Extrusion Of Teeth Research Articles

Intrusion Of Maxillary Anterior Teeth: A Comparative Clinical Study Between Mini-Implants And Utility Arch

Background: Deep bite is a common orthodontic malocclusion caused by factors like incisor supra-occlusion, molar infra-occlusion, or incisor angulation. Nonsurgical correction of deep bite involves extrusion of posterior teeth, intrusion of incisors, or both. Extrusion of posterior teeth in growing patients provides stable results due to secondary remodelling. In patients with deep bite and excessive gingival display, intrusion of incisors is typically required which can be accomplished using intrusion arches or mini-implants. Materials and Methods: A total of 10 subjects with an anterior deep bite (overbite >4mm) with excessive incisal display at rest and at smile were taken. Participants were evenly allocated into two groups based on their gingival display. Group I included five participants with less than 4 mm of gingival display, who received treatment using Rickett’s intrusion utility arch. Group II consisted of five subjects with more than 4 mm of gingival display, who were treated with two anterior mini-implants. Lateral cephalograms were utilized to evaluate maxillary anterior intrusion at two specific time points: Pre-treatment (T1) and following a 6-month interval (T2). Results: The amount of bite opening in both groups was comparable, however the amount of incisor intrusion was greater with mini-implants than with the utility arch. The utility arch group showed significantly greater labial tipping (P<0.01) and increased overjet (P<0.05) compared to the mini-implant group. The distance between the maxillary first molar (U6) and palatal plane (PP) significantly increased with the utility arch but decreased with mini-implants. The mandibular plane angle (GoGn-Sn) increased with the utility arch and decreased with mini-implants; however, the difference was statistically non-significant. Conclusion: Deep bite correction with intrusion utility arch occurs through incisor intrusion, incisor flaring, and molar extrusion, whereas with mini-implants, bite opening mainly occurs through incisor intrusion, making it an efficient alternative in cases where dental side effects such as incisor flaring and molar extrusion are undesirable.

Orthodontic Extrusion of Fractured Tooth with Clear Retainer

Tooth fracture at the cervical margin is frequently seen, and orthodontic extrusion of the same can be carried out to achieve a “ferrule effect” for successful restoration. Various techniques incorporating conventional removable and fixed orthodontics have been employed to facilitate orthodontic extrusion of the fractured tooth. The clear aligner can be used to facilitate the extrusion of a fractured tooth using the “bootstrap” arrangement. Bootstrap mechanics involve placing bonded buttons at the gingival margins on the facial, lingual, or both surfaces of a tooth that is lagging. In this pearl, an innovative and economical prerestorative orthodontic method, based on the biomechanical principles of the “bootstrap” arrangement used in aligners, is developed for the successful extrusion of a fractured tooth using a clear retainer and orthodontic elastics. The amount of extrusion of the fractured tooth was 2.5 mm and was achieved in a time frame of 3 weeks. The appliance is patient-friendly and cost-effective. Moreover, the appliance omitted the use of fixed orthodontic treatment mechanics.

Intentional Replantation in Combination with Fibroblast Growth Factor-2 Application and Orthodontic Tooth Extrusion for Periodontal Regeneration in the Treatment of Severe Endodontic-Periodontal Lesions.

Endodontic-periodontal lesions are characterized by the involvement of the pulp and periodontal disease in the same tooth. Despite successful root canal treatment, if the majority of bone support has been lost from periodontitis, the tooth may have a poor prognosis. In severe endodontic-periodontal lesions, the periodontal tissue regenerates poorly because of the significant loss of the periodontal ligament and cementum, poor tooth stability, and bone defect morphology unfavorable for bone regeneration. To overcome these difficult situations, in this case, osteotomy of the replantation bed and tooth replantation with horizontal rotation and deep placement were performed. To improve periodontal regeneration, fibroblast growth factor (FGF) 2 was applied to the artificially made periodontal defect. In addition, orthodontic extrusion of the deeply replaced tooth was performed for potential coronal migration of the periodontal tissue. This case presents a unique multidisciplinary method of treating severe endodontic-periodontal lesions using intentional replantation combined with FGF 2 application and orthodontic extrusion.

