Treatment of subgingival crown root fracture: forced eruption--case report]

The conventional treatment methods for a subgingival crown root fracture are (1) extract the residual root and restore with a fixed bridge; (2) crown restoration with a deep subgingival margin; and (3) exposure of the fracture line by a crown lengthening operation and restoration with a crown. However, these methods require reduction of either the tooth structure or the periodontal support. Improvements in endodontic and orthodontic therapy followed Heithersay in 1973 to combine the use of endodontic and orthodontic therapy to manage subgingival crown root fractures--the so-called forced eruption method. This method can save the tooth structure and periodontal tissue. We can now use this method with different appliances to treat subgingival fractures, subgingival caries, subgingival perforations, infrabony pockets, etc. In this report, we present three cases using forced eruption to manage a subgingival fracture and subgingival caries and in the follow-up examination after crown restoration.     

Orthodontic extrusion of subgingivally fractured incisor before restoration. A case report: 3-years follow-up

Abstract –  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 patients compared with the prosthetic restoration after extraction. This case describes a multidisciplinary approach using the orthodontic forced eruption facilitating the composite restoration of a fractured upper permanent central incisor.     

Multidisciplinary approach to traumatized teeth: a case report

Abstract – Treatment of crown fractures often requires a multidisciplinary approach. In the anterior teeth, reestablishment of proper esthetics and function is quite important for the patient. However, crown‐root fractures with fracture line below the gingival attachment or alveolar bone crest presents restorative difficulties. This case report presents a cervical tooth fracture that had been treated with minimal invasive approach with different disciplines. The tooth had endodontic treatment and a glass‐fiber post, and a composite core was accomplished. Then, the tooth was extruded to the desired level with orthodontic forced eruption before definitive restoration.     

Periodontal concerns associated with the orthodontic treatment of impacted teeth

Impacted teeth are common and are often treated with orthodontic eruption, but periodontal problems associated with the process can evade detection. Profound destruction of the periodontium of an impacted tooth or adjacent teeth can occur. This case report describes the orthodontic eruption of 4 impacted canines in a 19-year-old woman. An open surgical approach was used. Within 6 months of treatment, the maxillary right canine and the lateral incisor experienced severe periodontal destruction, resulting in questionable prognoses for the teeth. Plaque control, periodontal architecture, and subgingival microflora were examined as local etiologic factors of periodontal destruction associated with orthodontic eruption of impacted teeth. Plaque control measures were evaluated, and the consequences of orthodontic tooth movement in the presence of inadequate plaque control were considered. Areas of periodontal architecture made vulnerable by the surgical exposure of the impacted teeth were identified, and the effect of orthodontic force on the periodontium was explored. An increase in putative periopathogens in the subgingival microflora after orthodontic appliance placement was observed. Microbiologic monitoring for pathologic levels of periopathogens and antibiotic therapy were considered. Orthodontic treatment of impacted teeth might require additional professional and personal plaque control measures, 3-dimensional diagnostic imaging, and control of putative periopathogens to preserve the health of the periodontium.     

Augmentation of an anterior edentulous ridge for fixed prosthodontics with combined use of orthodontics and surgery: a clinical report

Untreated periodontitis may lead to tooth and tissue loss that can result in diminished masticatory function and esthetic deformities. Combined periodontal/prosthodontic treatment for patients with advanced periodontal disease has been well documented, and treatment results can often be improved with the use of adjunctive orthodontic treatment such as forced eruption. This clinical report describes a method of preprosthetic preparation of an edentulous ridge for a fixed partial denture that incorporates the combined use of orthodontics and surgical ridge augmentation.     

Management of an unerupted dilacerated maxillary central incisor: a case report

Abstract –  A case with a dilacerated maxillary permanent central incisor, treated with forced eruption technique is illustrated and the results of the 4-year follow up are presented. After the successful eruption of the tooth, the root development was completed and the root canal was obliterated. The 4-year follow-up results revealed the tooth to be still functional and the radiographic evaluation showed that the periodontal and periapical tissues were intact and healthy. In conclusion, the impacted dilacerated incisor diagnosed in the early mixed dentition should be treated with the aid of orthodontic traction. The long-term follow up showed that once the tooth is placed in the occlusion properly, it may function well esthetically and preserve its periodontal and periapical health.     

