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

Abstract

ObjectivesCrown-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 MethodsTwenty-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.ResultsAfter 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.ConclusionSurgical extrusion of maxillary premolars can be a possible therapeutic option in cases of subgingival crown-root fracture.

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

“…To overcome this problem, in 2010, a new protocol called "Atraumatic Safe Extraction" (ASE) was introduced by Choi et al, whereby a preoperative orthodontic extrusion for 2-3 weeks is performed before surgery to increase the mobility and volume of the periodontal ligament of the tooth to be intentionally replanted [1,82,83]. The preoperative orthodontic mobilization makes extraction easier, thus reducing the risk of complications such as root resorption and ankylosis [82,83].…”

“…The author suggested that performing a preoperative orthodontic extrusion would increase the volume of the periodontal ligament of the donor tooth, preventing root resorption after transplantation [83,85]. In the ASE protocol, the same concept was adapted as that of intentional replantation to prevent root resorption [1,83]. Similarly, the same methodology should be applied to surgical extrusion techniques as well; its use has been described only in a retrospective study by Choi et al in 2019 [1].…”

“…Similarly, the same methodology should be applied to surgical extrusion techniques as well; its use has been described only in a retrospective study by Choi et al in 2019 [1]. In this method, orthodontic forces of about 50 g are applied using a system of orthodontic brackets or orthodontic brackets and buttons and a Ni-Ti arch 0.014 [1,82,83]. In the posterior teeth, a 0.016 × 0.022 arch can be bent as a L to achieve extrusion [83].…”

“…"Severely damaged teeth" are considered as teeth with severe structural damage due to multiple factors: crown-root fractures, extensive carious lesions, cervical root resorption or other causes that lead to the loss of part of the clinical crown. Such teeth need to be rehabilitated, even considering the high prevalence of subgingival root caries among the elderly [1].…”

“…Finally, the flap is repositioned at the level of the bone crest and sutured [12]. Bone removal can cause a significant worsening of the crown/root ratio, exposure of the furcation and severe weakening of the periodontal ligament of the tooth to be exposed and of the adjacent teeth [1,4,13]. Therefore, this technique is contraindicated in the exposure of subgingival lesions of a single tooth, especially in aesthetic areas [12].…”