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Treatment guidelines for luxated and avulsed primary teeth

Concussion

Subluxation

Lateral luxation

Intrusion

Extrusion

Avulsion

DIAGNOSIS

Clinical findings

Tooth tender to touch.

Tooth is mobile.

The tooth is displaced laterally with the crown in a palatal direction.

Tooth is usually displaced through the labial bone plate

Tooth is mobile and elongated

Tooth is out of the socket

Radiographic findings

Take one radiograph (2).
No radiographic abnormalities will be found.

Take one radiograph (1)
Increased periodontal space apically is best seen on the occlusal radiograph

Take two radiographs (2-3).
When the apex is displaced through the labial bone plate, the intruded tooth appears shorter than its contralateral (2).
When the apex is displaced towards the permanent tooth germ, the intruded tooth appears elongated

Take one radiograph (2)

Take one radiograph (2)A radiographic examination is essential to ensure that the missing tooth is not intruded

TREATMENT


Observation

If there is no occlusal interference, the tooth is allowed to reposition spontaneously, otherwise, reposition and splint (xx)

If the apex is displaced through the labial bone plate, the tooth is left for spontaneous repositioning (xx)If the apex is displaced into the developing tooth germ, extract (xx)

Extract or reposition (xx)

The avulsed primary tooth should not to be replanted (xx)

Patient instruction

Soft diet
Brush teeth with a soft toothbrush after each meal
Topical use of chlorhexidine twice a day for 1 week
Follow up (see Table)


(1)Occlusal - (2)Periapical central angle - (3)Extraoral lateral


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