Orthodontic Extrusion Research Articles

Orthodontic-periodontal interactions: Orthodontic extrusion in interdisciplinary regenerative treatments

Orthodontics is a periodontal treatment. "Guided orthodontic regeneration" (GOR) procedures use orthodontic movements in perio-restorative patients. The GOR technique includes a guided orthodontic "soft tissue" regeneration (GOTR) and a guided orthodontic "bone" regeneration (GOBR) with a plastic soft tissue approach and a regenerating reality. The increased amount of soft tissue gained with orthodontic movement can be used for subsequent periodontal regenerative techniques. The increased amount of bone can as well improve primary implant stability and, eventually, simplify a GTR technique to regenerate soft tissues, to restore tooth with external resorption in aesthetic zone or to extract a tooth to create new hard-soft tissue for adjacent teeth.

Implant Site Development Using Forced Eruption: A Mini Review

With the advent of esthetic dentistry, implant treatment has gained much importance, and osseointegrated implant requires appropriate positioning three-dimensionally to achieve optimum functional and esthetic results. The various techniques available for implant site development are mostly invasive with variable outcomes. On resorting to alternate modalities, orthodontic extrusion/forced eruption is the primary choice as it is noninvasive and aids in optimal increase in the volume of residual bone and soft tissue. In orthodontic extrusion, the available periodontal ligament acts as a source of cell supply and signals, while the socket itself acts as a naturally occurring scaffold for regeneration. The presence of gingival inflammation or active periodontal disease is always a negative predictor for periodontal regeneration. Hence, periodontal ligament in an uninflamed state is essential before performing orthodontic extrusion. This article aims to provide an insight into the mechanisms by which the periodontal ligament cells act at a molecular level to provide an improved bone and soft tissue levels for optimum implant placement.

Predictable method to deliver physiologic force for extrusion of palatally impacted maxillary canines.

Orthodontic treatment of palatally impacted maxillary canines raises many difficulties; to minimize complications, careful planning of orthodontic extrusion and the use of physiologic force are crucial. The aim of this study was to quantitatively evaluate a simple and reproducible system for orthodontic extrusion of impacted canines that can provide the correct amount of force. Ten specimens were constructed, consisting of a cantilever made with a 0.6-mm or 0.7-mm stainless steel wire modeled around a transpalatal bar with 3, 5, or 7 loops in the shape of a helical torsion spring. A mechanical testing machine was used to measure the force produced by the cantilever at 3, 6, 9, 12, and 15mm of activation. The force values ranged from 1.24±0.13N for the 0.7-mm wire with 3 loops to 0.48±0.04N for the 0.6-mm wire with 7 loops. The forces measured for the 0.6-mm wire with 3 loops and the 0.7-mm wire with 7 loops were similar at 15mm of deflection. The proposed system has a simple and robust design, is easy to construct and manage, and can provide the desired amount of force by changing the wire diameter and number of loops.

Management of a crown-root fracture: A novel technique with interdisciplinary approach

Anterior teeth with subgingival fractures require a complex treatment plan that addresses biologic, functional and aesthetic factors. This case report describes the management of a crown-root fractured maxillary left central incisor. An interdisciplinary approach was used to restore the tooth due to the complex nature of the treatment. Orthodontic extrusion was performed to move the fracture line above the alveolar bone and periodontal surgery to recontour the altered gingival margin. Finally, the incisor was restored performing a root canal retreatment with a fiber post and a full ceramic crown. The treatment resulted in secured periodontal health and good aesthetics. Key words:Crown-root fracture, orthodontic extrusion, crown lengthening, root canal retreatment, full ceramic crown.

Nonsurgical esthetic rehabilitation of a medically compromised patient

Restoration of anterior esthetic zone is a challenge to the restorative dentist. It is more challenging when it presents with insufficient tooth structure. Crown lengthening procedures or orthodontic extrusion can be employed to restore such cases. The aim of this paper is to present the rehabilitation of an anterior tooth with insufficient tooth structure in a medically compromised patient. An interdisciplinary approach was employed wherein a customized cast post and core with a hook was fabricated for facilitating orthodontic extrusion.