The Impact of Orthodontic Extrusion on Keratinized Gingiva.

Background and Objectives: The key factor that enables osteoblastic activity and the formation of new bone, as well as gingiva, during orthodontic tooth extrusion (OE) is the periodontal ligament. The reaction of periodontal tissues associated with changes in the gingiva is a part of orthodontic tooth displacement. The aim of this study was to examine the effect of OE on the width of the zone of the keratinized and attached gingiva, the position of the mucogingival junction, and the height of the interdental papillae in the region where the OE was performed as well as in the adjacent region. Materials and Methods: This research included 28 adult patients (both orthodontically treated and untreated). The treated group included 15 patients, in whom orthodontic extrusion of the upper or lower frontal teeth was indicated and performed. The untreated group included 13 patients, with no previous or undergoing orthodontic treatment. Patients with periodontal disease and periodontal pockets in the frontal region and patients allergic to iodine were excluded from the study. Gingivomorphometric measurements were performed on two occasions in three groups of teeth (24 extruded and 30 agonist teeth in the treated patients; 66 teeth in the untreated patients). Statistical analysis of the obtained data was performed using the software package SPSS version 26.0. Results: Orthodontic extrusion induced changes in the position of the mucogingival line and an increase in the width of the keratinized gingiva. There were no statistically significant effects on the depth of the gingival sulcus, the attached gingiva width, or the height of the interdental papillae. Conclusions: Orthodontic tooth extrusion has an effect on the periodontium in the observed region. Vertical orthodontic force, directed towards the coronal plane, affects the surrounding soft oral tissues.

Presence of an included mesiodens. Report of a case

Introduction: Supernumerary teeth are additional teeth to the normal formula, in turn these can be retained; that is to say that they are prevented from erupting due to anomalies of position or situation. Objective: The objective of this work is to report the clinical case of an included mesiodens, its affectations in the oral cavity and the surgical treatment. Case report: A 20 year old male patient presented several dental malpositions; in addition to the radiographic examination (panoramic x-ray) the presence of a supernumerary tooth compatible with a mesiodens was observed, which due to its location was affecting the roots of the teeth and caused the partial extrusion of tooth 2.1 and the widening of its periodontal ligament. An occlusal radiograph was requested to establish the best approach. After the radiological diagnosis of the supernumerary tooth, surgical treatment was performed. Conlusion: In the present clinical case, the presence of impacted teeth is observed, indicating that some teeth have failed to fully emerge into the oral cavity. These impacted teeth may be causing dental misalignment, malposition and possible bite problems. Detailed radiographic evaluation and clinical analysis suggest the need to consider treatment options, such as extraction or surgical intervention, to allow proper eruption and restore optimal dental function and esthetics

Gummy Smile: A Narrative Review

Imaginary line that follows the lower superior lip is known as the grin level, and it appears to be convex. Gummy smile is caused by gingival band exposures that are 3 mm or greater throughout normal speech or smiles. Multifactorial etiology can be demonstrated by extrusion of the anterior teeth, excessive labial contraction, shorter upper lip, gingival excess, and excessive vertical maxillary growth up. In addition to being useful for orthognathic, plastic, and periodontal surgery, orthodontic therapy is also frequently interdisciplinary. Many techniques can be used to treat the issue of excessive gingival show. These operations involve both non-surgical and surgical techniques. The technique to be chosen may vary depending on the underlying reason of the gummy smile.

Enhancing the aesthetics with anterior deep bite correction: A case report

One of the most challenging orthodontic treatment scenarios is deep bite. Anterior bite plane can be used to facilitate the extrusion of posterior teeth and intrusion of incisors in growing individuals, as a part of deep bite correction strategy. This clinical case report is of a 16-year-old female patient with anterior deep bite and crowding. With combined approach of anterior bite plane placement and fixed orthodontics both improved aesthetics as well as functions were achieved.

