Orthodontic Extrusion: Guidelines for Contemporary Clinical Practice

A systematic and comprehensive protocol for rapid orthodontic extrusion

OBJECTIVE

The aim of the present paper is to describe a systematic and detailed protocol for rapid orthodontic extrusion, and to summarize the main results of this protocol in terms of migration of dental, hard and soft tissues, for 10 cases.

CLINICAL CONSIDERATIONS

The working design was to apply a protocol lasting 4 weeks of active phase with intense forces (greater than 300 g), perform weekly the circumferential supra-crestal fiberotomy procedure associated with root-planning, follow up with a passive stabilization phase of another 4 weeks and evaluate the results.

CONCLUSIONS

We believe that despite the partial migration of periodontal tissue, the defined protocol we used is, for simplicity of application, brevity of treatment and results, a viable alternative to the surgical technique of clinical crown lengthening in those cases where it is necessary to have more dental tissue exposed for restorative and prosthetic purposes.

Forced orthodontic extrusion for an apparently hopeless anterior tooth by using a simplified approach

When restoring severely compromised teeth, respecting the supracrestal tissue attachment and retaining the most coronal and radicular tooth structure is essential to achieving a sufficient ferrule. Forced orthodontic extrusion is a minimally invasive method that allows hard- and soft-tissue conservation. This article describes the treatment of a severely damaged maxillary central incisor that was managed by using a simplified orthodontic extrusion method with intracoronal elastic and metal ligatures applied through a palatal bar and followed by the biologically oriented preparation technique (BOPT). This orthodontic procedure reduces a forward clockwise advance during vertical extrusion, thus maintaining the buccal bone plate.

Multidisciplinary approach to restore esthetics and function in a young patient with three consecutive impacted teeth: a case report with 18-month follow-up

This case report describes the orthodontic treatment of an 11-year-old patient with three maxillary impacted teeth on the right side. Cone-beam computed tomography showed that these teeth were close together, with the lateral incisor in a lower position, followed by the central incisor, and the canine in a more apical position. Treatment included applying traction to these teeth. A transpalatal arch was used as an anchorage device, and surgical exposure of the lateral incisor was performed for traction with an elastic chain toward the hook welded to the 0.017 × 0.025-inch steel segmented arch. Subsequently, the central incisor was surgically exposed, elastic chains were used, along with a 0.016-inch steel arch with a box loop for correcting the tooth position. The canine spontaneously began to erupt, and a 0.017 × 0.025-inch TMA segmented arch with boot loop was used to control rotation and torque of the canine during its distalization. Once these three teeth were in the arch, treatment was finished in the usual manner. For esthetic improvement, gingivoplasty was performed in the maxillary arch. Eighteen-month follow-up showed that orthodontic treatment allowed preservation of the natural teeth, the contour of gingival support, and avoidance of prosthetic rehabilitation, reestablishing the patient's esthetics and function, with satisfactory stability.

Alveolar ridge preservation: Complications and cost-effectiveness

Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous clinical studies and reviews on this topic have populated the literature. In recent years the focus has primarily been on analyzing efficacy outcomes pertaining to postextraction dimensional changes, whereas other relevant facets of alveolar ridge preservation therapy have remained unexplored. With this premise, we carried out a comprehensive evidence-based assessment of the complications associated with different modalities of alveolar ridge preservation and modeled the cost-effectiveness of different therapeutic modalities as a function of changes in ridge width and height. We conclude that, among allogeneic and xenogeneic bone graft materials, increased expenditure does not translate into increased effectiveness of alveolar ridge preservation therapy. On the other hand, a significant association between expenditure on a barrier membrane and reduced horizontal and vertical ridge resorption was observed, though only to a certain degree, beyond which the return on investment was significantly diminished.

Digital orthodontic extrusion system for complex crown-root fracture of anterior teeth: A technique report

Patients with traumatic dental injuries commonly present in clinical practice with complex crown-root fractures. Prosthodontic treatment of such patients may be unsuccessful because of the violation of the supracrestal tissue attachment, making their management challenging. Minor tooth movement is an effective solution to extruding the residual root but may require referral to an orthodontist. The purpose of this technique was to present a digital orthodontic system including a 3-dimensional virtual patient technique, a computer-aided design and computer-aided manufacture (CAD-CAM) resin facial veneer-retained pontic, and a zirconia post as an orthodontic appliance for tooth extrusion in the esthetic zone. This veneered pontic may also serve as an interim prothesis. The appliance provides a precise design for the direction and extent of orthodontic extrusion.