Management of lateral incisor fractured at crestal level: An interdisciplinary case report

A successful restoration should not be limited to achieve esthetic and functional needs; it should also respect the dentogingival unit. A restoration, especially in a fractured tooth or short clinical crown, may violate biological width thus jeopardizing periodontal health, resulting in chronic inflammatory response and thereby inviting failure. Although crown lengthening can be achieved using surgical procedure, it is associated with removal of healthy bone and thus altering the crown length of the adjacent teeth. This article reports a case with 2½ years of clinical and radiographic follow-up success of maxillary left lateral incisor with crown-root fracture using orthodontic extrusion and fibrotomy.

Clinical management of a complicated crown-root fracture of maxillary central incisor in a 12-year-old patient

Traumatic injuries to permanent maxillary anterior teeth are seen commonly in children. Esthetic and functional rehabilitation of these teeth is important. A 12-year-old male patient reported to the Department of Paedodontics and Preventive Dentistry with fracture of the permanent maxillary right central incisor. Clinical and radiographic examinations revealed the presence of a complicated crown-root fracture. This case report describes the management of complicated crown-root fracture by endodontic therapy, orthodontic extrusion, fiber post placement, core build-up with composite, and esthetic restoration using polycarbonate crown.

Does muscular activity related to vertical facial divergence influence the time needed for orthodontic extrusion of palatally impacted maxillary canines? A retrospective study.

BackgroundThe aim of the present study was to evaluate if the different muscular activity correlated to different degrees of facial divergence has an effect on the time needed to extrude a palatally impacted maxillary canine.Material and MethodsTwenty-six patients were retrospectively selected, all treated with a specific cantilever appliance that allows extrusion of the impacted canine applying a physiologic amount of force below 0.6 N in a predictable way. For all the patients, pre-treatment cephalometric tracings were used to evaluate facial divergence through the FMA angle, the angle between the maxillary and mandibular plane, and the angles between the occlusal plane and either the maxillary and mandibular plane. Linear bivariate regression was calculated to evaluate if facial divergence can predict the time needed for canine extrusion.ResultsThe linear regression model was not able to predict extrusion time from variables explaining the facial divergence.ConclusionsPalatally impacted maxillary canines can be treated with the application of physiologic extrusion force regardless of patients’ facial divergence and muscular activity. Key words:Impacted canines, cantilever, facial divergence, muscular activity.

Spontaneous re-eruption, surgical or orthodontic extrusion: What is the choice for intrusive luxation in permanent teeth?

Data sourcesMedline, Embase, the US Clinical Trials and ISRCTN Registry databases.Study selectionTwo reviewers independently selected studies. Interventional and observational studies comparing the outcomes of orthodontic or surgical re-position of intrusive luxation of permanent teeth compared with spontaneous re-eruption were considered.Data extraction and synthesisTwo reviewers abstracted data and assessed study quality using the Cochrane Risk of Bias tool. Periodontal and pulpal outcomes after treatment were compared using risk ratios (RR) with 95% confidence intervals (CI) and meta-analysis conducted.ResultsEight studies involving a total of 440 patients were included. All of the studies were considered to be at high risk of bias. A meta-analysis of four studies comparing surgical re-positioning vs spontaneous re-eruption suggested no significant difference RR = 1.30 (95% CI; 0.90-1.88) P = 0.16. Meta-analyses were also performed for secondary outcomes and other sub-groups.ConclusionsWhile the review suggests that spontaneous re-eruption should be the treatment of choice the quality of the available evidence is poor.

Surgery of Labially Impacted Canine & Orthodontic Management - A Case Report

Maxillary canines are one of the most common teeth that are impacted among patients seeking orthodontic treatment. Depending on the position of these impacted teeth, various surgical techniques have been employed for their exposure. His primary goal of surgical phase is to provide the means for correct position of orthodontic anchorage. Additionally, the technique used must ensure favorable tissue anatomy that will permit long-term maintenance of periodontal health. In the present case, a labially impacted maxillary left canine was surgically exposed using an apically positioned flap. Orthodontic extrusion was carried out further.

