Forced eruption. I. A method of treating isolated one and two wall infrabony osseous defects-rationale and case report

Immediate orthodontic treatment after regeneration of periodontal intrabony defects: A long-term retrospective study

BACKGROUND/PURPOSE

Orthodontic movement is often necessary for periodontally compromised patients to enhance esthetics, function, and long-term occlusal stability. However, the impact of orthodontic treatment immediately following the regeneration of intrabony defects on periodontal healing remains a topic of debate. The objective of this long-term case series study was to test the hypothesis that orthodontic treatment performed immediately after regenerative procedures for periodontal intrabony defects did not adversely affect periodontal healing.

MATERIALS AND METHODS

This case series study involved nine periodontally compromised subjects with a total of 17 intra-bony defects. Orthodontic brackets were applied immediately before surgery. Flaps were raised, and diseased roots were debrided. All intra-bony defects were filled with alloplastic bone grafts and covered with resorbable membranes, except for one defect treated with Emdogain. All patients initiated orthodontic treatment immediately after periodontal regenerative surgery. Clinical parameters, including probing depth, attachment level, and bone fill, were assessed at baseline and during final maintenance therapy.

RESULTS

The mean follow-up duration was 12.8 years. None of the 17 surgically regenerated teeth were lost. The mean reduction in probing depth was 3.94 mm (95% confidence level, 3.19-4.68; P < 0.001), with a mean clinical attachment gain of 3.47 mm (95% confidence level, 2.90-4.03; P < 0.001). The mean radiographic bone fill was 4.89 mm (P < 0.001).

CONCLUSION

Based on the findings of this long-term case study, it can be concluded that immediate orthodontic treatment does not adversely affect the maturation process of periodontal regeneration outcomes and can be maintained for more than ten years.

Effect of orthodontic forced eruption for implant site development in the maxillary esthetic zone: A systematic review of clinical data

Dental implant placement in the esthetic zone is associated with challenges for clinicians. The best esthetic outcome of this procedure can be obtained through precise management of hard and soft tissue. Orthodontic forced eruption (OFE) has presented an alternative approach to augment hard and soft tissues, which can be applied rapidly or slowly. OFE of hopeless teeth with its periodontal attachment results in a favorable implant preparation site. Therefore, the present systematic review evaluated the effect of implant site preparation using OFE in hopeless teeth. A complete electronic search was performed in PubMed/MEDLINE, Scopus, and Google Scholar from June 2020 to November 2023. The search was limited to clinical English language studies. Studies were excluded if OFE was performed without implant placement. Finally, 15 studies with a total of 21 teeth, all located in the maxillary anterior region, were included in this study. In eight studies, bone grafting procedures were performed before implant placement. Using OFE could rapidly prepare the implant site by enhancing hard and soft tissues. However, additional interventions like guided bone regeneration should be considered case-dependent.

Periodontal considerations during orthodontic intrusion and extrusion in healthy and reduced periodontium

In patients with advanced periodontal disease, pathological tooth migration may occur, which may require subsequent orthodontic treatment for both aesthetic and functional purposes. When planning orthodontic treatment mechanics, intrusive or extrusive forces are frequently indicated. Understanding tissue reactions during these movements is essential for clinicians when devising a comprehensive orthodontic-periodontal treatment plan. This knowledge enables clinicians to be fully aware of and account for the potential effects on the surrounding tissues. The majority of our understanding regarding the behavior of periodontal tissues in both healthy and compromised periodontal conditions is derived from animal studies. These studies offer the advantage of conducting histological and other assessments that would not be feasible in human research. Human studies are nevertheless invaluable in being able to understand the clinically relevant response elicited by the periodontal tissues following orthodontic tooth movement. Animal and human data show that in dentitions with reduced periodontal support, orthodontic intrusion of the teeth does not induce periodontal damage, provided the periodontal tissues do not have inflammation and plaque control with excellent oral hygiene is maintained. On the contrary, when inflammation is not fully controlled, orthodontic intrusion may accelerate the progression of periodontal destruction, with bacterial plaque remnants being displaced subgingivally, leading to further loss of attachment. Orthodontic extrusion, on the other hand, does not seem to cause further periodontal breakdown in dentitions with reduced periodontal support, even in cases with deficient plaque control. This is attributed to the nature of the tooth movement, which directs any plaque remnants coronally (supragingivally), reducing the risk of adverse effects on the periodontal tissues. This specific type of tooth movement can be leveraged to benefit periodontal conditions by facilitating the regeneration of lost hard and soft periodontal tissues in a coronal direction. As a result, orthodontic extrusion can be employed in implant site development, offering an advantageous alternative to more invasive surgical procedures like bone grafting. Regardless of the tooth movement prescribed, when periodontal involvement is present, it is essential to prioritize periodontal therapy before commencing orthodontic treatment. Adequate plaque control is also imperative for successful outcomes. Additionally, utilizing light orthodontic forces is advisable to achieve efficient tooth movement while minimizing the risk of adverse effects, notably root resorption. By adhering to these principles, a more favorable and effective combined orthodontic-periodontal approach can be ensured. The present article describes indications, mechanisms, side effects, and histological and clinical evidence supporting orthodontic extrusion and intrusion in intact and reduced periodontal conditions.

