Implant Site Development by Orthodontic Forced Eruption of Nontreatable Teeth: A Case Report

Abstract

Abstract:Background: Loss of bone and soft tissue attachment are common sequelae of periodontitis that may jeopardize the aesthetic outcome and compromise the functional and aesthetic outcomes of treatment. The following case report describes one of the most predictable techniques of vertical ridge augmentation, which is orthodontic extrusion or forced eruption of hopeless teeth. Method:A 34-year-old woman who presented with severe attachment loss and deep pockets was diagnosed with generalized aggressive periodontitis. The mobile maxillary incisors were consequently extracted and were replaced with dental implants. However, prior to extraction, orthodontic extrusion of the hopeless incisors was performed to correct vertical ridge defects. Following extrusion and extraction of the maxillary incisors, to prevent soft tissue collapse and to preserve the papillae during socket healing, the crowns of the extracted teeth were used as pontics on a removable partial provisional denture. After 8 weeks, the implants were placed, and an immediate functional restoration was delivered. After 4 months of healing, a fixed definitive partial prosthesis was fabricated and delivered.Result: After periodontal treatment, over a 2-year period, the progression of aggressive periodontitis was controlled. The mean vertical movement of marginal bone was 3.6 mm. The use of the crowns of extracted teeth appears to be an effective method to maintain papillae. Conclusions:Orthodontic extrusion is a predictable method for the correction of vertical ridge defects. Orthodontic treatment does not aggravate or hasten the progression of aggressive periodontitis.

In the dental implant era, why do we still bother saving teeth?

“…73 This can become more challenging if a tooth is extracted and bone resorption occurs, leading to altered hard and soft tissues. [74][75][76] Orthodontic extrusion becomes an even more conservative option because the patient is more likely to not need bone augmentation when a dental implant is placed. In order to avoid the bone resorption caused by the extraction of compromised teeth, orthodontic extrusion of the tooth may be a valid treatment option.…”

“…73 This treatment involves orthodontically extruding the root, leading to an increase in the width of attached gingiva, and preserves the alveolar bone for future implant placement. [74][75][76] Orthodontic extrusion becomes an even more conservative option because the patient is more likely to not need bone augmentation when a dental implant is placed. 63…”

Treatment Planning of Dental Implants in the Anterior Maxilla; Risk Assessment and Review of Soft Tissue along with Bone Preservation and Augmentation Techniques for Successful Clinical Outcomes

“…The PDL around the natural tooth is the key factor that allows bone and soft tissue augmentation prior to extraction [30,31]. Not only does orthodontic extrusion increase the dimensions of bone, but it also moves the free gingival and interdental papilla more coronally while the location of the mucogingival junction stays the same [32] Indications include periodontal vertical defects, site preservation or enhancement before dental implant placement, and sites that have uneven osseous or gingival levels [30,31] Recommendations for use of extrusion include sites that do not have active periodontal disease, usually extruded teeth need endodontic therapy prior to extrusion [31] It usually involves a slow extrusion process of between 1-2 mm per month with orthodontic forces parallel to long axis of the tooth using orthodontic brackets or elastic thread for movement [31]. Potential drawbacks for the procedure include increased treatment time with technique, and potential to lose interproximal papilla with excessive force, as well as it is not usually recommended for labially inclined teeth [28].…”

Implant Site Development by Orthodontic Forced Eruption for Esthetic Restoration of Adjacent Implants

“…Ridge preservation has been shown to regenerate only a portion of pre‐extraction bone volume, 2 thus negatively affecting the final esthetic result. Orthodontic implant site development does improve alveolar bone volume to a certain level by regenerating some bone at the apex of the extruded tooth 3,4 . The literature cautions that achievement of predictable esthetic outcomes when restoring multiple adjacent implants in the maxillary anterior region is very challenging 5,6 .…”

“…Orthodontic implant site development does improve alveolar bone volume to a certain level by regenerating some bone at the apex of the extruded tooth. 3,4 The literature cautions that achievement of predictable esthetic outcomes when restoring multiple adjacent implants in the maxillary anterior region is very challenging. 5,6 This is especially true in patients with both a high smile line and esthetic demands coupled with significant gingival and interdental papillae display.…”