Comparison between screw retained arch bars and conventional Erich’s arch bar in maxillofacial fractures

: Establishing a stable occlusion and Maxillomandibular fixation (MMF) is a cornerstone for rigid fixation. Conventional Erich’s arch bar poses a risk of wire stick injury, and extrusion of teeth, and is unsuitable for patients with periodontally compromised teeth or edentulous dentition. There is a dearth of literature comparing modified Screw retained arch bars to the Conventional Erich’s arch bar. Hence, a study was conducted to evaluate the same.: The study compared 30 patients requiring MMF. Group A patients received modified SRAB and group B patients received CEAB. The primary predictor variable was the use of conventional Erich arch bars versus modified screw-retained arch bars. The parameters considered were time taken to place the arch bar, perforation in the gloves, patient compliance, stability, oral hygiene, mouth opening, and post-op occlusion.: The mean time taken for placement of the modified SRAB was lower (27.87 mins) as compared to the CEAB (90.20 mins). The rate of glove perforation was higher in the CEAB group. All patients were compliant in the modified SRAB group as compared to the control group (30%). There was no significant difference in the mouth opening between the two groups.: Based on the study results, we can conclude that modified SRAB is a superior alternative compared to CEAB in maxillomandibular fractures. The usage of modified SRAB does not affect the functional outcome of fracture management.

SURGICAL MANAGEMENT OF UNERUPTED CANINES: A CASE REPORT

Management of impacted canines includes an interdisciplinary approach to achieve desired esthetics, and functional, and occlusal treatment goals. The present case series included various surgical procedures, used for the management of impacted canines and it also highlights the periodontal and orthodontic considerations to be taken before surgical canine exposure. The surgical exposure of canine creates a sufficient space and view of teeth that helps in the proper orthodontic extrusion and traction of teeth into the dental arch.

Orthodontic Correction of an Anterior Open Bite with Periodontally Compromised Upper Incisors Using Miniscrews

This case report describes the camouflage treatment of a patient with an anterior open bite, bimaxillary skeletal protrusion with a mild class II skeletal pattern, reduced periodontium with generalized slight bone loss, localized severe bone loss at the maxillary upper incisors, and a tongue thrust habit. Orthodontic treatment included modifying the resting posture of the tongue and sectionally intruding maxillary posterior teeth while controlling the extrusion of mandibular posterior teeth using temporary anchorage devices (TADs), followed by sectional mechanics at the maxillary arch and continuous arch mechanics at the mandibular arch, along with interpromximal reduction at the mandibular teeth and inter-arch elastics from the mandibular teeth to the maxillary TADs to minimize orthodontic force magnitude and duration specifically applied to periodontally compromised maxillary incisors. The patient’s chief complaint was addressed, and treatment objectives were achieved, with good esthetic and occlusal outcomes. Stability was shown over a 56-month follow-up period.

Biomechanical and clinical considerations in deep bite treatment using temporary skeletal anchorage devices

Deep bite is usually treated by intrusion of the anterior teeth, extrusion of the posterior teeth, or a combination thereof. Various traditional methods have been used to correct deep bites, but they can cause negative side effects. Recently, temporary skeletal anchorage devices (TSADs) have been used to intrude the anterior teeth simply and efficiently without side effects. The amount of incisal exposure at rest should be considered as the first factor in determining which tooth segment should be intruded to correct a deep bite. The center of resistance of the anterior teeth should be considered to achieve the proper biomechanics when intruding them. The location of TSADs should be determined to ensure sufficient interradicular bone to achieve the desired tooth movement. Therefore, clinicians should understand the biomechanical and clinical considerations to correct a deep bite using TSADs.

P040 The use of cone-beam computer tomography (CBCT) and stereolithic models in planning surgical removal of supernumerary teeth and orthodontic extrusion of ectopic teeth in cleidocranial dysostosis

P040 The use of cone-beam computer tomography (CBCT) and stereolithic models in planning surgical removal of supernumerary teeth and orthodontic extrusion of ectopic teeth in cleidocranial dysostosis

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

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. 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 ). 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. 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. 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.

