Tooth Luxation

TOOTH LUXATION, i.e., the disruption of its connection with the alveolus, can be complete or incomplete. Every luxation entails at least a minor fracture of the alveolus, and in some cases, it may also be associated with a fracture of the root apex. Tooth luxations occur either as a result of accidental trauma (fall, blow, contusion) or during extraction as a result of unskilled use of forceps or levers. Accidental trauma most often affects the least protected anterior teeth, whereas unsuccessful extractions more often result in luxations of the posterior teeth. Tooth luxation sooner or later leads to necrosis of the dental pulp, which occurs either from a complete rupture of the vessels supplying the pulp or—in cases of mild trauma—from a sharp disruption of the pulp's nutrition. In lower incisors, due to the narrow pulp chamber and the narrowness of the root canals, pulp necrosis is observed more frequently, while externally the teeth appear undamaged. In most cases, gangrene in such teeth is complicated by pericementitis (periodontitis), which often leads to the formation of granulomas or cysts. Granulating pericementitis arising in this way is often the cause of submental fistulas, and at times, exacerbations of the process can occur with symptoms of acute osteomyelitis of the jaw. In these cases, an operation from the outside, through the skin, and gouging of the bone do not help, and only an operation performed from the oral vestibule, with exposure of the root apex and removal of the latter and the associated granuloma or cyst, eliminates the process while preserving the tooth for the patient (provided, of course, that it is previously trepanned, the canal disinfected, and filled with an impermeable mass; see Resection). In cases of complete tooth luxation, one should attempt to reimplant it by inserting it back into the alveolus and securing it appropriately, i.e., replant it. In many cases, this is successful, and the hopes for healing are greater the sooner the replantation occurs after the luxation and the less the tooth has been contaminated. Symptoms of periodontitis in these cases usually pass on their own, thanks to the rest obtained as a result of fixing the tooth with a splint or ligature. If suppuration joins, the tooth must be extracted. Replantation of knocked-out teeth is successful not only in permanent but also in deciduous dentitions. It is necessary to remember that the pulp of the replanted tooth must be previously removed and the tooth canal filled. Through trauma, a tooth can be driven into the jaw, after which it appears shorter than its neighbors. In cases of incomplete luxation combined with a fracture of only the root apex, it is sometimes possible to save the tooth by means of an alveolotomy.