Paediatric Trauma III- Permanent Dentition Luxation Injuries:

What is concussion and what are the features?

Injury to supporting tissues with NO loosening or displacement of the tooth.

TTP, Bleeding or bruising at gingival margin

What is subluxation and what are the features?

Injury to the tooth’s supporting tissues WITH abnormal loosening

Tooth will feel mobile, NO displacement, bleeding or bruising at gingival margin

What is Lateral Luxation and what are the features?

Bodily movement of the tooth within the socket - crown moves in one direction (usually direction of force) and root moves in opposite.

Apex displacement - rupture of neurovascular bundle and crushing of PDL cells in palatal cervical region

What is extrusion?

Axial displacement partially out of the socket

Mobile tooth, looks elongated

What is intrusion and what are the features?

Tooth forced upwards into the socket

(in developing dentition – may be difficult to tell if teeth were partially erupting anyway

Crushing of PDL cells and neurovascular bundle

If complex or severe - needs specialist management

What is avulsion?

Tooth completely lost from the socket

Ischaemia of pulp, PDL cell death

Emergency management in practice

What structures do we need to consider regarding luxation injuries?

Impact on PULP

Impact on PDL - ruptured tissues may repair but crushed tissue cannot be repaired

Regarding the pulp after trauma, what factors affect prognosis? (3)

Type of injury

• Intrusion and avulsion have worst prognosis (blood supply cut off)

Age of PT (stage of apical development)

• Open apex (younger pts) = higher chance of revascularisation

An additional hard tissue injury

• E.g complicated crown fracture (where pulp exposed) - worsens prognosis

How will pulp healing present? (3)

• Complete Healing- vitality maintained. 

• Pulp Canal Obliteration 

• Pulpal Necrosis- which can cause inflammatory resorption of the root.

What is pulpal canal obliteration?

Tertiary dentine laid down in canal in response to injury

Shows pulp is alive but chance it may become necrosed in future

Root canal narrowed over time and dentine yellower

How does pulp necrosis cause root resorption?

Pulp death → toxins from pulp leach into PDL space → inflammatory response → inflammatory cells attempt to destroy debris but destory root in process

= inflammatory resorption aka infection related resorption

Can occur 2 weeks after injury

What to do as GDP if you see any inflammatory root resorption?

Attempt extirpation place CaOH + refer to paeds

What are the three types of root resorption related to trauma?

1. Inflammatory (infection related)- can either be internal or external. 

2. Replacement (ankylosis related)

3. Internal (infection related)

How does inflammatory (external) resorption occur?

Same as mentioned b4 → toxins from necrotic pulp leach into PDL space → inflammatory response

Will progress until bacteria removed

On healing → resorbed tissue filled with cementum or bone

How does inflammatory (internal) resorption occur?

toxins from necrotic pulp → inflammatory response → ballooning of canals

Tx → extirpation and dress with CaOH otherwise will lead to perforation

How does replacement resorption occur?

From extensive PDL damage (from extrusion or intrusion)

Many PDL cells die to damage → repair response not fast enough to stop osteoclasts from resorbing tooth → eventually tooth root replaced by bone

Occurs more readily in children during puberty (as rapid bone turnover) → thats why avulsion in adults has better prognosis