Surgical Extrusion Research Articles

Effects of different splinting times on surgically extruded teeth with a crown-root fracture: A randomized controlled trial.

Clinical studies evaluating the splinting time for surgically extruded teeth with crown-root fractures are lacking. The aim of this study was to compare 2-week splinting versus functional splinting times after surgical extrusion. Children aged 8-13years who presented with crown-root fractures were included. Surgical extrusion was performed, and teeth were splinted either for 2weeks or until normal Periotest values were achieved (functional splinting time). The outcome measures were tooth mobility, tooth loss, root resorption, marginal bone resorption and ankylosis. Measurements were taken at baseline, weekly after splint removal, and after 1, 3, 6 and 12months. Nineteen patients were included in the analysis. Surgically extruded teeth splinted for 2weeks showed significantly higher mobility directly after splint removal and at 1month after splinting compared with the functional splinting time group. The mean differences for horizontal Periotest values were 14.96 (95% confidence interval: 8.52, 21.39) and 6.63 (95% confidence interval: 0.25, 13), respectively. The vertical Periotest values were 10.47 (95% confidence interval: 1.95, 18.99) and 4.81 (95% confidence interval: -1.57, 11.18), respectively. At the 3-, 6- and 12-month follow-up intervals, there were no statistically significant differences between the groups. One tooth in the 2-week splinting group was lost. None of the teeth had ankylosis, marginal bone resorption or root resorption. Although both groups showed neither statistical nor clinically significant differences after 12months, there was a significant difference immediately after splint removal, with greater tooth mobility in the 2-week splinting group. Thus, a functional splinting time (4-6weeks) can be suggested for better healing and optimal stability to allow placement of the final restoration directly after splint removal.

Surgical extrusion to provide a ferrule for restoring a tooth with a compromised prognosis: A clinical report

A surgical extrusion technique was used to provide a ferrule for a tooth with significant tooth structure loss and an oblique coronal fracture. The maxillary lateral incisor was surgically repositioned coronally to provide sufficient dentinal wall for a good prognosis of the restorative treatment. The procedure is conservative and relatively straightforward and can be performed rapidly with minimal patient discomfort.

Clinical procedures and outcome of surgical extrusion, intentional replantation and tooth autotransplantation - a narrative review.

Surgical extrusion is defined as the procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally. Intentional replantation is defined as the deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position. Tooth autotransplantation is defined as the transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket. The advent of titanium implant rehabilitation has reduced the use of these treatments in day-by-day clinical practice; however, the re-emerging trend to conserve and preserve natural sound tissues has led to a rediscovery of these treatments. All three distinct surgical methods are closely related, as they act to treat teeth that cannot be predictably treated using other more conventional procedures in endodontics, periodontics and restorative dentistry. Furthermore, these procedures share the same treatment approach and include the atraumatic extraction of a tooth, visual inspection of the tooth/root and its subsequent replantation. The clinical procedures for surgical extrusion, intentional replantation and tooth autotransplantation treatment have undergone several changes in recent years, and currently, there are no clear clinical treatment protocols/guidelines available. The clinician should be aware of the outcome of these treatments. Hence, the aim of this narrative review is to provide the background, clinical procedures and outcomes of surgical extrusion, intentional replantation and tooth autotransplantation.

Biologically oriented preparation technique for surgically extruded teeth: A clinical report

Surgical extrusion allows a ferrule to be obtained without the use of orthodontic extrusion or the need to remove hard and soft tissues. However, after the healing period, the soft tissue of the extruded tooth might become thinner, creating an unesthetic gingival margin. Unlike other preparation techniques, the biologically oriented preparation technique provides increased long-term gingival thickness. This article describes the treatment of 3 patients with teeth with no ferrule that were surgically extruded and restored with the biologically oriented preparation technique .

Surgical extrusion: A dental technique

This article describes a technique for surgically extruding severely compromised roots needing prosthetic rehabilitation. Unlike previously described approaches, the technique does not require advanced clinical skills or equipment, may reduce the risk of tooth or bone fracture during the luxation maneuvers, and does not seem to interfere with the alveolar socket healing process.

