Download Orthodontic Forced Eruption

Continuing Education
Course Number: 175
Orthodontic Forced
Eruption:
A Team Approach in Aesthetic Treatment
Authored by
Ahmad Soolari, DMD, MS; Duane Erickson, DDS; and
Amin Soolari, CDRT
Upon successful completion of this CE activity 2 CE credit hours may be awarded
A Peer-Reviewed CE Activity by
Dentistry Today, Inc, is an ADA CERP Recognized Provider. ADA CERP is
a service of the American Dental Association to assist dental professionals
in indentifying quality providers of continuing dental education. ADA CERP
does not approve or endorse individual courses or instructors, nor does it
imply acceptance of credit hours by boards of dentistry. Concerns or
complaints about a CE provider may be directed to the provider or to
ADA CERP at ada.org/goto/cerp.
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, 2012 to
May 31, 2015 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
Orthodontic Forced Eruption:
Mr. Amin Soolari is a student in the predental program at the University of
Maryland. He has been a dental assistant
for 6 years and has experience in
orthodontics, periodontics, and assisting
in general treatment and oral surgery,
and he is currently taking courses to prepare for dental
school. He started his career in a periodontal office, where
he became a Certified Dental Radiation Technologist. He
can be reached via e-mail at [email protected].
A Team Approach in Aesthetic Treatment
Effective Date: 7/1/2014
Expiration Date: 7/1/2017
LEARNING OBJECTIVES
After participating in this CE activity, the individual will learn:
• The literature-supported scientific basis for the clinical
use of forced orthodontic eruption.
• A team approach to treating a difficult periodontalrestorative challenge in the anterior maxilla for a patient
with extreme aesthetic concerns.
Disclosure: Mr. Amin Soolari reports no disclosures.
ABOUT THE AUTHORS
INTRODUCTION
Dr. Ahmad Soolari is a Diplomate of
American Board of Periodontology. He has
a certificate in periodontics from the
Eastman Dental Center and an MS degree
from the University of Rochester (New
York). He earned his DMD degree from the
University of Mississippi Medical Center. A former clinical
associate professor at the University of Maryland, Dental
School in Baltimore, he operates a specialty practice in the
Silver Spring and Gaithersburg areas of Montgomery County,
Md. He can be reached via e-mail at [email protected].
Extraction of maxillary anterior teeth with severe attachment
loss leaves an obvious defect that is difficult to reconstruct.
The lost soft and hard tissues must be regenerated prior to
implant therapy or fixed partial denture placement to replace
the missing tooth for the most aesthetically conscious
patients. Orthodontic forced eruption (OFE) has been
practiced as one method of restoring the soft and hard
tissues lost due to periodontal disease.1-3
This article illustrates a team approach to treating a
difficult periodontal-restorative challenge in the anterior
maxilla for a patient with extreme aesthetic concerns. Her
gummy smile, midline diastema, and severe periodontal
disease were successfully treated with periodontal therapy,
forced extrusion, and crown lengthening surgery prior to the
restorative phase. This method can be used in similar
patients as a more conservative, predictable alternative to
achieve aesthetic harmony versus more invasive and timeconsuming techniques such as ridge augmentation.
Periodontal disease causes loss of both hard and soft
tissues. The loss may be uniform throughout the dentition,
but more often it is asymmetric.4,5 Especially in the aesthetic
zone (ie, the anterior jaws), asymmetry coupled with
periodontal disease presents a challenge for dentists. In
addition, in patients with severe periodontal disease, a tooth
or teeth may be deemed unrestorable if attachment loss is
significant.
When planning restoration of a tooth, dentists can
choose from many different techniques to regain the lost
Disclosure: Dr. Ahmad Soolari reports no disclosures.
Dr. Erickson has been in private practice
in orthodontics for 25 years and has offices
in Silver Spring and Olney, Md. He earned
his dental degree at the University of
Maryland, Baltimore, and practiced general
and restorative dentistry for 9 years before
receiving his certification in orthodontics in 1988 from Fairleigh
Dickinson University in New Jersey. He is past president of the
Maryland State Orthodontic Society and has served as
chairman of the education committee of the Middle Atlantic
Association of Orthodontists. He can be reached at
[email protected].
