Extrusion is defined as partial displacement of a tooth axially from the socket. The periodontal ligament usually is torn. Clinical examination reveals a tooth that appears elongated and is mobile. Radiographic findings reveal an increased periodontal space apically. Treatment consists of:
Primary teeth: Treatment depends on the degree of displacement, occlusal interferences and time to exfoliation. If the injury is not severe ( less than 3mm extrusion), the tooth may be repositioned or allowed to spontaneously align. When the injury is severe, the tooth is nearing exfoliation, or the patient is uncooperative, extraction should be considered.
Permanent teeth: Active repositioning of the tooth with digital pressure into its anatomically correct position should be initiated as soon as possible. The tooth should be repositioned using slow and steady finger pressure in an apical direction to gently displace the clot formed between the floor of the socket and the tooth apex. If the tooth is displaced greater than 5mm, the pulp should be extirpated within 48 hours and the canal filled with calcium hydroxide, followed by final obturation after three months. The tooth should be splinted to the adjacent teeth for two weeks. Antibiotics, tetanus prophylaxis, and 0.2% chlorhexidine gluconate mouthrinse should be prescribed.
Treatment follow up is two weeks when the splint is removed and then clinical and radiographic examination at four weeks, eight weeks, six months and one year. In permanent mature teeth with closed apices there is increased risk for pulp necrosis and, therefore, these teeth must be carefully followed.
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