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.

Orthodontic tooth extrusion to regenerate missing papilla adjacent to maxillary anterior single implants: A 2- to 7-year retrospective study

INTRODUCTION

Regeneration of the missing papilla adjacent to single implants in the esthetic zone has always been challenging, despite advances in vertical hard and soft tissue regeneration. Orthodontic tooth extrusion has been shown to effectively gain alveolar bone and gingival tissue. This retrospective study evaluated the effectiveness of orthodontic tooth extrusion on regenerating missing papilla between existing maxillary anterior single implant and its adjacent tooth.

METHODS

Patients who underwent orthodontic tooth extrusion to regenerate missing papilla adjacent to a single implant in the esthetic zone were included in this study. The gingival phenotype, orthodontic extrusion movement, proximal bone level, dento-implant papilla level, facial gingival level, mucogingival junction level, and keratinized tissue width, of the extruded tooth were recorded at pre-orthodontic extrusion (T0 ), post-orthodontic extrusion and retention (T1 ), and latest follow-up (T2 ).

RESULTS

A total of 17 maxillary single tooth had orthodontic tooth extrusion to regenerate missing papilla adjacent to 14 maxillary anterior single implants in 14 patients. After a mean follow-up time of 48.4 months, implant success rate was 100% (14/14), with none of the orthodontically extruded teeth being extracted. After a mean extrusion and retention period of 14.3 months, a mean orthodontic extrusion movement of 4.62 ± 0.78 mm was noted with a mean proximal bone level gain of 3.54 ± 0.61 mm (77.0% efficacy), dento-implant papilla level gain of 3.98 ± 0.81 mm (86.8% efficacy), and facial gingival tissue gain of 4.27 mm ± 0.55 mm (93.4% efficacy). A mean keratinized tissue width gain of 4.17 ± 0.49 mm with minimal mean mucogingival junction level change of 0.10 ± 0.30 mm were observed. The efficacy of orthodontic eruption movement on dento-implant papilla gain was less in the thin (80.5%) phenotype group when compared with that in the thick (91.5%) phenotype group.

CONCLUSIONS

Within the confines of this study, orthodontic extrusion is an effective, noninvasive method in regenerating mid-term stable proximal bone and papilla adjacent to maxillary anterior single implants.

CLINICAL SIGNIFICANCE

This retrospective study presents a mid-term result on orthodontic extrusion as a mean to regenerate dento-implant papilla defect. The extended retention period following orthodontic extrusion showed stable and efficacious proximal bone and papilla gain.

Orthodontic treatment in patients with periodontitis - a narrative literature review

Patients with periodontitis often require an inter-disciplinary approach, including orthodontic treatment, for effective rehabilitation of masticatory function, aesthetics and quality of life. The aim of this narrative review was to comprehensively discuss literature focusing on the biology, indications and inter-disciplinary connections related to the orthodontic approach in patients with periodontitis and to present clinical concepts in accordance with valid guidelines. The outcomes of the experimental studies indicate that orthodontic tooth movement (OTM) can be performed safely for teeth with reduced periodontium, provided infection and inflammation are controlled. Orthodontic treatment can correct pathological tooth migration, is not associated with deterioration of clinical periodontal parameters and improves aesthetics. Intrusion is safe when performed with light forces and under a strict oral hygiene regimen. Teeth can be moved either towards or away from the intrabony defect previously subjected to regenerative procedures, and research suggests that OTM has the potential to enhance bone formation after regenerative therapy. The data on orthodontic movement of teeth with furcation involvement are very scarce. The improvement in furcation involvement following either combined periodontal and orthodontic treatment was only documented in animal model studies. Due to bone and tooth loss, special consideration should be given to orthodontic treatment mechanics. © 2023 Australian Dental Association.

Perception of Undergraduates in the Field of Periodontology

The dentistry specialty known as periodontology focuses on problems with the tissues that support and surround teeth. A thorough understanding of basic sciences and health care is necessary for periodontology. To ensure that the dentition has adequate form, function, esthetics, and comfort, it is essential to have a thorough understanding of the relationship between periodontal tissues and how it relates to other branches of dentistry, such as restorative dentistry, orthodontics, prosthodontics, and implants. The periodontal ligament is a soft tissue between the alveolar bone and teeth. Since the alveolar bone is the foundation for successful dental treatment, proceeding with subsequent dental procedures, including restorative dentistry, implants, and prosthetic uses, is only possible with sufficient bone support. The current review article aims to assess the perception of undergraduate students regarding periodontics and its range of practice. It also gives a general overview of the field of periodontology by outlining current practices, exploring how students perceive this branch's range of courses, and emphasizing more recent and sophisticated developments.

