Orthodontic Extrusion Emerges As Key Tooth Preservation Technique

Imagine suffering a dental injury that fractures your tooth below the gumline. Would your first thought be extraction? Modern dentistry offers an alternative: orthodontic extrusion, an increasingly valued tooth-preserving technique. This article explores the principles, applications, procedures, advantages, and considerations of this innovative treatment.

Orthodontic extrusion, also called forced eruption, involves gradually moving subgingivally fractured tooth segments into proper position through controlled orthodontic forces. This technique stimulates periodontal tissue regeneration and alveolar bone remodeling, allowing both tooth and supporting bone to migrate coronally. Rather than simply "pulling" the tooth, this biological process ensures stable repositioning.

Orthodontic extrusion isn't universally applicable, but proves effective for:

• Subgingival caries or fractures: When decay or trauma extends below the gumline, extrusion exposes sound tooth structure for restorative procedures like fillings, inlays, or crowns.
• Post-root canal fractures: Even properly treated teeth may fracture subgingivally. Extrusion improves restoration success rates and longevity.
• Impacted teeth: For teeth failing to erupt normally due to spatial constraints, extrusion facilitates proper emergence and occlusal function.

The extrusion process typically involves:

1. Evaluation: Comprehensive assessment including radiographs and CBCT scans to evaluate periodontal health, root morphology, and bone density.
2. Treatment planning: Customized strategy determining force direction, magnitude, duration, and subsequent restoration.
3. Appliance placement: Selection of fixed (brackets/archwires) or removable devices based on clinical needs.
4. Active extrusion: Controlled force application with periodic adjustments to guide tooth movement.
5. Retention: Stabilization period lasting months to prevent relapse.
6. Restoration: Final prosthetic rehabilitation to restore form and function.

• Tooth preservation: Avoids extraction-related bone loss and adjacent tooth migration.
• Aesthetic improvement: Restores natural tooth position and appearance.
• Functional recovery: Reestablishes proper mastication.
• Periodontal regeneration: Enhances tooth stability through tissue remodeling.

• Extended treatment: Requires weeks to months of active management.
• Financial considerations: Often not covered by insurance plans.
• Potential complications: Rare risks include gingival inflammation or root resorption.
• Temporary aesthetic impact: Visible appliances during treatment.

• Select experienced clinicians for this technique-sensitive procedure.
• Maintain meticulous oral hygiene to prevent gingival complications.
• Adhere to scheduled follow-ups for timely adjustments.
• Avoid hard foods that might damage appliances or teeth.

Orthodontic extrusion offers a viable alternative to extraction for subgingivally compromised teeth. While not universally applicable, this technique demonstrates how modern dentistry prioritizes tooth preservation through innovative biological approaches.