Spontaneous re‐eruption of a permanent maxillary central incisor after 15 years of ankylosis – a case report

Abstract – Intrusion injuries are considered among the most severe forms of dental trauma, potentially leading to ankylosis as a late consequence. In 1991, a 7‐year‐old boy suffered a traumatic intrusion leading to an infraposition of tooth 21 along with its immobility. Based on the clinical findings, including bright‐sounding percussion testing, disappearance of the periodontal space and a failed attempt at orthodontic movement, a diagnosis of ankylosis was made. Following prosthetic restoration of the infrapositioned tooth, spontaneous re‐eruption occurred 15 years later. With the help of a partial multibracket appliance, the tooth could be adjusted to occlusal level and was then restored to the patient’s satisfaction. Radiographically, it was demonstrated that extrusion of the tooth had been accompanied by a significant gain in local alveolar bone volume. While a wait‐and‐see strategy cannot be recommended as a treatment option following ankylosis, considering that spontaneous re‐eruption after several years is an extremely rare finding, elucidating the mechanisms at work in spontaneous re‐eruption at a cellular level might create an opportunity for iatrogenic triggering of re‐eruption, thus paving the way to new forms of therapy.     

Reposition of intruded permanent incisor by a combination of surgical and orthodontic approach: a case report

This report presents a case of a completely intrusive luxation of an immature permanent central incisor in a 7 years 9 months-old girl. Because there are severe intrusive trauma and cortical alveolar bone fracture, it was impossible to reposition with orthodontic or surgical method alone. The intruded tooth was repositioned to healthy alveolar bone level by using surgical extrusion and stabilization with sutures and periodontal pack. After healing of adjacent bone, the intruded maxillary central incisor erupted orthodontically by removable orthodontic appliance. It was moved from a high position to level of adjacent tooth in about 7 months. A radiograph was taken 6 months after ceasing forced eruption, which demonstrated minor root resorption, but the alveolar bone height had increased.     

Analysis of lateral tooth movement during forced orthodontic eruption

STATEMENT OF PROBLEM: Forced eruption is a prosthodontic procedure that enables the treatment of otherwise problematic restorative conditions. During the vertical orthodontic movement, the root may be moved laterally, affecting the position of a tooth in the arch. PURPOSE: This study quantified the degree of lateral movement possible during the eruptive procedure and addressed the significance of this movement from a theoretical and clinical standpoint. MATERIAL AND METHODS: A patient treatment, which demonstrated the movement in a single direction on the buccolingual axis, was isolated. On the basis of this theoretical model, a clinically relevant model was developed: A "worst-case" situation for each posterior tooth was calculated, from which clinical conclusions may be derived. RESULTS:. In a given extrusion angle of 30 degrees, a lateral movement/shift of 0.58 mm resulted per 1 mm of eruption distance. The lateral movement for every millimeter of eruption and the maximum extrusion angle for each of the maxillary and mandibular posterior teeth were calculated. CONCLUSION: The lateral movement that accompanies the forced eruption procedure may compromise or be used to esthetically enhance prosthodontic treatment.     

Numerical simulation of orthodontic bone remodeling

Orthodontic tooth movement is the result of alveolar bone remodeling due to response to mechanical stimulus at the interface with periodontal ligament. Therefore, periodontal ligament plays a critical role in the orthodontic tooth movement. The present study sought to develop a numerical model capable of simulating orthodontic bone remodeling. A three-dimensional finite elements model of mandibular incisor has been constructed based on CT data from a 15-year-old boy prior to orthodontic treatment. Simulations of orthodontic tooth movement were performed for tooth translation (bodily movement). The normal strain of periodontal ligament was assumed to be the key mechanical stimulus for alveolar bone remodeling. As bone remodeling is an iterative procedure, tooth position and the geometry of tooth supporting structures were updated at each iteration. The results indicated that the total amount of tooth movement after a 30-day therapy period was approximately 0.9 mm, which was in good agreement with clinical observations. Therefore, orthodontic bone remodeling, and consequently, orthodontic tooth movement can be simulated using finite elements method. These simulations can be used in treatment planning strategy and predicting clinical tooth movement.     

