Download Forced Eruption by Fiber-Reinforced Composite

Continuing Education
Course Number: 118.1
Forced Eruption by
Fiber-Reinforced Composite
Authored by Morteza Oshagh, DMD, MScD, Ahmad Reza Sadeghi, DMD, MScD,
Farahnaz Sharafeddin, DMD, MScD, Ali Asghar Alavi, DMD, MScD,
Reza Amid, DMD, MScD and Reza Derafshi, DMD, MScD
Upon successful completion of this CE activity 1 CE credit hour may be awarded
A Peer-Reviewed CE Activity by
Dentistry Today is an ADA CERP
Recognized Provider.
Approved PACE Program Provider
FAGD/MAGD Credit Approval
does not imply acceptance
by a state or provincial board of
dentistry or AGD endorsement.
June 1, 2009 to May 31, 2011
AGD Pace approval number: 309062
Opinions expressed by CE authors are their own and may not reflect those of Dentistry Today. Mention of
specific product names does not infer endorsement by Dentistry Today. Information contained in CE articles and
courses is not a substitute for sound clinical judgment and accepted standards of care. Participants are urged to
contact their state dental boards for continuing education requirements.
Continuing Education
Recommendations for Fluoride Varnish Use in Caries Management
Forced Eruption by
Fiber-Reinforced Composite
Dr. Derafshi is a prosthodontist and is assistant professor,
Prosthodontics Department, School of Dental Medicine,
Shiraz University of Medical Sciences, Shiraz, Iran. He can be
reached at [email protected].
LEARNING OBJECTIVES:
Disclosure: The authors report no conflicts of interest.
After reading this article, the individual will learn:
INTRODUCTION
• The scientific and clinical rationale for forced tooth eruption.
• A clinical technique for achieving forced tooth eruption
without the use of orthodontic brackets.
Teeth with defects in the cervical third of the root and which
require a full coverage restoration present a challenging dental
treatment situation. In these cases forced eruption permits
crown margins to be placed on sound tooth structure. Two
methods are available for forced eruption: with and without the
use of orthodontic brackets.
This article reviews the literature on the topic of forced tooth
eruption, and presents a clinical case in which a newly
designed appliance utilizing fiber-reinforced composite (FRC)
without orthodontic brackets was used to achieve forced
eruption.
Forced eruption was first introduced by Heithersay and
then followed by Ingber for the correction of alveolar bony
defects.1-3 Although the primary aim of this treatment has been
the correction of bony defects, it is currently used in clinical
crown lengthening of fractured teeth or teeth with subgingival
decay.4,5 Fracture of teeth at or below the alveolar bone crest
present certain restorative complications if restored without
correction of the defects.6 Maintenance of biologic width is vital
during prosthodontic treatment, and encroachment on this
width can cause gingival inflammation, attachment loss, pocket
formation, and subsequent bone loss.7-11
There are 4 treatments that can be used for maintenance
of biologic width: tooth extraction and replacement, crown
lengthening surgery, moving the tooth by surgical extrusion,
and forced eruption. Tooth extraction seems to be the easiest
method, but this requires costly prosthodontic or implant
placement, and often can present aesthetic challenges in the
anterior region. Crown lengthening surgery is also useful for
posterior teeth because no aesthetic considerations are
necessary.2,3,12-14 Surgical extrusion of teeth was first
introduced by Kahnberg,15 with the procedure consisting of
moving the tooth by surgical approaches and fixing it in a new
ABOUT THE AUTHORS
Dr. Oshagh is an orthodontist and
is assistant professor, Orthodontics
Department, School of Dental Medicine,
Shiraz University of Medical Sciences,
Shiraz, Iran. He can be reached at
+989-123-723-280 or via e-mail at
[email protected].
Dr. Sadeghi is a postgraduate student, Operative & Esthetic
Dentistry Department, School of Dental Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran. He can be
reached at [email protected].
Dr. Sharafeddin is a restorative and aesthetic dentistry
specialist and assistant professor, Operative & Esthetic
Dentistry Department, School of Dental Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran. She can be
reached at [email protected].
Dr. Alavi is a restorative and aesthetic dentistry specialist and
full professor, Operative & Esthetic Department, School of
Dental Medicine, Shiraz University of Medical Sciences,
Shiraz, Iran. He can be reached at [email protected].
