1
|
Jenisha J, Geeth Deepika KG, Sherwood IA, Abirami AA. Survival evaluation of surgical extrusion for the management of complicated crown-root fractured maxillary incisors: A clinical study. AUST ENDOD J 2024. [PMID: 39253870 DOI: 10.1111/aej.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/13/2024] [Accepted: 09/02/2024] [Indexed: 09/11/2024]
Abstract
This study aimed to clinically evaluate the survivability of surgically extruded teeth, to assess the success rate and predictable factors pertaining to alterations in both hard and soft tissues adjacent to extruded teeth. A total of 46 complicated crown-root fractured maxillary central and lateral incisors with >75% tooth structure loss relatively due to trauma were included. Preoperative clinical and radiographic variables were recorded. Single operator performed endodontic treatment before surgical extrusion. Patients were recalled for review at 6, 12, 18, 24 and 36 months. Survivability was assessed using Kaplan-Meier survival analysis. With a mean follow-up of 2.8 years, survival rate was 95.7%. Mobility observed in only two cases. The crown-root ratio was favourable (1:2) in all the cases except for five teeth. Only two teeth displayed non-progressive root resorption. Survival of surgically extruded teeth relies on significant predictors like favourability of CRR and implementation of atraumatic extrusion.
Collapse
Affiliation(s)
- J Jenisha
- Department of Conservative Dentistry and Endodontics, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - K G Geeth Deepika
- Department of Conservative Dentistry and Endodontics, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - I Anand Sherwood
- Department of Conservative Dentistry and Endodontics, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| | - A Azhagu Abirami
- Department of Conservative Dentistry and Endodontics, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India
| |
Collapse
|
2
|
Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101482. [PMID: 36295642 PMCID: PMC9610387 DOI: 10.3390/medicina58101482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Dietschi and Spreafico first proposed deep margin elevation (DME) in 1998 to address the multiple clinical problems associated with sub-gingival margins, where sub-gingival margins will be repositioned coronally using composite resin restorations. Given that dentistry is directing towards conservatism, its use is currently trending. Materials and Methods: a search was performed through PubMed, Scopus, and Google Scholar search engines to obtain relevant articles with no time restriction. Results: With biological width taken into consideration, well-defined and polished sub-gingival restorations are compatible with periodontal health. Marginal integrity in the DME technique seems to be affected by the type of adhesive, restoration, and incremental layering of the restoration. Regarding fracture resistance, DME has no significant effects. Conclusion: The DME technique seems to be a minimally invasive alternative to surgical crown lengthening (SCL) and orthodontic extrusion (OE) with respect to biological width. Well-controlled clinical trials are limited in this field; further long-term follow-up studies emphasizing the periodontal outcomes and prevention of complications are needed.
Collapse
|
3
|
Dentoalveolar Trauma of Children and Adolescents. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
4
|
Reichardt E, Krug R, Bornstein MM, Tomasch J, Verna C, Krastl G. Orthodontic Forced Eruption of Permanent Anterior Teeth with Subgingival Fractures: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312580. [PMID: 34886307 PMCID: PMC8656787 DOI: 10.3390/ijerph182312580] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/09/2021] [Accepted: 11/24/2021] [Indexed: 12/29/2022]
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.
Collapse
Affiliation(s)
- Elisabeth Reichardt
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine UZB, University of Basel, Mattenstr. 40, 4058 Basel, Switzerland;
- Correspondence: or
| | - Ralf Krug
- Department of Conservative Dentistry and Periodontology, University of Würzburg, Pleicherwall 2, 97070 Würzburg, Germany; (R.K.); (G.K.)
| | - Michael M. Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine UZB, University of Basel, Mattenstr. 40, 4058 Basel, Switzerland;
| | - Jürgen Tomasch
- Department of Molecular Bacteriology, Helmholtz Centre for Infection Research (HZI), IInhoffenstraße 7, 38124 Braunschweig, Germany;
| | - Carlalberta Verna
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine UZB, University of Basel, Mattenstr. 40, 4058 Basel, Switzerland;
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, University of Würzburg, Pleicherwall 2, 97070 Würzburg, Germany; (R.K.); (G.K.)
| |
Collapse
|
5
|
Pre-endodontic restoration of structurally compromised teeth: current concepts. Br Dent J 2021; 231:343-349. [PMID: 34561585 PMCID: PMC8463293 DOI: 10.1038/s41415-021-3467-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
Teeth that require endodontic treatment are often structurally compromised and this considerably complicates endodontic procedures. Therefore, pre-endodontic restoration is a key approach that dentists should consider for such teeth. This article discusses current concepts of pre-endodontic restoration, with a focus on adhesive restorative methods and surgical/orthodontic techniques, and provides a relevant decision-making flowchart. Highlights the importance of pre-endodontic restoration for the predictability of endodontic treatment. Discusses restorability aspects for structurally compromised teeth. Reviews current restorative and surgical/orthodontic techniques for pre-endodontic restoration and provides a decision-making flowchart.
