Orthodontic Extrusion Research Articles

Management of crown-root fracture by orthodontic extrusion

Management of crown-root fracture by orthodontic extrusion

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.

Orthodontic extrusion with fixed appliances for treatment of intrusive luxation injuries: A prospective study of 28 permanent maxillary incisors.

Limited evidence exists on the treatment options of tooth repositioning after intrusive luxation. The study aimed to investigate the outcomes and complications of orthodontic extrusion in treating intruded maxillary permanent incisors. A prospective study was conducted involving 28 intruded maxillary permanent incisors treated with orthodontic extrusion, compared with a retrospective control group of 29 teeth that underwent spontaneous re-eruption. The success rate of tooth repositioning, as well as pulp condition, periodontal healing, and root development were assessed and compared. The success rate of orthodontic extrusion was 96.4%, excluding one tooth that was ankylosed before treatment. There were no significant differences in pulp condition between the orthodontic extrusion and control groups for teeth with immature root development. Teeth with mature root development in the orthodontic group, however, showed a significantly higher rate of pulp necrosis (100%, p < .05). Periodontal healing outcomes were similar across both groups, regardless of the maturity of root development. The root length continued increasing during orthodontic extrusion treatment. Orthodontic extrusion treatment could effectively reposition moderately to severely intrusive permanent incisors, without increasing the risk of complications compared with spontaneous re-eruption.

Long-term complications and management of dental trauma in the adult patient - Part 2: discoloured, displaced and missing teeth.

The second paper in this two-part review series aims to outline the long-term complications of dental trauma in the adult patient in relation to discoloured, displaced or missing teeth. A brief overview of the cause of discolouration is outlined, followed by assessment and management options. These can include bleaching, veneers, or crown restorations to mask the discolouration. Displacement of teeth from the socket can occur due to luxation injuries. Management can include simple digital manipulation, surgical repositioning, or orthodontic extrusion based on the severity of extrusion and the time from injury. Teeth can be lost early or in the long-term following dental trauma and associated hard and soft tissues deficiencies may also ensue. Replacement options can include a removable partial prosthesis, resin-retained bridge or dental implants. Often, hard and soft tissue augmentation procedures may be required to address any defects and rebuild lost anatomical contours. A thorough assessment followed by the development of a sound management plan which takes patients' general and local factors into account can ensure a predictable and successful treatment outcome. This would end in an aesthetically pleasing and a functionally stable result for the patient.

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.

Use of Orthodontic Mini-Implants in Conjunction with Elastics for Extrusion of Impacted Canines and Correction of Bimaxillary Protrusion.

Orthodontic extrusion of canines, although challenging, can yield excellent results without tooth extraction. Temporary anchorage devices (TADs), involving mini-implants in the alveolar bone, offer stable anchorage via biomechanics. This case report details orthodontic extrusion of bilaterally impacted maxillary canines using TAD mini-implants and elastics. The patient had bimaxillary protrusion, moderate crowding, deep bite, and vertical growth pattern, necessitating careful treatment planning. The combination of TAD mini-implants with Class-II elastics simplified biomechanics. The treatment achieved efficient results, maintained adjacent teeth positioning, and improved patient compliance.

Enhancing orthodontic precision: A comprehensive review of temporary anchorage devices

Temporary anchorage devices (TADs) have revolutionized orthodontic treatment by providing additional support for tooth movement, enabling precise control over tooth positioning, and expanding the scope of treatment options available to orthodontists. Temporary anchoring devices (TADs) provide a dependable means of accomplishing efficient and consistent tooth movement, and have emerged as a key breakthrough in modern orthodontic practice.: The present review aims to provide a comprehensive overview of TADs, including their types, applications, advantages, and limitations. : The review begins by elucidating the various types of TADs, such as mini-implants, miniplates, and microscrews, highlighting their differences in design, placement techniques, and biomechanical characteristics. Subsequently, it explores the diverse clinical applications of TADs, ranging from orthodontic tooth movement, space closure, intrusion, and extrusion to the management of skeletal discrepancies and complex cases requiring multidisciplinary approaches.: Moreover, the review examines the advantages offered by TADs, including enhanced treatment precision, reduced reliance on patient compliance, and the ability to achieve challenging tooth movements with minimal side effects. It also addresses the limitations and potential complications associated with TADs, such as risk of infection, mucosal irritation, and mechanical failure, emphasizing the importance of careful patient selection, proper placement techniques, and vigilant monitoring throughout treatment, highlighting their potential to further enhance orthodontic outcomes and patient satisfaction.: The significant role of temporary anchorage devices in modern orthodontic practice, emphasizing their versatility, efficacy, and potential to optimize treatment outcomes while minimizing the reliance on traditional anchorage methods and enhancing patient comfort and experience.

