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Interdisciplinary management of severe intrusion injuries in permanent incisors: a case series
I N B R I E F
Outlines interdisciplinary management techniques of severe intrusion injuries in permanent incisors.
Highlights the benets of orthodontic repositioning of severely intruded teeth in the short and medium terms.
Stresses the importance of an immediate referral of such complex cases to a specialist centre.
PRACTICE
H. Nazzal,*1 H. K. Dhaliwal,2 S. J. Littlewood,3 R. J. Spencer4 and P. F. Day5
VERIFIABLE CPD PAPER
Intrusion injuries to the permanent dentition are amoung the most severe types of dental injuries, occurring in 0.31.9% of all dental trauma cases. The current clinical guidelines in the management of intrusion injuries are based on level B evidence due to the infrequent nature of this type of injury, coupled with a lack of high quality evidencebased studies. This paper presents fourcases of severe intrusion injuries that were successfully managed using an interdisciplinary approach. The cases described here highlight the benets of orthodontic repositioning of severely intruded teeth in the short and medium terms. Although orthodontic repositioning was unsuccessful in the nal case, this did not preclude subsequent surgical repositioning. Interdisciplinary collaboration allowed twoof the cases described to be effectively managed with premolar autotransplantation alongside orthodontic treatment. The cases demonstrated here indicate the difculties in providingthe current recommended treatment modalities at nonspecialist clinics. They accentuate the importance of an immediate referral of such complex cases to a specialist centre where interdisciplinary management is readily available.
INTRODUCTION
Intrusion injuries to the permanent dentition, although rare (0.31.9%),1 are oneof the most severe types of traumatic dental injuries. By denition, an intrusion is an axial displacement of the tooth into the alveolar socket.1,2 This type of injury is often associated with severe damage to the tooth, gingival tissues, alveolar bone and pulpal tissues.13 The rarity of this injury, coupled with the lack of wellconducted outcome studies, means that the clinical guidelines are based on grade B evidence (clinical/case control/cohort studies).2
The British Society of Paediatric Dentistry (BSPD)2 and the International Association of Dental Traumatology (IADT)4 guidelines recommend that teeth with severe intrusion injuries (>67mm) and open apices should be repositioned either orthodontically or
surgically, while those with closed apices should be surgically repositioned.
Many patients in the UK...