Conservative Approach for Traumatic Anterior Crown-Root Fractured Teeth by Orthodontic Extrusion using Customized Mini-Tube Appliance: A Clinical Review

A complicated crown-root fracture is a fracture involving enamel, dentin, cementum, and pulp. Because crown fracture generally extends below the gingival margin, several options may be indicated to expose the margins before permanent restoration. Among them, orthodontic extrusion is the most non-invasive treatment option. In this case report, a case of traumatic crown-root fracture of the maxillary incisor was managed by root canal treatment with fiber-reinforced ceramic post-placement followed by orthodontic extrusion using a customized mini-tube appliance technique. Then, the porcelain fused zirconia crown was restored. Traumatized orthodontic extruded teeth have shown a reliable prognosis without inflammatory signs nor complications after a 15-month follow-up.

Orthodontic treatment in periodontally compromised patients: a systematic review

OBJECTIVES

The aim of this systematic review was to examine the literature on aggressive and chronic periodontitis and orthodontics to clarify the therapy-relevant aspects of orthodontic treatment with altered biomechanics in periodontally compromised dentition.

MATERIALS AND METHODS

Literature searches were conducted in the electronic databases "PubMed" and "DIMDI" using the keywords "aggressive periodontitis AND ortho*," "aggressive periodontitis AND orthodontics," "chronic periodontitis AND ortho*," and "chronic periodontitis AND orthodontics" for the publication period from January 1990 to July 2022. In addition, a manual search was carried out in the selected trade journals "Community Dental Health," "European Journal of Oral Sciences," and "Parodontologie." Human clinical trials were included, whereas animal experimental studies, case reports, and reviews were generally excluded. The appropriate studies were selected, and the relevant data was tabulated according to different parameters, regarding the study design, the study structure, and the conduct of the study.

RESULTS

A total of 1067 articles were found in the preliminary electronic search. The manual search and review of all related bibliographies resulted in an additional 1591 hits. After the first screening, 43 articles were classified as potentially relevant and reviewed in their original form. After the suitability test, 5 studies with a total of 366 participants were included in the final evaluation. These included one randomized controlled trial and four low-evidence intervention studies. The studies were conducted in two university hospitals and three private practices. All participants underwent scaling and root plaining and periodontal surgery before the orthodontic treatment started. Mean probing pocket depth reduction before and after the interdisciplinary treatment was analyzed in all the included studies; mean difference in clinical attachment level in four of the studies was also included. All participants were enrolled in a continuous recall system. In all studies, orthodontic therapy in periodontally compromised patients improved function and esthetics, resulting in lower probing depths and clinical attachment gains.

CONCLUSIONS

Orthodontic treatment can be used for patients with reduced periodontal support to stabilize clinical findings and improve function and esthetics. The prerequisite for this is a profound knowledge of altered biomechanics and an adapted interdisciplinary treatment approach. Due to the large heterogeneity of the included studies and their limited methodological quality, the results obtained in this review must be considered critically. Further randomized controlled long-term studies with comparable study designs are necessary to obtain reliable and reproducible treatment results.

CLINICAL RELEVANCE

Patients with periodontal impairment can be successfully treated with orthodontics as part of interdisciplinary therapy. Orthodontic treatment has no negative impact on the periodontium; if minimal, controlled forces are used under non-inflammatory conditions.

Periodontal and Orthodontic Synergy in the Management of Stage IV Periodontitis: Challenges, Indications and Limits

This retrospective study described the clinical and radiographic long-term outcomes of combined periodontal and orthodontic treatment (OT) with fixed appliances in patients with Stage IV periodontitis and pathologic tooth migration (PTM) in the anterior sextants. OT was performed in either one or both arches, using tooth-supported or skeletal anchorage, following completion of active periodontal treatment and accurate planning of tooth movement biomechanics. Twenty-nine patients were identified and retrospectively examined when presenting for a supportive periodontal care (SPC) appointment. The mean SPC duration was 8.9 years (range 5 to 12 years). All anterior-migrated teeth showed statistically significant periodontal improvement compared to baseline values and stable radiographic bone levels at the final follow-up. Residual probing depths were 2.9 ± 0.5 mm at the end of active periodontal treatment, and they remained stable at the completion of OT (2.9 ± 0.6 mm) and at the last follow-up visit (2.8 ± 0.5 mm). These findings suggest that OT is a safe and effective treatment in improving the long-term prognosis of teeth with PTM in Stage IV periodontitis provided that periodontal health has been re-established and maintained with individualized SPC sessions.

