Orthodontic extrusion and implant site development using an interocclusal appliance for a severe mucogingival deformity: A clinical report

doi:10.1016/S0022-3913(11)00012-6

The Journal of Prosthetic Dentistry

Volume 105, Issue 2, February 2011, Pages 72-77

https://doi.org/10.1016/S0022-3913(11)00012-6 Get rights and content

A multidisciplinary therapy used to treat a patient with a severe mucogingival deformity in the area of maxillary anterior teeth is presented. The simple technique uses an interocclusal appliance and elastic band for orthodontic extrusion to correct the mucogingival deformity and develop an implant site. This approach is designed to increase the amount of keratinized tissue and new alveolar bone, which are necessary for the development of an implant site. Clinical and radiographic examinations at the 5-year follow-up revealed a successful tooth replacement and improved esthetic appearance that was achieved with multidisciplinary treatment. The advantages and disadvantages of this technique are discussed.

Section snippets

Clinical Report

A 30-year-old white woman was referred to the Department of Periodontology at the Pontifical Catholic University of Paraná, Brazil. The patient reported having successive scaling and root planing procedures, to treat localized severe periodontitis in the area of the maxillary anterior teeth.

Periodontal examination revealed Class II recession in the right maxillary canine, a severe loss of attachment, and Class IV recession in the right maxillary lateral and central incisors with a reduced width

Discussion

Periodontal disease with bone and tissue loss in the anterior region affects esthetics and may result in low self-esteem. This situation encourages patients to seek a treatment solution. Unfortunately, typical periodontal regeneration procedures and mucogingival therapy do not have entirely predictable outcomes, especially in relation to interproximal bone and tissue loss. The complexity of the clinical findings and predictability of the conventional therapies suggest that a multidisciplinary

Summary

This clinical report describes the use of orthodontic tooth extrusion for regeneration of soft tissue and alveolar bone, and demonstrates the benefit of orthodontic tooth extrusion for developing the implant site. Clinical and radiographic follow-up is presented, which gives clear evidence of successful tooth replacement and improved esthetic appearance that was achieved by multidisciplinary treatment.

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Cited by (15)