Multidisciplinary approach for cervical crown fracture: Orthodontic extrusion followed by prosthetic rehabilitation

Introduction: Fractured maxillary anterior teeth often lead to esthetic, functional and phonetic problems. Crown-root fractures at cervical third area result in biological width violation and are challenging to treat. The treatment modalities involve exposing the cervical margins by means of surgical crown lengthening and/or orthodontic extrusion. Case Report: This paper reports a case of fractured maxillary anterior tooth at the coronal third level that was managed by forced orthodontic extrusion and intentional root canal therapy followed by esthetic rehabilitation. Conclusion: Out of the two available options, orthodontic extrusion, a much forgotten technique was utilized and proved to be a conservative and cost effective technique. Keywords: Biological Width, Cervical Third Fracture, Esthetic Rehabilitation, Orthodontic Extrusion

Multidisciplinary approach for esthetic management of crown-root fracture: Orthodontic extrusion and prosthetic rehabilitation

Fracture of anterior teeth poses functional as well as esthetic implications. Subgingival fractures are often treated by extraction of tooth followed by implant placement or a conventional fixed partial denture due to absence of adequate ferrule at the fracture site. Orthodontic extrusion/forced eruption can aid in the traction of fractured plane coronal to the gingival level, providing enough tooth structure for prosthetic rehabilitation. Since the surrounding periodontium also remodel during tooth extrusion, periodontal intervention may be required for their recontouring leading to a more esthetic final result. Endodontics need to be carried out when the pulp is involved due to traumatic injury. This kind of multidisciplinary approach can save many teeth with subgingival fracture from extraction. It can save the patient from the stress of extraction, especially at young age.

Orthodontic extrusion with followed surgical extraction of high-risk lower third molar

lower third molar with sings that indicates high risk of postoperative complications. Materials and methods: We represent an orthodontic extrusion followed by surgical extraction of lower third molar. For precise diagnostics and approach to suitable method of treatment we used standard panoramic radiograph and CBCT. As a method of surgical treatment we chose assisted orthodontic extraction with individually manufactured ring with soldered bar, fixed to tooth 47. Results: In our clinical case we achieved traction of the impacted lower third molar to safe distance from the mandibular canal. On the second stage of the treatment we performed a classic odontectomy without affect or damaging the IAN. Conclusion: The classic odontectomy is surgical method with high risk of damaging the IAN when the impacted tooth is very close to the mandibular canal. The orthodontic extraction like an alternative surgical method of high-risk lower third molars is preventive method, by which there is minimal risk of damaging the nerve during the surgery. The orthodontic extrusion makes the following surgical extraction a safe and secure method for the patient.

Effects of increased occlusal vertical dimension on the jaw-opening reflex in adult rats

ObjectiveMalocclusion with deep overbite and facial esthetics improve when facial height is intentionally increased during orthodontic extrusion of the posterior teeth. Thus, a better understanding of post-treatment stability of increased occlusal vertical dimension (iOVD) in adult patients is important. We focused on the jaw-opening reflex (JOR), which plays an important role in the control of jaw movements during mastication, and investigated the effects of iOVD on the JOR in rats with an electrophysiological technique. DesignOne hundred and twenty 13-week-old male Wistar rats were randomly divided into control and experimental groups. Rats in the experimental group received a 2-mm buildup of composite resin on the maxillary molars at 13 weeks of age. The JOR was induced by low-intensity electrical stimulation of the left inferior alveolar nerve. The electromyographic responses were recorded from the digastric muscle at 13, 14, 15, 17, 19, and 23 weeks of age. JOR properties including latency, duration, and peak-to-peak amplitude were measured and compared between the groups. ResultsThe latency of the JOR was significantly longer and the peak-to-peak amplitude was significantly smaller in the experimental group than in the control group from 14 to 19 weeks of age, while the reflex duration was not significantly different. Intra-group comparisons of the latency and peak-to-peak amplitudes among rats 14–19 weeks of age were significantly different between the experimental group and the control group. ConclusionsiOVD affected the latency and amplitude of the JOR but not the duration. The JOR adapted after 10 weeks of iOVD.