Implant Site Changes in Three Different Clinical Approaches: Orthodontic Extrusion, Regenerative Surgery and Spontaneous Healing after Extraction: A Systematic Review

Both surgical and non-surgical techniques are employed for implant site development. However, the efficacy of these methods has not been thoroughly evaluated and compared. This systematic review aims to compare the biologic, functional and esthetic outcomes of three different approaches before implant placement in both the maxillary and mandibular arches: orthodontic extrusion, regenerative surgery and spontaneous healing after extraction. The systematic research of articles was conducted up to January 2020 in Medline, Scopus and the Cochrane Library databases. Studies were selected in a three-stage process according to the title, the abstract and the inclusion criteria. The methodological quality and the risk of bias of the included studies were evaluated using ROBINS-I tools for non-randomized studies, Rob 2.0 for RCT. Quality evaluation of case reports was performed using CARE guidelines. Through the digital search, 1607 articles were identified, and 25 of them were included in the systematic review. The qualitative evaluation showed a good methodological quality for RCT, sufficient for non-randomized studies and poor for case reports. Based on the available results, both orthodontic extrusion and regenerative surgery allowed the development of the implant site with satisfying esthetic and functional outcomes. Studies about the spontaneous healing of the extraction socket showed resorption of the edentulous ridge, which complicated the implant insertion. No study referred to failures or severe complications. Most of the studies reported only qualitative results. The present systematic review demonstrated that there is a substantial lack of data and evidence to determine which of the presented methods is better for developing a future implant site. Both surgical and non-surgical procedures appear effective in the regeneration of hard tissue, whereas not all the techniques can improve soft tissue volume, too. The orthodontic technique simultaneously enhances both hard and soft tissue.

Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review

Dietschi and Spreafico first proposed deep margin elevation (DME) in 1998 to address the multiple clinical problems associated with sub-gingival margins, where sub-gingival margins will be repositioned coronally using composite resin restorations. Given that dentistry is directing towards conservatism, its use is currently trending. Materials and Methods: a search was performed through PubMed, Scopus, and Google Scholar search engines to obtain relevant articles with no time restriction. Results: With biological width taken into consideration, well-defined and polished sub-gingival restorations are compatible with periodontal health. Marginal integrity in the DME technique seems to be affected by the type of adhesive, restoration, and incremental layering of the restoration. Regarding fracture resistance, DME has no significant effects. Conclusion: The DME technique seems to be a minimally invasive alternative to surgical crown lengthening (SCL) and orthodontic extrusion (OE) with respect to biological width. Well-controlled clinical trials are limited in this field; further long-term follow-up studies emphasizing the periodontal outcomes and prevention of complications are needed.

Clinical Considerations in Orthodontically Forced Eruption for Restorative Purposes

For restorations on teeth involving invasion of the supracrestal tissue attachment (biological width), as well as for lack of ferrule effect, crown lengthening is required for long-term periodontal health and success of the restoration. In the same fashion, site development is often necessary prior to implant placement in order to provide optimal peri-implant soft and hard tissue architecture conducive to future esthetics and function. Orthodontic extrusion, also known as forced eruption, has been developed and employed clinically to serve the purposes of increasing the clinical crown length, correcting the periodontal defect, and developing the implant site. In order to provide comprehensive guidance on the clinical usage of this technique and maximize the outcome for patients who receive the dental restoration, the currently available literatures were summarized and discussed in the current review. Compared to traditional crown lengthening surgery, forced eruption holds advantages of preserving supporting bone, providing improved esthetics, limiting the involvement of adjacent teeth, and decreasing the negative impact on crown-to-root ratio compared to the traditional resective approach. As a non-invasive and natural technique capable of increasing the available volume of bone and soft tissue, forced eruption is also an attractive and promising option for implant site development. Both fixed and removable appliances can be used to achieve the desired extrusion, but patient compliance is a primary limiting factor for the utilization of removable appliances. In summary, forced eruption is a valuable treatment adjunct for patients requiring crown lengthening or implant restorations. Nonetheless, comprehensive evaluation and treatment planning are required for appropriate case selection based upon the known indications and contraindications for each purpose; major contraindications include inflammation, ankylosis, hypercementosis, vertical root fracture, and root proximity. Further studies are necessary to elucidate the long-term stability of orthodontically extruded teeth and the supporting bone and soft tissue that followed them.

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.

Pre-endodontic restoration of structurally compromised teeth: current concepts

Teeth that require endodontic treatment are often structurally compromised and this considerably complicates endodontic procedures. Therefore, pre-endodontic restoration is a key approach that dentists should consider for such teeth. This article discusses current concepts of pre-endodontic restoration, with a focus on adhesive restorative methods and surgical/orthodontic techniques, and provides a relevant decision-making flowchart.

Highlights the importance of pre-endodontic restoration for the predictability of endodontic treatment.

Discusses restorability aspects for structurally compromised teeth.

Reviews current restorative and surgical/orthodontic techniques for pre-endodontic restoration and provides a decision-making flowchart.

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.

