Lateral Luxation

What Is Tooth Luxation?

A tooth luxation is a dislodgment of the tooth from its normal position in the alveolar socket. The dislodgement can be sometimes invisible, as that occurs when trauma disrupts the ligaments and tissues holding the tooth in place. It may also affect the nerve and blood supply to the tooth.

What Is Lateral Luxation?

Lateral luxation is defined as the forward or backward displacement of the tooth due to fracture of the alveolar bone which holds the tooth. Horizontal forcespalatally or labially displace the crown, root apex, or both.

What Is the Possible Etiology of Lateral Luxation?

Lateral luxation can be caused by games, accidents, and falls. Lateral luxation is also related to contusion, comminution or root fracture, crown fracture, alveolar bone fracture, and buccal plate fracture.

What Are the Clinical Features of Lateral Luxation?

Males are commonly affected more than females. Maxillary (upper jaw) lateral luxation is more common than lateral luxation in the mandibular region (lower jaw). The periodontal ligament gets ruptured and compressed. The blood supply and nerve supply to the pulp are also affected, resulting in pulpal necrosis.

What Are the Signs of Lateral Luxation?

• The tooth will be locked in the alveolar socket.
• The tooth will not be mobile.
• It does not show any symptoms of pain.
• On percussion, the teeth gives a metallic sound.
• If the teeth are checked for vitality, they show negative response in electric pulp testing, sensibility testing, and laser Doppler flowmetry.
• Usually, crowns are luxated in a lingual direction. As it is luxated primarily in the lingual direction, buccal alveolar bone gets fractured.

How Can We Diagnose Lateral Luxation?

Lateral luxation is confirmed by electric pulp testing, percussion testing, radiographs, and checking mobility. The radiographs taken to ensure lateral luxation are commonly periapical, occlusal, lateral, and CBCT (cone beam computed tomography).

What Is the Radiographic Interpretation for Lateral Luxation?

A widened periodontal ligament is seen in radiographs. Pulpal response is usually absent to electric pulp tests and other sensitivity tests.

What Else Is Initially Assessed?

If the patient shows central nervous symptoms, like unconsciousness, they should be referred to a general hospital. History of present illness is gathered, such as when, how, and where the trauma occurred. Then all cranial and oral examinations are done to assess the presence of facial and oral injuries like any fractures of bones, including maxillary bone, mandibular bone, alveolar bone, and hard and soft tissue injuries, including gingiva, mucosa, palate, and throat. Hard and soft tissues are analyzed to confirm whether first aid is enough or immediate management is necessary.

How Is Lateral Luxation Treated?

First, the soft tissues are treated. Saline irrigation and debridement of wounds are done, followed by hemostasis (bleeding control) and suturing. Resorbable and non-resorbable sutures are used for the closure of wounds to prevent future infections. In case if the damage is deep, refer the patient to an oral surgeon and general surgeon. If the patient is conscious after the trauma, the patient is asked to use mouthwash three times a day. The commonly used mouthwash is Chlorhexidine 0.1%.

Immediate Management:

When the teeth are luxated laterally, the teeth have to be repositioned in place. The repositioning procedure causes pain. So local anesthesia is given in buccal and lingual mucosa. Then after feeling numbness, the teeth are repositioned using forceps or manual pressure. After repositioning, the teeth have to be stabilized in the same position using splinting methods. Usually, splinting is done for four weeks.

Splinting

A splint has been defined as 'an apparatus used to support, protect or immobilize teeth that have been loosened, replanted, fractured, or subjected to specific endodontic surgical procedures. For splinting, make sure that the region where teeth are to be splinted is dry. There are two basic types of splinting done based on materials. They are; resin splint and wire splint. Both the splints have to be etched before curing it. Etching is done with 37% phosphoric acid. Leave the etchant for nearly 30 seconds and then wash it. After washing the etchant, a bonding agent is applied to the tooth surface. Light curing is done for an average of 30 seconds. The resin is placed and light-cured.

• Resin Splints- Composite resin is placed on the tooth surface, connecting laterally luxated teeth with adjacent normal and sound teeth.
• Wire or Fiberglass Ribbon Composite Splints- The wire is measured, stretched, and adapted to the tooth surface. The wire or fiberglass splinting is similar to resin splinting. But it differs in the way that the wire is added to resin for proper adaptation. The etchant is applied and rinsed after 30 seconds, the bonding agent is placed on the tooth surface and light-cured for 30 seconds. Then the wire is adapted, and composite resin is added on the wire to the tooth surface and light-cured for another 30 seconds. If composite is required more to restore the wire, add more composite and cure. A soft diet is recommended for at least one week. The patient is asked to maintain good oral hygiene using mouthwash and gentle brushing.

Intermediate Management:

Mostly, pulp infections follow lateral luxation. Pulp infections include pulpal necrosis and pulpal inflammation. In case pulpal necrosis is spotted, root canal treatment has to proceed. In case if pulpal necrosis occurs in primary teeth or teeth in which root development is incomplete, an apexification procedure is done. The pulp vitality test has to be done at every appointment.

Final Management:

The splint is removed after four weeks. The root canal procedures are followed up with the patient.

What All Medications Can Be Taken for Lateral Luxation?

Nonsteroidal anti-inflammatory drugs and systemic antibiotic drugs are prescribed. Tetanus prophylaxis should be considered in case of contaminated injuries.

What Are the Complications of Lateral Luxation?

• Pulp necrosis.

• Pulp canal obliteration.

• Root resorption.

• Marginal bone loss.

• Apical periodontitis.

• External root resorption.

How to Treat Lateral Luxation in Primary Teeth?

If lateral luxation is seen in primary teeth following dental trauma, follow-up is essential until the eruption of permanent teeth to prevent damage to the permanent teeth. Radiographic and clinical trials are needed to verify the root condition and any infections in the root. Ensure that the tooth position after luxation does not affect the occlusion. If it involves the occlusion, the child’s biting habit varies, leading to certain complications like difficulty chewing food. The treatment consists of the repositioning of teeth. Splinting is done for 1 to 2 weeks.

When Is Extraction of Luxated Primary Teeth Needed?

The teeth are extracted if it interferes with the permanent teeth eruption. If the laterally luxated teeth are near-exfoliating, then the luxated teeth have to be removed. If the luxation is profound and severe, the luxated teeth are extracted. If the crown is pushed labially in lateral luxation, then the teeth have to be removed. The primary teeth can be extracted if it disturbs the permanent teeth below.

Is Root Canal Treatment Necessary After Luxation?

Mainly after luxation, pulpal inflammation, necrosis, and discoloration are seen. This leads to further discomforts. So root canal treatment is done as a measure to protect the condition of the luxated teeth in the future to prevent the infections present periapically.

Conclusion:

After a trauma to the face, seek the help of a medical professional and do not stick to home remedies to treat it. Even if the trauma has not produced many visible injuries, it is always recommended to visit an oral and maxillofacial surgeon or a general physician to look for any underlying damage.