Permanent teeth which have been driven into the jaw bone along their long axis, such that the tooth’s crown appears shorter, have an uncertain long term prognosis. In such cases, damage to the nerve and blood vessels entering the tooth generally leads to pulp death. Damage to fibers of the periodontal ligament and tooth-supporting alveolar bone often leads to an aggressive inflammatory response by the body, which can dissolve away the root in a process called inflammatory resorption. Sometimes the alveolar bone itself may also resorb.
Treatment for intruded permanent teeth generally involves orthodontic extrusion of the injured tooth with light forces, whether or not its roots are fully developed.
Fully Developed Permanent Teeth
A pulpectomy (complete removal of the pulp) is often performed on fully developed permanent teeth, and medical grade calcium hydroxide is placed into the tooth to suppress the inflammatory response that can lead to root resorption. It may be necessary to change the calcium hydroxide medication several times over a period of one to two years, and the tooth is typically monitored at regular intervals during that time period by exposing periapical X-ray images to check for signs of resorption. Traditional endodontic (root canal) treatment is generally recommended when avoidance/suppression of resorption appears successful.
Incompletely Developed Permanent Teeth
If the intruded permanent tooth’s roots are not fully developed, apexogenesis may be recommended to stimulate completion of root formation, and to suppress the inflammatory response that may otherwise resorb the tooth root. After root formation is complete, traditional endodontic (root canal) treatment is generally recommended. The tooth will need to be monitored long term for signs of resorption.
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