Lateral luxation is defined as displacement of a tooth in a direction other than axially. The tooth may be displaced in a labial, lingual, or lateral direction. Damage to the periodontal ligament and contusion or fracture of the supporting alveolar bone may accompany this injury. Clinical examination reveals a tooth that is displaced in a lateral, palatal or lingual direction and may be locked into its new position thus not mobile. The tooth usually is not tender to touch. Pulp sensibility testing will likely give negative results. In immature teeth, pulpal revascularization usually occurs. Radiographic findings reveal an increase in the periodontal ligament space and displacement of the apex toward or through the labial bone plate. Treatment consists of:
Primary teeth: Treatment depends on the degree of displacement, occlusal interferences and time to exfoliation. The teeth may be allowed to passively reposition if not interfering with occlusion. If interferences are present, the tooth is actively repositioned and splinted to the adjacent teeth for one to two weeks to allow for healing. Primary teeth requiring positioning have an increased risk of developing pulp necrosis compared to teeth that are left to spontaneously reposition. 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 into its anatomically correct position should be initiated as soon as possible. The tooth is repositioned using finger pressure under local anesthesia. The tooth may need to be extruded to free the apical lock in the cortical bone. If the tooth is displaced greater than 5mm, the pulp is extirpated within 48 hours and the canal filled with calcium hydroxide. The tooth is splinted to the adjacent teeth for two-to-four weeks. Antibiotics, tetanus prophylaxis, and 0.2% chlorhexidine gluconate mouthrinse is prescribed.
Lateral luxations always have a dento-alveolar fracture component, and the alveolar bone is repositioned into its correct position to maintain alveolar integrity. The bone may be stabilized with a flexible splint or suture material for four weeks.
In the primary dentition follow up treatment is clinical observation at two-to-three weeks and clinical observation and radiographs at six-to-eight weeks and one year. In the permanent dentition follow up is clinical and radiographic examination every two weeks while the splint is in place and then six-to-eight weeks, six months and annually up to five years. There is considerable risk for pulp necrosis and root resorption.
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