Frequency of Intrusive Luxation in Potential Orthodontic Patients with Increased Over-Jet

Shabbir Hussain Shah1                                           BDS, MDS
Muhammad Azeem2                                                 BDS, FCPS
Ahmad Shamim Qureshi3                                        BDS, MDS
Isham Jawaid4                                                           BDS, MOrth RCSEd
Muhammad Usman Ghani5                                      BDS, FCPS
Junaid Dayar6                                                            BDS, FCPS
Asif Ali Shah7                                                             BDS, MSc, MDS

OBJECTIVE: To find out the frequency of intrusive luxation in potential orthodontic patients with increased over-jet.
METHODOLOGY:Total 50 orthodontic patients having permanent dentition with increased overjet was included in the study
and were examined in OPD as per selection criteria. The patients were examined for the presence of intrusive luxation of upper
front teeth as per defined criteria.
STUDY DESIGN:A Cross Sectional Study.
SETTING: Orthodontic Center of Rashid Latif Dental College, Lahore
DURATION: January 2021 to June 2023
RESULTS: The results showed that frequency of traumatic upper maxillary incisors intrusive luxation was found to be 3%,
out of which 80% were females and 20% were males.
CONCLUSION: There is increased frequency of traumatic upper maxillary incisors intrusive luxation in orthodontic patients
having increased over-jet. 
KEYWORDS: Intrusive luxation; Orthodontic repositioning, Re-eruption; Orthodontic extrusion
HOW TO CITE:Shah SH, Azeem M, Qureshi AS, Jawaid I, Ghani MU, Dayar J, Shah AA. Frequency of intrusive luxation
in potential orthodontic patients with increased over-jet. J Pak Dent Assoc 2023;32(3):95-98
DOI: https://doi.org/10.25301/JPDA.323.95
Received:  27 September 2023, Accepted: 10 December 2023

INTRODUCTION

Prevalence of intrusive luxation injuries is constant on an elevated scale and its variations mostly reflect the local differences.1 Children are common victims of dental injuries and estimation suggests 25% of injuries are encountered in childhood.2,3 Prevalence of intrusive luxation injuries is around 3%, and due to its significance in causing occlusal interferences and malocclusion this dental injury warrants immediate treatment.5-8 Right now there is no consensus on management of intrusive luxation injuries for permanent teeth. Various treatment modalities include spontaneous re-eruption, orthodontic repositioning, surgical repositioning and somewhere periodontal crown lengthening.9,10

Mildly intruded tooth is allowed to re-erupt without any active treatment.4 If no progress is noted within two or four weeks then there is an indication for orthodontic / surgical repositioning to prevent other complication such as ankylosis. If no progress is noted within two or four weeks and there is more than 7mm then there is an indication for orthodontic / surgical repositioning to prevent other complication such as ankylosis.11-13 Severely displaced teeth which are embedded deep into bone are predisposed to ankylosis. Such teeth should be luxated to produce some mobility and partially repositioned to allow the placement of orthodontic appliance and access for the endodontic treatment.12-15 Furthermore Shapira, Tronstad and others suggested gingivectomy to uncover the crown,16,17 while on the other hand the gingivectomy procedure has its own limitations.18 Consequently the endodontic access should not be delayed at the cost of waiting for passive re-eruption. Time-dependent predictable sequelae such as formation of abscess or inflammatory root resorption may possibly develop.19,20

The objective of this study was to find out the frequency of intrusive luxation in potential orthodontic patients with increased over-jet.

METHODOLOGY

The present study was conducted at orthodontic department of Rashid Latif Dental College, Lahore. The sample size was calculated and study was conducted after taking informed consent from the patients and institutional ethics approval. Estimated Sample size was 50 patients using 95% confidence level, 80 % power of test, with increased overjet (of at least 6 mm or more and up to 10mm).19 According to the IADT the tooth completing following criteria was considered as intrusively luxated: the tooth has moved upward into the socket, resulting in a fracture to the alveolar bone. The tooth isn’t loose, and it has the highmetallic sound when tapped as with the lateral luxation. Periapical radiograph show no periodontal ligament space, and the pulp test is negative.9,10.

Total 50 orthodontic patients, irrespective of gender and age range of 12-16 years, having permanent dentition with increased overjet (of at least 6 mm or more and up to 10mm) was included in the study and were examined in OPD as per selection criteria. The patients were examined for the presence of intrusive luxation of upper front teeth as per defined criteria. (Figure 1)

Following patients were excluded from the study: the orthodontic patients in primary or mixed dentition, history of any other oro-facial trauma, history of orthodontic or any surgical treatment, history of dental extraction, cleft lip palate and other craniofacial anomalies. The data was collected and presented using descriptive statistics.

RESULTS

The results showed that frequency of traumatic upper maxillary incisors intrusive luxation was found to be 3% (Table 1), out of which 80% were females and 20% were males.

DISCUSSION

Dentoalveolar trauma is common occurrences during childhood in 25% of children with more than 60% are reported to be luxation type of injuries.1,2,3 Such injuries cause damage to the pulp and supporting tissue of the tooth.21 The orthodontist must be well equipped to handle such type of dental injuries.4 The objective of this study was to find out the frequency of intrusive luxation in potential orthodontic patients with increased over-jet.

Dental Intrusive Injuries usually occur between 7 to 14 years of age before the cessation of facial growth.22 Therefore it is necessary to preserve the tooth and adjacent bone before the completion of facial growth. Therefore, permanent restorations are not suitable. The eventual aim and success of treatment in growing patients is preservation of the tooth along with bone for few years and not necessarily require its health and function for the entire life if not sustainable any longer.23.

Luxation injuries are classified as concussion, subluxation, and extrusive, lateral and intrusive luxation.24,25 Intrusive luxation in permanent dentition accounts to only 3% of all traumatic injuries.4-6,24-25 This is in accordance with the results of present study which showed that frequency of traumatic upper maxillary incisors intrusive luxation was found to be 3%. Dental intrusive injuries are referred to as apical displacement of the injured tooth into alveolus after the application of traumatic force.4-6 Dental trauma involves teeth and other associated structures including pulp, periodontal ligament, alveolar bone, and gingiva. Healing subsequent to trauma is a complex process. Management of such injuries has been modified from rigid splints to flexible and short-term interventions for the period of 7 to 10 days now.24-30 Extension of such techniques has been the use of orthodontic traction rather the manual repositioning of teeth.4 There is no consensus concerning management of DII in permanent teeth. Routine treatment modalities include spontaneous re-eruption, orthodontic repositioning, surgical repositioning and periodontal crown lengthening.9,10 IADT guidelines recommend passive re-eruption of mild traumatically intruded tooth.13 In case no movement observed after 2 to 4 weeks, repositioning the tooth orthodontically/surgically is indicated before the development of ankylosis. Almost identical guidelines are suggested by British Society of pediatric dentistry, allowing mildly intruded tooth (<3 mm) to re-erupt and review. In severe cases (>6 mm) surgical repositioning of tooth is better option. There are several limitations of this study such as small sample size and cross sectional nature; however, within these, it was found that there is increased frequency of traumatic upper maxillary incisors intrusive luxation in orthodontic patients having increased over-jet. Our suggestion is to conduct further large scale studies.

CONCLUSION

There is increased frequency of traumatic upper maxillary incisors intrusive luxation in orthodontic patients having increased over-jet.

CONFLICT OF INTEREST

None declared

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