Disclosure: Dr. Erickson reports no disclosures.
1
Continuing Education
Orthodontic Forced Eruption: A Team Approach in Aesthetic Treatment
hard and soft tissues. Guided tissue regeneration, bone
grafting with either blocks or particulated material, ridge
augmentation, gingival grafting, distraction osteogenesis,
and sinus elevation are some of the most frequently used
and documented methods of restoring tissue architecture.
However, these methods are invasive, time-consuming, and
expensive. They are also associated with morbidity (for
example, at graft donor sites)6 and, occasionally, unpredictable resorption.7 Thus, noninvasive and more
predictable techniques have been sought.
In the mid-1970s, Ingber1,8 advocated forced eruption of
diseased teeth to treat one- and 2-wall defects. Salama and
Salama9 introduced forced eruption as a method of
developing/restoring tissues prior to implant treatment.
Subsequent studies reported success with this technique
prior to both conventional and implant therapies.2,10-13 The
method is predictable and can be done more quickly than
many other techniques, saving time and expense.
The current report details the treatment of a patient with
excessive gingival display, a midline diastema, asymmetry at
the maxillary central incisors, and significant attachment loss
caused by periodontal disease. Her disease activity was
controlled, attachment levels were improved and stabilized,
and a poor aesthetic appearance was corrected through
periodontal therapy, OFE, and crown lengthening surgery.
Figure 1. Initial
appearance of the
patient (June 7,
2010). Excessive
gingival display, a
midline diastema,
gingival and
dental asymmetry,
rotated maxillary left canine (No. 11), and short clinical crowns on most
teeth are apparent.
Figure 2. Initial
periapical view of
the maxillary
central incisors
(June 7, 2010).
CASE REPORT
A 55-year-old female smoker was not happy with her smile
and rejected a proposed treatment plan from another office
that involved extraction of “2 upper front teeth” and placement
of 2 adjacent implants. Clinical and radiographic evaluation
disclosed excessive gingival display, incomplete passive
eruption, asymmetry of the maxillary central incisors, a
midline diastema, and significant attachment loss in the
anterior maxilla (Figures 1 to 4). The only tooth in her anterior
maxilla that showed aesthetic proportions was the left central
incisor (No. 9); the other teeth had rather short crowns.
A treatment plan was recommended to harmonize the
remaining teeth in the aesthetic zone with the maxillary left
central incisor. The proposal included OFE following
nonsurgical periodontal therapy (scaling and root planing)
and surgical treatment, which included flap surgery to treat
teeth No. 8 (maxillary right central incisor) and No. 9, and
Figure 3. Palatal
view showing
significant
attachment loss,
dehiscence, and
heavy subgingival
calculus (October
9, 2010).
Figure 4. Facial
view of teeth Nos.
8 and 9 showing
the buccal plate,
which was missing
on the palatal
aspect (October 9,
2010).
crown lengthening surgery for the remaining maxillary
anterior teeth. The patient agreed to periodontic2
Continuing Education
Orthodontic Forced Eruption: A Team Approach in Aesthetic Treatment
orthodontic-restorative therapy. The OFE was needed to
minimize the ridge deformity; these are hard to hide and
difficult to manage following the removal of maxillary
anterior teeth. The key to the success of this treatment plan
was careful implementation of OFE to support the
restorative effort.
The periodontal surgery disclosed severe bone loss on
the palatal aspect of teeth Nos. 8 and 9 with heavy calculus
deposits. The bone loss was more severe on No. 9 than on
No. 8 (Figure 2). Following removal of infected tissue and
calculus, periodontal regenerative therapy (PRT) was
performed; this included bone grafting, application of
demineralized freeze-dried bone allograft (LifeNet Health),
and placement of a resorbable bilayer collagen membrane
(Geistlich Bio-Gide [Geistlich Pharma North America]).
