Definition of Extrusion in Dental Trauma
Extrusion (extrusive luxation) is the partial vertical displacement of a tooth out of its socket, also termed a partial avulsion. 1
Clinical Presentation
The extruded tooth presents with the following characteristics:
- Visible lengthening of the tooth compared to adjacent teeth due to partial displacement from the alveolar socket 1
- Increased mobility of the affected tooth 1
- The tooth appears longer than normal when examining the clinical crown 1
- May be accompanied by sulcular bleeding at the gingival margin 1
Key Distinguishing Features from Other Luxation Injuries
Understanding extrusion requires differentiating it from related dental trauma:
- Concussion: Tooth is tender but shows no mobility or displacement 1
- Subluxation: Abnormal mobility present but no displacement of the tooth 1
- Lateral luxation: Tooth displaced horizontally (typically palatally/lingually) rather than vertically 1
- Intrusive luxation: Opposite of extrusion—tooth is forced deeper into the alveolus 1
- Complete avulsion: Total displacement of the tooth from its socket, not partial 1
Clinical Significance
The severity of extrusion determines management approach, with minor extrusions (<3mm) amenable to gentle repositioning while severe extrusions (>3mm in primary teeth) typically require extraction. 1
Management Considerations:
- Primary dentition: Minor extrusions can be gently repositioned; severe extrusions (>3mm) warrant extraction and immediate dental referral 1
- Permanent dentition: Requires different management protocols than primary teeth, emphasizing preservation when possible 1
- Occlusion assessment: Critical to verify the extruded tooth does not interfere with the patient's bite by having them gently close their teeth together 1
Monitoring Requirements
Following extrusive injury, vigilance for complications is essential:
- Monitor for crown discoloration, gingival swelling, increased mobility, and sinus tract formation as signs of pulpal necrosis 2
- Obtain periapical radiographs at 3 months, 6 months, 1 year, and annually for 3 years post-injury 2
- Watch for development of localized parulis (gum boil) indicating infection requiring dental referral within days 1