Periodontal considerations during orthodontic intrusion and extrusion in healthy and reduced periodontium.

In patients with advanced periodontal disease, pathological tooth migration may occur, which may require subsequent orthodontic treatment for both aesthetic and functional purposes. When planning orthodontic treatment mechanics, intrusive or extrusive forces are frequently indicated. Understanding tissue reactions during these movements is essential for clinicians when devising a comprehensive orthodontic-periodontal treatment plan. This knowledge enables clinicians to be fully aware of and account for the potential effects on the surrounding tissues. The majority of our understanding regarding the behavior of periodontal tissues in both healthy and compromised periodontal conditions is derived from animal studies. These studies offer the advantage of conducting histological and other assessments that would not be feasible in human research. Human studies are nevertheless invaluable in being able to understand the clinically relevant response elicited by the periodontal tissues following orthodontic tooth movement. Animal and human data show that in dentitions with reduced periodontal support, orthodontic intrusion of the teeth does not induce periodontal damage, provided the periodontal tissues do not have inflammation and plaque control with excellent oral hygiene is maintained. On the contrary, when inflammation is not fully controlled, orthodontic intrusion may accelerate the progression of periodontal destruction, with bacterial plaque remnants being displaced subgingivally, leading to further loss of attachment. Orthodontic extrusion, on the other hand, does not seem to cause further periodontal breakdown in dentitions with reduced periodontal support, even in cases with deficient plaque control. This is attributed to the nature of the tooth movement, which directs any plaque remnants coronally (supragingivally), reducing the risk of adverse effects on the periodontal tissues. This specific type of tooth movement can be leveraged to benefit periodontal conditions by facilitating the regeneration of lost hard and soft periodontal tissues in a coronal direction. As a result, orthodontic extrusion can be employed in implant site development, offering an advantageous alternative to more invasive surgical procedures like bone grafting. Regardless of the tooth movement prescribed, when periodontal involvement is present, it is essential to prioritize periodontal therapy before commencing orthodontic treatment. Adequate plaque control is also imperative for successful outcomes. Additionally, utilizing light orthodontic forces is advisable to achieve efficient tooth movement while minimizing the risk of adverse effects, notably root resorption. By adhering to these principles, a more favorable and effective combined orthodontic-periodontal approach can be ensured. The present article describes indications, mechanisms, side effects, and histological and clinical evidence supporting orthodontic extrusion and intrusion in intact and reduced periodontal conditions.

ORTHODONTIC EXTRUSION TECHNIQUE AS A METHOD FOR ALVEOLAR BONE VOLUME INCREASE BEFORE DENTAL IMPLANTATION. CLINICAL CASE

Objectives: Tooth extraction and replacement with dental implant represents a common treatment choice, when teeth are hopeless. We presented a clinical case, the treatment of which was carried out by the method of orthodontic extrusion technique. This technique can increase alveolar bone level and also soft tissue level. The increased amount of alveolar bone can improve primary implant stability and be compared with bone regeneration techniques. The purpose of presenting this clinical case is to emphasize the efficiency of orthodontic extrusion. Methods and materials: A 45-year-old female patient referred by the general dentist regarding cosmetic defect and tooth mobility in the area of the anterior upper teeth. During the examination, her upper right central incisor was found to be mobile, with diastema and slight congestion in the anterior teeth Photographs, CT and X-ray studies of the patient were used. The patient was bonded with .018 slot Roth prescription ceramic brackets (Dentaurum, Germany). After achieving the optimal results of orthodontic treatment and the necessary extrusion of the upper right central incisor, the tooth was removed and replaced with a dental implant. After six months, the patient had a crown with a screw fixation of zirconium dioxide with ceramic application Results: As a result of orthodontic extrusion, clinically significant increase in alveolar bone and gingival tissue was reported. This resulted significant qualitative and quantitative improvements in the implant site. As the clinical case was in aesthetic zone, we could also rehabilitate beautiful smile of patient and increase her self-esteem. Conclusions: Summing up the above and the results of the treatment of this patient, we can definitely say that orthodontic extrusion technique is effective for implant site development. As we have described, this can effectively move the facial gingival margin and allow for esthetic restoration of implant placed in the extruded tooth position without any bone graft.

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.