Orthodontic treatment in periodontitis-susceptible subjects: a systematic literature review.

The aim is to evaluate the literature for clinical scientific data on possible effects of orthodontic treatment on periodontal status in periodontitis‐susceptible subjects. A systematic literature review was performed on studies in English using PubMed, MEDLINE, and Cochrane Library central databases (1965‐2014). By manually searching reference lists of selected studies, we identified additional articles; then we searched these publications: Journal of Periodontology, Periodontology 2000, Journal of Clinical Periodontology, American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, International Journal of Periodontics & Restorative Dentistry, and European Journal of Orthodontics. Search terms included randomized clinical trials, controlled clinical trials, prospective and retrospective clinical studies, case series >5 patients, periodontitis, orthodontics, alveolar bone loss, tooth migration, tooth movement, orthodontic extrusion, and orthodontic intrusion. Only studies on orthodontic treatment in periodontally compromised dentitions were included. One randomized controlled clinical trial, one controlled clinical trial, and 12 clinical studies were included. No evidence currently exists from controlled studies and randomized controlled clinical trials, which shows that orthodontic treatment improves or aggravates the status of periodontally compromised dentitions.

Rapid orthodontic extrusion of a subgingivally fractured incisor

Rapid orthodontic extrusion of a subgingivally fractured incisor

Esthetic Rehabilitation of Crown Fracture Utilizing Orthodontic Extrusion and Restorative Modality

INTRODUCTION: Complicated crown fractures involve enamel, dentine and the pulp, whereby the most commonly affected tooth is the maxillary central incisor. Fractures of anterior teeth cause not only esthetic and functional, but also psychological problems. Various treatment modalities are available depending upon the clinical, physiological and radiographic status of the involved tooth. In complex cases, a combination of endodontic, periodontal, orthodontic and restorative procedures may be required. CASE DISCUSSION: This case report describes the management of a crown fracture of maxillary left central incisor. A complex procedure was designed to manage this case including orthodontic extrusion to move the fracture line above the alveolar bone and surgical recontouring of the altered gingival margin. Finally, the tooth was restored prosthodontically. Prosthodontic treatment was based on performing post and core and all ceramic crown on the extruded tooth. CONCLUSION: The treatment resulted in good esthetics and secured periodontal health. This case report demonstrates that a multidisciplinary treatment approach is a reliable and predictable option to save a tooth.

Esthetic Restoration of Complicated Crown-Root Fractures Utilizing Orthodontic Extrusion

Complicated crown-root fracture of permanent incisors cause esthetic, functional, and psychological problems to patients. Therefore, treatment is important and multidisciplinary treatment is required. This case report describes the clinical procedures involved in the treatment of trauma-induced complicated crown-root fractures in the maxillary incisor of two young patients. Conventional root canal treatment and apexification were performed in each patient. To expose the fracture margins to the supragingival level and to reestablish the biologic width, orthodontic extrusions with fixed appliances were performed followed by a retention period. During the retention period, fiber-optic posts and cores were built up and provisional crowns were placed. Finally, ceramic crowns manufactured using a computer-aided design/computer-aided manufacturing (CAD/CAM) system were placed. In both patients, the teeth presented satisfactory functional and esthetic outcomes without relapse. The periodontal tissues were healthy.

Salvation of severely fractured anterior tooth: An orthodontic approach

Restoration of severely fractured teeth presents a challenge to the endodontist and may require an interdisciplinary approach for proper management. When the available crown structure is less, orthodontic forced extrusion is the option where the coronal root structure is exposed for proper restoration. This report describes the management of severely fractured maxillary right lateral incisor with extensive loss of coronal structure and fracture line extending below gingival margin. Endodontic treatment of the fractured tooth was followed by controlled orthodontic extrusion to expose fracture margin and providing sufficient coronal tooth structure to support the prosthesis. Orthodontic extrusion may be considered as a viable option for the salvation of fractured anterior teeth.Journal of College of Medical Sciences-Nepal, Vol.11(4) 2015: 35-38

Impacted Central Incisor with Dilacerated Root-Treat with Ease.