Collapse
|
6
|
Pontons-Melo JC, Garcia IM, Melo MA, Collares FM. Single-Tooth Rehabilitation Combining Root Displacement and Crown Lengthening Two-Year Follow-Up: A Case Report. Oper Dent 2021; 46:246-254. [PMID: 34242393 DOI: 10.2341/20-110-s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE Combined techniques to expose circumferential tooth structure associated with subsequent restoration may represent a valid option in many situations. This case provides an example of the successful management of the anterior tooth rehabilitation combining root displacement and crown lengthening. SUMMARY Rehabilitation of an extensively compromised single anterior tooth represents an intriguing challenge for dentists, particularly when the rehabilitation involves esthetic, psychosocial, and functional requirements. The success in rehabilitating a patient with a conservative approach depends on a critical evaluation of the remaining structures, precise treatment plan, systematic treatment strategies, and patient compliance. In this case, the patient's chief complaint was the undesirable appearance of the maxillary right lateral, caused by the displacement of the post and crown. Clinical examination revealed a remaining tooth with coronal fracture, severe loss of tissue due to caries, and absence of ferrule effect. Radiographic examination revealed that the fracture margin was located subgingival. This case report describes a single-tooth rehabilitation involving a combination of root displacement via orthodontic extrusion and crown lengthening. The rehabilitation was followed by post-and-core restoration using a prefabricated glass fiber post associated with a disilicate lithium crown. The clinical decision making and combined effect of both treatment strategies are explained in this report. The treatment required three months, including recovery times after surgery and the placement of the provisional crown. The patient was esthetically and functionally satisfied with the restoration. Patient follow-up examination was performed 24 months after the treatment. This clinical report contributes to the clinical practice and exemplifies the possibility of rehabilitating the natural tooth using combined techniques, which may offer particular advantages regarding prognosis and invested efforts.
Collapse
|
7
|
Mohamed M, Moheb D, Waly N, Abdalsamad A, Elkhadem A. Effects of different splinting times on surgically extruded teeth with a crown-root fracture: A randomized controlled trial. Dent Traumatol 2020; 37:264-274. [PMID: 33179388 DOI: 10.1111/edt.12624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Clinical studies evaluating the splinting time for surgically extruded teeth with crown-root fractures are lacking. The aim of this study was to compare 2-week splinting versus functional splinting times after surgical extrusion. MATERIAL AND METHODS Children aged 8-13 years who presented with crown-root fractures were included. Surgical extrusion was performed, and teeth were splinted either for 2 weeks or until normal Periotest values were achieved (functional splinting time). The outcome measures were tooth mobility, tooth loss, root resorption, marginal bone resorption and ankylosis. Measurements were taken at baseline, weekly after splint removal, and after 1, 3, 6 and 12 months. RESULTS Nineteen patients were included in the analysis. Surgically extruded teeth splinted for 2 weeks showed significantly higher mobility directly after splint removal and at 1 month after splinting compared with the functional splinting time group. The mean differences for horizontal Periotest values were 14.96 (95% confidence interval: 8.52, 21.39) and 6.63 (95% confidence interval: 0.25, 13), respectively. The vertical Periotest values were 10.47 (95% confidence interval: 1.95, 18.99) and 4.81 (95% confidence interval: -1.57, 11.18), respectively. At the 3-, 6- and 12-month follow-up intervals, there were no statistically significant differences between the groups. One tooth in the 2-week splinting group was lost. None of the teeth had ankylosis, marginal bone resorption or root resorption. CONCLUSIONS Although both groups showed neither statistical nor clinically significant differences after 12 months, there was a significant difference immediately after splint removal, with greater tooth mobility in the 2-week splinting group. Thus, a functional splinting time (4-6 weeks) can be suggested for better healing and optimal stability to allow placement of the final restoration directly after splint removal.
Collapse
Affiliation(s)
- Maii Mohamed
- Pediatric Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Dalia Moheb
- Pediatric Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Nevine Waly
- Pediatric Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Ahmad Abdalsamad
- Department of Oral Radiology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Ahmed Elkhadem
- Pediatric Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| |
Collapse
|
8
|
Khandelwal P, Srinivasan S, Arul B, Natanasabapathy V. Fragment reattachment after complicated crown-root fractures of anterior teeth: A systematic review. Dent Traumatol 2020; 37:37-52. [PMID: 32813931 DOI: 10.1111/edt.12602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM Fragment reattachment is a procedure that can immediately restore form and function in crown-root fracture cases and is considered a minimally invasive and cost-effective treatment option. The aim of this systematic review was to analyze the methods used and the outcome of fragment reattachment for complicated crown-root fractures of anterior teeth. MATERIALS AND METHODS Five electronic databases (PubMed, Web of Science, Embase, Scopus, and Google Scholar) were searched for English language articles regarding fragment reattachment after complicated crown-root fractures of anterior teeth. RESULTS Twelve case reports and two case series were selected for this review after applying the inclusion and exclusion criteria. In eleven articles, the fracture line was exposed prior to reattachment. Root canal treatment was performed in all cases except one, where conservative pulp treatment was done prior to reattachment. A post was used as part of the restoration in 85% of the cases. Additional fragment preparation was done in 42% of the cases in the form of beveling and groove formation. Adhesive strategies used to reattach the coronal fragments were total-etch, self-etch, or self-cure adhesive. Intermediate materials used for reattachment were resin cement, glass-ionomer cement, composite and self-adhesive cement. Treatment outcomes were favorable in all the included articles and the follow-up period ranged from three months to seven years. CONCLUSION Fragment reattachment after complicated crown-root fractures of anterior teeth can be considered as a viable treatment option if the clinical conditions are favorable.
