Staged Approach Involving Orthodontic Implant Site Development with Labial Root Torque and Guided Bone Regeneration; 3-Year Follow-up Case Report

Restoring periodontally compromised teeth in aesthetic zones through dental implant rehabilitation poses significant challenges due to the loss of supporting tissues. This case report describes a staged treatment strategy designed for a 48-year-old woman with advanced chronic periodontitis of the aesthetic zone. This approach combined various advanced techniques, including periodontal regeneration, orthodontic implant site development with labial root torque, guided bone regeneration, and soft tissue augmentation. The innovative orthodontic implant site development with labial root torque technique was employed to harness healthy palatal periodontal ligament cells by strategically applying labial root torque in the horizontal labial-palatal direction. This technique uses healthy palatal periodontal ligament cells, which benefits overall periodontal health. The procedure involved gradually shifting hopeless teeth at a rate of 2 mm per month using nickel-titanium wires, thereby maintaining overcorrection for two months before extraction. Following successful orthodontic implant site development with labial root torque, the next phase involved guided bone regeneration using a honeycomb-structured titanium membrane. This set the stage for implant placement six months later, ensuring a stable foundation for subsequent prosthetic intervention. Soft tissue augmentation was then meticulously performed using an artificial collagen dermis infused with fibroblast growth factor-2, contributing to the overall aesthetic outcome. Final prosthesis integration revealed a harmonious blend with the adjacent teeth and gums, underscoring the success of this multidisciplinary approach. This case report provides valuable insights into severe periodontitis in the aesthetic field. Our findings highlight the importance of continuously researching and improving procedures for optimal patient care.

Immediate loading of implants inserted through impacted teeth in the aesthetic area: A retrospective study with a mean follow-up period of 7 years

PURPOSE

To evaluate the survival and success rate of and the incidence of complications affecting implants inserted and immediately loaded in sites where an impacted tooth was present in the maxilla.

MATERIALS AND METHODS

A total of 10 patients were treated and 14 implants were inserted, 4 in healed sites and 10 in extraction sites. The implant site preparation started in the crestal bone and continued in the enamel and dentine of the impacted tooth. The radiographic depth of implant penetration into the impacted tooth, peri-implant soft tissue and hard tissue condition at the 1-year follow-up and the last follow-up appointment, marginal bone loss at the 1-year follow-up and the last follow-up appointment, and the final aesthetic result were evaluated.

RESULTS

The implants healed uneventfully with an adequate hard and soft tissue response and no adverse clinical or radiographic signs or symptoms. They were in function for a minimum of 3 and a maximum of 11 years (mean 7.2 years).

CONCLUSION

Although further studies with a larger sample size are required to validate this unconventional approach, it can be considered a valuable clinical option to replace teeth in an area of impaction.

Orthodontic Implant Site Development Using Labial Root Torque: A Case Series with CBCT Analysis

This case series assessed the efficacy of Orthodontic Implant Site Development with Labial Root Torque (OISD-LRT) as a nonsurgical technique for addressing labial bone deficiencies in seven patients. The procedure involved strategically placing a multi-bracket of 2-3 mm apically on the hopeless teeth, gradually shifting them with Ni-Ti wires at the rate of 2 mm per month and maintaining overcorrection for 2 months before extraction. OISD-LRT consistently augmented tissue for flapless guided implant surgery, with an average treatment duration of 404Å}311.7 days. Cone-beam computed tomography (CBCT) scans at various stages revealed increases in both vertical and horizontal bone dimensions, especially in the sockets with complete labial bone loss. Despite inevitable post-extraction reductions in bone height and width, sufficient dimensions were maintained to ensure long-term implant stability. This case series highlights the effectiveness of OISD-LRT as a valuable method for horizontal bone augmentation, particularly in patients with labial bone deficiency. This approach provides a robust foundation for subsequent implant placement, showcasing its success in addressing challenging anatomical conditions and contributing to the broader field of implant dentistry.