牙周再生性手术联合正畸移动治疗垂直型骨缺损

牙周再生性手术能够使牙周炎患者的垂直型骨缺损获得最佳的治疗效果,正畸患者在牙周手术后炎症得到控制,正畸牙齿的移动也相对安全。牙周再生性手术后,可通过早期牙齿移动,使牙根在不牺牲安全性的情况下尽早进入移植部位,手术过程中使用的骨替代物或屏障膜等移植材料可能会阻碍牙齿移动,但是另一方面也会降低牙根吸收发生的概率。牙周再生性手术联合正畸治疗垂直型骨缺损能否维持长期较好的临床效果,受到牙周维护频率、正畸加力频率及大小等多方面因素的影响,术后疗效有待进一步观察和研究。     

Forced eruption: principles in periodontics and restorative dentistry

Forced orthodontic eruption is based on an understanding of the normal dental unit. The relationships between tooth, attachment apparatus, gingival unit, and force and stress demand consideration when forced eruption is used to treat carious or traumatic destruction of clinical crowns, lateral root perforations, or isolated vertical periodontal defects. Factors that must be judged acceptable prior to the initiation of therapy are (1) esthetics, (2) clinical root length, (3) root proximity, (4) root morphology, (5) furcation location, (6) individual tooth position, (7) collective tooth position, and (8) the ability to restore teeth. A correct diagnosis is essential and must precede the choice of forced eruption as a clinical solution. Correctly chosen, force eruption allows the tooth to assist in the support of a multiunit restoration or maintain its individual integrity while contributing to esthetics, speech, and function.     

19例儿童及青少年期含牙囊肿的外科-正畸联合导萌治疗分析

目的: 观察闭合式开窗导萌术联合正畸牵引治疗儿童及青少年含牙囊肿的效果。方法: 收集永康市第一人民医院2014—2016年收治的19例儿童及青少年期含牙囊肿,采取闭合式开窗导萌术治疗。术中开窗并去除部分囊壁,充分暴露粘接牙面,粘接正畸牵引附件,将黏膜瓣复位缝合,待1~2个月后开始正畸牵引助萌。结果: 19例患者经治疗后囊腔均逐渐减小直至消失,愈合良好。牙成功达到正常咬合位置;所有萌出牙均牙周健康,牙髓活力正常,牙根形态满意。结论: 使用闭合式开窗导萌术联合正畸牵引治疗儿童及青少年含牙囊肿,可取得良好的临床疗效,为其治疗提供了新的方法。     

Orthodontic extrusion of an extensively broken down anterior tooth: a clinical report.

A predictable esthetic restoration is not limited to the restored teeth; it has to include the gingival unit and its interface with the teeth involved. Failure to deliver restorations that maintain gingival health jeopardizes the success of any restorative procedure and creates potential for periodontal problems. Perforations, fractures, root resorption, or caries in the cervical area of the tooth, especially in the anterior part of the mouth, present many challenges to the clinician. Failure to place the crown margins on sound tooth material may violate the biologic width and should be considered a restorative failure. Orthodontic root extrusion or forced eruption is a well-documented clinical method for altering the relation between a nonrestorable tooth and its attachment apparatus, elevating sound tooth material from within the alveolar socket. It has some advantages over surgical crown lengthening, which is less conservative considering the sacrifice of supporting bone and the negative change in the length of the clinical crowns of both the tooth and its neighbors. This article presents a case of a maxillary right lateral incisor, extensively broken down following trauma, treated with orthodontic extrusion combined with gingival fiberotomy, without a need for a corrective surgical procedure.     

An Interdisciplinary Treatment Approach Combining Orthodontic Forced Eruption with Immediate Implant Placement to Achieve a Satisfactory Treatment Outcome: A Case Report

Background: Periodontal disease often results in severely bony defects around the teeth and leads to eventual extraction. Remaining bone morphology often compromises ideally restoration‐driven positions and deteriorates the success rates for dental implants. Purpose: The present investigation illustrates the clinical outcome of immediately installing an implant following orthodontic forced eruption and atraumatic extraction. Material and Methods: The subject of this study is a 40‐year‐old Asian female with a right mandibular first molar that had a deep probing depth on the mesial side and mobility. Via the aid of radiographic examination, the tooth that had an angular bony defect and apical lesion was diagnosed as having deep caries and chronic periodontitis with a poor prognosis. After consultation with the patient, we developed a treatment plan incorporating a forced eruption with immediate implantation, intended to augment the alveolar bone volume and increase the width of keratinized gingivae, in a nonsurgical manner. Results: Following 12 months of orthodontic treatment, the tooth was successfully moved occlusally in conjunction with an 8 mm vertical interdental bone augmentation. Because of sufficient volume of bone and satisfactory gingival dimensions, the implant showed adequate initial stability in the correct position to facilitate physiological and aesthetic prerequisites. After 6 months of ossteointegration, a customized impression coping was utilized to transfer the established emergence profile to a definitive cast for the fabrication of a customized abutment. The final prosthesis was made using a customized metal abutment and ceramometal crown. Conclusion: In the face of difficult clinical challenges, meticulous inspection and a comprehensive treatment plan were crucial. Interdisciplinary treatment through the careful integration of multiple specialists suggests the possibility of optimal results with high predictability.     

