Cronicon O P EN A C C ESS EC DENTAL SCIENCE

Case Report

Orthodontic Movement in a Laterally Luxated Tooth: A Case Report

Darren Owens1*, David Waring2, Emma Critchley3 and Suhail Bhatti4
1
Dental Core Trainee, Department of Orthodontics, University of Manchester Dental Hospital, Manchester, UK
2
Consultant and Clinical Lead in Orthodontics, Department of Orthodontics, University of Manchester Dental Hospital, Manchester, UK
3
Dental Core Trainee, Department of Restorative Dentistry, University of Manchester Dental Hospital, Manchester, UK
4
Consultant in Restorative Dentistry, Department of Restorative Dentistry, University of Manchester Dental Hospital, Manchester, UK

*Corresponding Author: Darren Owens, Dental Core Trainee, Department of Orthodontics, University of Manchester Dental Hospital,
Manchester, UK.
Received: January 11, 2018; Published: March 12, 2018

Abstract
There is a small evidence base for the orthodontic movement of certain types of dental trauma beyond the acute and subacute
phase in the adult population. This may be due to the vast majority of dental injuries receiving early intervention and few delayed
presentations. This report describes a clinical case of central incisor trauma with delayed presentation and its management with a
short-term fixed sectional orthodontic appliance. The trauma was treated successfully via a multi-disciplinary approach between
Orthodontic and Restorative Departments in a dental hospital within a time frame of 12 weeks.
Clinical Relevance: Most dentists are familiar with the emergency management of dental trauma. Some presentations do not fall
under one definitive treatment protocol and therefore careful evaluation is required prior to beginning treatment.

Keywords: Orthodontic Movement; Dental Trauma

Introduction

Dental trauma is a relatively common presentation within the population, particularly in paediatric and adolescent age groups. The age
group most at risk of dental trauma is 6 - 12 years and the second most prevalent age group 16 - 20 years [1]. A study showed a peak inci-
dence of those attending emergency “after-hours” clinics or departments to be between the ages of 18 - 23 years, with almost a quarter of
the injuries to the permanent dentition being a luxation-type trauma [2]. The recommended emergency management for a lateral luxation
injury is to manually reposition the displaced tooth digitally, or with forceps, into its correct location (surgical repositioning), followed by
stabilisation with a splint for 4 weeks [3]. The earlier this is performed, the greater the chance of periodontal healing. When presentation
is delayed, pulpal death and ankylosis or infection related resorption of the tooth is almost certain. This is due to mechanical damage of
the periodontal ligament resulting in cellular necrosis which disrupts the normal homeostatic mechanism [4]. Evidence of the efficacy of
orthodontic appliances in managing dental trauma is lacking [5]. Guidelines for management suggest following the common acute (less
than 1 hour) and subacute (within 24 hours) management protocols [6]. In the delayed presentation of a laterally luxated, mature central
incisor where ankylosis is inevitable, early orthodontic movement of the tooth can reposition and align the tooth into its correct position,
improving overall long-term prognosis.

Literature Review
The current literature documenting the treatment outcomes for orthodontically repositioned teeth, following lateral luxation injury, is
sparse. However, literature documenting the outcomes of intrusive injuries is more common. There are three accepted treatment options
for intrusive injuries: allowing spontaneous re-eruption, orthodontic extrusion or surgical repositioning. As the sequealae of lateral and
intrusive luxation injuries are similar, combined results of these studies are outlined below.

Citation: Darren Owens., et al. “Orthodontic Movement in a Laterally Luxated Tooth: A Case Report”. EC Dental Science 17.4 (2018): 336-
341.
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Andreasen., et al. [7] performed a prospective analysis of the healing outcome (pulpal necrosis, root resorption and marginal bone
breakdown) related to treatment delay and method of repositioning for 140 intruded permanent teeth. Allowing spontaneous eruption
(in immature teeth with incomplete root formation) resulted in the lowest number of healing complications. This is supported by other
studies [8-10]. Their findings also suggest a small but not significant decrease of marginal bone breakdown for orthodontically, as op-
posed to surgically repositioned teeth.

A retrospective study conducted by Tsilingaridis., et al. [8] of intrusive injuries to 60 permanent incisors evaluated treatment alterna-
tives in relation to pulp survival, periodontal healing, degree of intrusion and root development. In this study surgical repositioning was
least favourable, suggesting that it may induce a second trauma to the already damaged tooth. Despite this no firm conclusion could be
drawn comparing orthodontic extrusion versus surgical repositioning. This is supported by a longitudinal study examining the treatment
outcomes of 31 intruded incisors [9]. Both of these studies also highlighted the importance of immediate active treatment (orthodontic
traction or surgical repositioning) post-injury. An increased failure rate was observed if active repositioning was performed after 2 weeks.