Clinical applications and outcomes of the surgical tooth extrusion technique: A bibliometric analysis from 1982 to 2023

The surgical extrusion technique has been advocated for severely damaged teeth as well as for intruded and unerupted teeth. However, a quantitative literature analysis is lacking. The purpose of this bibliometric analysis was to provide a comprehensive overview of surgical extrusion, assess the applications and outcomes, and evaluate topics for future research. An electronic search was conducted in leading databases in April 2023. Human studies with surgical tooth extrusion or synonyms in titles or abstracts were included. A bibliographic analysis, co-occurrence analysis, and coupling of publications were performed. The analysis of variance was used to assess the characteristics of the subgroups based on indications. The survival rate was evaluated by using the Kaplan-Meier method in the R software program (α=.05). Fifty-one studies from 1982 to 2023 were included. The Journal of Dental Traumatology and the Journal of Prosthetic Dentistry combined published approximately one-third of the papers and acquired the most citations. The burst detection of keywords revealed 4 popular research topics: the Benex extraction system, chlorhexidine for infection control, rigid or semi-rigid splints to decrease the risk of complications, and novel restorative materials to improve esthetics. An overall survival rate of 96.36% was reported among 316 participants with 330 extruded teeth. No significant differences were found in study types, geographic distribution, year of publication, or citation counts among the 4 subgroups (surgical extrusion for subgingival fractures, extensive caries, intruded teeth, and unerupted teeth). A significant difference was observed among the Kaplan-Meier curves of the 4 subgroups (P=.030). Surgical extrusion may be used to save otherwise nonrestorable teeth, and the procedure has shown promising survival rates when teeth are properly selected and the procedure is well executed. Subgingival fractures and extensive caries near bone level are the predominant indications, as well as intruded and unerupted teeth. Surgical extrusion is a reliable treatment option to facilitate tooth restoration for severely damaged teeth, especially for maxillary anterior teeth.

Deep bite -An insight

Deep bite is one of the most common malocclusion which affects children and even adults leading to a number of oral health problems. Patients with deep bite encounter periodontal and temporomandibular problems. Deep overbite refers to the increase of overlap of maxillary incisors over mandibular incisors beyond normal coverage of 30-40%. There are many factors which lead to the development of deep bite like inherent and acquired factors. Inherent factors like tooth morphology, skeletal patterns, rotation of condyle affects the bite. Acquired factors like muscle habits, loss of posterior tooth support or lateral tongue thrust may affect the bite. Deep bite can be corrected by number of different methods which include intrusion of anterior teeth, extrusion of posterior teeth or a combination of both. In non-growing patients surgical treatment is a suitable option to achieve stable results.This article describes various appliances and their biomechanics involved for correcting deepbite malocclusion

The consequences of orthodontic extrusion on previously intruded permanent incisors-A retrospective study.

The aim of this study is to compare the adverse effects that occur after orthodontic extrusion of teeth that have been traumatically intruded with those of similar teeth that have not experienced any trauma. The outcome of incisors intrusion can be affected by the patient's age, extent of injury, root development, and malocclusion. Orthodontic extrusion is a potential solution, but it may also cause complications. A retrospective study of the effects of extrusion of traumatically intruded teeth was carried out. The study group included 21 teeth in 14 patients. The control group included 32 teeth in 10 patients that underwent orthodontic extrusion with no history of trauma. Patients' age, gender, and stage of root development were recorded. The severity of the intrusion was classified as mild (<3 mm), moderate (3-6 mm), and severe (≥7 mm). A comparison of signs of pulp necrosis and root resorptions between the groups was made. The central incisor is the tooth that is most injured in 80.9% of cases. A majority of these incidents involve severe intrusion, which was found in 42.9% of cases. 90% of the traumatized teeth had already lost their vitality prior to orthodontic treatment. Various forms of root resorption were observed in the study group. In the control group, 31.2% of teeth showed signs of external root resorption, but no endodontic intervention was carried out during the follow-up period, as these teeth remained vital. Following intrusion, there is a high risk for root resorption and pulp necrosis. Orthodontic repositioning should be carried out with caution and mild force to prevent complications. Long-term follow-ups are required to ensure the best possible outcome.

Using digital image correlation to measure displacement and strain during involving distal movement of anterior teeth with clear aligner.