A Pilot Retrospective Study on the Effect of Bone Grafting after Wisdom Teeth Extraction

This study aimed to retrospectively investigate the effect of bone graft after extraction of wisdom teeth impacting with the distal aspect of the second molar, on soft tissue wound healing, bone loss, and periodontal parameters. Sixteen patients treated an for impacted mandibular wisdom tooth at least one year ago were re-called (18 teeth). Dental panoramic tomography and periodontal parameters were assessed. A graft material was used to fill the post-extractive sockets in the test group (GUIDOR easy-graft CRYSTAL), whereas in the control group, the socket was filled using a collagen sponge and blood clot (Hemocollagene, Septodont, Matarò, Spain). The radiographic bone loss was measured at the distal aspect of the second molar. The Wilcoxon singed-rank test for paired data was performed to evaluate statistical differences. In the test group, only two cases out of nine showed bone loss, with an average of 0.55 ± 1.30 mm. Conversely, in the control group, five teeth out of nine showed bone resorption with an average of 1.22 ± 1.30 mm. However, the differences were not statistically significant. Periodontal parameters at the second molar demonstrated similar behavior between the test and control groups. Soft tissue healing complications were lower in the grafted compared to the comparator sites without reaching statistical significance. Within the limitations of the present study, no difference was found between the two groups.

Alveolar ridge alterations in the maxillary anterior region after tooth extraction through orthodontic forced eruption for implant site development: a clinical CBCT study

OBJECTIVE

To investigate the effects of orthodontic forced eruption (OFE) with the straight-wire appliance in the dimensions of the alveolar process when used for extracting compromised maxillary anterior teeth and implant site development.

MATERIAL AND METHODS

Cone-beam computed tomography (CBCT) scans of 7 patients needing extraction of 17 maxillary anterior teeth were obtained before and immediately after OFE. Alveolar plate height and thickness measurements were performed on the buccal and palatal socket walls in CBCT sagittal cross sections. Statistical analysis included sample size calculation, paired t-test, and Wilcoxon test to evaluate alveolar plate dimensional changes and linear regression analysis to assess whether bone changes and the feasibility of implant insertion were associated to tooth type and root length, baseline alveolar plate thickness, and age.

RESULTS

OFE caused statistically significant reduction of the buccal alveolar plate height (1.95 ± 1.83 mm) and significant increase of the palatal alveolar plate height (1.31 ± 2.41 mm) in the central tooth socket areas. Buccal reduction was associated positively to the baseline root length and negatively to the thickness of the corresponding plate in the apical level. A non-significant increase was noted in both buccal (0.23 ± 0.93 mm) and palatal (0.63 ± 1.59 mm) proximal bone. Inadequate buccal bone support hindered immediate implant placement in six sockets; however, all inserted implants showed adequate and gradually increasing stability from insertion to final restoration.

CONCLUSIONS

OFE resulted in favourable increase in the heights of the palatal and proximal alveolar bone and significant reduction in the buccal plate height, which inhibited implant placement in 35% of the treated sockets.

Predictability of a New Orthodontic Extrusion Technique for Implant Site Development: A Retrospective Consecutive Case-Series Study

In clinical daily practice, there are situations in which implant sites have vertical and/or horizontal bone defects and often we must improve their morphology and dimensions before fixture insertion. It is crucial to carefully evaluate the surgical site as regards the characteristics of both hard and soft tissues. The orthodontic extrusion technique can be used for nonsurgical augmentation of the implant site as an alternative to traditional regenerative/reparative surgical therapies. The orthodontic extrusion is based on a biological mechanism that uses the portion of periodontal ligament, still present on the root before the tooth extraction, for the increase of hard and soft tissues. In the literature, there is no evidence of common guidelines for this technique but only tips based on personal experience and/or previous studies. The aim of this study was to investigate and to validate the reliability of a new orthodontic extrusion technique (MF Extrusion Technique, by Dr. Mauro Fadda) by means of a retrospective consecutive case-series study. After we have done a review of the literature, we evaluated the X-rays of twelve consecutively treated patients before the orthodontic extrusion (T0) and after the stabilization period (T1), in order to quantify, by two different measurements, area and linear, the bone gain obtained by the application of the new technique. All the patients examined showed a significant increase in bone areas with an average value of 31.575 mm². The linear bone gain had an average value of 4.63 mm. Data collected were statistically analysed by the Wilcoxon signed-rank test. The results obtained both from area and linear measurements at T0 and at T1 times showed that there was a statistically significant bone gain with p < 0.01.

Staged orthodontic treatment in preparation for immediate implant placement: A clinical report with a 5-year follow-up

Anterior implant restoration is one of the most challenging restorative procedures, especially for sites with vertical and/or horizontal hard and soft tissue deformities. Orthodontic extrusion before implant placement may be the best means of overcoming vertical deficiencies. This article describes a modification to the standard technique, involving staged orthodontic extrusion and buccal root torque. The main advantage of this modification is that it encourages bone and soft tissue development, thereby allowing the patient to receive immediate or early implant treatment. A clinical procedure is presented to illustrate the modified technique that resulted in an esthetically pleasing and stable 5-year outcome.