Dr. Amid is a periodontist and is assistant professor,
Periodontology Department, School of Dental Medicine,
Shiraz University of Medical Sciences, Shiraz, Iran. He can be
reached at [email protected].
1
Continuing Education
Forced Eruption by Fiber-Reinforced Composite
predetermined position by sutures and dressings.15
Forced eruption is one of the easiest orthodontic
approaches that can have an acceptable outcome and
prognosis, and has a low incidence of relapse.7 Orthodontic
forces cause a tension in the periodontal ligament and create a
wider periodontal space. This tension stimulates osteoblastic
function, and consequently, bone formation will occur in situ.
The rate of tooth movement serves as the main determinant of
the amount of bone formation and alveolar bone movement. If
the tooth is moved slowly (1 to 2 mm per month), alveolar bone
crest will move with the tooth and the clinical crown will show no
changes in size.16 However, if the tooth is moved at a faster rate
(3 to 4 mm per month), forces can tear periodontal ligament and
cause the tooth to extrude from the alveolar bone. However,
using heavy forces or very fast movements can also cause
tissue damage or ankylosis. It must be considered that if
residual ligaments are not cut by fibrotomy, their presence can
cause some extent of bone formation at the alveolar crest.17-19
Selection of the movement rate depends on the aim of the
treatment. Tooth fracture management mandates the fast
option, while for the correction of bony defects, bone
augmentation for the reconstruction of interdental papilla, or
implant insertion, the slow movement is preferred.4,20,21 It
should be noted that tooth movements intended for the
reconstruction of adjacent bone before the insertion of implants
is an accepted method.22
Certain considerations must be taken into account
regarding forced eruption, including: root length, where after
movement the tooth must have a proper crown/root ratio; root
shape, where wider roots are more appropriate because
tapered roots may compromise aesthetics in the cervical
aspect of prostheses; importance of the tooth, eg, it is more
important to preserve a root in young people with full dentitions
compared to partially edentulous elderly patients; position of the
fracture, eg, if the fracture occurred at least 3 mm under
alveolar bone crest, treatment would be more complicated; and
aesthetics, eg, if the gingival line is placed in the aesthetic zone,
root preservation can improve gingival aesthetics.23
Three points must be considered when determining the
amount of tooth movement desired: defect position; required
space for prosthetic crown margin (about 1 mm); and required
space for biologic width maintenance (about 2 mm).19 There
are different alternative methods proposed for tooth movement
in forced eruption. Simon24 suggests bonding a wire to adjacent
teeth and transferring the force by elastic from the wire to the
root. The primary advantage of this method is simplicity.19,24
Nappen25 performed forced eruption by bonding brackets to the
target tooth and adjacent teeth using nickel titanium wire with
high elasticity potential, which has the tendency to return to its
straight form, moving the tooth with it.19,25 Osterle9 placed a
temporary crown on the residual root and placed a hook over
the crown, then used elastic to connect the hook to the wire
bonded to adjacent teeth.9 Segelnick6 used a C clasp with an
occlusal rest and transitional arm.6 Other methods involve the
use of removable appliances and magnets.12,14,26
Forced eruption has 4 main stages: (1) proper case
selection, root canal therapy, and appliance fabrication; (2) force
application (the force needed for 1 mm of tooth movement in a
week is about 25 to 30 grams in rapid movements. About 4
weeks is needed for the desired amount of movement, and the
patient must be followed once or twice a week for prevention of
gingival inflammation and elimination of occlusal interferences);
(3) maintenance period (there are different suggestions about
the duration of this period, but it is well known that 3 to 6 weeks
is the required time for ligament reconstruction. Fibrotomic
surgery can be performed before, during, or after the tooth
moving procedure); and (4) Prosthetic treatment (4 to 6 weeks
after osseous surgery, and 2 to 4 weeks after soft tissue
shaping is the required healing time for prosthetic
treatment).19,27-29
The following case report introduces a new method for
forced eruption, which includes some modifications to the
conventional technique. Some of the advantages of this method
are aesthetic maintenance during the treatment period, no
need for occlusal adjustments, simplicity, low cost, and stability
of the treatment outcome (no relapse).
