-Background: Crown-root and cervical root fractures constitute a restorative challenge due to sub-gingival position of the fracture margin. Surgical tooth extrusion is one of the treatment options. There is uncertainty regarding the prognosis of such treatment modality. Objective: To assess adverse events of surgical tooth extrusion in the treatment for crown-root and cervical root fractures in permanent teeth. Methods: PubMed, Embase, and Google Scholar were searched through 15th of June 2012. Search was limited to English and Arabic languages. Reference list of relevant studies were hand-searched. Grey literature was searched using Open Grey. Two review authors independently extracted data, while only one assessed trial quality using 8-point methodological index for non-randomized studies (MINORS) scale. A sensitivity analysis was performed to exclude studies with suspected patients' duplicates. Results: Eleven case reports and eight case series involving 226 patients with 243 teeth were identified. No randomized controlled trials were found. The mean quality score for all case series was 9 suggesting a fair quality, while that of all case reports was 5 suggesting poor quality. Non-progressive root resorption is the most common finding following surgical extrusion with an event rate of 30% (95% CI 24.6-36.7%). This is followed by low event rates of tooth loss (5%), slight mobility (4.6%), marginal bone loss (3.7%), and progressive root resorption (3.3%). No ankylosis occurred to any extruded tooth, while severe tooth mobility showed negligible overall event rate of 0.4%. Conclusion: The available evidence suggests that surgical tooth extrusion is a valid technique in management of crown-root and cervical root fracture of permanent teeth. Minimal adverse events and good prognosis are expected. Further, surgical extrusion can be considered as a treatment option in teeth suffering sub-gingival decay.Crown-root fracture (CRF) is a fracture involving enamel, dentin, and cementum (1) (Figs 1 and 2) with or without pulp involvement, while cervical root fracture (CRR) is a fracture involving cementum, dentin, and pulp extending from the alveolar bone crest up to 5 mm below (2). The prevalence of CRF is 5% in permanent dentition (3), while all root fractures affect 0.5-7% of permanent teeth (4, 5).The sub-gingival location of the fracture margin in crown-root and cervical root fracture constitutes a restorative challenge. The sub-gingival placement of the restorative margin would encroach on the biologic width with subsequent gingival inflammation, clinical attachment loss, and bone loss. This would be clinically manifested as gingival bleeding, deepened periodontal pockets or gingival recession (6, 7). Several treatment modalities have been proposed to address this problem: extraction (8) of traumatized tooth, crown lengthening by gingivectomy and ostectomy (9, 10), intentional replantation (11, 12), reattachment of the coronal fragment to the root surface (13), and root extrusion (14) whether orthodontic (15...

No abstract

Objective To assess the efficacy of using a bone substitute material (BSM) in the fixture–socket gap in patients undergoing tooth extraction and immediate implant placement. Materials and methods MEDLINE, EMBASE, and CENTRAL databases were searched for randomized controlled trials (RCTs). RCTs were screened for eligibility, and data were extracted by two authors independently. Risk of bias (ROB) was assessed using Cochrane's ROB tool 2.0. Primary outcomes were implant failure, overall complications, and soft‐tissue esthetics. Secondary outcomes were vertical buccal bone resorption, vertical interproximal bone resorption, horizontal buccal bone resorption, and mid‐buccal mucosal recession. Meta‐analysis was performed using random‐effects model with generic inverse variance weighing. GRADE was used to grade the certainty of the evidence. Results After screening 19 544 potentially eligible references, 20 RCTs were included in this review, with a total of 848 patients (916 sites). Most included RCTs were deemed of some concerns (53%) or at low (38%) risk of bias, except for overall complications (high ROB). Implant failure did not differ significantly RR = 0.92 (confidence intervals [CI] 0.34 to 2.46) between using a BSM compared with not using a BSM (NoBSM). BSM use resulted in less horizontal buccal bone resorption (MD = −0.52 mm [95% CI −0.74 to −0.30]), a higher esthetic score (MD = 1.49 [95% CI 0.46 to 2.53]), but also more complications (RR = 3.50 [95% CI 1.11 to 11.1] compared with NoBSM. Too few trials compared types of BSMs against each other to allow for pooled analyses. The certainty of the evidence was considered moderate for all outcomes except implant failure (low), overall complications (very low), and vertical interproximal bone resorption (very low). Conclusion BSM use during immediate implant placement reduces horizontal buccal bone resorption and improves the periimplant soft‐tissue esthetics. Although BSM use increases the risk of predominantly minor complications.

No abstract

Background/Aim 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. Material and methods Children aged 8‐13 years who presented with crown‐root fractures were included. Surgical extrusion was performed, and teeth were splinted either for 2 weeks 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 12 months. Results Nineteen patients were included in the analysis. Surgically extruded teeth splinted for 2 weeks showed significantly higher mobility directly after splint removal and at 1 month 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. Conclusions Although both groups showed neither statistical nor clinically significant differences after 12 months, there was a significant difference immediately after splint removal, with greater tooth mobility in the 2‐week splinting group. Thus, a functional splinting time (4‐6 weeks) can be suggested for better healing and optimal stability to allow placement of the final restoration directly after splint removal.