Orthodontic-periodontal interactions: Orthodontic extrusion in interdisciplinary regenerative treatments

Orthodontics is a periodontal treatment. "Guided orthodontic regeneration" (GOR) procedures use orthodontic movements in perio-restorative patients. The GOR technique includes a guided orthodontic "soft tissue" regeneration (GOTR) and a guided orthodontic "bone" regeneration (GOBR) with a plastic soft tissue approach and a regenerating reality. The increased amount of soft tissue gained with orthodontic movement can be used for subsequent periodontal regenerative techniques. The increased amount of bone can as well improve primary implant stability and, eventually, simplify a GTR technique to regenerate soft tissues, to restore tooth with external resorption in aesthetic zone or to extract a tooth to create new hard-soft tissue for adjacent teeth.

A longitudinal study on timing and velocity of rat molar eruption: Timing of rat molar eruption

Rat molar eruption and occlusion data were compiled from several studies but several inconsistencies were found, rendering the planning of eruptional studies difficult and imprecise. Our aim was to measure eruption and occlusion days, as well as eruption velocity, in the upper and lower three molars from infancy to end of adolescence in the rat. A total of 19 male and female Wistar rats were scanned daily by micro-computed tomography (CT) from day 15 to 70. We measured the eruption of all maxillary and mandibular molars with reference points at the hard palate and mandibular canal at three stages: pre-emergent, pre-occlusal, and functional. Statistical analysis was performed with a mixed-model analysis of variance (ANOVA) and a Sidak post hoc test. The first molar erupts on average on day 17, the second molar on day 20, and the third molar on day 33. The eruption velocity of the first molar was the highest at 90.9 microns/day (standard error (se) = 12.80), followed by the second molar at 65.9 microns/day (se = 5.80), and the lowest was the third at 47.0 microns/day (se = 3.28), ( p < 0.001). On average, the pre-occlusal phase had the highest velocity at 97.2 microns/day (se = 1.72), the pre-emergent was lower at 84.9 (se = 2.29), and the functional was the lowest at 21.7 (se = 0.45), ( p < 0.001). The eruption rate decreased from the first to third molar and was also different between phases: the pre-occlusal phase had the highest rate, closely followed by the pre-emergent phase while the functional eruption rate was significantly lower than the other phases.

Decision-Making for Residual Periodontal Pockets after Aetiological Treatment

The practitioner may have difficulties making decisions regarding the most appropriate therapeutic approach in the case of the persistence of periodontal pockets after initial periodontal treatment. Several options may be considered: aetiologic retreatment, maintenance, surgery of the pocket or extraction of the tooth for strategic reasons or when the conservation of the tooth is impossible. There are no clear guidelines for the treatment decision. The aim of this article is to present the main factors involved in making a treatment decision. An algorithm and its background rationale are presented to help the practitioner make a decision about residual periodontal pockets after aetiological treatment.

Guided orthodontic regeneration: A tool to enhance conventional regenerative techniques in implant surgery

A hopeless upper central incisor was subjected to forced eruption before implant substitution to improve and develop the amount of soft tissue. This involved a GBR to insert the implant and a GTR to regenerate the tissue around the dehiscence of the nearby lateral using a "Guided Orthodontic Regeneration" (GOR) approach. The extrusion was performed esthetically in lingual orthodontics. The GOR technique included a Guided Orthodontic "Bone" Regeneration (GOBR) and a Guided Orthodontic "Soft Tissue" Regeneration (GOTR). This developed a 3D implant site while correcting the osseous defects and increasing the amount of soft tissue, which was used for a subsequent regenerative technique.

Periodontal regeneration - intrabony defects: a systematic review from the AAP Regeneration Workshop

BACKGROUND

Previous systematic reviews of periodontal regeneration with bone replacement grafts and guided tissue regeneration (GTR) were defined as state of the art for clinical periodontal regeneration as of 2002.

METHODS

The purpose of this systematic review is to update those consensus reports by reviewing periodontal regeneration approaches developed for the correction of intrabony defects with the focus on patient-, tooth-, and site-centered factors, surgical approaches, surgical determinants, and biologics. This review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews. A computerized search of the PubMed and Cochrane databases was performed to evaluate the clinically available regenerative approaches for intrabony defects. The search included screening of original reports, review articles, and reference lists of retrieved articles and hand searches of selected journals. All searches were focused on clinically available regenerative approaches with histologic evidence of periodontal regeneration in humans published in English. For topics in which the literature is lacking, non-randomized observational and experimental animal model studies were used. Therapeutic endpoints examined included changes in clinical attachment level, changes in bone level/fill, and probing depth. For purposes of analysis, change in bone fill was used as the primary outcome measure, except in cases in which this information was not available. The SORT (Strength of Recommendation Taxonomy) grading scale was used in evaluating the body of knowledge.

RESULTS

1) Fifty-eight studies provided data on patient, tooth, and surgical-site considerations in the treatment of intrabony defects. 2) Forty-five controlled studies provided outcome analysis on the use of biologics for the treatment of intrabony defects.

