Abstract
Once the biologic width of the supporting periodontal attachment apparatus has been severely violated, more extensive procedures are often necessary to manage compromised root structure and supporting bone. Surgical techniques advocated are primarily corrective in nature and consist of root movement and repositioning or root removal and alteration of tooth morphology, with concomitant correction of the periodontium.
 Some indications for surgical corrective intervention to manage radicular perforations include extensive cervical resorption or traumatic perforation which extends well below the osseous crest in both single and multirooted teeth and damage to the furcation region of multirooted teeth which is not responding to nonsurgical therapy, is not amenable to simple surgical correction, or is complicated and compromised further by extensive periodontal disease.
 Common indications for orthodontic root extrusion include fractured tooth margins below crestal bone, deep carious margins, some isolated infrabony defects, and perforations from resorptions, post space preparation and aberrant access openings. When root extrusion is indicated to elevate a perforative root defect above the osseous crest; seldom is the desired result achieved without surgical crown lengthening. This is necessary to compensate for the coronal movement of the gingival attachment and alveolar bone which occurs with the tooth during eruption resulting in unacceptable esthetics. Although it is possible to extrude nearly any tooth the simplest cases are those that have single roots and an immediate proximal tooth on either side for appliance anchorage. Molars are generally difficult to treat as are the terminal teeth in the arch or free standing teeth.
Highlights
Aesthetic considerations have influenced the management of dental maladies in varying degrees for many years
Extrusion is usually performed by means of fixed orthodontic appliances utilizing arch wires or elastics attached to the tooth but it can be accomplished with the use of occlusal plates and elastics.[9]
If the gingival margin of the tooth to be restored is in harmony with adjacent teeth and at an acceptable level with regard to aesthetics, crown lengthening would need to be performed on all of the adjacent anterior teeth, and this could adversely affect aesthetics
Summary
Aesthetic considerations have influenced the management of dental maladies in varying degrees for many years. While there are several possible etiologies involved in excessive display of the gingival tissues upon smiling, cases in which teeth present with incomplete eruption ( referred to as altered passive eruption) are most amenable to successful treatment with surgical crown lengthening.[1] Isolated infrabony periodontal defects may be amenable to crown lengthening .This will improve the existing periodontal environment by modifying the osseous topography and pocket epithelium as they relate to adjacent teeth.[14] Carious invasion of the tooth in the cervical region can result in a perforation, or near perforation, both laterally and in the furcation region, at or below the level of the crestal bone Many of these require cases of crown lengthening, root extrusion and tooth resection to retain valuable radicular segments.[5]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