CASE REPORT
A 25-year-old female with a fracture in the right
maxillary central incisor was referred to the dental school,
Shiraz University of Medical Sciences. A horizontal root
fracture had occurred at the level of the alveolar crest.
Adjacent teeth had no decay or restorations, and
2
Continuing Education
Forced Eruption by Fiber-Reinforced Composite
radiographs showed that the fracture did not extend beyond
the crest level. The tooth had been endodontically treated
previously. There was not enough tooth structure for
restoration without invasion of the biologic width (Figure 1).
Different treatment options were discussed with the patient,
including tooth extraction and replacement by a fixed partial
denture or implant prosthesis, crown lengthening surgery,
or forced eruption. Because the patient had a gummy smile,
the extraction of the root followed by fixed partial prosthesis
treatment was not considered a good treatment option.
Further, the patient was not willing to have sound tooth
structure removed from adjacent teeth for prosthodontic
preparation. Crown lengthening surgery would have
resulted in discrepancies of the gingival level and the loss
of interdental papillae, which was not aesthetically pleasing.
Use of an implant would be relatively costly in terms of the
patient’s financial situation. Following thorough descriptions
to the patient regarding all treatment options, she preferred
the forced eruption technique.
Because the tooth had previously undergone root canal
therapy, the coronal 3 mm of gutta-percha was removed. A
piece of wire (0.032 inch in diameter) in the form of a loop
was fixed into the prepared root using glass ionomer
cement. Another loop was formed at the other end of the
same wire. The FRC tape (Thinner Higher Modulus,
Ribbond) was passed through this latter loop (Figure 2),
and the complex was bonded to the adjacent teeth. The
proper distance of the 2 loops (the one placed into the
canal and the loop attached to the FRC) should be
determined prior to the placement of the complex. The
internal diameter of the bracket’s elastic (O ring), which
served as the major force exertion during treatment, was
measured to be 3 mm while active. Therefore, it was
decided to set a 5 to 6 mm distance to provide the
possibility of a 3 mm tooth movement.
To bond the FRC-loop complex to the adjacent teeth
(maxillary left central incisor and right lateral incisor), the
proximal surfaces of the crowns of these teeth were first
cleaned with fluoride-free pumice and spot etched using
37% phosphoric acid for 20 seconds. Etched surfaces were
then irrigated and dried. Bonding agent (Single Bond, 3M
ESPE) was applied and light cured for 20 seconds. Fiber
was immersed into a hydrophobic resin and saturated.
Figure 1.
Maxillary central incisor
fracture at the level of
alveolar crest.
Figure 2.
Hooks made of 0.032inch stainless steel wire.
Figure 3.
The hook is cemented
in the root canal.
Figure 4a.
The complex of fiberreinforced composite
(FRC) and hook is
bonded to proximal
areas of adjacent teeth
before curing
Figure 4b.
The complex of FRC
and hook is bonded to
proximal areas of
adjacent teeth after
curing.
Figure 5.
The composite veneer.
3
Continuing Education
Forced Eruption by Fiber-Reinforced Composite
Fiber, containing the loop, was then placed on the proximal
surfaces of the adjacent teeth and light cured. To strengthen
the complex, FRC was covered with flowable composite
resin and cured (Figure 3).
To provide aesthetics during treatment, a labial veneer
shaped as the labial face of the central incisor was
fabricated from particulate filled composite resin (shade A3,
Z250, 3M ESPE) and attached to the FRC within the
edentulous area (Figures 4a to 6). Deficient space and a
deep bite required placement of the hook-FRC complex
with a slight distal inclination. The 2 hooks were connected
to each other by an O ring elastic bracket, and oral hygiene
instructions were given to the patient (Figure 7).
The patient had been referred from another city and it
was not possible for her to travel to the dental school for
adjustments, so a dentist in her area was asked to change
the elastic every 3 to 4 days. After 29 days, 3 mm extrusion
was observed in the mesial, distal, and palatal surfaces, but
the extrusion on the labial surface was less that 3 mm
(Figures 8 to 10). Although in this stage the hooks were
closer to each other, for the maintenance period the same
elastic was used to connect them. Internal bevel
gingivectomy and circumferential fibrotomy were performed
after 10 days to detach the attachment apparatus moved
during extrusion (Figure 11). For this reason the FRC-hook
complex and adjacent temporary crown were removed, and
for aesthetic reasons during the healing period another
appliance was designed to cover the edentulous area. For
this purpose an impression with alginate was taken and
poured in orthodontic stone before the surgery and after
removing the FRC complex. Then a removable orthodontic
appliance (including 2 Adams clasps on the first maxillary
molars and an acrylic tooth in the edentulous area) was
designed and fabricated. The acrylic tooth was prepared to
avoid applying pressure on the dressing following the
surgery (Figure 12).