CONCLUSIONS

1) Biologics (enamel matrix derivative and recombinant human platelet-derived growth factor-BB plus β-tricalcium phosphate) are generally comparable with demineralized freeze-dried bone allograft and GTR and superior to open flap debridement procedures in improving clinical parameters in the treatment of intrabony defects. 2) Histologic evidence of regeneration has been demonstrated with laser therapy; however, data are limited on clinical predictability and effectiveness. 3) Clinical outcomes appear most appreciably influenced by patient behaviors and surgical approach rather than by tooth and defect characteristics. 4) Long-term studies indicate that improvements in clinical parameters are maintainable up to 10 years, even in severely compromised teeth, consistent with a favorable/good long-term prognosis.

Surgical extrusion of multiple teeth with crown-root fractures: a case report with 18-months follow up

The objective of this case report is to describe the treatment procedure involved in surgical extrusion of multiple crown-root fractures and review the critical factors to be considered for successful and predictable outcome. The treatment of complicated crown-root fracture in anterior teeth is likely to compromise function and aesthetics when approached with conventional surgical crown lengthening. Orthodontic extrusion has also been suggested; however, it is time-consuming, aesthetically compromising and hardly applicable on multiple anterior crown-root fractures due to the limited source of anchorage. To overcome the shortcomings of suggested treatment modalities, we performed atraumatic surgical extrusion of four anterior fractured teeth along with their rotation within the sockets. The teeth were gently luxated and extruded to the desired position, minimizing damage to the marginal alveolar bone and root surfaces without rigid splint. The treated teeth were functioning normally 18 months after the procedure, and the mobility and probing depths were within normal limits. Radiographs revealed functional periodontal ligament space along with lamina dura formation around the extruded roots. There was neither root resorption nor significant marginal bone loss. This technique might be a promising alternative to conventional crown lengthening, especially in the anterior zone to avoid functional or aesthetic complications.

The trimeric model: a new model of periodontal treatment planning

Treatment of periodontal disease is a complex and multidisciplinary procedure, requiring periodontal, surgical, restorative, and orthodontic treatment modalities. Several authors attempted to formulate models for periodontal treatment that orders the treatment steps in a logical and easy to remember manner. In this article, we discuss two models of periodontal treatment planning from two of the most well-known textbook in the specialty of periodontics internationally. Then modify them to arrive at a new model of periodontal treatment planning, The Trimeric Model. Adding restorative and orthodontic interrelationships with periodontal treatment allows us to expand this model into the Extended Trimeric Model of periodontal treatment planning. These models will provide a logical framework and a clear order of the treatment of periodontal disease for general practitioners and periodontists alike.

Intentional passive eruption combined with scaling and root planing of teeth with moderate chronic periodontitis and traumatic occlusion

PURPOSE

The aim of this clinical trial was to explore the impact of intentional passive eruption (IPE) using occlusal reduction on the periodontal parameters of teeth with moderate chronic periodontitis and traumatic occlusion.

METHODS

This study was performed on 40 teeth from 16 subjects. At baseline, 4 weeks after initial periodontal treatment, and 6 months after IPE, clinical and radiographic examinations were performed. The 20 teeth in the test group underwent IPE using occlusal reduction, whereas the 20 control teeth did not undergone occlusal reduction.

RESULTS

All the periodontal parameters were improved by the initial periodontal treatment. The teeth in the test group showed a significantly greater decrease in pocket depth, tooth mobility, and marginal bone loss than did the control group (P<0.05), but there were no significant changes in the attachment level. Significantly greater improvements in all the parameters were observed in the test group after 6 months of IPE compared to 4 weeks after the initial periodontal treatment (P<0.05).

CONCLUSIONS

Within the limits of this study, performing initial periodontal therapy combined with IPE using occlusal reduction was shown to be very simple and effective. Moreover, IPE would be helpful in improving periodontal parameters.

Multidisciplinary treatment approach to restore deep horizontally fractured maxillary central incisor

This case report demonstrates sequential periodontic, orthodontic and prosthodontic treatment modalities to save and restore deep horizontally fractured maxillary central incisor. The location of fracture was deep in the mucosa which reveals less than 2 mm of tooth structure to receive the crown. The procedures like surgical crown lengthening, endodontic post placement, orthodontic forced eruption, core build-up and metal-ceramic crown restoration were sequentially performed to conserve the fractured tooth. Forced eruption is preferred to surgical removal of supporting alveolar bone, since forced eruption preserves the biologic width, maintains esthetics, and at the same time exposes sound tooth structure for the placement of restorative margins.

An esthetic appliance for the management of crown-root fracture: a case report

Orthodontic extrusion is usually performed by means of a fixed orthodontic appliance that utilizes arch wire attached to adjacent teeth and transfers the desired force by elastic from the wire to the root. However, clinicians often encounter cases where the bonding required for tooth traction is not possible because the adjacent teeth have been restored with ceramic or veneer. The purpose of this case report is to describe a modified orthodontic extrusion appliance that is useful when conventional orthodontic treatment is not possible. The modified appliance was fabricated using an artificial tooth, clear plastic sheeting, and a braided fiber-reinforced composite strip that covered adjacent teeth without bonding. It satisfied the esthetic and functional needs of the patient and established the optimal biologic width.