Orthodontic Extrusion of Subgingivally Fractured Lateral Incisor and Canine Using Gold Post: A Case Report: 1 Year Follow-Up

The case report describes a multidisciplinary approach using orthodontic forced eruption to facilitate prosthetic restoration of a maxillary permanent lateral incisor and canine with poor restorability for a young patient. Restoration after orthodontic eruption presents a more conservative treatment choice in young patients compared with prosthetic restoration after extraction. On examination, the patient had root stumps in the region of 22 and 23. We decided to treat the patient by orthodontic extrusion followed by endodontic post and core. The case was treated with the help of 19 gauge wire and gold posts.

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.

Biomechanically and Periodontally-Based Orthodontic Treatment of a Patient with Upper Canine Affected by External Cervical Resorption (ECR): A Case Report

(1) Background: Orthodontic treatment may be a potential predisposing factor for ECR. The affected tooth goes to ankylosis, which could lead to a malocclusion. Although teeth severely affected by ECR (class IV Heithersay) are usually extracted, this case report aims to present the use of an ECR class IV upper canine, both as ankylosed to solve the malocclusion and the occlusal plane canting, as well as not ankylosed to correct its ridge defect with orthodontic extrusion. (2) Methods: A 14-year-old male, complaining of an ugly smile and a failed orthodontic attempt to recover an impacted canine, was referred to the orthodontic clinic. He was diagnosed with class II right subdivision, midline deviation, both upper and lower occlusal plane canting, and an upper left canine, previously impacted, showing ECR class IV. The treatment first included canting resolution with a cantilever and a spring, exploiting the anchorage offered by the ankylosed ECR canine. Then, a coronectomy, endodontic treatment, and orthodontic extrusion of that canine were performed to obtain the implant site development. (3) Results: Clinical and radiographic outcomes showed normocclusion and better bony conditions for safer implant placement in the aesthetic zone. (4) Conclusions: The high aesthetics and the periodontal and bony conditions obtained are probably not achievable by other therapeutic alternatives.

Surgical orthodontic intervention for impacted maxillary permanent central incisors: A case series

Key Clinical Message

Impacted maxillary central incisors represent a relatively infrequent occurrence. This condition significantly impacts the patient's self-esteem and aesthetic concerns. Effective resolution is achievable through a combined strategy involving surgical exposure, bracket attachment, and subsequent orthodontic extrusion. The Surgical orthodontic approach is the optimal strategy for addressing impacted maxillary central incisors.

Abstract

Central incisor is rarely impacted teeth often associated with supernumerary teeth. This case series includes three cases of central incisor impaction presented with complaints of missing teeth, unesthetic appearance, and unclear speech. All the cases were managed with surgical exposure followed by traction by orthodontic force, restoring smile aesthetics.

Implant or Tooth?-A Prospective Clinical Study on Oral Health-Related Quality of Life for Patients with "Unrestorable" Teeth

In cases of severely compromised teeth, dental practitioners are confronted with the therapeutic decision of whether to restore a tooth or replace it with an implant. Comparative scientific evidence on patient perception of both treatment approaches is scarce. The subject of this prospective clinical study was to compare oral health-related quality of life (OHRQoL) between two treatment groups: restoration of severely destroyed teeth after orthodontic extrusion (FOE) versus tooth extraction and implant-supported single crown restoration (ISC). A self-selected trial was performed with 21 patients per group. OHRQoL was assessed with the aid of the Oral Health Impact Profile (OHIP-G49) at different time intervals: before treatment (T1), after treatment (T2), after restoration (T3) and at recall (T4). Overall, OHIP scores improved from baseline to follow-up for both concepts with no significant differences between groups. There were no significant differences in subscales between FOE and ISC at T1, T3 and T4. In terms of functional limitations (p = 0.003) and physical disability (p = 0.021), patients in the FOE group temporarily exhibited lower OHRQoL at T2 in comparison to the ISC group. However, at baseline, after final restoration and at recall, the study demonstrates the same level of OHRQoL for both treatment concepts.

