Lateral luxation can be a daunting injury to manage. The issue stems from the fairly strange position the tooth presents with and the relative rigidity of the tooth. This is by and large caused by the dislodgement of the tooth or its root into alveolus. This is commonly where the apex moves buccally and the crown moves towards the palate or the tongue resulting in a steadfast tooth and an increase in the occlusal vertical dimension.
By definition a lateral luxation is displacement of the tooth other than axially. This is likely to be accompanied by contusion, comminution or fracture of the bone. The apex and the periodontal ligament are ruptured with a significant need for acute management. Healing of the site in this adopted position can be catastrophic to manage due to a combination of ankylosis and hard tissue defect.
Author Dental Trauma Guide
Presentation
The tooth will be positioned more often than not towards the palate. Palpating the buccal sulcus you are likely to feel the apex. The patient may be very distressed as they will be biting on this injured tooth in isolation (See above). If they continue to bite in this position they are likely to compound the problem.
Radiographically the tooth is extruded and the crown height may seem foreshortened due to the angulation of the tooth. Please see below.
In most instances greater information can be obtained from a CBCT scan, as illustrated below (Atlanta Endodontics).
In some occasions a segment of alveolus is involved resulting in two or more teeth involved in the same type of injury. Please see below.
When viewed palatally the true magnitude of the luxation is realised and also this can be related to the relative position of the apex as seen below.
General management
- Cleanse any soft tissue wounds with saline, remove any debris, achieve haemostasis and close with stitches if appropriate.
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Clinicians may consider pre-operative anti-inflammatory drugs and potentially systemic antibiotics depending on the magnitude and number of injuries needing management
- Buccal and palatal infiltration in the vicinity of the luxated tooth until well anesthetised.
From the buccal aspect the crown of the tooth may have moved mesially or distally depending on the force and direction of the blow.
The crown is angulated palatally with the apex buccally. This is largely due to the relatively reduced thickness of the buccal plate as opposed to the palatal vault which results in the force being communicated so that the tooth rotates on an axis the center of which is the enamel-dentine junction on the palatal side.
Luxation management
Once adequately anaesthetised repositioning of the tooth should be achieved by disengaging the apical portion from the buccal alveolus downwards and essentially flipping the tooth back into the socket. This can be worrying and daunting for the clinician as there will be concerns at extracting the tooth. If the tooth is inadvertently extracted the injury should be managed the same way as an avulsion.
The below video illustrates how repositioning of a luxated tooth can be achieved with forceps.
Author www.endodonticsonly.com.au
Once stabilisation splinting for 4 weeks is recommended. Root canal treatment will also be required. In the same manner as other areas of endodontics, clinicians are now attempting to revascularize teeth with severe dental injuries. Cehreli and colleagues published a case report in the Journal of the Canadian Dental Association in 2012. This can be read here.
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