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Orthodontic extrusionBy : hoda pouyanfar Orthodontic forced eruption may be a suitable approach without risking the esthetic appearance in tooth fracture below the gingival attachment or alveolar bone crest.Extrusion of such teeth allows elevating the fracture line above the epithelial attachment and so the proper finishing margins can be prepared. Restoration after orthodontic eruption may present a more conservative treatment choice in young

J Can Dent Assoc 2004; 70(11):77580Orthodontic ExtrusionMovement of a tooth by extrusion involves applying traction forces in all regions of the periodontal ligament to stimulate marginal apposition of crestal bone.

Because the gingival tissue is attached to the root by connective tissue, the gingiva follows the vertical movement of the root during the extrusion process. Similarly, the alveolus is attached to the root by the periodontal ligament and is in turn pulled along by the movement of the root.

J Can Dent Assoc 2004; 70(11):77580Indications for Orthodontic Extrusionfor treatment of a subgingival or infraosseous lesion of the tooth between the cementoenamel junction and the coronal third of the root (caries, oblique or horizontal fractures, perforations caused by a pin or Post , internal or external root resorption), especially when there are esthetic considerations for treatment of a restoration impinging on the biological width for reduction of angular bone defects and isolated periodontal pocketsfor preimplant extraction to maintain or re-establish the integrity of an alveolar ridge for orthodontic extraction where surgical extraction is contraindicated (chemotherapy or radiotherapy) for treatment of trauma or impacted teeth(canines)

J Can Dent Assoc 2004; 70(11):77580

J Can Dent Assoc 2004; 70(11):77580Contraindications to Orthodontic Extrusionankylosis or hypercementosisroot proximity and premature closure of embrasuresshort rootsinsufficient prosthetic spaceexposure of the furcation.the presence of chronic, uncontrollable inflammatory lesions, including combined endodontic-periodontic lesions and fractured roots; an inability to control inflammation and acute infection that would adversely affect healing and the overall response to treatmentan absence of attachment apparatus because forced eruption only relocates the existing attachment, it does not create a new attachmentJ Can Dent Assoc 2004; 70(11):77580

J Can Dent Assoc 2004; 70(11):77580Advantages conservative procedure that allows retention of a tooth without the disadvantages of a fixed bridgedoes not involve loss of bone or periodontal support, as commonly occurs during extractionAvoid resection of bone of the teeth adjacent to the tooth this simple technique requires a relatively easy movement of the tooth.

J Can Dent Assoc 2004; 70(11):77580

DisadvantagesWearing an orthodontic deviceesthetic problemsoral hygieneduration of treatment (4 to 6 weeks of extrusion and 4 weeks to 6 months of retention for implant cases in which tissue and bone remodelling are the objectives)periodontal surgery

J Can Dent Assoc 2004; 70(11):77580Periodontal EffectsOrthodontic extrusion forces coronal migration of the root and increases the bone ridge as well as the quantity of attached gingiva , in particular when weak to moderate forces are applied.The amount of attached gingiva is increased through eversion of the sulcular epithelium, appearing first as immature nonkeratinized tissue (known asred patch) and then as keratinized tissue; the process of keratinization requires 28 to 42 days.

J Can Dent Assoc 2004; 70(11):77580

J Can Dent Assoc 2004; 70(11):77580J Can Dent Assoc 2004; 70(11):77580After coronal movement of the periodontal attachmentminor surgical correction weekly fibrotomysingle fibrotomyJ Can Dent Assoc 2004; 70(11):77580

Extrusion and EndodonticsTreated endodontically to prevent sensitivity and exposure of the pulp during the occlusal reduction required during the extrusion.calcium hydroxidePulpectomy

extrusion force of 50 gpreimplant extractionodontoblastic degeneration1 week pulpal fibrosis4 weeks J Can Dent Assoc 2004; 70(11):77580J Can Dent Assoc 2004; 70(11):77580pulpal reaction would differ depending on the diameter of the apical foramen Pulp prolapse would be due to ischemia secondary to rapid movementDuring rapid extrusion, a pseudo-apical lesion appears, which must be differentiated from a true lesion of endodontic originExtrusion and ProsthodonticsThe mesiodistal diameter of the root, which is naturally strangled at the cementoenamel junction of single-rooted teeth, is reduced with progression of the extrusion (especially in the case of conical roots), which involves expansion of interproximal gingival embrasures. The contour shape of the crowns must not be exaggerated to compensate for this reduction in diameter . Similarly, embrasures should not be filled to prevent an overcontour, which could adversely affect the marginal periodontium.J Can Dent Assoc 2004; 70(11):77580

J Can Dent Assoc 2004; 70(11):77580

Choice of treatment37 teethre-eruption 7 teethRepositioned orthodontically (two teeth within 1 week and five teeth after 18 months)7 teethwith forceps at the day ofthe injury and splinted with wire and composite for 26 weeksResultsRe-eruption occurred in 35 out of 37 teeth2 teeth ankylosisboth necrosis and the external root resorptions occurred more often in orthodontically and surgically repositioned teeth than in the non-repositioned teeth

Condition 5 days after injury, before start ofendodontic treatment. A gingivectomy was performed to gain access to the root canal

Partial re-eruption 1 month later.Pulp canal is filled temporarily with calcium hydroxideComplete re-eruption and permanent root filling 10 months after trauma

Three weeks after complete intrusionFive years later25

20-year-old male

The total extrusion time was 4 months.The extruded tooth was retained with the same arch wire for 12 weeks to prevent any relapse. At the end of a 12-week retention period, gingivectomy and fiberotomy were performed for lingual margin exposure and better esthetics.

A 21-year-old white woman

oblique crown-root fracture in lateralcomplicated crown fracture in central

A temporary root canal therapy using acalcium hydroxide dressing was immediately performed on both incisors, which were then sealed with a glass ionomer cement

9-year-old child cervical root fractureCalcium hydroxide pulpotomy for apexogenesis43

extrusion of 23 mm was obtained within68 weeksThe patient was examinedevery 3 months during the follow-up period of18 months

After 3-year follow-upThank you