The patient was referred to an orthodontist, and
examination and treatment were as follows: The orthodontic
exam revealed a good Class I occlusion with generalized
periodontitis; in particular, severe horizontal and vertical
bone loss around teeth Nos. 8 and 9. Teeth Nos. 8 and 9 had
a hopeless prognosis due to severe periodontal defects,
mobility, poor crown-to-root ratios, and unaesthetic crowns.
The treatment plan was to remove Nos. 8 and 9 and replace
them with implant restorations. However, the periodontal
defects and the likelihood of further alveolar resorption
following the extraction of teeth Nos. 8 and 9 meant that the
prognosis for placement of implants was poor. Therefore,
OFE would be accomplished in order to create new alveolar
bone so that implants could be placed.
Orthodontic treatment in the presence of severe
periodontal disease is not recommended. Therefore, periodontal treatment was performed to control disease activity. Due
to the significant attachment loss and heavy subgingival
calculus on the palatal aspect of teeth Nos. 8 and 9 (Figure 2),
periodontal surgery was performed to gain access to the roots
of the teeth and the bony defects to resolve the inflammation,
stop bleeding on probing, reduce the pocket depth, and
remove the calculus. After a flap was raised and the necrotic
tissue and calculus were removed, PRT was performed to
prepare teeth Nos. 8 and 9 for OFE. The proposed orthodontic
therapy would slowly erupt teeth Nos. 8 and 9 to improve
alveolar height and minimize bony defects in the alveolus that
would result from the extraction of these teeth.
Figure 5. Intraoral
view (April 25,
2011) after 8
weeks of
orthodontic
treatment to rotate
the maxillary left
canine (No. 11).
Figure 6.
Periapical
radiograph taken
during orthodontic
forced eruption
(OFE) (July 6,
2011).
Figure 7. Clinical
appearance on
July 6, 2011,
during orthodontic
therapy, after 8
weeks of forced
eruption of the
incisors and
canines and reduction of the central incisor crowns from fremitus.
On November 24, 2010, partial fixed orthodontic
appliances (0.018-inch Innovation-R [GAC International] selfligating brackets) were placed on the anterior teeth (Nos. 6 to
11), and anchor tubes were placed on teeth Nos. 3 and 14
(0.022-inch) (Figures 5 to 7). A 0.016-inch Ni-Ti wire was
placed to align teeth Nos. 6 to 11; No. 11 in particular
required derotation. Derotation of No. 11 took somewhat
longer than expected but was accomplished by May 4, 2011
(Figure 5). At this time a 0.016- x 0.022-inch braided wire
(Quad Cat) was placed with 1.5-mm step-down bends to
3
Continuing Education
Orthodontic Forced Eruption: A Team Approach in Aesthetic Treatment
slowly super-erupt teeth Nos. 8 and 9.
During the next several months, the patient was seen
about every 3 to 4 weeks; at each appointment, the wire was
activated 0.5 to 1.0 mm to erupt teeth Nos. 8 and 9. In addition,
at each appointment, the teeth were evaluated to eliminate any
fremitus (traumatic occlusion) and the clinical crowns of teeth
Nos. 8 and 9 were adjusted accordingly (Figures 6 and 7). The
objective during this time was to slowly erupt the teeth so that
the tension on the periodontal ligament would stimulate
osteoblastic activity and the erupting tooth would bring bone
with it. Close monitoring and elimination of fremitus were
important so that untoward occlusal forces would not result in
the destruction of bone. During this time, teeth Nos. 8 and 9
each erupted 4 to 5 mm, and the interproximal spaces were
distributed for ideal restoration. On September 29, 2011, the
fixed appliances were removed. The patient was instructed to
wear a clear (Essix-type) retainer for 12 hours per day and to
return to the periodontist and general dentist to plan for the
replacement of teeth Nos. 8 and 9.