Creating labial bone for immediate implant placement: a minimally invasive approach by using orthodontic therapy in the esthetic zone

Orthodontic extrusion of nonrestorable teeth has been used for almost 20 years as an alternative to bone grafting in preparation for implant placement. Although this technique predictably creates bone and soft tissue, and improves the socket diameter and depth, most of the bone apposition occurs in the marginal alveolar and periapical areas of the extruded tooth. To create more labial bone, the standard orthodontic extrusion technique was modified to apply pressure on the hopeless tooth both coronally and palatally, which allowed bone at the site to develop apically and labially. Gingival thickness on the labial aspect was also increased, and the tissue biotype was improved. A clinical treatment is presented that illustrates the use of this technique.

Orthodontic-periodontic intervention of pathological migration of maxillary anterior teeth in advanced periodontal disease

This case report presents a female patient whose chief complaint was of mobile and palatally drifted upper left central incisor which led to malalignment of upper anterior teeth. Orthodontic treatment of upper left central incisor was done with the help of 'Z' spring for the alignment of the upper anterior teeth. It was followed by splinting of upper anterior teeth to improve the stability and masticatory comfort. Regenerative periodontal surgery with Decalcified freeze dried bone allograft was done in relation to upper left central incisor.

Short clinical crowns (SCC) - treatment considerations and techniques

When the clinical crowns of teeth are dimensionally inadequate, esthetically and biologically acceptable restoration of these dental units is difficult. Often an acceptable restoration cannot be accomplished without first surgically increasing the length of the existing clinical crowns; therefore, successful management requires an understanding of both the dental and periodontal parameters of treatment. The complications presented by teeth with short clinical crowns demand a comprehensive treatment plan and proper sequencing of therapy to ensure a satisfactory result. Visualization of the desired result is a prerequisite of successful therapy. This review examines the periodontal and restorative factors related to restoring teeth with short clinical crowns. Modes of therapy are usually combined to meet the biologic, restorative, and esthetic requirements imposed by short clinical crowns. In this study various methods for treating short clinical crowns are reviewed, the role that restoration margin location play in the maintenance of periodontal and dental symbiosis and the effects of violation of the supracrestal gingivae by improper full-coverage restorations has also been discussed.

Key words:Short clinical crown, surgical crown lengthening, forced eruption, diagnostic wax up, alveoloplasty, gingivectomy.

Multidisciplinary management of a fractured premolar: a case report with followup

The general dental practitioner must consider orthodontic extrusion of a tooth when a subgingival defect, such as, crown fracture occurs before prosthetic rehabilitation, especially in the aesthetic zone. Extrusion enables the root portion to be elevated which exposes sound tooth structure for placement of restorative margins. This case report describes the multidisciplinary management of a fractured upper first premolar in a general dental practice. The forced orthodontic eruption is achieved by an endodontic attachment and sectional fixed appliance with an offset placed in the wire. The ability to extrude premolars with this method is complicated by heavy occlusal forces, occlusal interferences, and short clinical crown length. The tooth was restored with a titanium post, composite core, and porcelain fused to metal crown. The entire course of treatment was carried out under National Health Scheme, UK and as a part of vocational training. The 21 months followup showed no change in occlusal contacts or gingival level.

Implant site development by orthodontic forced eruption of nontreatable teeth: a case report

Background:

Loss of bone and soft tissue attachment are common sequelae of periodontitis that may jeopardize the aesthetic outcome and compromise the functional and aesthetic outcomes of treatment. The following case report describes one of the most predictable techniques of vertical ridge augmentation, which is orthodontic extrusion or forced eruption of hopeless teeth.

Method:

A 34-year-old woman who presented with severe attachment loss and deep pockets was diagnosed with generalized aggressive periodontitis. The mobile maxillary incisors were consequently extracted and were replaced with dental implants. However, prior to extraction, orthodontic extrusion of the hopeless incisors was performed to correct vertical ridge defects. Following extrusion and extraction of the maxillary incisors, to prevent soft tissue collapse and to preserve the papillae during socket healing, the crowns of the extracted teeth were used as pontics on a removable partial provisional denture. After 8 weeks, the implants were placed, and an immediate functional restoration was delivered. After 4 months of healing, a fixed definitive partial prosthesis was fabricated and delivered.

Result:

After periodontal treatment, over a 2-year period, the progression of aggressive periodontitis was controlled. The mean vertical movement of marginal bone was 3.6 mm. The use of the crowns of extracted teeth appears to be an effective method to maintain papillae.

Conclusions:

Orthodontic extrusion is a predictable method for the correction of vertical ridge defects. Orthodontic treatment does not aggravate or hasten the progression of aggressive periodontitis.