Orthodontic Extrusion vs. Surgical Extrusion to Rehabilitate Severely Damaged Teeth: A Literature Review

Abstract

The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common treatment choice. However, the survival rate for implants is inferior to teeth, even if severely damaged but properly treated. In order to reestablish a physiological supracrestal tissue attachment of damaged teeth and to arrange an efficient ferrule effect, three options can be considered: crown lengthening, orthodontic extrusion and surgical extrusion. Crown lengthening is considered an invasive technique that causes the removal of part of the bony support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth. The aim of the present narrative review is to compare advantages, disadvantages, time of therapy required, contraindications and complications of both techniques.

Forced surgical extrusion using an axial tooth extraction system as a practicable technique for preserving severely destroyed teeth? ‐ Clinical outcomes up to 4.8 years

“…The orthodontic extrusion time is described with an average of four to six weeks and a retention period is recommended for four weeks up to six months 18 . One literature stated review that orthodontic extrusion is indicated in cases which request a highly predictable treatment, when an orthodontic device is already present, or tooth vitality should be preserved 15 . Although magnetic extrusion is described in individual case reports, no relevant reviews are currently available.…”

“…Surgical extrusion has been described as a viable treatment option in the management of teeth with insufficient residual substance, 15,20,21,25,29 although the level of evidence is very low since the available studies are often only case reports and case series. The advantages include minimum chair-side time compared with other procedures, good esthetics, ready acceptance from the patient, and low incidence of failure.…”

“…This can be achieved using magnets or orthodontic devices, generating adequate "ferrule" design for the subsequent prosthodontic restoration. 7,[13][14][15][16][17][18] Beyond that, the so-called "surgical extrusion" is a promising procedure, also known as "intra-alveolar transplantation". 19 Applying this method, the tooth is extracted and repositioned at a more coronal/supragingival position inside the same alveolar socket, [20][21][22][23][24][25] knowing that replantations have good long-term results.…”

Factors to Be Considered in Orthodontic Interdisciplinary Approach – A Review

“…Exposure of a great amount of intact tooth structure to obtain a "ferrule effect" should be ensured by conducting a supracrestalfiberotomy, in combination with extrusion, to prevent coronal migration of the gingiva and bone. The fracture resistance of the tooth absolutely requires 1.5-2 mm of sound supragingival tooth structure [16] .Once the biologic width (around 2 mm) is established, the orthodontic treatment should stop, and the tooth should be stabilized for 6 weeks before restorative treatment [5,17] .…”

Endodontic Considerations in Contemporary Orthodontic Practice- A Review

“…The retention of extruded tooth structure is equally very important. The duration of extrusion should be the duration of minimum retention period 49 .…”