However, tooth No. 8 had responded positively to
periodontal-regenerative therapy; therefore the decision
was made to retain it and utilize it as an abutment for the
definitive prosthesis. Tooth No. 9 remained hopeless. The
original treatment plan included placement of an implant
following the extraction of tooth No. 9, but the patient now
refused the implant, since the remaining teeth in the
aesthetic zone would still require prosthetic restoration to
achieve an acceptable appearance. The OFE improved
alveolar height for both Nos. 8 and 9. This approach
resulted in the creation of new alveolar bone. The
multidisciplinary treatment in this case significantly
improved the aesthetic appearance of a patient who was
not happy with her diastema, excessive gingival display,
midline asymmetry, tooth mobility, and significant bone loss.
The definitive prosthesis was placed a year later. Excellent
aesthetics and strong function were established for this patient,
who originally suffered from generalized moderate and
localized severe periodontitis. The patient was pleased with the
final appearance of her smile (Figures 8 to 11) and stopped
smoking. The aesthetics of the definitive restoration may have
been improved by moving the gingival margin of crown No. 8
apically to make it symmetrical with pontic No. 9. This highlights
the need for meticulous detailed communication between
Figure 8. Clinical
appearance on
September 29,
2011, following
removal of
orthodontic
appliances.
Figure 9. Final
appearance
(March 24, 2012)
after one year of
periodonticorthodonticrestorative
therapy.
Figure 10. Final
appearance in the
aesthetic zone.
The prosthesis is
supported by
healthy, pink, and
firm keratinized
gingiva.
Figure 11.
Radiographic
appearance after
OFE, extraction,
crown lengthening, and
prosthesis
placement.
the treating professionals and the patient during all phases
of this type of treatment.
4
Continuing Education
Orthodontic Forced Eruption: A Team Approach in Aesthetic Treatment
DISCUSSION
injured tooth/root must be intact to perform OFE and avoid
surgical treatment.
As the use of implants has increased, clinicians have
used OFE more frequently prior to implant placement to
prepare sites to receive implants. Makhmalbaf and Chee17
cited forced eruption as a viable alternative to
preimplantation bone augmentation in their treatment of a
woman with bone and gingiva loss. Mankoo and Frost12 used
OFE in 2 patients with advanced periodontal loss. The
procedure provided sufficient vertical augmentation for implant placement. Mirmarashi et al18 showed that OFE could
assist in the transition to definitive implant prosthetic
treatment. While the teeth to be extracted remained in situ,
they were used not only to assist in developing an
appropriate soft- and hard-tissue profile, but they also
supported a fixed provisional restoration so that a removable
provisional was not needed. Amato et al19 found that OFE
prior to implant treatment was successful for bone
regeneration about 70% of the time and for gingival
augmentation in about 60% of cases. The implant survival
rate in their series19 of 11 patients (27 implants) was 96%.
Kan et al20 used an interdisciplinary approach (periodontics,
orthodontics, and prosthodontics) to modify the tissue
architecture in the aesthetic zone for multiple adjacent teeth.
Tarnow et al21 noted that there is about a one- or 2-mm
difference between the thickness of the peri-implant soft
tissue and that of the soft tissue around the natural
dentition, with implants being associated with thinner
tissue. The crest of bone at the implant neck should be 2
mm coronal to the bone around the adjacent natural tooth
to ensure optimal control of soft-tissue aesthetics and avoid
the “black triangle” caused by inadequate papillae.21
Rokn et al13 noted that most attempts at vertical
augmentation were unpredictable, whether done via sinus
elevation, guided bone regeneration, or distraction
osteogenesis; resorption might be minimal or very dramatic
and uneven. In addition, these techniques are very invasive,
time consuming, and expensive. Periodontal treatment and
OFE followed by implant therapy in a woman with
generalized aggressive periodontitis was successful,
resulting in shallower probing pocket depths, improved
hard- and soft-tissue margins, and restoration with an
implant-supported prosthesis.
