dental extrusion treatment

Any time you develop a toothache or dental pain, its important to schedule a visit with your dentist. Due to the increased intensity of the reaction within the soft tissues, NaOCl may cause ulceration intra-orally and this is usually present adjacent to the offending tooth (Fig. The guideline aims to assist practitioners in the assessment of patients following hypochlorite injuries, with the aim to grade the severity of these injuries into mild, moderate and severe. British Dental Journal - Pre-endodontic restoration of structurally compromised teeth: current concepts . How can local anaesthesia be improved in the management of irreversible pulpitis? Glass Ionomer Cement as a preventative fissure sealant for first permanent molars in high caries risk patients waiting general anaesthetica case series. In this section, the most complex injuries and those which have been recently updated will be outlined. An avulsed tooth should be picked up by the crown. Etch the bonding surface of the teeth to be splinted with 37% phosphoric acid for approximately 20 seconds. Guidelines for management of sodium hypochlorite extrusion injuries. It's less common to dislodge your tooth or have it knocked completely out but these injuries are more severe. Using a cotton wool pledget soaked in sodium hypochlorite apply pressure to clean the area and stop the bleeding then apply non-setting calcium hydroxide or MTA. Becking A G . Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: e80e83. 5 This article chronicles the sequence of one such case from site development to final restoration. Follow us on Instagram and create an account on ProShop for easy ordering for yourself or your office. Andreasen JO, Andresen FM, Andersson L, editors. Chaudhry H, Wildan T M, Popat S, Anand R, Dhariwal D . Comparison of apical extrusion of NaOCl using the EndoVac or needle irrigation of root canals. Advertising on our site helps support our mission. Mitchell R P, Yang S, Baumgartner J C . Additionally, a tooth extraction can help ease dental pain almost immediately especially if your tooth was severely broken or infected. Irrigants for non-surgical root canal treatment in mature permanent teeth. 2). The mean treatment period was . Upper airway obstruction induced by a caustic substance found responsive to nebulised adrenaline. Removing your affected tooth gives you the best chance for optimal oral health. According to the guideline a clear concise history would identify patients with a high possibility of extrusion injury. We hereby present a modified method for tooth extrusion for cases where crown-lengthening surgery is contraindicated for aesthetic reasons. https://doi.org/10.1038/sj.bdj.2014.1099, DOI: https://doi.org/10.1038/sj.bdj.2014.1099. Primary duties include assessment and diagnosing, developing treatment plans, completing the necessary documentation, intakes/annual assessments, and providing individual and/or family therapy as . Department of Oral and Maxillofacial Surgery, The North West London Hospitals NHS Trust, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, S. A. Farook,V. Shah,O. Sheikh,Z. Sadiq&L. Cascarini, Department of Oral and Maxillofacial Surgery, King's College Hospital, Denmark Hill, SE5 9RS, London, You can also search for this author in Medically Reviewed By Colgate Global Scientific Communications. Preventing infection is also possible. Paraesthesia and anaesthesia affecting the mental, 22 inferior dental 22 and infra-orbital branches 18,22,23 of the trigeminal nerve following inadvertent extrusion of sodium hypochlorite beyond . You are using a browser version with limited support for CSS. The acute management can have a significant impact on the long-term prognosis of the traumatised tooth; therefore, it is essential that dentists make all efforts to manage all dental injuries immediately and in the long term. This option is usually reserved for complex cases, such as facial reconstruction or corrective jaw surgery. This isfirstly to establish whether it is a primary or permanent tooth. Use flexible splints (e.g., composite and wire splints) that allow physiological tooth movement to stabilize the affected tooth. Treatment Objectives. Not only is this important in the short term but close monitoring in the long term is also vital to the successful management of these cases. Treatment includes repositioning it the tooth gently. Injuries can have a wide distribution in the extra-oral tissue. The least accurate tooth movement was mandibular canine extrusion with a conventional attachment (16.1%). PubMedGoogle Scholar, Fard, R. A step-by-step guide to managing dental trauma in general practice. You have full access to this article via your institution. Redo a clinical and radiographic evaluation in 68 weeks, 6 months, 1 year and then annually for up to 5 years. Antibiotics may be prescribed if there is any evidence of infection. You are using a browser version with limited support for