Download Orthodontic extrusion

ORTHODONTIC
EXTRUSION
By : hoda pouyanfar
Orthodontic forced eruption may be a suitable
approach without risking the esthetic appearance in
tooth fracture below the gingival attachment or
alveolar bone crest.
•Extrusion of such teeth allows elevating the fracture
line above the epithelial attachment and so the
proper finishing margins can be prepared.
• Restoration after orthodontic eruption may present
a more conservative treatment choice in young
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J Can Dent Assoc 2004; 70(11):775–80
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Orthodontic Extrusion
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Movement of a tooth by extrusion involves applying
traction forces in all regions of the periodontal ligament to
stimulate marginal apposition of crestal bone.
Because the gingival tissue is attached to the root by
connective tissue, the gingiva follows the vertical movement
of the root during the extrusion process. Similarly, the
alveolus is attached to the root by the periodontal ligament
and is in turn pulled along by the movement of the root.
J Can Dent Assoc 2004; 70(11):775–80
Indications for Orthodontic Extrusion
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for treatment of a subgingival or infraosseous lesion of the tooth between
the cementoenamel junction and the coronal third of the root (caries,
oblique or horizontal fractures, perforations caused by a pin or Post ,
internal or external root resorption), especially when there are esthetic
considerations
for treatment of a restoration impinging on the biological width
for reduction of angular bone defects and isolated periodontal pockets
for preimplant extraction to maintain or re-establish the integrity of an
alveolar ridge
for orthodontic extraction where surgical extraction is contraindicated
(chemotherapy or radiotherapy)
for treatment of trauma or impacted teeth(canines)
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J Can Dent Assoc 2004; 70(11):775–80
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J Can Dent Assoc 2004; 70(11):775–80
Contraindications to Orthodontic
Extrusion
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ankylosis or hypercementosis
root proximity and premature closure of embrasures
short roots
insufficient prosthetic space
exposure of the furcation.
the presence of chronic, uncontrollable inflammatory lesions, including
combined endodontic-periodontic lesions and fractured roots;
an inability to control inflammation and acute infection that would
adversely affect healing and the overall response to treatment
an absence of attachment apparatus because forced eruption only
relocates the existing attachment, it does not create a new attachment
J Can Dent Assoc 2004; 70(11):775–80
Advantages
conservative procedure that allows retention of a tooth
without the disadvantages of a fixed bridge
 does not involve loss of bone or periodontal
support, as commonly occurs during extraction
 Avoid resection of bone of the teeth adjacent to the
tooth
 this simple technique requires a relatively easy
movement of the tooth.
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J Can Dent Assoc 2004; 70(11):775–80
Disadvantages
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Wearing an orthodontic device
esthetic problems
oral hygiene
duration of treatment (4 to 6 weeks of extrusion and 4 weeks to 6
months of retention for implant cases in which tissue and bone remodelling are the
objectives)
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periodontal surgery
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J Can Dent Assoc 2004; 70(11):775–80
Periodontal Effects
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Orthodontic extrusion forces coronal migration of the
root and increases the bone ridge as well as the
quantity of attached gingiva , in particular when weak
to moderate forces are applied.
The amount of attached gingiva is increased through
eversion of the sulcular epithelium, appearing first as
immature nonkeratinized tissue (known as“red patch”)
and then as keratinized tissue; the process of
keratinization requires 28 to 42 days.
J Can Dent Assoc 2004; 70(11):775–80
J Can Dent Assoc 2004; 70(11):775–80
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After coronal movement of the periodontal
attachment
minor surgical correction
weekly fibrotomy
single fibrotomy
J Can Dent Assoc 2004; 70(11):775–80
Extrusion and Endodontics
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Treated endodontically to prevent sensitivity and
exposure of the pulp during the occlusal reduction
required during the extrusion.
calcium hydroxide
Pulpectomy
preimplant extraction
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extrusion force of 50 g
1 week
odontoblastic degeneration
4 weeks
J Can Dent Assoc 2004; 70(11):775–80
pulpal fibrosis
J Can Dent Assoc 2004; 70(11):775–80
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pulpal reaction would differ depending on the
diameter of the apical foramen
Pulp prolapse would be due to ischemia secondary
to rapid movement
During rapid extrusion, a pseudo-apical lesion
appears, which must be differentiated from a true
lesion of endodontic origin
Extrusion and Prosthodontics
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The mesiodistal diameter of the root, which is naturally
“strangled” at the cementoenamel junction of single-rooted
teeth, is reduced with progression of the extrusion
(especially in the case of conical roots), which involves
expansion of interproximal gingival embrasures.
The contour shape of the crowns must not be exaggerated
to compensate for this reduction in diameter .
Similarly, embrasures should not be filled to prevent an
overcontour, which could adversely affect the marginal
periodontium.
J Can Dent Assoc 2004; 70(11):775–80
J Can Dent Assoc 2004; 70(11):775–80
Choice of treatment
37 teeth
re-eruption
7 teeth
with forceps at the day of
the injury and splinted with wire and composite
for 2–6 weeks
7 teeth
Repositioned orthodontically (two teeth within 1
week and five teeth after 1–8 months)
Results
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Re-eruption occurred in 35 out of 37 teeth
2 teeth → ankylosis
both necrosis and the external root resorptions
occurred more often in orthodontically and
surgically repositioned teeth than in the nonrepositioned teeth
Condition 5 days after injury, before start of
endodontic treatment. A gingivectomy was
performed to gain access to the root canal
Partial re-eruption 1 month later.
Pulp canal is filled temporarily with calcium
hydroxide
Complete re-eruption and permanent root
filling 10 months after trauma
Three weeks after complete intrusion
Five years later
20-year-old male
The total extrusion time was 4 months.
The extruded tooth was retained with the same
arch wire for 12 weeks to prevent any relapse.
At the end of a 12-week retention period,
gingivectomy and fiberotomy were performed
for lingual margin exposure and better
esthetics.
A 21-year-old white woman
complicated crown fracture in central
oblique crown-root fracture in lateral
A temporary root canal therapy using a
calcium hydroxide dressing was immediately
performed on both incisors, which were then
sealed with a glass ionomer cement
9-year-old child
cervical root fracture
Calcium hydroxide pulpotomy for apexogenesis
extrusion of 2–3 mm was obtained within
6–8 weeks
The patient was examined
every 3 months during the follow-up period of
18 months
After 3-year
follow-up