Orthodontic Forced Eruption of Permanent Anterior Teeth with Subgingival Fractures: A Systematic Review

Abstract

(1) Background: To assess orthodontic forced eruption (OFE) as a pre-restorative procedure for non-restorable permanent teeth with subgingival dental hard tissue defects after dental trauma. (2) Methods: A systematic electronic search of three databases, namely, MEDLINE, Cochrane Library, and EMBASE, revealed a total of 2757 eligible publications. Randomized controlled clinical trials (RCT), retro- and prospective clinical studies, or case series (with a minimum of three patients) were reviewed. (3) Results: Thirteen full-text papers were included: one RCT, one prospective clinical trial, two retrospective cohort studies, and nine case series. Within case series, statistical significance between age and cause of fracture (p < 0.03) was determined. The mean extrusion rate of OFE was 1.5 mm a week within a four to six weeks treatment period followed by retention. Three OFE protocols for maxillary single teeth are available: 1. OFE without migration of gingiva and alveolar bone, 2. OFE with gingival migration and slight alveolar bone migration, and 3. OFE with migration of both gingiva and alveolar bone. (4) Conclusions: The current state of the evidence suggests that OFE is a feasible pre-treatment option for non-restorable permanent teeth. OFE can promote the migration of tooth surrounding hard and soft tissues in the esthetic zone. Root resorption does not seem to be a relevant side effect of OFE.

Updated Guidelines for the Orthodontic Management of Traumatized and Endodontically Treated Teeth: A Review Study

“…Another review established that orthodontic tooth movement may develop blood flow disturbances in the pulp, vacuolization and, rarely, pulp necrosis [ 7 ]. It has also been reported that maxillary incisors with severe previous TDIs have a higher risk of pulp vitality loss with orthodontic extrusion [ 8 ]. In summary, it is not possible to say whether orthodontic movement of teeth with TDIs will increase the risk of vitality loss above that of uninjured teeth; however, all orthodontists must be aware of these risks and the possible need to undertake pulp vitality tests whenever necessary [ 5 , 3 ].…”

“…The adverse effect of coronal migration of the gingiva and bone around the orthodontically extruded tooth can be prevented by performing fiberotomy that aims to section the supra-crestal gingival fibers. This procedure should be performed at the beginning of orthodontic extrusion and repeated weekly or every two weeks, with simultaneous root planning [ 8 ]. When extruding a fractured tooth, it is ideal to use a stabilizing arch-wire (e.g., 0.018-inch stainless steel wire) to the adjacent teeth with a flexible ‘piggyback’ arch-wire (e.g., 0.012-inch NiTi) to extrude the fractured tooth with approximately 50 g force levels [ 8 ].…”

“…This procedure should be performed at the beginning of orthodontic extrusion and repeated weekly or every two weeks, with simultaneous root planning [ 8 ]. When extruding a fractured tooth, it is ideal to use a stabilizing arch-wire (e.g., 0.018-inch stainless steel wire) to the adjacent teeth with a flexible ‘piggyback’ arch-wire (e.g., 0.012-inch NiTi) to extrude the fractured tooth with approximately 50 g force levels [ 8 ]. During extrusion, the bracket should be positioned very close to the cemento-enamel junction.…”

“…An alternative option is to bond the wire directly on the surface of the injured tooth and including up to four anchor teeth to minimize adverse effects. The incisal edge of the affected tooth should be shortened up to 1 mm to allow for adequate eruption and to avoid occlusal interference [ 8 ]. Clinical and radiographic assessment has to be done at six months, one year, and two years after starting orthodontic treatment [ 28 ].…”

Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: a laboratory study

“…to a supragingival position is frequently used as a more straightforward alternative to surgical crown lengthening or orthodontic or surgical extrusion [1][2][3]. This restorative approach, termed deep margin elevation (DME), facilitates the subsequent preparation, impression taking, isolation with rubber dam, and adhesive luting of an indirect restoration [1].…”