partial loss of bony attachment

Intraoral film demonstrates that the tooth is axially dislocated out of its socket with partial or total loss of bony attachment.

Extrusion: Definition and clinical appearance

Extrusion

Extrusion is defined as an injury whereby the tooth suffers partial axial displacement out of its socket.

The tooth appears elongated. Maxillary teeth are usually palatally displaced. The tooth is very loose, in many cases attached only to the palatal gingiva, and there is bleeding from the gingival sulcus.

 

Extrusion: Clinical findings

Extrusion

Frontal and palatal view of left central maxillary incisor with extrusive luxation. The tooth is attached only to the palatal mucosa, and is grossly displaced in palatal direction.

Extrusion: Radiographic findings

Axially dislocated tooth out of its socket with partial loss of bony attachment

Intraoral films will show the tooth axially dislocated out of its socket with partial or total loss of bony attachment. In this case, there is a total loss of periodontal attachment to the bone, and the tooth is retained solely by the palatal mucosal attachment.

Intrusion: Definition and clinical appearance

Intrusion

An intrusion represents the most severe injury to the dentition as a result of the damage to gingival attachment, contusion of the periodontal ligament and bone, and, in immature teeth, damage of the tooth root forming structures (Hertwig’s epithelial root sheath). An intruded primary tooth may damage the underlying permanent tooth bud.

The intrusion is the result of a direct axial impact on the incisal edge. The tooth is pushed into the alveolar ridge, whereby the blood supply of pulp is severed (1) and the periodontal ligament is crushed (2). The tooth is locked into the bone.

Note:
Tooth intrusion is associated with major risk of loss of the tooth, which in most cases is due to replacement resorption (ankylosis).

Clinically, the tooth is not in alignment in the dental arch (infraposition). In most cases it is squeezed into the jaw. Percussion elicits a hard metallic sound. There is bleeding from the periodontal sulcus.

Intrusion: Clinical findings

Intrusion

The left central maxillary incisor is intruded in half its crown length in apical direction.

Intrusion

Axial view of the same patient.

Intrusion: Radiographic findinds

Intrusion

Following intrusive luxation, the entire periodontal ligament will be torn, and the ligament space will not be discernable in most cases.

Radiographic imaging may include orthopantomogram (OPG), intraoral dental films or cone beam/CT imaging.

X-ray shows the same patient.

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v1.0 2009-12-03