Bone Modeling after Orthodontic Extrusion: A Histomorphometric Pilot Study

During osteogenesis and bone modeling, high vascularity and osteoblastic/osteoclastic cell activity have been detected. A decrease in this activity is a sign of complete bone formation and maturation. Alveolar bone maturation seems to occur within weeks and months; however, the precise timing of the alveolar bone modeling is still unknown. The aim of this clinical pilot study was to investigate the bone modeling of neo-apposed tissue during orthodontic extrusive movements, through a histomorphometric analysis of human biopsies. This study was conducted on third mandibular molars sockets, and all teeth were extracted after orthodontic extrusion between 2010 and 2014. After different stabilization timings, extractions were performed, and a specimen of neo-deposed bone was harvested from each socket for the histomorphometric analysis. Histological parameters were evaluated to identify bone quantity and quality. This study included 12 teeth extracted from 9 patients. All specimens were composed of bone tissue. Bone samples taken after 1 and 1.5 months of stabilization presented remarkable percentages of woven bone, while after 2 months, a relevant decrease was observed. Histomorphometric analysis suggested that after orthodontic extrusion, a period of stabilization of 2 months allows the neo-deposed bone to mature.

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.

Tooth preservation of deeply destroyed teeth by forced orthodontic extrusion: A case series

Maintaining and restoring teeth exhibiting subgingival or even subcrestal defect extensions represent a common problem in daily practice. Such teeth are often deemed "unrestorable" due to a significant hard tissue loss and defect locations violating the biologic width. In order to achieve a sufficient 2-mm-ferrule design and reestablish the biologic width, both surgical crown lengthening and orthodontic extrusion have been suggested. However, surgical crown lengthening has a negative effect on the attachment level of adjacent teeth as well as esthetic disadvantages particularly in the esthetic zone. Therefore, orthodontic extrusion might be considered as a valid therapeutic alternative since gingival architecture is maintained. While most orthodontic appliances are too complex for daily application, forced orthodontic extrusion by means of the Tissue Master Concept might be a cost- and time-effective approach due to advances in adhesive and computer-assisted dentistry. This clinical case series illustrates the methodology of the rather straightforward Tissue Master Concept in specific clinical situations that may occur in clinical routine.

Management of compound odontoma with 70 denticles and impacted lateral incisor over an 8-year follow-up

Odontomas are benign developmental tumors formed by the improper growth of completely differentiated epithelial and mesenchymal cells of odontogenic origin. The etiology of odontoma is unknown and it is detected during routine radiographic examination. The ideal management is early detection and surgical enucleation. The commonly associated clinical problems of odontomas are delayed exfoliation of primary teeth, delayed eruption or impaction of permanent teeth, displacement of teeth, root resorption, congenital missing, and widening of follicular space. Here, we describe a unique case of compound odontoma with a high number of denticles managed based on a definite decision support system over 8 years. An 8-year-old boy with 70 denticles in the left maxillary region underwent enucleation. On periodic follow-up, the associated impacted lateral incisor was extruded orthodontically.

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.

Accelerated healing of endodontically treated teeth with a periapical lesion as a result of orthodontic extrusion: evaluation and rationale

Resolution of a periapical periodontal lesion as determined by radiographic examination may take a year or longer. Orthodontic movement is known to have a positive effect on the bone topography and morphology. The literature presents no information about the effect of orthodontic movement on the rate of periapical endodontic healing following a root canal treatment. The aim of this report was to present the use of orthodontic root extrusion in cases with a periapical lesion, where other options are ruled out. Three case reports involving endodontically treated teeth with a periapical lesion are presented. In each case, the performed orthodontic extrusion resulted with healing of the periapical environment towards a predictable crown fabrication or replacing a hopeless tooth more safely with an implant-supported crown. In all cases presented, signs of radiographic healing were demonstrated in a relatively shorter time than is considered acceptable, following the extrusive orthodontic movement, with no clinical sensitivity to percussion or periodontal pockets. In conclusion, orthodontic extrusion of endodontically treated teeth with periapical lesions presented positive radiographic healing signs along with no clinical symptoms of pain and mobility and a positive effect on marginal bone level and soft tissues, at a faster rate than was expected. This report may assist in supporting a clinical decision to apply vertical extrusive forces on compromised endodontically treated teeth presenting with a periapical lesion. Healing signs may be observed within a shorter time period, which may allow better prediction for the prosthetic phase.

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.