CSS. Koutroumpas DC, Lioumi E, Vougiouklakis G. Passarelli PC, Pagnoni S, Piccirillo GB, et al. September 2020. Neuropathic pain may need pharmacological treatment in a specialist centre. Neurological complications following extrusion of sodium hypochlorite solution during root canal treatment. In the cases of teeth which have been crowned, endodontic access must be carefully assessed as the crown and root angulations may differ.13 During apical preparation of the root canal system, it is important to shape to the apical constriction. Materials and methods Fourteen subjects with an initial mean age of 9.17 1.03 years presenting with dentoalveolar AOB (mean 1.28 1.46 mm) and normal facial pattern (FMA = 25.76) were treated with an extrusion arch. Complete a thorough verification of medical and dental history, and record the accident in detail. Apply a small amount of composite on the teeth and place the splint over the composite. http://www.dental-tribune.com/articles/specialities/endodontics/11609_irrigation_for_the_root_canal_and_nothing_but_the_root_canal.html, The evaluation of E. faecalis colonies dissolution ability of sodium hypochlorite in microenvironment by a novel device. For more information on how to carry out the Cvek partial pulpotomy technique to preserve tooth vitality and for guidance on how to treat other fracture types refer to the Saving Smile Practitioners' Toolkit.1, Under local anaesthesia, the coronal fragment should be digitally repositioned then check the occlusion before splint placement. Facial asymmetry due to swelling and a well delineated area of erythema. Oral Surg Oral Med Oral Pathol 1991; 71: 346348. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Cytotoxic effects of NaOCl on vital tissue. Preventive measures include wearing appropriate personal protective equipment, ensuring the use of a well-sealed rubber dam and high volume suction.9 Such precautions help to avoid injuries to skin, eyes, ingestion or even aspiration.10 Management of the aforementioned injuries is provided by the Health Protection Agency Compendium of Chemical Hazards. Int Endod J 2000; 33: 186193. British Dental Journal - Guidelines for management of sodium hypochlorite extrusion injuries . Published by the Canadian Dental Association, Figure 1. In cases where this has been over prepared, the loss of apical constriction will lead to an increased risk of hypochlorite extrusion.9 The severity of reactions have been noted to be more severe when increasing concentrations of NaOCl have been used.15 This has led to the debate of the optimum concentration of NaOCl. Avis de non-responsabilit: CDA Oasis ne fournit pas de conseils mdicaux, de diagnostics ou de traitements. If reimplantation at the accident site is not possible the tooth must be stored in either milk, saliva or saline until reimplantation by a clinician. Gently reposition the tooth using forceps while repositioning the displaced bone by applying finger pressure both labially and lingually (palatally in most cases). Intruded teeth that are surgically repositioned require appropriate splinting. Available at: www.dentaltraumaguide.org (accessed February 2021). These contain many features found in moderate injuries; however they are noted with increased severity. Available at: https://www.ekhuft.nhs.uk/patients-and-visitors/services/restorative-dentistry-service/patient-leaflets/?entryid103=494011 (accessed February 2021). If your dentist recommends an extraction, be sure to discuss replacement options with them, too. A malocclusion characterized by an open bite is one of the most difficult conditions to treat because it results from the interaction of multiple etiologic factors. Common risk factors of dry socket (alveolitis osteitis) following dental extraction: A brief narrative review. For root fractures root canal therapy is carried out up to the fracture line.1,2. Sedation is an excellent option for people who have dental anxiety or for those who simply want to be more comfortable during their appointment. In cases of wire splint, some composite material has to be applied over the wire and cured again. Acknowledgments: Dr. Stphane Schwartz, Montreal Children's Hospital, MUHC, for providing all images for the Figures. Most patients reviewed in our department have had their RCT carried out on the same day of presentation. Systematic approach is recommended to assess extra-oral and intra-oral tissues (Table 1). the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Instruct the patient to follow a soft diet for 1 week and to maintain proper oral hygiene. This is long-term treatment which can be carried out once soft tissues have been stable and show signs of healing. 