The changing role of endodontics and orthodontics in the management of traumatically intruded permanent incisors.

Disagreement remains regarding the optimal treatment for intrusive luxation injuries to permanent teeth. Three problems often present themselves following intrusive luxation: improper tooth position, pulpal necrosis, and internal or external root resorption. In the recent past, the accepted treatment was to allow the permanent teeth to reerupt spontaneously for 6-8 weeks. If this did not occur, orthodontic traction was applied. The pulpal status of the teeth was monitored and either calcium hydroxide therapy or conventional endodontics was instituted following pulpal necrosis depending on the maturity of the root end. Pulpectomy and a calcium hydroxide filling material were also the treatment of choice if there was evidence of internal or external root resorption. Recent evidence suggests that orthodontic repositioning should commence as soon as possible following the trauma regardless of the stage of root development. Teeth with open apices can be monitored. Those with closed apices should be opened, the pulp extirpated, and the canal filled with a calcium hydroxide material. This will reduce the chance of root resorption and provide a period of monitoring prior to a definitive root canal filling. Two cases are presented that demonstrate these contrasting treatment techniques and possible complications. Effective endodontic and orthodontic management of traumatic intrusive luxation of the permanent teeth in children arid adolescents continues to challenge the dental profession. Management should include an accurate diagnosis and treatment that will result in the best prognosis. The purpose of this paper is to present two instances of intrusive luxation Jr., DDS, MS, MSD MS Johnny Johnson, DMD and discuss the treatment and complications in view of the changing and contrasting literature regarding