Comparisons of different treatment methods and their outcomes for impacted maxillary and mandibular canines: A retrospective study

BACKGROUND

Impacted canines may pose a functional and an esthetic problem for patients and can affect neighboring incisors. The aim of the study was to compare different treatment methods and their outcomes for impacted maxillary and mandibular canines.

METHODS

The authors included 102 patients with 118 impacted canines (82 maxillary and 36 mandibular canines). Impacted canine were confirmed during clinical and radiologic examinations. Eighty-five patients (83%) with 97 impacted canines started the treatment. The authors analyzed treatment types and outcomes. Two maxillary and 4 mandibular canines were scheduled for extraction.

RESULTS

Orthodontic extrusion was used most frequently to treat impacted maxillary canines (89%), whereas orthodontic extrusion and transalveolar transplantation were performed most frequently in impacted mandibular canines (33% and 37.5%, respectively). The treatment was successful in 96% of the maxillary and 95% of the impacted mandibular canines.

CONCLUSIONS

Different methods were used for impacted maxillary and mandibular canines, but their overall success rate was high.

PRACTICAL IMPLICATIONS

Successful outcome is determined via a well-planned and carefully executed orthodontic and surgical treatment. Early diagnosis is pivotal in facilitating spontaneous canine eruption and implementing transalveolar transplantation in a timely way.

Management of Fracture Crown En Masse in Maxillary Central Incisors in a 13-Year-Old Child - A Multidisciplinary Approach

Traumatic dental injuries are the most common orofacial injuries sustained during play and sports. Injuries to anterior teeth with subgingival fractures present a clinical challenge for a predictable esthetic outcome. The treatment modalities of subgingival fractures are surgical crown lengthening and orthodontic extrusion. The purpose of this article is to report a case of a 13-year-old male patient with a subgingival fracture of maxillary anterior teeth managed by a multidisciplinary approach, utilizing orthodontic extrusion after endodontic treatment followed by prosthetic rehabilitation.

Management of Subgingival Root Fracture with Decoronation and Orthodontic Extrusion in Mandibular Dentition: A Report of Two Cases

Incidence of horizontal root fracture in permanent dentition is relatively uncommon with reported incidence being <7%. Treatment and prognosis of such injuries vary with the location of fracture line. More apical the fracture lines more likely the favorable outcome. Treatment includes immobilization for 2–4 weeks and root canal treatment to allay any chance of failure. Subgingival root fracture with possible bacterial contamination and insufficient crown height require multidisciplinary approach for the successful treatment and help patients to retain their natural dentition. In cases of extreme mobility of coronal fragment, endodontic treatment, decoronation, and orthodontic extrusion provides clinicians easy and conservative treatment option to functionally and esthetically rehabilitate the fractured tooth. This case report describes similar treatment plan in the management of subgingival root fracture in two different cases involving mandibular lateral incisor and mandibular premolar.

Laser-assisted management of ectopic eruption of permanent incisors

Ectopic eruption originates from the malpositioning of a tooth bud ending in the eruption of the tooth in an improper direction. This anomaly is a consequence of ectopic development of the tooth germ. This condition gives rise to significant aesthetic and occlusal issues in the early mixed dentition stage. The most frequently influenced teeth are the maxillary first molars, accompanied by the maxillary cuspids. Ectopic eruption is seldom seen and might derive from traumatic injury. In some cases, hyperplastic and fibrotic gingival tissue may lead to ectopic eruption of a permanent incisor. Managing ectopically erupting teeth generally rests on several reasons including extraction of supernumerary tooth, removal of cyst and excision of hyperplastic tissue and subsequent to orthodontic movement of tooth if necessary. In this case, the use of Er, Cr: YSGG lasers for the correction of hyperplastic soft tissues involving ectopically erupting permanent incisors are depicted considering two cases.