Periodontal health of unilateral labially vs. palatally impacted maxillary canines erupted by closed eruption technique

OBJECTIVE

This study's aim was to compare the periodontal health of labially and palatally impacted maxillary canines erupted by closed eruption technique, and to compare them with the contralateral canines that served as control teeth.

MATERIALS AND METHODS

A total of 32 subjects, 17 with unilateral labially impacted maxillary canines and 15 with palatally impacted maxillary canines were enrolled in this study. Pretreatment maxillary canine variables were evaluated from initial panoramic radiographs using Nolla stage, α‑angle, d‑depth and s‑sector. The closed eruption technique was used for surgical exposure of the impacted teeth. Posttreatment periodontal parameters such as plaque index (PI), gingival index (GI), gingival bleeding index (GBI), probing depth (PD), keratinized gingival width (KGW), attached gingival width (AGW), and gingival thickness (GT) were evaluated to compare the periodontal health with the contralateral canines.

RESULTS

Intergroup comparison results exhibited insignificant differences in all periodontal parameters between the labially and palatally impacted maxillary canines. Intragroup comparison results showed a significant increase in PI, GI, GBI, and PD, and a significant decrease in AGW, KGW, and GT in the impacted teeth compared to the controls, except for PI in the palatally impacted maxillary canines.

CONCLUSION

The decrease in KGW, AGW, and GT was not associated with the pre-eruptive position of the impacted teeth. These side effects seen after orthodontic treatment of impacted teeth should be followed carefully in the long term.

Alveolar ridge preservation reduces the need for ancillary bone augmentation in the context of implant therapy

Background

There is limited information on the need for bone augmentation in the context of delayed implant placement whether alveolar ridge preservation (ARP) is previously performed or not. The primary aim of this retrospective cohort study was to evaluate the efficacy of ARP therapy after tooth extraction compared with unassisted socket healing (USH) in reducing the need for ancillary bone augmentation before or at the time of implant placement.

Methods

Adult subjects that underwent non‐molar single tooth extraction with or without simultaneous ARP therapy were included in this study. Cone beam computed tomography scans obtained before tooth extraction and after a variable healing period were used to record the baseline facial bone thickness and to virtually plan implant placement according to a standard method. A logistic regression model was used to evaluate the effect of facial alveolar bone thickness upon tooth extraction and baseline therapy (USH or ARP) on the need for additional bone augmentation, adjusting for several covariates (i.e., age, sex, baseline KMW, and tooth type).

Results

One hundred and forty subjects that were equally distributed between both baseline therapy groups constituted the study population. Implant placement was deemed virtually feasible in all study sites. Simultaneous bone augmentation was considered necessary in 60% and 11.4% of the sites in the USH and ARP group, respectively. Most of these sites (64.2% in the USH group and 87.5% in the ARP group) exhibited a thin facial bone phenotype (<1 mm) at baseline. Logistic regression revealed that the odds of not needing ancillary bone augmentation were 17.8 times higher in sites that received ARP therapy. Furthermore, the need for additional bone augmentation was reduced 7.7 times for every 1 mm increase in facial bone thickness, regardless of baseline therapy.

Conclusions

Based on a digital analysis, ARP therapy, compared with USH, and thick facial alveolar bone largely reduce the need for ancillary bone augmentation at the time of implant placement in non‐molar sites.

The effect of orthodontic extrusion on alveolar bone - a prospective clinical study

Introduction/Objective. Orthodontic extrusion is the procedure for moving the teeth in a vertical, coronal direction. This movement induces changes in the periodontal ligament and the production of new alveolar bone. The objective of the study was to determine the changes on buccal, palatal and interdental alveolar bone as a result of orthodontic extrusion. Methods. Experimental group included 6 patients who received orthodontic treatment with the fixed appliances; the control group included 4 patients without orthodontic treatment. Two cone-beam computed tomography scans (initial and final) were obtained for each patient in both groups. Length of a tooth, shortest distance from tooth?s center of resistance to the referent plane, distance from buccal or palatal plate tip to the enamel-cement junction, the height of interdental septum, buccal and palatal plate vertical gain, buccal and palatal plate thicknesses were measured on initial and final scan in the experimental and control group. Results. The reduced length of the extruded tooth was observed in the experimental group. The distance from buccal and palatal plate tip to the enamel-cement junction, mesial interproximal bone septum and buccal plate gain significantly increased in the experimental group. No significant difference was found in the distal interproximal bone septum, palatal plate gain and buccal/palatal plate thickness between groups. Conclusion. Orthodontic extrusion affects alveolar bone level by gaining the hard tissue buccal and mesial of extruded teeth, while buccal and palatal plate thickness insignificantly changed.