One week later, the sutures and the dressing were
removed, and the prosthetic phase of treatment followed.
The removable appliance was used during fabrication of the
final restoration. To provide aesthetics, a full ceramic
restoration was the best alternative, but the patient’s deep
bite led to the decision to restore the tooth with a PFM
Figure 6.
The composite veneer
is bonded to adjacent
teeth
Figure 7.
Schematic view of the
complex of FRC and
composite veneer.
Figure 8.
Attachment of
elastomeric ligature
(O ring) between 2 hooks.
Figure 9.
After 29 days of
extrusion. Note the
radiolucent space
between apex and its
surrounding bone.
Figure 10.
Frontal clinical view of
extruded tooth
crown in order to place the occlusal contact on the metal
portion. The patient’s social circumstances caused a
4
Continuing Education
Forced Eruption by Fiber-Reinforced Composite
14-week delay between the maintenance period and
prosthesis cementation stage, which was longer than
necessary, but unavoidable (Figures 13 and 14).
Figure 11.
Occlusal clinical view of
extruded tooth
DISCUSSION
After tooth fracture, forced eruption is the technique of
choice if conditions are appropriate and the patient is
motivated.4 This method is also useful in the management
of decay, internal root defects, bony defects, and
periodontal pockets.5,13,14,20,24 Contrary to conventional
orthodontic treatments, the purpose of this method is not
the correction of tooth position in the arch; it is to preserve
the root and biologic width.30
Soft tissue and bone also move during extrusion. To
prevent this movement, it is proposed to make a sulcular
incision at each appointment. The incision can also be
made before the tooth movement or before the
maintenance period. In our case it was performed after
tooth movement. However, there is not enough evidence to
indicate the influence of fibrotomy on the required time for
maintenance.2,10,31
In some methods, a transitional crown or the fractured
part of the crown is attached to the root to provide
aesthetics during the treatment and to prevent adjacent
teeth from tipping into the edentulous space.32 The primary
disadvantage of this method is movement of the temporary
crown during the root extrusion, and as a consequence,
occlusal adjustment would be necessary at each
appointment.9 But in the method described in this article,
the transitional crown is attached to adjacent teeth and
does not move during extrusion. Further, spot etching
results in minimal enamel involvement in the adjacent teeth.
The extrusion rate in this case is in agreement with
another studies. After 29 days, tooth movement was
estimated at 3 mm (about 1 mm in 10 days).1,2,9 Heavy
extrusion forces can cause pulpitis, root resorption, bony
defects, and periodontitis and none of these pathologic
conditions were observed in this case.
For forced eruption, force application from the palatal
side creates a vertical force direction, which provides a
more proper angulation compared to a wire or bracket
Figure 12.
Gingivectomy.
Figure 13.
The removable
appliance which
included an artificial
tooth.
Figure 14.
Clinical view of
removable appliance at
delivery time.
attached to the buccal aspect of the tooth.9,19,24,25 However,
in this case, regarding the buccal tendency of force
direction, the tooth movement in the buccal aspect was less
than the palatal aspect, but this did not make a significant
clinical difference.
In the literature, different durations have been
suggested regarding the maintenance period.2,3,10,19,33 A
deficient maintenance period can produce unwanted
results; however, compared to the other orthodontic
5
Continuing Education
Forced Eruption by Fiber-Reinforced Composite
movements, the method described in this case has less
tendency to relapse.7 Lemon34 described that one month
would be the proper maintenance period for 1 mm of
extrusion.34 However, Simon35 believes 7 weeks is the
required time for periodontal ligament repair,35 and
Andreasen36 observed that 1 week of splinting is adequate
for an avulsed tooth.36 In our case, the maintenance period
(from the beginning of maintenance to final cementation of
the prosthesis) was about 3.5 months, and no untoward
outcomes were encountered.