Multidisciplinary approach to a subgingivally fractured incisor tooth: A case report

This case report describes a multidisciplinary approach using orthodontic forced eruption to facilitate prosthetic restoration of a subgingivally fractured maxillary permanent central incisor. A 14-year-old male patient presented at the pediatric dental clinic due to unesthetic appareance and for management of a fractured maxillary right central incisor tooth. Intraoral examination revealed that the maxillary right central incisor had sustained a crown-root fracture with pulp exposure. We treated the tooth endodontically and performed orthodontic root extrusion with a modified Hawley appliance prior to prosthetic rehabilitation. Approximately 2-3 mm of extrusion of the tooth was obtained within 8 weeks. A fiber post was then inserted into the root canal, and final restoration was completed with an all-ceramic crown. Follow-up 18 months after treatment revealed good periodontal health, esthetics and normal function.

Rehabilitation of complicated crown-root fracture by invisible approach

Dental trauma is one of the most common and significant problems met in all dental offices almost every day. In particular, injury to the anterior teeth is more vulnerable as it may affect the psychosocial behavior, severe emotional complications can occur leading to disturbances in their mental attitude. Cosmetic (lingual) orthodontics is the recent development in the field of dentistry in the last few decades. Patients are more concerned about their appearance during the treatment and are affected by psychosocial issues because of labially placed brackets, thus leading to the evolution of lingual orthodontic appliances. In this article, we are sharing our clinical experience treating a complicated crown-root fracture using the lingual orthodontic technique.

Implant Site Development by Orthodontic Forced Eruption for Esthetic Restoration of Adjacent Implants

INTRODUCTION

Despite recent advancements in ridge preservation techniques, complete tissue regeneration remains difficult to achieve when managing multiple tooth loss in the esthetic zone. Guided bone regeneration has been shown to be effective in creating sufficient bone support, but post-surgical complications including soft tissue deficiencies have been reported. Obtaining "natural" esthetic results has proven challenging, especially when restoring adjacent implants in patients with a high smile line. The addition of extrusion and palatal positioning of the implant facilitates ridge preservation surgery as well as the esthetic outcome, but requires an additional treatment phase devoted to orthodontics.

CASE PRESENTATION

A healthy 43-year-old female with a longstanding history of smoking presented with terminal periodontal disease on teeth #7 and #8 together with a wide diastema between teeth #8 and #9. Comprehensive dental treatment included smoking cessation, oral hygiene instruction, full-mouth scaling and root planing, orthodontic realignment, and implant placement to manage those teeth with a hopeless prognosis. Orthodontic therapy included forced eruption of teeth #7 and #8 to create optimum implant receptor sites. One year after prosthetic restoration, interproximal papillae height proved stable and similar to the contralateral side.

CONCLUSION

A multidisciplinary approach proved beneficial in achieving an improved esthetic outcome in a challenging situation in implant therapy.

A rare case of impacted supernumerary premolar causing resorption of mandibular first molar

The management of patients with pain in today's general practice has become a major concern and sometimes this pain is related to some rare causes. A male patient aged 26 years reported with pain in the lower left molar region (36) and then an intra-oral periapical radiograph (IOPA), and orthopantomograph was taken. IOPA revealed the presence of supernumerary premolar causing pressure and root resorption of 36. Also, there was missing 21 and proximal decay in 11. Eleven was treated endodontically, and then bridge was done in relation to 11, 21 and 22. Lower anterior crowding was also present. The treatment plan was to extract 36 followed by orthodontic extrusion of the supernumerary premolar and also the correction of lower anterior crowding. Hidden approach (lingual orthodontics) was used as the patient was insisting upon the braces not being seen outside during the course of the treatment. Later all ceramic bridge was done in relation to 11, 21 and 22. Orthodontic tooth extrusion techniques offer excellent treatment options for Partially Impacted tooth. It is a well-documented clinical method for extruding sound tooth material from within the alveolar socket by light forces. The use of lingual technique for forced eruption enhance acceptance of orthodontic treatment by adults. The treatment of a young adult patient illustrates the importance of treatment planning from one discipline to another, communication among team members and the benefits of working together in an interdisciplinary approach

An unusual case of compound odontome associated with maxillary impacted central incisor