Management of Immature Permanent Teeth With Crown-Root Fracture: A Case Report With a 24-Month Follow-up

Background: Crown root fractures are usually caused by severe horizontal trauma, involving enamel, dentine, and cementum, and continue down to the gingival margin. One of the most common areas affected by trauma in the mouth is maxillary central incisors. Case Presentation: A10-year-old boy fractured his maxillary central incisors. The fracture line involved the pulp and extended subgingivally on the palatal aspect invading the biologic width. The procedure used to manage this case included endodontic treatment of residual teeth and surgical extrusion to move the fracture line above the alveolar bone. Finally, the teeth were restored with composite build-up. Conclusion: During 24-month follow-up period, the teeth did not show any signs of root resorption. Therefore, surgical extrusion is recommended as a treatment option for crown/root fractures.

Surgical extrusion of immature permanent tooth with crown-root fractures: a case report with 36-month follow up

A 8-year-old patient presented with a crown-root fracture of the maxillary right central incisor with an oblique subgingival fracture line. A multidisciplinary treatment approach including endodontic treatment, surgical extraction and intraalveolar repositioning was used to gain sufficient crown length of the fractured maxillary incisor. The coronally repositioned maxillary right central incisor was stabilized by a resin wire splint. Apexification using MTA was performed. Resin core and direct resin restoration(Cl IV) on fractured teeth was built up. Clinical and radiographic follow-up of the maxillary right central incisor after 36 months showed no signs of root resorption or pathology and acceptable aesthetics and functions were maintained. Surgical extrusion can be considered as a good treatment modality for young patients.

Surgical extrusion of a maxillary premolar after orthodontic extrusion: a retrospective study.

ObjectivesCrown-root fracture and cervical caries in maxillary premolars constitute a challenge in cases of subgingival placement of restoration margins. Surgical extrusion has been practiced successfully in permanent anterior teeth. The aim of the present retrospective study was to assess the clinical outcome of surgical extrusion after orthodontic extrusion in maxillary premolars.Materials and MethodsTwenty-one single, tapered root maxillary premolars with subgingival crown-root fracture or caries were included. Presurgical orthodontic extrusion was performed on all teeth to prevent root resorption. Extent of extrusion and rotation was determined based on crown/root ratio. The postoperative splinting period was 7 to 14 days. Clinical and radiographic examination was performed at an interval of 1, 2, and 3 months.ResultsAfter the mean follow-up of 41.9±15.2 months, failure was observed as increased mobility in 3 of 21 cases. No significant difference was observed in the outcome of surgical extrusion based on tooth type, age, sex, 180° rotation, or time for extraction. Furthermore, marginal bone loss was not observed.ConclusionSurgical extrusion of maxillary premolars can be a possible therapeutic option in cases of subgingival crown-root fracture.

Treatment of dental subtotal coronal lesion through atraumatic surgical extrusion

Treatment of dental subtotal coronal lesion through atraumatic surgical extrusion

Restoring the unrestorable! Developing coronal tooth tissue with a minimally invasive surgical extrusion technique.

Surgical extrusion is a recognised treatment option for teeth that have insufficient coronal tooth structure remaining due to deep caries, resorption or traumatic injury. However, the technique has not been widely adopted, arguably because extraction of a severely compromised tooth may be difficult to achieve in a gentle and predictable way. In this paper, we present our novel approach to surgical extrusion and subsequent management of teeth using a vertical extraction system (Benex), which has become the method of choice in the authors' practice for many teeth that would otherwise be deemed unrestorable. We describe the clinical procedure in detail and discuss the advantages and disadvantages compared to alternative approaches, including surgical crown lengthening and orthodontic extrusion.

Surgical extrusion with biologically oriented preparation: An alternative to extraction

Surgical extrusion should be considered as an alternative treatment in patients with structurally compromised teeth that retain coronal integrity and have favorable root anatomy. The procedure described is straightforward and can be performed quickly. A situation in which it was used to treat a maxillary premolar with substantial structural loss but well-preserved periodontal attachment is presented. The biologically oriented preparation technique is a conservative method of tooth restoration.