Home care and oral hygiene are important
considerations in this method. Inadequate hygiene during
treatment could result in gingivitis, periodontitis, and/or
destruction of bone.
This appliance and technique incorporate some
modifications to traditional devices, and can provide proper
aesthetics, function, and stability using a relatively simple
procedure that can be performed by the specialist or
general practitioner.
3. Heithersay GS. Combined endodontic-orthodontic treatment
of transverse root fractures in the region of the alveolar crest.
Oral Surg Oral Med Oral Pathol. 1973;36:404-415.
CONCLUSIONS
12. Murchison DF, Schwartz RS. The use of removable
appliances for forced eruption of teeth. Quintessence Int.
1986;17:497-501.
4. Chandler KB, Rongey WF. Forced eruption: review and case
reports. Gen Dent. 2005;53:274-277.
5. Ziskind D, Schmidt A, Hirschfeld Z. Forced eruption technique:
rationale and clinical report. J Prosthet Dent. 1998;79:246-248.
6. Segelnick SL, Uddin M, Moskowitz EM. A simplified appliance
for forced eruption. J Clin Orthod. 2005;39:432-434.
7. Emerich-Poplatek K, Sawicki L, Bodal M, et al. Forced
eruption after crown/root fracture with a simple and aesthetic
method using the fractured crown. Dent Traumatol.
2005;21:165-169.
8. Silness J. Periodontal conditions in patients treated with
dental bridges. 3. The relationship between the location of the
crown margin and the periodontal condition. J Periodontal
Res. 1970;5:225-229.
9. Oesterle LJ, Wood LW. Raising the root. A look at orthodontic
extrusion. J Am Dent Assoc. 1991;122:193-198.
10. Ivey DW, Calhoun RL, Kemp WB, et al. Orthodontic extrusion: its
use in restorative dentistry. J Prosthet Dent. 1980;43:401-407.
11. Padbury A Jr, Eber R, Wang HL. Interactions between the
gingiva and the margin of restorations. J Clin Periodontol.
2003;30:379-385.
Forced eruption is often the most ideal option to restore
fractured teeth, especially in the anterior segment. The
advantages of this approach include preservation of the root
structure, enhancement of the gingival level and aesthetics of
the fractured tooth and adjacent teeth, and significantly less
cost compared to implant treatment. Although the treatment
is quite time-consuming, it requires almost the same time as
needed for implant therapy. Home care and oral hygiene
have a key role in treatment success. Using these small
appliances for forced eruption can eliminate the need for
fixed prosthesis appliances, and provide aesthetics and
function as acceptable as comparable techniques, using a
relatively simple procedure.
13. Benenati FW, Simon JH. Orthodontic root extrusion: its
rationale and uses. Gen Dent. 1986;34:285-289.
14. Mandel RC, Binzer WC, Withers JA. Forced eruption in
restoring severely fractured teeth using removable orthodontic
appliances. J Prosthet Dent. 1982;47:269-274.
15. Kahnberg KE. Surgical extrusion of root-fractured teeth–a
follow-up study of two surgical methods. Endod Dent
Traumatol. 1988;4:85-89.
16 Graber TM, Vanarsdall RL. Orthodontics: Current Principles
and Techniques. 2nd ed. St. Louis, Mo: Mosby; 1994.
17. Schwimer CW, Rosenberg ES, Schwimer DH. Rapid extrusion
with fiberotomy. J Esthet Dent. 1990;2:82-88.
18. Pontoriero R, Celenza F Jr, Ricci G, et al. Rapid extrusion
with fiber resection: a combined orthodontic-periodontic
treatment modality. Int J Periodontics Restorative Dent.
1987;7:30-43.
REFERENCES
19. Proffit WR, Fields HW Jr, Sarver DM. Contemporary
Orthodontics. 4th ed. St. Louis, Mo: Mosby; 2007:644-646.
1. Ingber JS. Forced eruption. I. A method of treating isolated
one and two wall infrabony osseous defects—rationale and
case report. J Periodontol. 1974;45:199-206.
20. Levine RA. Forced eruption in the esthetic zone. Compend
Contin Educ Dent. 1997;18:795-804.
