What is the correct management for Patient A (permanent tooth lateral luxation) and Patient B (primary tooth lateral luxation with minimal interference)?
OMS questions focus on surgical decision-making with medical comorbidities that change the surgical plan. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.
Two patients present to a dental emergency clinic with lateral luxation injuries. Patient A is a 25-year-old man whose permanent upper central incisor (tooth 11) is displaced palatally, immobile, and gives a metallic sound on percussion. Patient B is a 3-year-old girl whose primary upper central incisor (tooth 51) is displaced palatally with minimal occlusal interference. What is the correct management for Patient A (permanent tooth lateral luxation) and Patient B (primary tooth lateral luxation with minimal interference)?
- A. Patient A: reposition and splint 4 weeks. Patient B: allow spontaneous repositioning
- B. Both: allow spontaneous repositioning and monitor — as the natural healing capacity is sufficient for this injury severity
- C. Both: reposition digitally and splint for 4 weeks — as early definitive treatment reduces the need for follow-up interventions
- D. Patient A: allow spontaneous repositioning. Patient B: extract to protect the permanent successor
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This is one of the most important crossover distinctions in dental trauma: Permanent tooth lateral luxation: reposition digitally (disengage apex from bone, push tooth back), splint for 4 weeks, evaluate endo at 2 weeks for mature teeth. Primary tooth lateral luxation with minimal interference: allow spontaneous repositioning. Usually occurs within 6 months. The management philosophy is fundamentally different. For permanent teeth, the goal is active restoration of position and function. For primary teeth, the goal is minimising intervention — observation is the default, and active treatment is reserved for severe displacement with aspiration risk or significant occlusal interference. SOURCE — IADT Guidelines 2020, Fractures and Luxations Table 12; Injuries in Primary Dentition Table 10
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