4). Sensitivity test usually gives negative result. Extrusion of tooth 11 by orthodontic bonding and application of elastic force. Investigations including plain film radiography can be undertaken as per mild injuries. For apical and middle third fractures, four weeks of non-rigid splinting is needed but cervical third fractures require four months.4. Case reports have noted weakness of muscles associated with the buccal and also marginal mandibular branches of the facial nerve,27,28 as well as sensory disturbances of mandibular and maxillary branches of the trigeminal nerve.13 Therefore, a cranial nerve examination should be undertaken with particular emphasis on the trigeminal nerve and facial nerve. Long-term paresthesia following inadvertent forcing of sodium hypochlorite through perforation in maxillary incisor. The management of teeth with deep caries, fracture, or perforation in the cervical third of the root is an integral part of dental practice. Once your tooth is removed, the socket is cleaned and disinfected. After your extraction, your dentist will give you a detailed list of post-surgical instructions. A tooth extraction may be necessary for many reasons, including severe damage or decay. Figure 4. If completion of root canal treatment is the treatment of choice, an irrigant other than NaOCl would be advisable. Dr. Gupta is an assistant professor, department of pediatric and preventive dentistry, Santosh Dental College and Hospital, Ghaziabad NCR, Delhi, India. The management of dental trauma can be a very challenging and overwhelming experience especially in general practice. Witton R, Brennan P A . Zairi A, Lambrianidis T . Following a literature review and considering our own experience we have formulated clear and precise guidelines to manage patients with NaOCl injury. Osteomyelitis can occur in the mouth when the open wound created from an extraction becomes contaminated, and the infection spreads to the underlying bone. Methods: PubMed, Embase, and Google Scholar were searched through 15th . CDA Oasis se veut une source dinformation clinique sommaire qui est facile daccs et non pas une source dinformation exhaustive. Surgical extrusion Removal of the mobile fractured fragment Note any asymmetry (such as flattening of the cheek bones), step deformities or tenderness. Sometimes, people refer to this as pulling" a tooth. It is easier to place the wire and the composite on the supporting teeth first and finish with the displaced tooth. Practitioners' Toolkit. Diangelis AJ, AndreasenJO, EbelesederKA, KennyDJ, TropeM, SigurdssonA, et al. NaOCl results in the dissolution of organic matter and haemolysis,23 and facilitates NaOCl absorption into superficial facial veins which will spread into the soft tissues resulting in a diffuse ecchymosis and swelling (Fig. After reading this article, they'll be impressed with your dental knowledge. Additionally, dental extrusion is also defined as tooth displacement and appears as an elongated form. Apply adhesive to the surface of the teeth to be splinted and cure as per manufacturer's instructions. Anatomy of sodium hypochlorite accidents involving facial ecchymosis a review. Zehnder M . de Sermeo R F, da Silva L A, Herrera H, Herrera H, Silva R A, Leonardo M R . Lam T S M, Wong O F, Tang SYH . This can be in the pulp floor during endodontic access or whilst shaping the canal resulting in lateral perforation. Intrusion of a permanent incisor is a rare injury. This information is for educational purposes only. Due to the oversensitivity of teeth, dental trauma may cause intense pain. Dental interference, if maintained, causes serious hypofunction. Highlights that sodium hypochlorite (NaOCl) is the most common irrigant used in endodontics. If the pulp is exposed, pulpal treatment alternatives are pulp capping, pulpotomy, and root canal Other instances may require a bone graft (a surgical procedure that uses a transplanted bone to repair and rebuild the damaged bone). Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics. American Academy of Oral and Maxillofacial Surgeons. Report of a case. The canal should be temporarily dressed with nonsetting calcium hydroxide paste before obturation. Under local anaesthesia and isolation, 2-3 mm of pulp tissue is removed through the exposure using a small round diamond bur. If you suspect signs of facial fractures or if there is a deep or complex laceration that you do not feel comfortable treating, or it requires decontamination, consider referral to the maxillofacial department. Greater Manchester Local Dental Network. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. The soft tissue injuries in more severe cases may result in loss of adipose in the facial tissues resulting in cosmetic deformity,13 which can be addressed by multiple modalities such as fillers, implants and coleman fat transfer (Fig. Pashley E L, Birdsong N L, Bowman K, Pashley D H . The majority of these injuries are minor - chipped teeth. Note that the use of systemic antibiotics after avulsion and reimplantation is recommended to prevent infection, as often the avulsed tooth becomes contaminated by bacteria and it will also help to decrease the occurrence of inflammatory root resorption. It is also important to take a comprehensive medical history to identify additional patient risk factors which may also need to be taken into account during management. The following dental injuries in the permanent dentition require splinting: avulsion, intrusion, extrusion, lateral luxation, alveolar fractures and displaced root fractures. J Endod 2008; 34: 13461350. This involves management within the first week following immediate treatment and aims to stabilise the patient following injury prior to any definitive treatment to the tooth. The offending tooth and the gingiva is usually tender to percussion.17, Intra-oral ulceration with necrosis of the mucosa following NaOCl injury during root canal treatment of the 45 tooth. During this period, cold compresses are changed to warm towel compresses to stimulate the local circulation.31 If the tooth is deemed to be unrestorable due to gross perforation or pathological fracture secondary to resorption, extraction may the treatment of choice. Stock your fridge and pantry with soft foods like rice, pasta, eggs, yogurt and applesauce. have presented measurements of distances between six facial planes which can be compared with the opposite side to determine the extent of swelling.24 These planes are demonstrated in Figure 3 and include the Tragus-lip junction, Tragus-pogonion, angle-median point of chin, Mandibular angle-lateral canthus, Mandibular angle-ala nasi and Mandibular angle-lip junction.24 It is important to take measurements of both sides, thus allowing the degree of swelling to be compared to the contralateral side in an attempt to quantify this. Such deficits may be sensory or motor and will also need to be reviewed at regular intervals and may also require treatment. However, in higher risk injuries such as lateral luxation, intrusion and dento-alveolar fractures where management can be challenging referral to secondary specialist services can be considered for a second opinion or long-term treatment. When the procedure is complete, your dentist will place a piece of gauze over the extraction site and ask you to close down with firm, steady pressure. This article aims to highlight the main principles of dental trauma management and it will signpost resources to help update your knowledge and boost your confidence. Once the patient has attended the clinic, confirm the repositioning of the tooth both clinically and radiographically.Correct any mispositioning using gentle finger pressure under local anaesthesia up to 48 hours after the incident. Radiographs should be used to rule out an avulsion injury. Therefore, periodic assessment is essential. Prior to root canal treatment, the assessment of teeth is important to identify any factors which may predispose extrusion injuries, so that adequate preventive measures can be undertaken. 1998; 43: 250256. You have full access to this article via your institution. Advise the patient to use a soft toothbrush and chlorhexidine rinse (0.12%) for 1 week. Partial displacement of the tooth out of its socket An injury to the tooth characterized by partial or total separation of the periodontal ligament resulting in loosening and displacement of the tooth. Referral to an orthodontist is suggested. Lymphology 2007; 40: 138142. GO TO TREATMENT Accidental injection of sodium hypochlorite beyond the root apex. But sometimes, other restorative methods such as dental fillings or dental crowns arent enough. 2009 Oct. 54(4):585-92. Introduction. As the severity of the reaction is also linked to the concentration of NaOCl used, dilution by irrigating the canals with copious amounts of water or saline is recommended. Using specialized dental instruments, your dentist will gently loosen your tooth and carefully lift it from its socket. Periodic assessment is essential to rule out progressive root resorption. contracts here. If your tooth has been badly damaged past the point of repair, then removal may be necessary. Evidence based treatment guide. S, Szendi-Horvth K, Seres L, Boda K, Kemny L . Harrison J W . Irrigation for the root canal and nothing but the root canal. Kishor N . Extend the splint to no more than 2 teeth on each side. Pain is not usually associated with intrusion of a permanent tooth. Although there are many factors a patient may present with, an emphasis on the degree of pain, swelling and ecchymosis will be the main factors which can be used to determine the grading of such injuries (Table 2). ISSN 0007-0610 (print), Guidelines for management of sodium hypochlorite extrusion injuries. Left untreated, a decayed or damaged tooth can wreak havoc on your smile, causing a domino effect of problems. Sometimes during this process, complications arise, like dry socket and infection. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Tooth-related factors include endodontic treatment of an immature tooth with a wide apical foramen,16 as the apical constriction has not developed the risk of irrigants passing beyond the apex. The tooth is displaced partially out of the socket and is usually displaced palatally, depending on the trauma. If the patient has any eye signs such as pain behind the eyes, proptosis [protrusion of the eyeball] or loss of vision, an urgent referral is needed to the maxillofacial department and for an urgent ophthalmology assessment. Accidental extrusion of sodium hypochlorite into the maxillary sinus. For the treatment of extrusion, the tooth is restored to its original position, and a semirigid splint is placed by a dentist. 7 and 10 were tipped to provide at least 1.5 mm interproximal osseous clearance between roots and implant surfaces. In patients with moderate NaOCl injuries, the patient may complain of increased pain and discomfort compared to mild injuries. We've got you covered. If no repositioning is evident within 23 weeks, orthodontic repositioning will be required. Okamoto R, Mendona M R. Orthodontic Extrusion as Treatment Option for Crown-Root . Chlorhexidine gel to prevent alveolar osteitis following mandibular third molar extractions, Removal of accumulated hard tissue debris from mesial root of mandibular molars evaluated using micro-CT - a systematic review and network meta-analysis. Pain is perhaps the most common symptom and adequate pain relief should be prescribed.9,12 In mild injuries over-the-counter analgesia (OTC), or analgesia recommended in the Dental Practitioners Formulary, should be sufficient to manage symptoms. Jeansonne M J, White R R . Day P, Flores M T, O'Connell A et al. Surgical tooth extrusion is one of the treatment options. Figure 2. It is well known that taper and apical size influence the delivery of irrigation. Provided by the Springer Nature SharedIt content-sharing initiative, BDJ Team (BDJ Team) They can help determine the cause and design a personalized treatment plan. The most accurate tooth movement was the extrusion of the maxillary central incisor with a conventional attachment (73.9%), followed closely by the rotation of the maxillary premolar with an optimized attachment (72.8%). Baumgartner J C, Cuenin P R . If you have a job that requires a lot of lifting or physical labor, you may need to take a few more days off work. 2013. This helps slow bleeding so a blood clot can form. Assess intraorally if there are other soft tissue and/or other dental injuries. https://doi.org/10.1038/s41407-021-0623-y, DOI: https://doi.org/10.1038/s41407-021-0623-y. Avulsion: A completely intruded tooth may give a false impression of an avulsed tooth. Dental trauma is common in the UK, with more than one in ten children having experienced some form of dental trauma (Pitts et al., 2013).In addition, one in ten patients have been reported to have experienced dental trauma before orthodontic treatment (Bauss et al., 2004).A recent survey of orthodontists' knowledge and experience of orthodontic management of traumatised teeth has documented . As described, NaOCl injuries respond with an inflammatory reaction, the result being in the nature of swelling. Br Dent J 1998; 185: 336337. Tooth extraction offers a number of benefits. Fracture and Luxations of permanent teeth. Cone bean computer tomography (CBCT) can be used to assess the effect on surrounding tissues. Correspondence to Images of Extrusion. Check the occlusion to be sure there is no pressure on the tooth and follow the most current treatment guidelines for this type of trauma by the AAPD. Severe cases are better managed within secondary care; hence requires urgent referral to the local OMFS unit. Irrigation of the root canal system. Extraoral lateral cephalogram (or a lateral no. Fouad A F, Abbott P V, Tsilingaridis G et al. They all presented with rapid onset of pain and swelling which helped us to eliminate other possible causes, such as infection which has an indolent presentation when compared to extrusion injury. For more detailed information on history taking as well as clinical and radiographic examination refer to the Saving Smiles Practitioners' Toolkit1or the article by Chauhan et al.2, If there are signs of brain injury such as loss of consciousness, vomiting or nausea the patient should be urgently referred to A&E for further assessment. Each type of dental injury requires a different splinting time otherwise the risk of ankylosis increases. East Kent Hospitals University NHS Foundation Trust. Den Clinics North Am 1984; 28: 797808. Pension, Retirement Matching, Health/Dental/Vision . The use of irrigants in root canal treatment (RCT) is imperative to its success, with the emphasis of cleaning and over shaping of the root canal system.1 Sodium hypochlorite (NaOCl) is the most widely used irrigant, with a concentration ranging from 0.55.25%.2 It is bacteriocidal with the capacity to dissolve organic matter, dislodge debris from the root canal system and provide a degree of lubrication whilst shaping the canals during RCT.3,4,5,6 Although it confers many advantageous properties, care must be taken when using and handling NaOCl as it is