To investigate methods to suppress the bowing effects of lingual inclination and anterior tooth extrusion, digital image correlation (DIC) was used to evaluate aligner displacement in three-dimensions through comparing the distal movement of six and four anterior teeth. Computed tomography scans were used to measure aligner thickness and shape. Based on displacement direction and magnitude, a desirable deformation mode with minimal lingual inclination and extrusion was observed during distal movement of four anterior teeth. The aligner had a rigid "constriction zone" between the lateral incisor and the canine, facilitating control localized to the anterior teeth and minimizing the reaction of the molars. The mechanical behavior of aligners was greatly affected by the method of anterior teeth movement and the shape of aligners. DIC-based displacement measurements are useful in investigating correction directionality.

Predictability of anterior open bite treatment with Invisalign

Anterior open bite correction with Invisalign has been claimed to have relatively good predictability because of the proposed function of clear aligners to function as occlusal bite-blocks, limiting extrusion of the posterior teeth or possibly even intruding posterior teeth. This proposal, however, remains relatively unsubstantiated. The objective of this study was to investigate and determine the accuracy of Invisalign treatment in correcting anterior open bite by comparing the predicted outcome from ClinCheck to the achieved outcome for the initial aligner sequence. A retrospective study used pretreatment and posttreatment intraoral scans and predicted outcomes (ClinCheck) stereolithography files of 76 adult patients from private specialist orthodontic practices. Inclusion criteria comprised nonextraction treatment, with a minimum of 14 dual arch Invisalign aligners. Geomagic Control X software was used to measure overbite and overjet in the pretreatment, posttreatment, and predicted outcomes stereolithography files for each patient. Approximately 66.2% of the programmed open bite closure was expressed compared with the prescribed ClinCheck outcome. The use of posterior occlusal bite-blocks and prescribed movement of teeth via anterior extrusion, posterior intrusion, or a combination of the 2 made no difference to the efficacy of open bite closure. Two-week aligner changes resulted in 0.49 mm more bite closure on average. The prescribed bite closure in ClinCheck software overestimates the bite closure that is clinically achieved.

Early prosthetic management of mandible using interim guidance appliances in hemimandibulectomy patients

Mandible is the most common site for intraoral tumors which often requires resection of large portions of the mandible depending upon the location and extent of the tumor leading to various complications such as deviation of the mandible toward the resected side and facial disfigurement. Early prosthodontic intervention during the healing period helps in training the muscles and establish an acceptable occlusal relation using guide flange prosthesis (GFP). This article aims to describe the case reports of early prosthodontic management of two patients who underwent partial resection of the mandible due to squamous cell carcinoma using two different GFP: palatal ramp prosthesis and mandibular buccal GFP using an innovative approach. Prosthodontic intervention by guidance therapy serves the purpose of reducing mandibular deviation, preventing extrusion of maxillary teeth, and improving masticatory efficiency. Guidance appliances are the simplest and most commonly used treatment modality in restoring the form and function of the mandible.

Finite Element Analysis of Maxillary Teeth Movement with Time during En Masse Retraction Using Orthodontic Mini-Screw

Introduction: The aim of this study was to determine the placement of an orthodontic mini-screw (OMS) and the length of an anterior retraction hook (ARH) with en masse retraction. Continuous maxillary tooth movement pattern was simulated by finite element analysis (FEA). Materials and methods: Extraction of the first premolar was hypothesized with a finite element model. The placement of OMS was analyzed for the following two groups: (1) a high OMS (HOMS) group with OMS placed horizontally at the mesial side of the second premolar and apically 10 mm above the arch wire, and (2) a low OMS (LOMS) group with OMS placed horizontally between the second premolar and the first molar and apically 8 mm above the arch wire. According to the height of ARH, each group was divided into three subgroups. Results: When the extraction space of the first premolar was closed, anterior teeth were intruded in the HOMS group but extruded in the LOMS group. In all cases, the first molar was intruded. According to the intrusion of the first molar and extrusion of anterior teeth, the occlusal plane rotated clockwise (CW) in the LOMS group. However, in the HOMS1 group, the occlusal plane rotated counterclockwise (CCW) due to more intrusion of anterior teeth than that of the first molar. Conclusion: By analyzing six cases of different OMS and ARH, changes of incisor and molar in en masse retraction with the extraction of the first premolar could be predicted. In addition, OMS placement and ARH length can be determined based on results of incisal showing. This study can also help esthetic orthodontic results.