Dentists have been exploring the possibility of forced eruption
of diseased teeth as a means of augmenting soft and hard
tissue and eliminating infrabony defects since the 1970s.1,8
Since then, many reports of successful forced
eruption/extrusion followed by retention and conservative
restoration of what would have been hopeless teeth have been
published.2,10-12 In addition to its predictability, forced eruption
can usually be completed fairly quickly; Biggerstaff et al2
completed treatment in 3 patients within about 4 weeks.
Van Venrooy and Yukna3 provided proof of principle for
OFE in an animal study. The attachment apparatus was
damaged and periodontal disease was induced in beagle
dogs. Teeth extruded with orthodontic elastics were less
mobile and displayed shallower pockets, less bleeding, and
radiographic bone gain, whereas control (untreated) teeth
showed no improvement after 21 days.
In clinical studies, many authors have investigated the
use of extrusion for teeth that would otherwise be
considered nonrestorable. Biggerstaff et al2 “reclaimed”
nonrestorable teeth with OFE in 3 patients with teeth with
compromised gingival margins caused by tooth fractures or
perforation of the gingiva. The authors2 found that the
technique was relatively simple and quick, and bone support
was regained because the process resembled normal tooth
eruption. Camargo et al10 declared OFE the “technique of
choice” prior to crown lengthening in the aesthetic zone.
Fakhry11 also advocated OFE as a more conservative
method of restoring teeth, even in sites with minimal coronal
tooth structure in the aesthetic zone, but cautioned against
overaggressive use of the technique to prevent periodontal
damage and harm to coronal tooth structure.
Many authors have reported on the use of OFE to
restore fractured teeth or roots as a means of avoiding
more aggressive treatment, including extraction. Goenka et
al14 discussed the use of OFE for teeth that had fractured
at or coronal to the gingival level. They14 reported on the
successful treatment of such a case with OFE followed by
prosthetic treatment. Addy et al15 reviewed the literature on
treatment of root fractures, noting that sufficient root length
was needed to ensure success and avoid extraction of the
injured tooth. Valerio et al16 stated that, in addition, the
ferrule should be adequate and the biologic width of the
5
Continuing Education
Orthodontic Forced Eruption: A Team Approach in Aesthetic Treatment
CONCLUSION
OFE may allow for retention and restoration of otherwise
hopeless teeth, and it may also provide an alternative to
ridge augmentation surgery to regenerate lost hard and soft
tissues prior to implant placement or delivery of a fixed
partial denture. Extrusion will decrease periodontal pocket
depths, and in the case presented, it saved tooth No. 8. In
conjunction with conventional periodontal treatment of
maxillary anterior teeth, OFE is a viable and noninvasive
solution to a patient’s aesthetic concerns when dealing with
management of a nontreatable tooth in the aesthetic zone.
Most patients, if given a choice, will prefer quicker, less
aggressive, and more cost-effective treatment, and OFE
should be considered in appropriate cases.
10.
11.
12.
13.
ACKNOWLEDGMENT
The assistance of Jennifer Ballinger, ELS, in drafting this
manuscript is gratefully acknowledged.
14.
REFERENCES
1. Ingber JS. Forced eruption: part II. A method of treating
nonrestorable teeth—Periodontal and restorative
considerations. J Periodontol. 1976;47:203-216.
2. Biggerstaff RH, Sinks JH, Carazola JL. Orthodontic
extrusion and biologic width realignment procedures:
methods for reclaiming nonrestorable teeth. J Am
Dent Assoc. 1986;112:345-348.
3. van Venrooy JR, Yukna RA. Orthodontic extrusion of
single-rooted teeth affected with advanced periodontal
disease. Am J Orthod. 1985;87:67-74.
4. Papapanou PN, Wennström JL. The angular bony
defect as indicator of further alveolar bone loss. J Clin
Periodontol. 1991;18:317-322.
5. Greenstein B, Frantz B, Desai R, et al. Stability of
treated angular and horizontal bony defects: a
retrospective radiographic evaluation in a private
periodontal practice. J Periodontol. 2008;80:228-233.