Frequency of Intrusive Luxation in Potential Orthodontic Patients with Increased Over-Jet

OBJECTIVE: To find out the frequency of intrusive luxation in potential orthodontic patients with increased over-jet. METHODOLOGY:Total 50 orthodontic patients having permanent dentition with increased overjet was included in the study and were examined in OPD as per selection criteria. The patients were examined for the presence of intrusive luxation of upper front teeth as per defined criteria. STUDY DESIGN:A Cross Sectional Study. SETTING: Orthodontic Center of Rashid Latif Dental College, Lahore DURATION: January 2021 to June 2023 RESULTS: The results showed that frequency of traumatic upper maxillary incisors intrusive luxation was found to be 3%, out of which 80% were females and 20% were males. CONCLUSION: There is increased frequency of traumatic upper maxillary incisors intrusive luxation in orthodontic patients having increased over-jet. KEYWORDS: Intrusive luxation; Orthodontic repositioning, Re-eruption; Orthodontic extrusion.

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

ABSTRACT 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.

A systematic and comprehensive protocol for rapid orthodontic extrusion.

The aim of the present paper is to describe a systematic and detailed protocol for rapid orthodontic extrusion, and to summarize the main results of this protocol in terms of migration of dental, hard and soft tissues, for 10 cases. The working design was to apply a protocol lasting 4 weeks of active phase with intense forces (greater than 300 g), perform weekly the circumferential supra-crestal fiberotomy procedure associated with root-planning, follow up with a passive stabilization phase of another 4 weeks and evaluate the results. We believe that despite the partial migration of periodontal tissue, the defined protocol we used is, for simplicity of application, brevity of treatment and results, a viable alternative to the surgical technique of clinical crown lengthening in those cases where it is necessary to have more dental tissue exposed for restorative and prosthetic purposes.

Orthodontic Extrusion as an Aid for Restoring Extensively Destroyed Teeth and Preserving Implant Site Creation: A Case Series

Orthodontic Extrusion as an Aid for Restoring Extensively Destroyed Teeth and Preserving Implant Site Creation: A Case Series

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

Tensile forces in the neurovascular bundle: A contributor to orthodontic relapse?

The aim of this study is to investigate the neurovascular bundle (NVB) as a potential orthodontic relapse factor. The mechanical properties and the forces generated in the NVB after orthodontic extrusion are explored. Six NVBs branching from the inferior alveolar nerve to the apices of the mandibular canines and premolars of mature pigs were harvested. Stress relaxation tests were conducted. A standard linear solid model (SLS) was utilized to simulate the orthodontic extrusion of a single rooted tooth with NVB length and cross-sectional diameter of 3.6 and 0.5 mm, respectively, so the NVB was stretched 10% and 20% of its original length. The maximum force within the NVB was then calculated. Based on our data, the average Young's modulus before relaxation ( ), after relaxation ( ) and the difference between Young's moduli before and after relaxation ( ) were 324 ± 123, 173 ± 73 and 151 ± 52 kPa, respectively. The theoretical force within the NVB stretched to 10% and 20% strain was 3 and 5 mN, respectively. The data from our study indicate that the NVB exhibits stress relaxation, a characteristic trait of viscoelastic materials. SLS model simulation predicted residual forces around 5 mN for elongation up to 20%. We observed strain hardening with additional elongation, which has the potential to cause forces to increase exponentially. Therefore, tensile forces in the NVB should not be ruled out as a contributor to orthodontic relapse, especially in adult patients who may have decreased adaptability of their NVB. Further preclinical and clinical models should be developed to further clarify what is the contribution of the NVB to orthodontic relapse.

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.

Forced Orthodontic Extrusion to Restore the Unrestorable: A Proof of Concept.

The purpose of this clinical study was to assess the feasibility of forced orthodontic extrusion with the Tissue Master Concept to retain subgingivally fractured teeth as abutments for which extraction and replacement would be equal treatment opportunities. Participants were recruited from a group of consecutive patients in need of prosthodontic rehabilitation. In total, 36 deeply destroyed teeth in 31 patients underwent forced orthodontic extrusion with forces exceeding 50 g to reestablish biologic width and ensure a 2-mm dentin-ferrule design prior to single-crown restoration. The primary endpoint was the success of the extrusion in terms of the ability to restore the respective abutment tooth. Information about overall treatment time, frequency, and reasons for failure were collected. Four patients dropped out of the treatment. For the remaining 27 participants, data were fully collected. The amount of extrusion ranged between 2 and 6 mm (3.5 ± 0.9 mm), and the mean duration until retention was 20 ± 12 days. On average, patients returned three (± 3) times for control visits after extrusion. Adhesive failure (n = 6) and orthodontic relapse (n = 2) were the most frequent complication types. Forced orthodontic extrusion may be a useful tool to restore teeth evaluated as nonrestorable.

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.