2. Ingber JS. Forced eruption: part II. A method of treating
nonrestorable teeth—periodontal and restorative
considerations. J Periodontol. 1976;47:203-216.
21. Stroster TG. Forced eruption: clinical considerations. Gen
Dent. 1990;38:376-380.
6
Continuing Education
Forced Eruption by Fiber-Reinforced Composite
22. Erkut S, Arman A, Gulsahi A, et al. Forced eruption and
implant treatment in posterior maxilla: a clinical report.
J Prosthet Dent. 2007;97:70-74.
30. Stevens BH, Levine RA. Forced eruption: a multidisciplinary
approach for form, function, and biologic predictability.
Compend Contin Educ Dent. 1998;19:994-1004.
23. Kokich VG. The adjunctive role of orthodontic therapy. In:
Newman MG, Takei HH, Klokkevold PR, Carranza FA.
Carranza’s Clinical Periodontology. 10th ed. Philadelphia, Pa:
Saunders; 2006:864-865.
31. Durham TM, Goddard T, Morrison S. Rapid forced eruption: a
case report and review of forced eruption techniques. Gen
Dent. 2004;52:167-176.
32. Hovland EJ. Horizontal root fractures. Treatment and repair.
Dent Clin North Am. 1992;36:509-525.
24. Simon JH, Kelly WH, Gordon DG, et al. Extrusion of
endodontically treated teeth. J Am Dent Assoc. 1978;97:17-23.
33. Baker IM. Esthetic extrusion of a nonrestorable tooth. J Clin
Orthod. 1990;24:323-325.
25. Nappen DL, Kohlan DJ. Orthodontic extrusion of premolar teeth:
an improved technique. J Prosthet Dent. 1989;61:549-554.
34. Lemon RR. Simplified esthetic root extrusion techniques. Oral
Surg Oral Med Oral Pathol. 1982;54:93-99.
26. Bondemark L, Kurol J, Hallonsten AL, et al. Attractive
magnets for orthodontic extrusion of crown-root fractured
teeth. Am J Orthod Dentofacial Orthop. 1997;112:187-193.
35. Simon JH, Lythgoe JB, Torabinejad M. Clinical and histologic
evaluation of extruded endodontically treated teeth in dogs.
Oral Surg Oral Med Oral Pathol. 1980;50:361-371.
27. Potashnick SR, Rosenberg ES. Forced eruption: principles in
periodontics and restorative dentistry. J Prosthet Dent.
1982;48:141-148.
36. Andreasen JO, Andreasen FM, eds. Essentials of Traumatic
Injuries to the Teeth. Copenhagen, Denmark: Munksgaard; 1990.
28. Johnson GK, Sivers JE. Forced eruption in crown-lengthening
procedures. J Prosthet Dent. 1986;56:424-427.
29. Zyskind K, Zyskind D, Soskolne WA, Harary D. Orthodontic
forced eruption: case report of an alternative treatment for
subgingivally fractured young permanent incisors.
Quintessence Int. 1992;23:393-399.
7
Continuing Education
Forced Eruption by Fiber-Reinforced Composite
3. Optional treatment for the maintenance of biologic
width includes:
a. crown lengthening surgery.
POST EXAMINATION INFORMATION
To receive continuing education credit for participation in
this educational activity you must complete the program
post examination and receive a score of 70% or better.
b. tooth movement by surgical extrusion.
c. forced eruption.
Traditional Completion Option:
You may fax or mail your answers with payment to Dentistry
Today (see Traditional Completion Information on following
page). All information requested must be provided in order
to process the program for credit. Be sure to complete your
“Payment”, “Personal Certification Information”, “Answers”
and “Evaluation” forms, Your exam will be graded within 72
hours of receipt. Upon successful completion of the postexam (70% or higher), a “letter of completion” will be mailed
to the address provided.
d. all of the above.
4. In forced eruption, which rate of tooth movement
moves the alveolar bone crest with the tooth, with no
change in size of the clinical crown?
a. 1 to 2 mm per month
c. 4 to 5 mm per month
b. 3 to 4 mm per month
5. Fast tooth movement during forced eruption is
preferred for which of the following:
a. correction of bony defects.