Odontomas are the most common type of odontogenic tumor occurring within the jaws and are frequently associated with the retained deciduous teeth interfering with the eruption of permanent teeth. Compound odontomas are usually diagnosed in the anterior portion of the jaws and resemble tooth-like structure. These are usually asymptomatic. Complex odontomas are normally diagnosed in the posterior part of the jaws and consist of a disorganized mass with no morphologic resemblance to a tooth. The present case report of a 16-year-old female is a typical case of compound odontoma in the maxillary anterior region associated with retained deciduous incisor, which also resulted in failure of eruption of the permanent maxillary right central incisor. An intraoral periapical radiograph revealed the presence of a radio-opaque tooth-like structure in the apical region of retained deciduous incisor and an impacted permanent right central incisor whose path of eruption was impeded by the structure. Treatment included the surgical removal of the lesion followed by orthodontic extrusion of the impacted incisor. Follow-up was done for one 1 year and no recurrence was seen.

Multidisciplinary treatment for a patient with traumatically intruded permanent canine and premolar

When selecting treatment for traumatically intruded teeth, various factors should be evaluated including the degree of intrusion, pulp vitality, patient's age and maturity of the tooth. Treatment options consist of surgical repositioning, orthodontic extrusion and spontaneous re-eruption. This study describes a case of a 22-year-old male with traumatically intruded maxillary canine and first premolar that was treated comprehensively by an orthodontist, endodontist and prosthodontist two months after injury.

Orthodontic extrusion of horizontally impacted mandibular molars

OBJECTIVE

To introduce and evaluate a novel approach in treating horizontally impacted mandibular second and third molars.

MATERIALS AND METHODS

An orthodontic technique was applied for treatment of horizontally impacted mandibular second and third molars, which included a push-type spring for rotation first, and then a cantilever for extrusion. There were 8 mandibular third molars (M3s) and 2 second molars (M2s) in this study. Tooth mobility, extraction time, the inclination and parallelism of the impacted tooth, alveolar bone height of the adjacent tooth, and the relationship of impacted M3 and the inferior alveolar nerve (IAN) were evaluated.

RESULTS

Two horizontally impacted M2s could be upright in the arch and good occlusal relationships were obtained after treatment. All impacted M3s were successfully separated from the IAN, without any neurologic consequences. The average extraction time was 5 minutes. There was a significant change in the inclination and parallelism of the impacted tooth after treatment. A new bone apposition with the average height of 3.2 mm was noted distal to the adjacent tooth.

CONCLUSIONS

This two-step orthodontic technique as presented here may be a safe and feasible alternative in management of severely horizontally impacted mandibular molars, which achieves a successful separation of M3s from the IAN and an excellent position for M2s.

An interdisciplinary approach to treat crown-root-fractured tooth

Restoration of a crown-root subgingival fractured tooth, especially at anterior aesthetic zones is still a great challenge for restorative dentists. Crown lengthening procedure alone has the disadvantage of high gingival curve of the final restoration, which was not discontinuous to adjacent teeth and thus compromise cosmetic outcomes. The objective of this report is to display a new interdisciplinary approach which combining endodontic root canal treatment, orthodontic extrusion, periodontal crown lengthening surgery and prosthodontic post-core-crown restoration procedures to restore a crown-root subgingival fractured maxillary central incisor and achieved a satisfied cosmetic result. Computer-based spectrophotometer was also used to accurately select colour without objective interference to achieve ideal cosmetic effects.

Forced orthodontic eruption for augmentation of soft and hard tissue prior to implant placement

Forced orthodontic eruption (FOE) is a non-surgical treatment option that allows modifying the osseous and gingival topography. The aim of this article is to present a clinical case of a FOE, which resulted in an improvement of the amount of available bone and soft-tissues for implant site development. Patient was referred for treatment of mobility and unesthetic appearance of their maxillary incisors. Clinical and radiographic examination revealed inflamed gingival tissue, horizontal and vertical tooth mobility and interproximal angular bone defects. It was chosen a multidisciplinary treatment approach using FOE, tooth extraction, and immediate implant placement to achieve better esthetic results. The use of FOE, in periodontally compromised teeth, promoted the formation of a new bone and soft-tissue in a coronal direction, without additional surgical procedures, enabling an esthetic, and functional implant-supported restoration.

