Abstract
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.
Highlights
Bone defects can be treated by different surgical procedures, such as GBR and bone grafts depending on the characteristics of the defect itself
E technique of orthodontic extrusion for the correction of infrabony defects was described by Brown [7] in 1972. e study showed that only management of soft tissues was not enough to correct the periodontal pockets. e clinician has the opportunity to choose between two alternatives: (1) to surgically eliminate part of the bone crest, through osteoplasty and osteotomy procedures, to reduce or eliminate the infrabony defect; (2) to induce the growth of the periodontal ligament (PDL) that will fill the defect
A number of 99 articles were identified. e exclusion criteria were letters, editorials, thesis, articles focusing on orthodontic extrusion for any purpose other than implant site development, studies on the increase of the alveolar bone by means of an orthodontic extrusion without the subsequent insertion of the implant, articles that do not describe the techniques used for orthodontic extrusion, articles that do not describe changes in the hard and/or soft tissue of sites receiving the implant after orthodontic extrusion; and articles not available in English
Summary
Bone defects can be treated by different surgical procedures, such as GBR and bone grafts depending on the characteristics of the defect itself. In 1974, Ingber [8, 9] used the orthodontic extrusion for the so-called “nonrestorable or hopeless teeth” damaged by caries, fractures, or traumas, to restore the ferrule effect He concluded that orthodontic extrusion is an alternative technique for the management of fractures at the level of the alveolar crest because, thanks to the extrusive forces, there is a stretching of the periodontal fibers with consequent coronal displacement of soft and hard tissues. Salama [10], inspired by the works of Ingber [8, 9] and Brown [7], published several studies in which orthodontic extrusion was used, no longer to correct a defect of a natural tooth, but to increase hard and/or soft tissues with the aim of improving the morphologic and biologic characteristics of the implant site, before implant insertion. Salama [10], inspired by the works of Ingber [8, 9] and Brown [7], published several studies in which orthodontic extrusion was used, no longer to correct a defect of a natural tooth, but to increase hard and/or soft tissues with the aim of improving the morphologic and biologic characteristics of the implant site, before implant insertion. e main concept of their works can be summarized in the sentence “hopeless tooth is not a useless tooth.” In the following years, several authors [11,12,13,14] published, especially case reports, with different protocols and results
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