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

OBJECTIVES: Crown-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 METHODS: Twenty-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. RESULTS: After 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. CONCLUSION: Surgical extrusion of maxillary premolars can be a possible therapeutic option in cases of subgingival crown-root fracture.

Considerations in the selection of method for clinical crown lengthening / 대한치과보철학회지

Clinical crown lengthening procedure would be an effective method for overcoming adverse clinical condition such as short abutment length. There are three kinds of methods in clinical crown lengthening, those are, surgical crown lengthening, orthodontic extrusion and surgical extrusion. Clinicians have to try their best to choose a proper method among those for favorable results. This report aims to review the considerations in each method with various cases and to suggest a decision flow for appropriate selection.

Esthetic restoration of subgingival crown-root fractured maxillary anterior tooth using surgical extrusion / 대한치과보철학회지

Surgical extrusion, immediate extrusion following tooth luxation, is a method to preserve one's natural tooth and achieve esthetic restoration without additional periodontal surgery when subgingival dental caries or crown fracture occurs. A 16-year-old male was referred to the clinic from the department of operative dentistry for the esthetic restoration of maxillary left lateral incisor. Due to the crown to root fracture, the tooth was endodontically treated with a buccal crown length of 4 mm. When the palatal flap was elevated, the mesiopalatal cervical fracture area was situated 3 - 4 mm subgingivally. Crown lengthening was achieved through surgical extrusion. After 3 months of clinical observation and provisional restoration, the maxillary left central incisor was restored with all ceramic crown and obtained a satisfactory clinical result.

Clinical crown lengthening procedure using surgical extrusion in esthetic region / 대한치주과학회지

PURPOSE: Various methods are used in clinical crown lengthening procedure. Esthetic is more important in anterior region than in posterior region. Therefore when performing clinical crown lengthening procedure in esthetic region, clinicians should choose method which doesn't impair esthetic. Surgical extrusion could be a good method to achieve esthetic results MATERIAL AND METHODS: Two patients were scheduled to clinical crown lengthening procedure in esthetic region. Teeth were extruded with periotome carefully to the intended level. Extruded teeth were anchored with sutures. Sutures are removed after 7day. Restorations were seated after extruded teeth were stabilized. RESULT: Five to six months later, both cases showed favorable esthetic outcome that were harmonious with adjacent teeth. CONCLUSION: When clinicians are to do clinical crown lengthening procedure in esthetic region, predictable esthetic outcome could be achieved with surgical extrusion.

Surgical extrusion in aesthetic area / 대한치주과학회지

As a general treatment modality of subgingival tooth defect in aethetic area, implant or crown and bridge therapy after extraction of affected tooth can be used. But as more conservative treatment, crown lengthening can be considered and not to lose periodontal attachment and impair aethetic appearance, surgical extrusion can be considered as a treatment of choice. In this case report, 3 cases of surgical extrusion was represented and appropriate time for initiation of endodontic treatment according to the post-surgical tooth mobility was investigated. In 8 patient who has subgingival tooth defect in aethetic area, intracrevicular incision is performed and flap was reflected with care not to injure interproximal papillae. With forcep or periotome, tooth was luxated and sutured in properely extruded position according to biologic width with or without 180degreesrotation. 8 cases show favorable short and long term results. In some cases, surgical extrusion with 180degrees rotation can minimized extent of extrusion and semi-rigid fixation without apical bone graft seems to secure good prognosis. In 8 cases, endodontic treatment started about 3 weeks after surgery. This time corresponds with the moment when mobility of extruded tooth became 1 degree and this results concide with other previous reports. If it is done on adequate case selection and surgical technique, surgical extrusion seems to be a good treatment modalilty to replace the implant restoration in aethetic area.