A conservative multidisciplinary approach for improved aesthetic results with traumatised anterior teeth

A subgingival crown-root fracture presents a restorative problem to the clinician because restoration is complicated by the need to maintain the health of the periodontal tissues. If the remaining portion of the root is thought to be enough to support a definitive restoration, the root may be extruded by orthodontic forced eruption after root canal treatment. Extrusion enables the remaining root portion to be elevated above the epithelial attachment. Endodontic posts may be useful in exerting vertical forces to the root for extrusion without buccal tipping. The following case shows multidisciplinary management of a case of dental trauma. Orthodontic forced eruption is incorporated using endodontic posts and restoration with porcelain fused to metal crowns--leading to successful restoration of the traumatised teeth.     

Forced eruption of adjoining maxillary premolars using a removable orthodontic appliance: a case report

Forced eruption can be performed in teeth with caries, fracture, resorption or perforation in the cervical third of the root or isolated teeth with one- or two-walled vertical periodontal defects. The purpose of this case report is to introduce an innovative orthodontic appliance which enables forced eruption. This appliance is easy to fabricate, cost-effective and very effective in forced eruption of non-restorable teeth.     

Trattamento ortodontico-chirurgico di canini mascellari inclusi. Caso clinico

Objectives

Combined surgical-orthodontic treatment of impacted maxillary canines has advanced significantly in recent years, regarding management of both hard and soft tissues and forces of traction. The aim of this report is to describe a combined surgical-orthodontic approach used to treat an impacted maxillary canine and to evaluate the functional and esthetic results after 5 years of follow-up.

Materials and methods

A 13-year-old boy was seen in the Operative Unit of Orthodontics of Policlinico Tor Vergata in Rome. Radiographic images showed intraosseous impaction of tooth no. 2.3 in a setting of late mixed dentition, and the patient was scheduled for the combined surgical-orthodontic treatment.

Results

Five years after the combined treatment, the patient presented good occlusal stability.The maxillary canine that had been orthodontically repositioned showed keratinized mucosa of adequate width on the facial side with a margin that followed the course of the enamel-cement junction. Bleeding was absent on probing, the periodontal pocket depth was <4 mm, and there was no radiographically evident bone loss.

Conclusions

The combined surgical-orthodontic technique used in this case (closed eruption towards the center of the alveolar ridge associated with conservative periodontal surgery, the acid-etch technique, and controlled orthodontic traction) simulates physiological tooth eruption and results in proper alignment with good periodontal results. It should thus be regarded as the treatment of choice for impacted teeth whose eruption is not precluded by the position of the tooth and/or the presence of ankylosis.     

Horizontal/oblique root fractures in the palatal root of maxillary molars with associated periodontal destruction: case reports

Aim To report two cases of palatal root fracture in maxillary molars that were successfully managed in the short term by root canal treatment and root amputation. Summary In the first case, a 48‐year‐old woman with bony destruction and a deep periodontal pocket on the palatal root of tooth 26 (FDI) underwent root canal treatment. Bleeding into the palatal canal and radiolucent lines over the root suggested a fracture. Further evidence was provided by an electronic apex locator. Subsequent surgery confirmed the presence of a horizontal root fracture and the fractured root was removed. In the second case, a 75‐year‐old woman presented with pain from the left posterior teeth. Clinical examination revealed an oblique root fracture of tooth 27 palatal roots with abscess formation and a deep periodontal pocket. Palatal root amputation and odontoplasty were performed. This was followed by root canal treatment. Both teeth were preserved in the short term and early healing of these two cases was uneventful. Key learning points

• ? Horizontal/oblique root fracture of the palatal root in molars is rare.
• ? A combination of periodontal and root canal treatment and palatal root amputation may allow short‐term preservation of functional teeth.