A 12-year-old female patient reported to the Department of Orthodontics of Maulana Azad Institute of Dental Sciences, New Delhi with chief complaint of missing upper front tooth. On clinical examination it was found that maxillary left central incisor (21) was missing [Table/Fig-1]. No significant history of trauma or premature/delayed shedding of primary left central incisor was reported. Panoramic and maxillary occlusal view revealed impacted left central incisor with dilacerated root [Table/Fig-2,3]. Since the contralateral central incisor had erupted fully in the mouth and the root formation of the impacted central incisor was almost complete, it was decided to disimpact the tooth (21). Disimpaction was planned by surgical exposure followed by elastic traction with the help of removable appliance. Since the patient had well aligned upper and lower arches in good occlusion, it was decided to use a modified removable appliance for extrusion of 21. A removable appliance with modified labial bow was fabricated. Labial bow in the anterior region was fabricated with 22 gauge wire and helices were incorporated in the labial bow adjacent to left central incisor region. Retention was provided by the acrylic coverage in the palatal region and by well formed retentive clasps. Surgical exposure of left central incisor was performed by open exposure technique. A bondable button was placed onto the labial surface of exposed left central incisor crown [Table/Fig-4]. Patient was trained to use elastic in triangular fashion to engage button on 21, and two helices of the labial bow, which resulted in an extrusive force of 20 grams for disimpaction of 21[Table/Fig-5] [1]. Patient was advised to change the elastic daily and was reviewed every three weeks. At the end of six months, complete disimpaction of 21 was achieved with the tooth in its optimal alignment into the upper dental arch and in good relation with lower teeth [Table/Fig-6,7]. Post disimpaction panoramic view reveals tooth 21 in the optimal position with respect to maxillary occlusal plane [Table/Fig-8]. [Table/Fig-1]: Pretreatment intraoral maxillary occlusal photograph showing missing maxillary left central incisor. [Table/Fig-2,3]: Pretreatment panoramic and maxillary occlusal view showing vertically impacted maxillary left central Incisor with dilacerated root. [Table/Fig-4]: Intraoral frontal photograph after surgical exposure and with bonded attachment on labial surface of 21. [Table/Fig-5]: Intraoral frontal photograph showing mechanics for extrusion of 21 with elastic traction force. [Table/Fig-6,7]: Post treatment intraoral frontal and maxillary occlusal photographs showing 21 in alignment and good occlusion. [Table/Fig-8]: Post treatment panoramic view. In young patients, absence of maxillary anterior teeth has a major impact on esthetics, phonetics, mastication and psychosocial well being. Impaction of maxillary permanent central incisor due to dilaceration in the root is a rare condition which is associated with trauma to primary anterior tooth early in life leading to dilaceration of permanent succedaneous tooth [2]. Depending on the severity of dilacerations, decision is usually taken to either expose and align the maxillary central incisor or extract and replace it with prosthesis. Although prognosis of disimpaction of dilacerated central incisor is questionable but orthodontic alignment was preferred in this case due to two reasons. Following extraction of a tooth, the alveolar ridge becomes deficient both vertically and labiolingually which makes it unsuitable for prosthetic implant. Also, the region becomes unaesthetic for conventional prosthetic bridge placement. Any fixed prosthesis for replacement of missing central incisor cannot be given before 18 year of age to allow for completion of alveolar bone growth in growing children [3]. The removable appliance treatment chosen for this patient was a convenient treatment option with less chair side involvement with the patient. Moreover it reduces the overall treatment time required for fully bonded fixed appliance therapy since traction could be applied to the impacted tooth immediately after removable appliance insertion. Also, one of the major advantages of using this simple appliance is that it overcomes the detrimental effects encountered with fixed appliances such as demineralization and difficulty in maintenance of oral hygiene [4]. Orthodontic extrusion of an impacted tooth is usually carried out by a trained specialist by using fixed mechanics. A modified removable appliance with bonded attachment and elastic traction has been used to successfully disimpact and align maxillary central incisor in this case. Such an appliance can be fabricated and used by even a general practitioner with basic knowledge about optimal force delivery.