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Challenges in treating traumatically intruded and ankylosed permanent incisors: a case report with a multidisciplinary approach Serpil Djemal Teresa Kärki Gavin Mack Dental Update 2024 42:1, 707-709.
Authors
SerpilDjemal
BDS, MSc, MRD, RCS, FDS (Rest dent), RCS Dip Ed
Consultant in Restorative Dentistry, King's College Hospital, London SE5 9RS, UK
This report discusses the challenges, complications and management of traumatic intrusion injuries affecting the permanent dentition. A case is described where trimming of the incisal edge of a severely intruded and ankylosed upper lateral incisor resulted in an unexpected re-eruption of the tooth. It is suggested that the vibrations from drilling may have disrupted the ankylosis, initiating spontaneous re-eruption and this approach could provide a minimally invasive and conservative pathway to treating ankylosed teeth.
Clinical Relevance: To date no effective treatment has been described to reverse the development of replacement root resorption leading to the loss of the affected tooth. The hypothesis proposed here suggests that mechanical vibrations, if strong enough, may disturb the ankylosis and allow re-eruption of the intruded tooth.
Article
Intrusive luxation defines an injury where a tooth is displaced axially into the alveolar socket.1 As described in the literature, this causes both shearing stresses and compressive forces which result in extensive damage to the gingival fibres, periodontal ligament, apical tissues and alveolar socket wall.2,3 As such, it is perhaps the most severe injury to the dentition with the healing process dominated by complications including:
Whilst pulp necrosis and inflammatory root resorption can, in most cases, be managed by endodontic therapy with calcium hydroxide,4 there is no effective treatment to date for replacement root resorption or ankylosis. Pathogenesis involves competitive wound healing processes between bone marrow-derived stem cells destined to form bone and periodontal ligament–derived cells programmed to form periodontal ligament fibres and cementum.
As healing occurs almost exclusively by cells from the alveolar wall, the root is gradually resorbed and replaced by bone, leading to eventual tooth loss.5
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