It occurs when the tooth is displaced axially into the alveolar bone, often due to a direct impact to the anterior maxilla during early childhood.
This trauma not only affects the primary tooth but may also compromise the developing permanent successor, making accurate diagnosis, monitoring, and management essential for favorable long-term outcomes.
1. Pathophysiology and Etiology
Intrusive luxation is caused by a vertical impact that drives the tooth into the alveolar bone.
The direction of displacement determines the potential involvement of the permanent tooth germ:
- Labial displacement typically spares the permanent bud.
- Palatal displacement often indicates potential damage to the developing successor, as the root apex is forced toward the follicle of the permanent tooth.
Children aged 1 to 3 years are most at risk due to bone elasticity and the short root length of primary teeth.
2. Clinical and Radiographic Diagnosis
Clinically, the intruded tooth may appear shortened or absent in the dental arch, accompanied by gingival bleeding and mobility reduction.
Radiographically, the key findings include:
★ Loss of periodontal ligament space.
★ Altered inclination of the root apex.
★ Possible displacement toward the developing permanent bud.
Cone-beam computed tomography (CBCT) may be indicated in severe or ambiguous cases to evaluate root position and the proximity to the permanent germ.
3. Management Strategies
The management approach depends on the degree of intrusion and the relation to the permanent tooth germ:
★ Mild to moderate intrusion (labial direction)
Observation is often sufficient. Spontaneous re-eruption can occur within 2–6 months. Regular clinical and radiographic controls are necessary every 3–4 weeks.
★ Severe intrusion or displacement toward the permanent germ
Extraction may be indicated to prevent damage to the developing tooth.
★ Infection or pulp necrosis
Endodontic intervention in primary teeth is rarely recommended; extraction remains the preferred approach.
During follow-up, clinicians must monitor for complications such as ankylosis, pulp necrosis, or inflammatory root resorption.
4. Follow-Up and Prognosis
Prognosis largely depends on the direction and severity of the intrusion.
Re-eruption rates are high in mild cases, but permanent tooth anomalies (e.g., enamel hypoplasia, crown/root malformation, eruption disturbances) may develop due to trauma to the successor bud.
Long-term follow-up — ideally until the eruption of the permanent tooth — is recommended.
5. Parental Guidance and Preventive Education
Parents should receive guidance on trauma prevention (e.g., home safety, supervision during play) and the importance of immediate dental evaluation after trauma.
Clear communication about the possible sequelae on permanent teeth is essential to ensure consistent follow-up and timely intervention.
Conclusion
Dental intrusion in primary teeth requires a multidisciplinary approach involving pediatric dentists, endodontists, and sometimes oral radiologists.
Conservative management with close observation remains the gold standard, but every case must be individualized based on the direction of intrusion and the child’s developmental stage.
Prompt diagnosis and consistent follow-up are vital to ensure proper healing and minimize long-term sequelae in the permanent dentition.
References
1. Malmgren B., Andreasen J.O. Guidelines for the management of traumatic dental injuries: 3. Primary teeth. Dental Traumatology, 2020;36(4):343–349.
2. Yvonne YL Lai. Traumatic Dental Injuries in Children: The Controversies of Managing Primary Tooth luxation Injuries. JPDA Vol. 28 No. 02 Apr-Jun 2019
3. Elizabeth Elleray; Melina Brizuela; Tom Pepper. Trauma to the Primary Dentition. Last Update: June 1, 2023.
4. E. Spinas, L. Carboni, T. Mallus, N. Zerman. Intrusive Luxation Injuries in deciduous teeth: Literature Review and Treatment Complications Update. European Journal of Paediatric Dentistry vol. 25/1-2024.