In summary, where repositioning of a tooth is necessary, there is no clear difference in terms of healing outcomes for surgically repo-
sitioned verus orthodontically repositioned teeth. The latter may not be favoured due to increased clinical time and costs incurred [7,9].
Some case reports have documented successful outcomes for intruded teeth repositioned orthodontically, particularly in the delayed pre-
sentation where healing processes have begun. Orthodontic repositioning may avoid further trauma to the periodontium in comparison
to surgical repositioning [8]. A further benefit may be the avoidance of the loss of bone support and aesthetic defects that can occur after
surgical repositioning [11].

Case Report
History
A 20-year-old male presented to the emergency dental department more than 48 hours after sustaining dental trauma as a result of a
fall. The patient had received some emergency soft tissue management shortly after the injury in a local accident and emergency depart-
ment. No acute treatment of the dental trauma was provided.

Assessment and management

Clinical and radiographic examination confirmed a lateral luxation injury to the upper right central incisor which was in anterior cross-
bite (Figures 1 and 2). The tooth was non-mobile with a degree of intrusion. There was also a complicated crown fracture of the upper
right lateral incisor. Due to the delay in presentation and to avoid further trauma to the already compromised periodontium, the decision
was made not to reposition surgically. As the tooth was a mature incisor in anterior crossbite, it would not correct spontaneously. A fixed
sectional appliance therefore was suggested to assist in repositioning the tooth. The appliance used was a pre-adjusted fixed appliance
system (Victory series, 3M Unitek). This was bonded from the upper right canine to upper left canine tooth. A temporary bite-raising glass
ionomer restorative was placed on the occlusal surface of both upper first permanent molar teeth to allow for correction of the anterior
crossbite.

Citation: Darren Owens., et al. “Orthodontic Movement in a Laterally Luxated Tooth: A Case Report”. EC Dental Science 17.4 (2018): 336-
341.
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Figures 1 and 2: Intraoral views of trauma.

The patient returned 3 weeks later for orthodontic review and first stage endodontic treatment of the traumatised teeth. At this ap-
pointment the upper right central incisor had already moved into an acceptable position and the glass ionomer was removed. The sec-
tional appliance was removed 2 weeks later with a good aesthetic result. The patient’s endodontic and restorative treatment was finished
thereafter within a brief period of retention (Figures 3, 4 and 5). Follow-up was arranged for 3-month radiographic review.

Figure 3: Period of retention with a Hawley-type retainer.

Citation: Darren Owens., et al. “Orthodontic Movement in a Laterally Luxated Tooth: A Case Report”. EC Dental Science 17.4 (2018): 336-
341.
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Figures 4 and 5: Endodontic treatment and final restoration.

Discussion
Most dentists are familiar with the emergency management of dental trauma. However, some presentations, particularly those that are
delayed or combination injuries, do not fall under one definitive treatment protocol. Teeth that have been traumatised must be evaluated
carefully prior to beginning or continuing orthodontic movement [12]. A minimum 6-month wait is recommended when there has been
moderate to severe damage to the periodontium [13]. This is a guideline designed for patients due to undergo orthodontic movement of
teeth for general malocclusion and do not reflect presentations such as the above. Following this guideline is likely to result in the tooth
becoming ankylosed in an unfavourable position. Early orthodontic repositioning allows supervised ankylosis to occur when the tooth is
aligned.

Citation: Darren Owens., et al. “Orthodontic Movement in a Laterally Luxated Tooth: A Case Report”. EC Dental Science 17.4 (2018): 336-
341.
Orthodontic Movement in a Laterally Luxated Tooth: A Case Report

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Conclusion
There is a small evidence base for the orthodontic movement of certain types of dental trauma beyond the acute and subacute phase
in the adult population. This may be due to the vast majority of dental injuries receiving early intervention and few delayed presentations.
We are unaware of any guidelines that pertain to specific presentations such as in this case where the clinical outcome shows merit for
orthodontic tooth movement.

Contributors
All authors contributed to the design and preparation of this manuscript.

Funding
None.

Conflicts of Interest
None.

Ethics Approval

None required.

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Citation: Darren Owens., et al. “Orthodontic Movement in a Laterally Luxated Tooth: A Case Report”. EC Dental Science 17.4 (2018): 336-
341.
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Volume 17 Issue 4 April 2018

©All rights reserved by Darren Owens., et al.

Citation: Darren Owens., et al. “Orthodontic Movement in a Laterally Luxated Tooth: A Case Report”. EC Dental Science 17.4 (2018): 336-
341.