Traumatic Dental Injuries in Children: The Controversies of Managing Primary Tooth luxation Injuries

One of the areas that are most contentious in the diagnosis and management of traumatic dental injuries in children are in the approach toward luxation injuries in the primary dentition. Although the majority of injuries to the primary anterior dentition are luxations, there appears to be little definitive evidence in the dental literature for the management of luxation injuries in primary dentition; namely, intrusive luxations and lateral luxations. Some of the controversies centre on whether particular management approaches are likely to increase likelihood of further damage to the permanent successor, whilst others centre on question of whether certain approaches are likely to increase likelihood of pulpal necrosis or periapical inflammation of the injured primary tooth. There is conflicting published evidence over whether intruded or luxated primary teeth are best extracted, positioned, or monitored for spontaneous repositioning. For intrusion injuries, factors considered in the literature include the degree of intrusion, presence of multiple injuries, and orientation. Many approaches to management of primary tooth luxation focus on the degree of injury or occlusal interference, and novel approaches are described. The controversies are described herein.