6. Pandit N, Pandit IK, Malik R, et al. Autogenous bone
block in the treatment of teeth with hopeless
prognosis. Contemp Clin Dent. 2012;3:437-442.
7. Schallhorn RG. Postoperative problems associated
with iliac transplants. J Periodontol. 1972;43:3-9.
8. 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.
9. Salama H, Salama M. The role of orthodontic
15.
16.
17.
18.
19.
20.
21.
6
extrusive remodeling in the enhancement of soft and
hard tissue profiles prior to implant placement: a
systematic approach to the management of extraction
site defects. Int J Periodontics Restorative Dent.
1993;13:312-333.
Camargo PM, Melnick PR, Camargo LM. Clinical
crown lengthening in the esthetic zone. J Calif Dent
Assoc. 2007;35:487-498.
Fakhry A. Enhancing restorative, periodontal, and
esthetic outcomes through orthodontic extrusion. Eur
J Esthet Dent. 2007;2:312-320.
Mankoo T, Frost L. Rehabilitation of esthetics in
advanced periodontal cases using orthodontics for
vertical hard and soft tissue regeneration prior to
implants—a report of 2 challenging cases treated with
an interdisciplinary approach. Eur J Esthet Dent.
2011;6:376-404.
Rokn AR, Saffarpour A, Sadrimanesh R, et al.
Implant site development by orthodontic forced
eruption of nontreatable teeth: a case report. Open
Dent J. 2012;6:99-104.
Goenka P, Marwah N, Dutta S. A multidisciplinary
approach to the management of a subgingivally
fractured tooth: a clinical report. J Prosthodont.
2011;20:218-223.
Addy LD, Durning P, Thomas MB, et al. Orthodontic
extrusion: an interdisciplinary approach to patient
management. Dent Update. 2009;36:212-218.
Valerio S, Crescini A, Pizzi S. Hard and soft tissue
management for the restoration of traumatized anterior
teeth. Pract Periodontics Aesthet Dent. 2000;12:143-150.
Makhmalbaf A, Chee W. Soft- and hard-tissue
augmentation by orthodontic treatment in the esthetic
zone. Compend Contin Educ Dent. 2012;33:302-306.
Mirmarashi B, Torbati A, Aalam A, et al.
Orthodontically assisted vertical augmentation in the
esthetic zone. J Prosthodont. 2010;19:235-239.
Amato F, Mirabella AD, Macca U, et al. Implant site
development by orthodontic forced extraction: a
preliminary study. Int J Oral Maxillofac Implants.
2012;27:411-420.
Kan JY, Rungcharassaeng K, Fillman M, et al. Tissue
architecture modification for anterior implant esthetics:
an interdisciplinary approach. Eur J Esthet Dent.
2009;4:104-117.
Tarnow D, Elian N, Fletcher P, et al. Vertical distance
from the crest of bone to the height of the
interproximal papilla between adjacent implants. J
Periodontol. 2003;74:1785-1788.
Continuing Education
Orthodontic Forced Eruption: A Team Approach in Aesthetic Treatment
POST EXAMINATION INFORMATION
POST EXAMINATION QUESTIONS
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.
1. Hard- and soft-tissue loss due to periodontal disease
may be uniform throughout the dentition, but more
often it is asymmetric.
a. True.
b. False.
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.
2. The following is/are the most frequently used and
documented methods of restoring tissue
architecture:
a.
b.
c.
d.
Ridge augmentation.
Distraction osteogenesis.
Gingival grafting.
All of the above.
3. Orthodontic treatment in the presence of severe
periodontal disease is not recommended.
Online Completion Option:
Use this page to review the questions and mark your
answers. Return to dentalcetoday.com and sign in. 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.
a. True.
b. False.
4. In the clinical case presented, orthodontic forced
eruption (OFE) of teeth Nos. 8 and 9 resulted in
_______ of eruption for each tooth.
a.
b.
c.
d.
2
3
4
5
to
to
to
to
3
4
5
6
mm.
mm.
mm.
mm.
