Intrusive Luxation — ORE Part 1 MCQ

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HardOral SurgeryIntrusive LuxationORE Part 1

A 9-year-old child is seen immediately after intrusive luxation of the permanent upper right central incisor. Radiographic examination confirms an open apex. The incisor is intruded by 5 mm and there is no associated alveolar fracture. What is the most appropriate initial management?

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Correct answer: D — Allow spontaneous re-eruption with close review

The correct answer is D. The decisive feature is the open apex: IADT guidance for intrusive luxation of an immature permanent tooth is to allow spontaneous re-eruption, regardless of intrusion depth. This maximises the potential for continued root development and avoids unnecessary additional trauma to the periodontal tissues. If no spontaneous movement occurs within 8 weeks, orthodontic repositioning should be started. Immediate surgical repositioning is used principally for intruded mature teeth, particularly when intrusion exceeds 7 mm, not as routine initial treatment for an open-apex incisor. Extraction is not first-line where the tooth is retainable. A splint alone does not reposition an intruded tooth, and active orthodontic repositioning is premature initially in this immature tooth.

Reference: Levin L, Day PF, Hicks L, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations, 2020. PubMed record, https://www.england.nhs.uk/long-read/clinical-standard-oral-health-dental-care-children-young-people/