Collapse
Affiliation(s)
- Priyal Khandelwal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education And Research (MAHER), Chennai, India
| | - Siddharth Srinivasan
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education And Research (MAHER), Chennai, India
| | - Buvaneshwari Arul
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education And Research (MAHER), Chennai, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education And Research (MAHER), Chennai, India
| |
Collapse
|
9
|
Choi YH, Lee HJ. Surgical extrusion of a maxillary premolar after orthodontic extrusion: a retrospective study. J Korean Assoc Oral Maxillofac Surg 2019; 45:254-259. [PMID: 31728332 PMCID: PMC6838351 DOI: 10.5125/jkaoms.2019.45.5.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 11/07/2022] Open
Abstract
Objectives Crown-root fracture and cervical caries in maxillary premolars constitute a challenge in cases of subgingival placement of restoration margins. Surgical extrusion has been practiced successfully in permanent anterior teeth. The aim of the present retrospective study was to assess the clinical outcome of surgical extrusion after orthodontic extrusion in maxillary premolars. Materials and Methods Twenty-one single, tapered root maxillary premolars with subgingival crown-root fracture or caries were included. Presurgical orthodontic extrusion was performed on all teeth to prevent root resorption. Extent of extrusion and rotation was determined based on crown/root ratio. The postoperative splinting period was 7 to 14 days. Clinical and radiographic examination was performed at an interval of 1, 2, and 3 months. Results After the mean follow-up of 41.9±15.2 months, failure was observed as increased mobility in 3 of 21 cases. No significant difference was observed in the outcome of surgical extrusion based on tooth type, age, sex, 180° rotation, or time for extraction. Furthermore, marginal bone loss was not observed. Conclusion Surgical extrusion of maxillary premolars can be a possible therapeutic option in cases of subgingival crown-root fracture.
Collapse
Affiliation(s)
- Yong-Hoon Choi
- Department of Conservative Dentistry, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Jung Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
10
|
Bailey O, O’Connor C. Papilla management in sub-gingival, interproximal, direct composite restoration: a key step to success. Br Dent J 2019; 226:933-937. [DOI: 10.1038/s41415-019-0412-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
11
|
Nieto-Aguilar R, Serrato-Ochoa D, Medina-Navarro R, Aguilera-Méndez A, Morales-Soto KD, Loyola-Rodriguez JP, Campos A, Alaminos M. In vitro retention efficiency of temporary type zinc oxide cement for orthodontic forced eruption. Int Orthod 2019; 17:96-102. [PMID: 30772354 DOI: 10.1016/j.ortho.2019.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the retention efficiency of three types of temporary zinc oxide cement trademarks on forced eruption using intracranal wire device. METHODS An in vitro evaluation included intracanal wire device displacement and detachment at 50g load force for 120 days and then the retention resistance at maximum load force. RESULTS All groups of temporary zinc oxide cements were efficient to support 50g load forces after 120 days. None statistical differences were found between groups. Zinc oxide cements supported a maximum retention load force, which exceeded in more than 84 times the lowest value obtained in controls (420g). CONCLUSION Zinc oxide cements are efficient to retain intracanal wire devices on forced eruption processes in vitro and allows removal of both when necessary (wire device and cement, respectively).
Collapse
Affiliation(s)
- Renato Nieto-Aguilar
- Universidad Michoacana de San Nicolás de Hidalgo, Faculty of Odontology, Postgraduate Studies Division, Morelia, Michoacán, Mexico.
| | - Deyanira Serrato-Ochoa
- Universidad Michoacana de San Nicolás de Hidalgo, Faculty of Odontology, Postgraduate Studies Division, Morelia, Michoacán, Mexico
| | | | - Asdrúbal Aguilera-Méndez
- Chemical and Biological Investigation Institute, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Michoacán, Mexico
| | - Karina Denisse Morales-Soto
- Universidad Michoacana de San Nicolás de Hidalgo, Faculty of Odontology, Postgraduate Studies Division, Morelia, Michoacán, Mexico
| | | | - Antonio Campos
- University of Granada, Faculty of Medicine and Faculty of Odontology, Granada, Spain
| | - Miguel Alaminos
- University of Granada, Faculty of Medicine and Faculty of Odontology, Granada, Spain
| |
Collapse
|
12
|
Krug R, Connert T, Soliman S, Syfrig B, Dietrich T, Krastl G. Surgical extrusion with an atraumatic extraction system: A clinical study. J Prosthet Dent 2018; 120:879-885. [DOI: 10.1016/j.prosdent.2018.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/06/2018] [Accepted: 02/06/2018] [Indexed: 12/16/2022]
|