Alternative treatment approach for anterior subgingival dental lesions: Forced eruption using attractive magnets
2020, American Journal of Orthodontics and Dentofacial Orthopedics
This article reports the use of a minimally invasive technique to address a challenging clinical problem in the esthetic zone. The clinical steps taken to achieve forced eruption by 1.5-2.0 mm of a maxillary central incisor that presented minimal clinical crown because of caries are described in detail. This subsequently allowed the successful placement of a crown. The tooth was extruded by forces generated between 2 neodymium-iron-boron magnets. One was affixed to the palatal surface of the tooth, and the other was embedded in a thermoformed splint. Weekly circumferential supracrestal fiberotomies were performed to enable extrusion without osseous migration. The extrusion was clinically and radiographically detectable after 6 weeks of magnetic force application. After an initial retention period of 8 weeks, the maxillary incisors were restored with lithium-disilicate ceramic veneers and crowns.
An efficient and noncompliant method for forced eruption with microimplants that is bracket free, and its long-term stability
2019, Journal of the American Dental Association
The authors describe a bracket-free forced eruption technique using microimplants that does not require patient compliance and report relapse after long-term observation.
In 2 patients who needed to undergo forced eruption of carious and fractured roots of anterior teeth, the authors erupted the roots forcefully with a cantilever wire and microimplants as an anchorage. The microimplants provided sufficient anchorage by approximately 6 to 7 millimeters for forced eruption of the roots. The authors observed minor relapse of approximately 0.5 mm in both cases at the 1.5-year follow-up.
The forced eruption method using microimplants and a sectional wire is simple and does not require patient compliance, but it does provide precise tooth movement. Clinicians can consider using long retention, overcorrection, and delayed cementation of prosthetic crowns to manage relapse.
Implementation of orthodontic extraction for pre-implant soft tissue management: A systematic review
2019, International Orthodontics
Citation Excerpt :
Five out of these six cases received a follow-up at respectively 3, 4, 6 and 7 years post-implantation; all had a retention period, and reported a stable bone level. The sixth case [23], with no retention period, unfortunately does not allow a comparison of the bone level between the day of implant placement and the control visit at 5 years, because no radiograph was taken on the day of the implant placement. Therefore, we were unable to conclude on a possible difference, at medium and at long-term, related to the tissue augmentation achieved with or without a retention period before surgical extraction.
This systematic review aims to define the recommendations allowing an optimized clinical implementation for orthodontic extraction as a pre-implant soft tissue management procedure.
A digital search was performed in the Cochrane Library, PubMed, Scopus, and DOSS databases; a pre-screening was conducted according to the title and summary of the articles. After a complete reading, only the articles meeting all of our inclusion criteria were selected, and a second search, this time manual, was performed within their references. The selected articles were then analysed according to twelve parameters.
Thirty-nine articles were included. Despite low statistical evidence in the available literature, some principal guidelines, which seem generally accepted by the scientific community, could be highlighted based on this analysis. However, no ideal clinical protocol could be established.
Orthodontic extraction is an efficient procedure for pre-implant soft tissue management, however, further studies are needed to establish full clinical recommendations and optimize its clinical implementation.
Cette revue systématique de la littérature vise à définir des recommandations permettant une mise en œuvre clinique optimisée de l’extraction orthodontique en tant que technique d’aménagement tissulaire pré-implantaire.
Une recherche numérique a été menée dans les bases de données de Cochrane Library, Pubmed, Scopus, et DOSS ; une présélection a été effectuée selon le titre et le résumé des articles. Après une lecture complète, seuls les articles satisfaisant l’ensemble de nos critères de sélection ont été retenus et une seconde recherche, cette fois-ci manuelle, a été menée dans leur bibliographie. Les articles retenus ont ensuite été analysés selon douze paramètres.
Trente-neuf articles ont été inclus. Malgré un niveau de preuve faible de la littérature disponible, de grandes lignes de conduite, qui semblent globalement admises par la communauté scientifique, ont pu être mises en évidence grâce à cette analyse. Cependant, aucun protocole clinique complet, qui puisse être considéré comme idéal, n’a pu être établi.
L’extraction orthodontique est une technique efficace d’aménagement tissulaire pré-implantaire mais de nouvelles études sont nécessaires pour permettre d’établir des recommandations cliniques complètes et d’optimiser sa mise en œuvre clinique.
Resolution of complex esthetic problems in abnormal anterior teeth: A clinical report
2014, Journal of Prosthetic Dentistry
Citation Excerpt :
They were discarded because of the risk of an unpredictable esthetic outcome, concerns regarding the long-term stability of the gingival tissues, and cost.10,11 Endodontic treatment was performed to allow for the orthodontic extrusion (Fig. 2A), which was carried out to position the hard and soft tissues more coronally12 to correct the gingival contour (Fig. 2B). The size of the right maxillary lateral incisor coronal portion of the root and the clinical crown was reduced.
A conservative treatment is presented for a patient with complex severe esthetic problems related to the presence of anomalous teeth. The patient showed a rare occurrence of macrodontia of the maxillary right lateral incisor and microdontia of the maxillary left lateral incisor. The treatment plan was conservative to avoid tooth extraction, periodontal tissue trauma, and the risk of an unpredictable esthetic outcome. A multidisciplinary treatment involving orthodontic extrusion, endodontic therapy, periodontal therapy, and minimally invasive restorations was performed. A successful outcome was observed after a 2-year follow-up.
Orthodontic single tooth intrusion with a removable interocclusal device: A clinical report
2013, Journal of Prosthetic Dentistry
Interdisciplinary therapy was used to treat a patient missing a single posterior tooth opposing an extruded tooth. The simple technique used a removable interocclusal device and elastic band for orthodontic intrusion over a 2-month period after implant placement in the opposing arch to aid in prosthetic site development. This approach was designed to increase the interocclusal space needed to restore the implant, obtain a more consistent occlusal plane, and improve esthetics. Clinical and radiographic examinations at the 6-month follow-up revealed an acceptable occlusal relationship and improved esthetic appearance that was achieved with the documented course of treatment.
Forced Eruption for Implant Site Development Utilizing a CAD/CAM Provisional Fixed Dental Prosthesis: A Case Report
2023, International Journal of Periodontics and Restorative Dentistry

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Orthodontic extrusion and implant site development using an interocclusal appliance for a severe mucogingival deformity: A clinical report

Section snippets

Clinical Report

Discussion

Summary

Am J Orthod

J Am Dent Assoc

J Am Dent Assoc

J Prosthet Dent

J Prosthet Dent

J Prosthet Dent

J Prosthet Dent

A classification of marginal tissue recession

Int J Periodontics Restorative Dent

Forced eruption: Alteration of soft tissue cosmetic deformities

Int J Periodontics Restorative Dent

The effect of orthodontic therapy on certain types of periodontal defects. I. Clinical findings

J Periodontol

Forced eruption. I. A method of treating isolated one and two wall infrabony osseous defects–rationale and case report

J Periodontol

Isolated vertical infrabony defects treated by orthodontic tooth extrusion

Angle Orthod