Applying extrusive orthodontic force without compromising the obturated canal space

BACKGROUND

Complicated tooth fractures can be the unfortunate result of orofacial trauma and can offer a therapeutic challenge for the dentist. A conservative solution for gaining supragingival sound tooth structure often includes orthodontic forced eruption. Usually, this procedure is carried out by applying extrusive force after placing a provisional acrylic Richmond crown on the tooth. However, this long-lasting dental treatment may jeopardize the coronal seal of the root canal space, leading to microleakage and endodontic failure.

CASE DESCRIPTION

Orthodontic forced eruption demands application of force to an attachment connected to the remaining short clinical crown. In this article, the authors describe a case in which they used a new technique for orthodontic forced eruption of a traumatized tooth, using an extracanal attachment to apply extrusion force, and discuss its possible advantages and limitations.

CONCLUSIONS

An extracanal attachment approach for orthodontic forced eruption without compromising the obturated canal space can be a solution for posttraumatic crown fracture. Practical Implications. The described procedure for forced eruption by using an extracanal pin attachment is efficient and convenient and does not require the clinician to apply force directly to the provisional crown. Therefore, during the application of force, there is less risk of loosening the provisional crown, and the canal space is kept intact with either the final restoration or dressing material.

Clinical management of a complicated crown-root fracture using autogenous tooth fragment: A biological restorative approach

Trauma resulting in crown-root fracture is one of the most challenging fracture types. However, biologic width involvement should be carefully evaluated. Reattachment of tooth fragment to a fractured tooth remains as the treatment of choice because of its simplicity, natural esthetics, and conservation of tooth structure. The reattachment procedure using composite resin should be considered if the subgingival fracture can be exposed to provide isolation. This report presents a case of complicated crown-root fracture of permanent maxillay left central incisor, involving the biologic width in a 10-year-old girl. The traumatized tooth was treated endodontically. Access to the subgingival margins was gained by orthodontic extrusion followed by gingivectomy. The fractured fragment was reattached using bonding system and composite resin.

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.

Forced orthodontic extrusion and use of CAD/CAM for reconstruction of grossly destructed crown: A multidisciplinary approach

The aim of this study is to present a report of a case where forced orthodontic extrusion and computer-aided design and computer-aided manufacturing (CAD/CAM) technique was used for reconstruction of right maxillary central incisor with grossly destructed crown. Aesthetic rehabilitation of a fractured maxillary right central incisor was performed employing a multidisciplinary approach i.e. conventional endodontic treatment followed by orthodontic extrusion and final restoration using CAD-CAM and one piece milled zirconia post and core with full coverage zirconia crown. After the procedure being completed, periapical radiographs taken at 3 month follow up period demonstrated that the post and core remained well adapted to post space and there was a complete healing of periapical lesion. This technique can provide a complete aesthetic rehabilitation of a grossly destructed tooth without hampering the biological width and thus has a better prognosis.

Management of subgingival fracture by an esthetic approach

Extrusion of fractured anterior teeth with fracture line extending subgingivally requires exposure of sound tooth structure. Orthodontic extrusion is the preferred method of choice. Conventional orthodontic appliance is usually unesthetic because of exposure of brackets. This case report describes an esthetic management of such a tooth with a lingually placed orthodontic appliance which also allows placement of a labial composite resin laminate so as to restore esthetics at the earliest. This was followed by a post-endodontic restoration. This approach enabled us to establish not only to a long-term restorative success, but also an immediate replacement of esthetics so that the patient is able to confidently smile during the course of treatment also.

Orthodontic management of pathological migration of central incisor in a patient with moderate to severe periodontal disease

Proclination and extrusion of upper central incisors are considered as the main manifestations of pathological migration. They are the most common chief complaint of adult patients nowadays. With adequate orthodontic-periodontal teamwork it is possible to reestablish a healthy and well-functioning dentition with good occlusion, sufficient masticatory function, and satisfactory esthetics that will improve the psychological status of the patient after correcting the elongation and the migration of the anterior teeth. This report present a case with pathological migration of upper right central incisor treated orthodontically with a combination of intrusion, extrusion and retraction movement. This mechanics improve the bone topography, improve esthetics and also helps the patient to achieve good home oral hygiene care.