November 2007
Dr Gerhard Steenkamp

A dog is presented to your surgery 24 hours after it was in a dog fight. His right maxillary canine has been luxated laterally (See photo)
 

  a) What is the difference between an avulsed and a luxated tooth?
b) What is the prognosis for avulsed/luxated teeth within the first 24 hours post trauma?
c) If the prognosis for a tooth is still good, which steps need to be taken to save the tooth?

Memo

a) Avulsion – tooth completely removed from alveolus, luxation – tooth still has contact with the alveolus. Luxation can be into the alveolar socket (intrusive luxation), out of the alveolar socket (extrusive luxation), or laterally.  The latter is the most common presentation seen.

b) For any luxated/avulsed tooth, the time out of the socket is crucial.  This time should be restricted to as a short a time as possible (minutes to hours).

c) An avulsed tooth should be kept moist.  Oral fluids are the best medium, however if the tooth has been completely lost from the patient’s mouth milk can be used as a suitable transport medium.  The patient should be referred as soon as possible for treatment.  This will include the careful cleaning of the root surface as well as alveolus, trying not to disrupt the periodontal ligament remnants that are left.  The tooth is then re-implanted and splinted to the contra-lateral canine tooth via a figure of 8 wire bonded to the teeth (Photo).  The treated tooth should be re-evaluated within 7 – 21 days after implantation and a root canal treatment should be performed to remove the pulp, which blood supply was severed during the avulsion/luxation.