Detailed three-dimensional orthodontic tooth repositioning to improve restorative outcome

The case describes the interdisciplinary treatment of a 23-year-old woman with a Class III malocclusion, missing an upper right lateral incisor, abrasion of the maxillary incisal edges, anterior gingival margin discrepancies, and gingival recession. Initially, the patient was treated with fixed appliances combined with orthognathic surgery. The extraction of the upper left lateral incisor and bilateral canine substitution plan was chosen. At the end of the surgical and orthodontic treatment, the restorative treatment with six veneers was accomplished to improve smile esthetics. Despite the missing lateral incisors, the patient showed a natural, good-looking final result. A symmetric incisal plane was established, a functional occlusion with average vertical and horizontal overlap was set, and the bone scallop and consequently the gingival margins were leveled. The interdisciplinary approach hid all of the initial esthetic defects of the case. The result highlights how to obtain a remarkable improvement of the smile outcome with a well-functioning masticatory system.

Orthodontic Forced Eruption of Permanent Anterior Teeth with Subgingival Fractures: A Systematic Review

(1) Background: To assess orthodontic forced eruption (OFE) as a pre-restorative procedure for non-restorable permanent teeth with subgingival dental hard tissue defects after dental trauma. (2) Methods: A systematic electronic search of three databases, namely, MEDLINE, Cochrane Library, and EMBASE, revealed a total of 2757 eligible publications. Randomized controlled clinical trials (RCT), retro- and prospective clinical studies, or case series (with a minimum of three patients) were reviewed. (3) Results: Thirteen full-text papers were included: one RCT, one prospective clinical trial, two retrospective cohort studies, and nine case series. Within case series, statistical significance between age and cause of fracture (p < 0.03) was determined. The mean extrusion rate of OFE was 1.5 mm a week within a four to six weeks treatment period followed by retention. Three OFE protocols for maxillary single teeth are available: 1. OFE without migration of gingiva and alveolar bone, 2. OFE with gingival migration and slight alveolar bone migration, and 3. OFE with migration of both gingiva and alveolar bone. (4) Conclusions: The current state of the evidence suggests that OFE is a feasible pre-treatment option for non-restorable permanent teeth. OFE can promote the migration of tooth surrounding hard and soft tissues in the esthetic zone. Root resorption does not seem to be a relevant side effect of OFE.

Orthodontic Extrusion vs. Surgical Extrusion to Rehabilitate Severely Damaged Teeth: A Literature Review

The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common treatment choice. However, the survival rate for implants is inferior to teeth, even if severely damaged but properly treated. In order to reestablish a physiological supracrestal tissue attachment of damaged teeth and to arrange an efficient ferrule effect, three options can be considered: crown lengthening, orthodontic extrusion and surgical extrusion. Crown lengthening is considered an invasive technique that causes the removal of part of the bony support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth. The aim of the present narrative review is to compare advantages, disadvantages, time of therapy required, contraindications and complications of both techniques.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.

Peri-implant marginal mucosa defects: Classification and clinical management

Peri-implant marginal mucosa defects (PMMDs) are alterations of the peri-implant soft tissue architecture characterized by an apical discrepancy of the mucosal margin respective to its ideal position with or without exposure of transmucosal prosthetic components or the implant fixture surface. PMMDs may not only represent an esthetic concern but also predispose to biofilm accumulation and subsequent initiation and progression of peri-implant inflammatory diseases. A treatment-driven classification for tooth-bound, facial PMMDs in non-molar sites, consisting of three different levels of complexity, is proposed. Clinical recommendations pertaining to the prosthetic and surgical management of each type of PMMD, illustrated with practical examples, are provided with the purpose of facilitating decision-making processes in daily practice.