5. Forced eruption of diseased teeth as a means of
augmenting soft/hard tissue and eliminating
infrabony defects has been explored by dentists
since:
a.
b.
c.
d.
General Program Information:
Online users may log in to dentalcetoday.com any time in
the future to access previously purchased programs and
view or print letters of completion and results.
The
The
The
The
1950s.
1960s.
1970s.
1980s.
6. Biggerstaff et al completed OFE treatment in 3
patients within approximately ________.
a.
b.
c.
d.
7
4 weeks.
8 weeks.
12 weeks.
16 weeks.
Continuing Education
Orthodontic Forced Eruption: A Team Approach in Aesthetic Treatment
7. The following factor(s) is/are necessary to ensure
successful OFE treatment and tooth restoration:
a.
b.
c.
d.
10. OFE may allow for retention and restoration of
otherwise hopeless teeth. OFE may also provide an
alternative to ridge augmentation surgery to
regenerate lost hard/soft tissues prior to implant
placement.
Sufficient root length.
Adequate ferrule.
Intact biologic width.
All of the above.
a.
b.
c.
d.
8. Amato et al found that OFE prior to implant treatment
was successful for bone regeneration approximately
______ of the time.
a.
b.
c.
d.
50%.
60%.
70%.
80%.
9. The crest of bone at the implant neck should be
_________ the bone around the adjacent natural
tooth to ensure optimal control of soft-tissue
aesthetics.
a.
b.
c.
d.
Level with.
2 mm coronal to.
1 mm apical to.
2 mm apical to.
8
The first statement is true, the second is false.
The first statement is false, the second is true.
Both statements are true.
Both statements are false.
Continuing Education
Orthodontic Forced Eruption: A Team Approach in Aesthetic Treatment
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 7 of
the 10 questions correctly.
Last Name
First Name
Profession / Credentials
Suite or Apartment Number
TRADITIONAL COMPLETION INFORMATION:
Mail or fax this completed form with payment to:
City
Dentistry Today
State
Zip Code
Daytime Telephone Number With Area Code
Department of Continuing Education
100 Passaic Avenue
Fairfield, NJ 07004
Fax Number With Area Code
Fax: 973-882-3622
E-mail Address
PAYMENT & CREDIT INFORMATION:
ANSWER FORM: COURSE #: 175
Examination Fee: $40.00 Credit Hours: 2.0
Please check the correct box for each question below.
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.
o
License Number
Street Address
Complete online at: dentalcetoday.com
o
(PLEASE PRINT CLEARLY OR TYPE)
1. o a
ob
3. o a
ob
2. o a
4. o a
I have enclosed a check or money order.
5. o a
I am using a credit card.
ob
oc
od
ob
oc
od
ob
oc
od
6. o a o b
oc
od
8. o a o b
oc
od
7. o a o b
9. o a o b
10. o a o b
oc
oc
oc
od
od
od
My Credit Card information is provided below.
o American Express o Visa o MC o Discover
Please provide the following
PROGRAM EVAUATION FORM
Please complete the following activity evaluation questions.
(please print clearly):
Rating Scale: Excellent = 5 and Poor = 0
Course objectives were achieved.
Exact Name on Credit Card
Content was useful and benefited your clinical practice.
Review questions were clear and relevant to the editorial.
/
Credit Card #
Illustrations and photographs were clear and relevant.
Expiration Date
Written presentation was informative and concise.
How much time did you spend reading the activity and
completing the test?
Signature
What aspect of this course was most helpful and why?
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, 2012 to
May 31, 2015 AGD PACE approval
number: 309062
Dentistry Today, Inc, is an ADA CERP Recognized
Provider. ADA CERP is a service of the American
Dental Association to assist dental professionals in
indentifying quality providers of continuing dental
education. ADA CERP does not approve or endorse
individual courses or instructors, nor does it imply
acceptance of credit hours by boards of dentistry.
Concerns or complaints about a CE provider may be
directed to the provider or to ADA CERP at
ada.org/goto/cerp.
What topics interest you for future Dentistry Today CE courses?
9