Management of traumatic intrusion of permanent teeth with immediate surgical repositioning: A case report from Hasan Sadikin Hospital, Bandung-Indonesia

Introduction: Traumatic dental injuries (TDI) of permanent teeth frequently occur in children and young adults. Intrusive luxation is one of the most severe forms of traumatic injuries in which the affected tooth is forced to displace deeper into the alveolus. As a consequence of this type of injury, maximum damage occurs to the pulp and all the supporting structures. The aim of this study is for proper diagnosis, treatment planning and follow up for improving a favorable outcome. Case: A 14 years old male patient came to the emergency department of Hospital Dr. Hasan Sadikin with bleeding from mouth due to an accident. Through clinical and radiographic examination discovered there was an intrusion of teeth 11,21. The intruded teeth were immediately repositioned and splinted within hours following injury with Arch Bar. Antibiotic therapy was initiated at the time of repositioning and maintained for five days. The splint was removed one month later. Clinical and radiographic examination one month after the surgical extrusion revealed satisfactory progressive apical and periodontal healing. Intrusion injuries have the poorest prognosis and complex treatment among all tooth injuries. No consensus has been reached on the optimal treatment of this type of injuries. The recommended treatment options for intruded teeth include the following such as allowing spontaneous re-eruption of the teeth, immediate surgical repositioning, and fixation and orthodontic repositioning. The treatment has to be adaptable according to complications.Conclusion: Further surgical repositioning in the presented case with one month follow up proved to be a viable treatment method for intruded teeth without any additional risk of resorption.Â

Periodontal status of anterior teeth following clinical crown lengthening by minimally traumatic controlled surgical extrusion.

The number of fractured anterior teeth following trauma has been increasing while not every patient is able to afford a dental implant instead of maintaining the injured tooth. Thus, a tooth conservation solution is required to place an aesthetic and functional restoration without biologic width violation. The aim of this study was to evaluate the effectiveness of minimally traumatic controlled surgical extrusion in fractured anterior teeth crown lengthening by assessing the periodontal status through clinical examination and radiographs. This longitudinal observational study investigated a group of 18 patients (six males and 12 females) at the Department of Periodontology, National Hospital of Odonto-stomatology, Ho Chi Minh City, Vietnam. Following pre-surgery procedures and examination, minimally traumatic controlled surgical extrusion was carried out using a periotome. Patients were examined at four follow-up appointments after 1week, 1, 3 and 6months to record the following experimental variables: periodontal parameters including the gingival index (GI), pocket depth (PD), bleeding on probing (BOP), mobility, marginal gingiva position, alveolar ridge resorption, periapical osteogenesis, tooth resorption and ankylosis. All periodontal parameters were significantly decreased at 3 and 6months post-procedure (P<0.001). Tooth mobility decreased gradually following surgery, and at 6months, all teeth became normal at level 0. Periapical osteogenesis changes were significantly increased at 1, 3 and 6months in comparison with pre-surgery (P<0.001). Marginal gingiva position and alveolar ridge resorption were not significantly different between pre-surgery and 1, 3 and 6months post-surgery. No cases of root resorption or ankylosis were observed at 6months post-surgery. A minimally traumatic controlled surgical extrusion technique for clinical crown lengthening yielded highly successful results in both aesthetic and functional aspects, and no cases had unfavourable outcomes during the 6-month follow-up period.

Reconstrucción nasal con cartílago costal de banco de hueso

Presentamos una serie de reporte de casos de 10 pacientes con deformidad rinoseptal de distinta etiología; traumáticas, infecciosas y quirúrgicas. Estos pacientes presentaban obstrucción nasal como principal síntoma además de la deformidad estética. Los pacientes fueron tomados de la consulta externa del servicio de Otorrinolaringología del Hospital de San José. A los pacientes se les realizó reconstrucción nasal con cartílago costal de banco de hueso, se les practicó un abordaje por técnica abierta y se utilizó el injerto de banco de hueso. Los pacientes fueron seguidos por 7 meses como mínimo y máximo 16 meses. Los pacientes se evaluaron con registro fotográfico pre y posquirúrgicamente. Dentro del periodo de seguimiento no hubo infección del sitio operatorio o extrusión del injerto. La mejoría funcional y estética fueron evaluadas con grado de satisfacción del paciente y del cirujano como buenas-excelentes. La aplicabilidad de la técnica mostró buenos resultados y aplicación en diferentes grupos etarios y etiológicos.

Surgical extrusion: A reliable technique for saving compromised teeth. A 5-years follow-up case report

Aim: To present a long term follow up clinical case in which a compromised anterior tooth was saved by a surgical extrusion procedure. Summary: Although different techniques have been suggested for clinical crown lengthening in the anterior zone, some of them have limitations in terms of aesthetics and procedural requirements. The current case report demonstrates how a simplified surgical extrusion procedure was successfully performed for saving a severely damaged anterior tooth; furthermore, it is possible to apply the technique described in this case using minimum and simple armamentarium like a scalpel, elevators, forceps and splinting flexible cord. Key-learning points: Saving severely compromised anterior teeth is possible by applying surgical extrusion techniques when crown-root ratio allows it. Risk of root resorption or ankylosis is minimum.

