Abstract
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.
Highlights
Any subgingival or subosseous extension of a pathologic or traumatic defect that precludes the traditional restorative approach is a possible indication for orthodontic extrusion
When stronger traction forces are exerted, as in rapid extrusion, coronal migration of the tissues supporting the tooth is less pronounced because the rapid movement exceeds their capacity for physiologic adaptation
Rapid extrusion must be followed by an extended retention period to allow remodeling and adaptation of the periodontium with the new tooth position, as discussed by Bach et al in [2]
Summary
Any subgingival or subosseous extension of a pathologic or traumatic defect that precludes the traditional restorative approach is a possible indication for orthodontic extrusion. When stronger traction forces are exerted, as in rapid extrusion, coronal migration of the tissues supporting the tooth is less pronounced because the rapid movement exceeds their capacity for physiologic adaptation. There are several treatment protocols for forced eruption involving removable [7] and fixed appliances depending upon the specific clinical situation. This case demonstrates a technique for orthodontic extrusion of upper premolar with two roots by a sectional fixed appliance and subsequent prosthodontic rehabilitation
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