TIPS FROM OUR READERS Rapid orthodontic extrusion of a subgingivally fractured incisor Jean-Philippe Ré, DDS a and Jean-Daniel Orthlieb, DDS, PhD b A subgingivally fractured incisor presents a restorative challenge. Orthodontic eruption is a good alternative to crown lengthening for restoring the biological width, maintaining the alveolar bone, and restoring esthetics. 1,2 The technique requires a hook to serve as the attachment system, fixed to the fractured tooth root, and an anchorage bar to allow movement of the root. The bar should not interfere with the occlusion, should be directly above the hook, and should ensure stabilization of the anchored teeth. The elastic provides the force. The forces must be vertically directed along the long axis of the tooth. With sufficient force, the periodontal fibers are ruptured. Therefore, tooth movement is rapid, and there is no movement of the periodontal tissues. 3 The eruption described required 1 week. Figure 1. Maxillary lateral incisor fractured at subgingival level. Elastic between cemented wire hook and rod acts as extrusion device. Figure 2. Extrusion after 1 week. Figure 3. Definitive restoration. a Associate Professor, Faculty of Odontology, Aix-Marseille University, Marseille, France. b Professor, Faculty of Odontology, Aix-Marseille University, Marseille, France. 464 THE JOURNAL OF PROSTHETIC DENTISTRY
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TIPS FROM OUR READERS
Figure 1. Mbetween ce
aAssociate PrbProfessor, F
464
Rapid orthodontic extrusion of a subgingivally fractured incisor
Jean-Philippe Ré, DDSa and Jean-Daniel Orthlieb, DDS, PhDbFigure 2. Extrusion after 1 week.
A subgingivally fractured incisor presents a restorativechallenge. Orthodontic eruption is a good alternative tocrown lengthening for restoring the biological width,maintaining the alveolar bone, and restoring esthetics.1,2
The technique requires a hook to serve as the attachmentsystem, fixed to the fractured tooth root, and ananchorage bar to allow movement of the root. The barshould not interfere with the occlusion, should be directlyabove the hook, and should ensure stabilization of theanchored teeth.
The elastic provides the force. The forces must bevertically directed along the long axis of the tooth. Withsufficient force, the periodontal fibers are ruptured.Therefore, tooth movement is rapid, and there is nomovement of the periodontal tissues.3 The eruptiondescribed required 1 week.
axillary lateral incisor fractured at subgingival level. Elasticmented wire hook and rod acts as extrusion device.
Figure 3. Definitive restoration.
ofessor, Faculty of Odontology, Aix-Marseille University, Marseille, France.aculty of Odontology, Aix-Marseille University, Marseille, France.
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Figure 4. Periapical radiographs made during treatment. A, Initial presentation. B, During extrusion. C, After endodontic retreatment. D, Definitiverestoration.
September 2016 465
Ré and Orthlieb THE JOURNAL OF PROSTHETIC DENTISTRY
466 Volume 116 Issue 3
PROCEDURE
1. Remove the existing gutta percha to at least half thedepth of the root canal.
2. Bend one end of a steel wire (Wironit-clasp Wire,round, 0.7 mm; Bego) to form a hook and cut theother end to the desired length.
3. Cement the wire in the root canal with resin-modified glass ionomer cement (Fuji Plus Corp;GC America).
4. Cut a length of the same wire to fit the space be-tween the 2 adjacent teeth.
5. Etch and bond the adjacent teeth (Gel Etchant; KerrCorp) (Prime&Bond NT; Dentsply Intl) and attachthe wire with composite resin (Permaflo; UltradentProducts Inc) at a distance from the root thatanticipates the required eruption.
6. Put an elastic (Dyna-Link Elastomeric Chain; G&HOrthodontics) on the hook, go around the bar andreturn to the hook (Figs. 1-3).
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7. Complete conventional endodontic treatment be-fore fabricating the definitive restoration (Fig. 4).
REFERENCES
1. Geron S, Ziskind D. Lingual forced eruption orthodontic technique: clinicalconsiderations for patient selection and clinical report. J Prosthet Dent2002;87:125-8.
2. Kim SH, Tramontina VA, Papalexiou V, Luczyszyn SM, Grassi MB, de FatimaScarpim M, et al. Rapid orthodontic extrusion using an interocclusal appliancefor the reestablishment of biologic width: a case report. Quintessence Int2011;42:201-4.
3. Carvalho CV, Bauer FP, Romito GA, Pannuti CM, de Micheli G. Orthodonticextrusion with or without circumferential supracrestal fiberotomy and rootplaning. Int J Periodontics Restorative Dent 2006;26:87-93.
Corresponding author:Dr Jean-Philippe Ré71, Place de la Liberté83 000 ToulonFRANCEEmail: [email protected]
Copyright © 2016 by the Editorial Council for The Journal of Prosthetic Dentistry.
Ré and Orthlieb
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