Surgical extrusion with an atraumatic extraction system: A clinical study

Statement of problemClinical studies evaluating the feasibility of a novel technique for the surgical extrusion of nonrestorable teeth with subgingival caries are lacking. PurposeThe purpose of this clinical study was to investigate the success rate and incidence of biological and technical complications after tooth extrusion with an atraumatic extraction system (AES). Material and methodsParticipants were recruited from 61 consecutive patients initially referred to a specialist oral surgery practice. Fifty-one participants who underwent surgical extrusion with an AES followed by endodontic treatment and coronal restoration could be re-evaluated clinically and radiographically. ResultsThe mean observation period was 3.1 years (range: 0.8 to 6.5 years). The participants varied in age between 24.8 and 86.3 years. The amount of extrusion was between 2.5 and 5.0 mm (mean 3.2 mm). At recall, 92.2% (47 of 51) of the extruded teeth were considered successful. All extruded teeth were asymptomatic, without clinical signs of inflammation. Percussion appeared normal and did not differ from that of the adjacent teeth, indicating absence of ankylosis. Transient resorption with a slightly altered root contour was detected in 5 of the 51 teeth. Minor reduction of the bone level (less than 10%) was detected in 8 of the 51. In a further 2 teeth, bone loss amounted to 25% and 30%. Periapical periodontitis at recall was seen in 4 of the 51 teeth, and a preexisting periapical lesion healed in 10 of 13. Root perforation was identified in 3 of the 51, and a further 3 of 11 were not available for recall. Thus, the technical complication rate was 9.7% (6 of 62). ConclusionsThe AES may be successfully used for surgical extrusion to save apparently nonrestorable teeth, irrespective of patient age.

Tooth loss following surgical extrusion of crown-root fractured teeth: A 6-years survival analysis

Aim: This study aimed to show the adverse effect of surgical extrusion technique in the management of crown-root fractures regarding tooth loss over a six-year follow-up period.Methods: Twenty patients with a crown-root fracture in maxillary incisors were selected from an outpatient clinic in pediatric dentistry department- Cairo University. Twelve males and eight females with age range from 11-14 years participated in this study. Surgical extrusion was performed combined with endodontic treatment. Patients were recalled every year following surgical extrusion to assess the risk of tooth loss.Results: Twenty patients participated in this study with mean age of 131 months. Only 17 patients completed a follow-up period of at least one year. Overall, five teeth were lost over a follow-up period of six years constituting 29% (95% CI 13 to 53%) of the study population.Conclusion: Surgical tooth extrusion could be considered as a treatment option for crown-root fractures. Nevertheless, tooth loss is not an uncommon adverse effect. The first two years are critical for deciding the survival of surgical extruded tooth.

A Case Report of Surgical Extrusion for Gemination of Impacted Premolar in a Patient with Autistic Spectrum Disorder

A Case Report of Surgical Extrusion for Gemination of Impacted Premolar in a Patient with Autistic Spectrum Disorder

Management of complicated crown-root fracture in central incisors using intentional replantation with 180° rotation: A case report

Introduction: Complicated crown-root fractures are rare and their treatment is complex. Numerous methods such as crown lengthening and orthodontic or surgical extrusion have been described for the treatment of crown-root fracture. The aim of this study was to report managing complicated crown-root fracture using intentional replantation with 180° rotation. Case report: This case report demonstrates successful management of complicated crown-root fracture in central incisor of a 10-year-old boy using intentional replantation with 180° rotation. Discussion: At 18-month follow-up, the replanted tooth revealed normal function with no obvious resorption.

Atraumatic surgical extrusion to improve tooth restorability: A clinical report

This clinical report describes the use of an “atraumatic” vertical extraction system to facilitate the restorative treatment of a tooth that would otherwise be considered unrestorable because of subgingival caries. Minimally invasive surgical root extrusion was undertaken using the Benex extraction system, which can provide controlled tooth extrusion with minimal deformation of the bone socket. A carious endodontically treated mandibular premolar was extruded to provide routine restorative treatment and endodontic retreatment.