caustic to the vital tissues7,8 and related injuries are a recognised risk. It is highly effective at dissolving organic debris and disinfecting the root canal system due to the high pH. We have proposed to categorise extrusion injuries as mild, moderate and severe according to a patient's signs and symptoms. Figure 4. Thank you for visiting nature.com. Have questions about your smile? Was mandibular canine extrusion with a high possibility of extrusion injury AndreasenJO, EbelesederKA, KennyDJ, TropeM,,..., other restorative methods such as facial reconstruction or corrective jaw surgery and/or... To be splinted with 37 % phosphoric acid for approximately 20 seconds substance responsive... Ebelesederka, KennyDJ, TropeM, SigurdssonA, et al needed but cervical third require., de diagnostics ou de traitements usually displaced palatally, depending on same! Regular intervals and may also require treatment injuries can have a wide distribution in the nature swelling... The wire and cured again give you a detailed list of post-surgical.. 5 years images for the Figures splinting is needed but cervical third fractures four! R P, Flores M T, O'Connell a et al and isolation, mm. If maintained, causes serious hypofunction knocked completely out but these injuries are more severe semirigid splint is placed a. ) that allow physiological tooth movement was mandibular canine extrusion with a high possibility of extrusion, patient! Teeth, dental extrusion is one of the treatment options clinique sommaire qui est facile daccs et non pas source! Colonies dissolution ability of sodium hypochlorite solution during root canal treatment the fracture line.1,2 Am 1984 28... However they are noted with increased severity the sequence of one such case from site development to final restoration during. A review assess intraorally if there are other soft tissue and/or other dental injuries solution during canal. Usually displaced palatally, depending on the same day of presentation which can a! Accidental extrusion of sodium hypochlorite solution during root canal treatment in a centre... Systematic approach is recommended to assess extra-oral and intra-oral tissues ( Table 1 ) out on the to! Splints ( e.g., composite and wire splints ) that allow physiological tooth movement was canine! Orthodontic repositioning will be outlined features found in moderate injuries ; however they are with. Complications arise, like dry socket and is usually reserved for complex cases, such as dental fillings dental. Flores M T, O'Connell a et al S less common to dislodge your tooth is removed, the of! Apical and middle third fractures, four weeks of non-rigid splinting is needed but cervical third fractures four. ( alveolitis osteitis ) following dental extraction: a brief narrative review reading this article chronicles sequence... A well delineated area of erythema ProShop for easy ordering for yourself or your office methods! In 68 weeks, orthodontic repositioning will be required site development to final restoration a completely intruded tooth may a!, Piccirillo GB, et al fractures, four weeks of non-rigid splinting is needed but cervical third fractures four! Paste before obturation non-responsabilit: CDA dental extrusion treatment se veut une source dinformation clinique qui! Intra-Oral tissues ( Table 1 ) found responsive to nebulised adrenaline some composite has!, Wildan T M, Wong O F, da Silva L a, M... Exposure using a browser version with limited support for CSS the bonding surface of the teeth to more! Ionomer Cement as a preventative fissure sealant for first permanent molars in high caries risk patients general! Oasis ne fournit pas de conseils mdicaux, de diagnostics ou de traitements plain film radiography can be out... Treatment option for Crown-Root neuropathic pain may need pharmacological treatment in mature teeth! 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Wire and the composite for apical and middle third fractures, four weeks of non-rigid splinting is but! Kemny L responsive to nebulised adrenaline fissure sealant for first permanent molars high. Dc, Lioumi E, Vougiouklakis G. Passarelli PC, Pagnoni S, Piccirillo,. Injuries: 1 risk of ankylosis increases usually displaced palatally, depending on the.... It & # x27 ; S less common to dislodge your tooth is restored its! Are minor - chipped teeth other soft tissue and/or other dental injuries 1. Intruded teeth that are surgically repositioned require appropriate splinting are more severe be outlined to categorise extrusion injuries as,! A semirigid splint is placed by a dentist your tooth was severely broken or infected for Crown-Root mature teeth... Following inadvertent forcing of sodium hypochlorite ( NaOCl ) is the most complex injuries and those which been! T M, Wong O F, Tang SYH treatment of choice, an irrigant than. 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( alveolitis osteitis ) following dental extraction: a brief narrative review of post-surgical....