Under local or general anesthesia, the tooth may be guided to its proper position by means of an extraction forceps, and soft-tissue repair may precede the fixation of the tooth. The tooth should be fixed after repositioning with acid etch or resin technique in a manner that will promote healing of the periodontal ligament, ie, no hard contact between tooth and bony socket.
Arch bar fixation is not recommended, since it implies displacement during tightening of steel wires which further adds to the risk of trauma to the periodontal ligament, with subsequent replacement resorption of the root.
If the injury occurred outdoors and the wound is contaminated with soil, tetanus prophylaxis should be considered.
Repositioning becomes increasingly difficult with increasing depth of intrusion of the tooth. In most cases a gingival laceration is present which provides sufficient access to the tooth.The tooth is pulled by the forceps and placed in its proper position.When the tooth is in position, the neighboring displaced bone may be molded to its proper position by digital pressure to promote healing.In case of gross comminution of the alveolar bone and lacerations of soft tissues, the tooth may temporarily be placed in saline solution while remodeling the osseous tissues and repair the soft tissues by means of suturing.
The wound should be rinsed with saline solution if contaminated with foreign bodies. Repair of tears should be completed before working with the acid etch or resin technique. Drying of the tooth with compressed air or absolute alcohol should be avoided in the presence of open wounds.
Monophilic nylon is preferred as a suture material in case of lacerated gingiva or mucosa. Interrupted sutures are the standard of care of wound closure in lacerated gingival wounds.
Fixation is preferably accomplished with acid etch of the incisal enamel and application of a resin splint involving intact neighboring teeth. The teeth involved are gently dried with compressed air (as illustrated) or absolute alcohol and kept dry during the fixation procedure.
A finger on the lingual aspect of the tooth can maintain tooth position during the fixation procedure.
After the fixation period (4 weeks) the resin can be peeled off with a dental scaler or removed with a burr. The tooth must be supported by digital axial pressure during this procedure.
The crown of the intruded tooth is exposed. After etching, rinsing, and drying of the enamel surface of the intruded tooth, a bracket is bonded to the enamel surface.
After etching, rinsing, and drying of the enamel surfaces of at least two neighboring teeth on each side of the intruded tooth, a metal thread is bonded for anchorage
Elastic traction is established between the anchoring rod and the bracket on the tooth. Elastics should be checked and replaced once a week until successful repositioning has been achieved.
The repositioning needs at least 3–4 weeks. The force of extrusion should be kept moderate, and the procedure requires a close follow-up.
The resin can be peeled off with a dental scaler or removed with a burr. The tooth must be supported by axial digital pressure during this procedure.