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Contusion and subluxation

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Type of injury

Injury type - Contusion
  • Trauma of the desmodontium with bleeding and/or oedema in the periodontal gap resulting from overstretching
  • The desmodontal ligament and the apical neuro-vascular bundle are intact
  • There is no dislocation or loosening


Injury type - Subluxation
  • There is a partial rupture of the parodontal ligament system with partial or total rupture of the apical nerve vessel bundle
  • The tooth is loosened and sensitive on percussion, but not dislocated
  
Contusion
No loosening of the tooth
   Subluxation
Loosening of the tooth
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Clinical presentation

  • Clear sensitivity to percussion (vertically/horizontally)
  • Possible visible haemorrhage from the desmodontal gap
  • Bite sensitivity
  • Sensitivity test positive/negative
  • Slight elongation of the tooth is possible
Radiography
There are no pathological changes on the radiograph.

Therapie

  • Checking of occlusion with slight adjustment of the antagonistic contact, if indicated
  • Splinting in case of contusion is not mandatory and only indicated for a maximum of 7-10 days
  • Flexible splinting in cases with subluxation: 7-10 days
  • Monitoring

Recall intervals and parameters to examine

Recall intervals

After
  • 1 week
  • 3 weeks
  • 6 weeks
  • 3 months
  • 6 months
  • and 12 months
Parameters

Clinical
  • Sensitivity
  • Percussion sensitivity
  • Discoloration
  • Spontaneous pain
  • Sensitivity to pressure in the vestibule
Radiographic
  • Osteolysis of hard tissue and bone
  • Root formation

Prognosis

Contusion

The critical prognostic factor is the developmental stage of the root.

Open apical foramen (> 1.2 mm)
  • Root canal obliteration in 3% of cases
Complete root formation
  • Pulp necrosis in less than 5% of cases
  • Root canal obliteration in 5-10% of cases
(Andreasen et al. 1985, Andreasen et al. 1987)

Subluxation

Open apical foramen
  • Pulp necrosis rarely
  • Root canal obliteration in 12% of cases
Complete root formation
  • Pulp necrosis in 16% of cases
  • Root canal obliteration in 5-10% of cases
(Andreasen et al. 1985, Andreasen et al. 1987)