Online Completion Option:
Use this page to review the questions and mark your
answers. Return to dentalCEtoday.com and signin. If you
have not previously purchased the program select it from
the “Online Courses” listing and complete the online
purchase process. Once purchased the program will be
added to your User History page where a Take Exam link
will be provided directly across from the program title.
Select the Take Exam link, complete all the program
questions and Submit your answers. An immediate grade
report will be provided. Upon receiving a passing grade
complete the online evaluation form. Upon submitting the
form your Letter Of Completion will be provided
immediately for printing.
b. bone augmentation for reconstruction of interdental
papilla.
c. management of tooth fracture.
d. implant insertion.
6. In forced eruption, about 12 weeks is needed for the
desired amount of tooth movement. The patient must
be followed once or twice a week for prevention of
gingival inflammation and elimination of occlusal
interferences.
a. The first statement is true, the second is false
b. The first statement is false, the second is true
c. Both statements are true
General Program Information:
Online users may login to dentalCEtoday.com anytime in
the future to access previously purchased programs and
view or print “letters of completion” and results.
d. Both statements are false
7. For forced eruption, force application from the palatal
side creates a vertical force direction. This provides a
more proper angulation compared to a wire or bracket
attached to the buccal aspect of the tooth.
a. The first statement is true, the second is false
POST EXAMINATION QUESTIONS
1. The primary objective of forced tooth eruption when it
was introduced was for:
a. clinical crown lengthening for fractured teeth.
b. clinical crown lengthening for teeth with subgingival
decay.
c. correction of bony defects.
d. both a and b.
b. The first statement is false, the second is true
c. Both statements are true
d. Both statements are false
8. With forced eruption, the required time for ligament
reconstruction is:
a. 1 to 2 weeks.
2. Encroachment on the biologic width can cause:
a. gingival inflammation.
c. pocket formation.
b.
attachment loss.
d. 5 to 6 mm per month
b. 2 to 4 weeks.
c. 3 to 6 weeks.
d. all of the above.
d. 8 to 10 weeks.
8
Continuing Education
Forced Eruption by Fiber-Reinforced Composite
PROGRAM COMPLETION INFORMATION
PERSONAL CERTIFICATION INFORMATION:
If you wish to purchase and complete this activity
traditionally (mail or fax) rather than Online, you must
provide the information requested below. Please be sure to
select your answers carefully and complete the evaluation
information. To receive credit you must answer at least six
of the eight questions correctly.
Last Name (PLEASE PRINT CLEARLY OR TYPE)
First Name
Profession / Credentials
Complete online at: www.dentalcetoday.com
Street Address
TRADITIONAL COMPLETION INFORMATION:
Suite or Apartment Number
Mail or Fax this completed form with payment to:
City
License Number
State
Zip Code
Dentistry Today
Daytime Telephone Number With Area Code
Department of Continuing Education
100 Passaic Avenue
Fairfield, NJ 07004
Fax Number With Area Code
Fax: 973-882-3662
E-mail Address
PAYMENT & CREDIT INFORMATION:
Examination Fee: $40.00 Credit Hours: 2.0
ANSWER FORM: COURSE #: 118.1
Note: There is a $10 surcharge to process a check drawn on
any bank other than a US bank. Should you have additional
questions, please contact us at (973) 882-4700.
1. a b c d
2. a b c d
I have enclosed a check or money order.
I am using a credit card.
3. a b c d
My Credit Card information is provided below.
American Express Visa MC Discover
Please provide the following
Please check the correct box for each question below.
4. a b c d
5. a b
6. a b
7. a b
8. a b
c d
c d
c d
c d
(please print clearly):
PROGRAM EVAUATION FORM
Exact Name on Credit Card
Please complete the following activity evaluation questions.
/
Credit Card #
Expiration Date
Signature
Dentistry Today is an ADA CERP
Recognized Provider.
Approved PACE Program Provider
FAGD/MAGD Credit Approval
does not imply acceptance
by a state or provincial board of
dentistry or AGD endorsement.
June 1, 2009 to May 31, 2011
AGD Pace approval number: 309062
Rating Scale: Excellent = 5 and Poor = 0
Course objectives were achieved.
Content was useful and benefited your
clinical practice.
Review questions were clear and relevant
to the editorial.
Illustrations and photographs were
clear and relevant.
Written presentation was informative
and concise.
How much time did you spend reading
the activity & completing the test?