Orthodontic extrusion for pre-implant site enhancement: Principles and clinical guidelines  Abdulaziz Alsahhaf, BDS, Wael Att, DDS, Dr Med Dent, PhD  Journal of Prosthodontic Research  Volume 60, Issue 3, Pages 145-155 (July 2016) DOI: 10.1016/j.jpor.2016.02.004 Copyright © 2016 Japan Prosthodontic Society Terms and Conditions

Fig. 1 Clinical example of hopeless teeth; #13, 23 (a–d) that were extruded using dual magnets for pre-implant site enhancement. First part of the magnet was cemented in the tooth surface; the second part was attached in an essix appliance (e and f). The orthodontic extrusive phase was followed by 3 months of stabilization using the same appliance. The amount of papilla height gain compared to the neighboring teeth is noticeable (f–h). Journal of Prosthodontic Research 2016 60, 145-155DOI: (10.1016/j.jpor.2016.02.004) Copyright © 2016 Japan Prosthodontic Society Terms and Conditions

Fig. 2 Images show bone level gain prior to implant placement (a and b). Extraction of teeth #13, 23 was followed by immediate implant placement 3mm apical to the neighboring CEJ (c). The excess bone coronal to the platform of the implants was used to fill up the void between the extraction socket and the implant surface, bypassing the need for bone substitute materials. Journal of Prosthodontic Research 2016 60, 145-155DOI: (10.1016/j.jpor.2016.02.004) Copyright © 2016 Japan Prosthodontic Society Terms and Conditions

Fig. 3 Post-operative clinical images showing a healthy soft tissue profile around the implants (a and b). Post-delivery radiograph showing the amount of bone level maintained around the implants (c and d). Journal of Prosthodontic Research 2016 60, 145-155DOI: (10.1016/j.jpor.2016.02.004) Copyright © 2016 Japan Prosthodontic Society Terms and Conditions

Fig. 4 Example of rubber bands for orthodontic extrusion. An interocclusal appliance was used for anchorage. The patient is instructed to connect the two-cemented projecting buttons ‘buccally and lingually’ regularly with a rubber band. Journal of Prosthodontic Research 2016 60, 145-155DOI: (10.1016/j.jpor.2016.02.004) Copyright © 2016 Japan Prosthodontic Society Terms and Conditions

Fig. 5 Example on hock and ring method for extrusion of a hopeless tooth. Flexible arm is attached on an acrylic stent with a conventional bracket (a). Ring or hock projection is cemented in the tooth to be extruded (b). The patient is instructed to connect the flexible arm with the ring (c). Journal of Prosthodontic Research 2016 60, 145-155DOI: (10.1016/j.jpor.2016.02.004) Copyright © 2016 Japan Prosthodontic Society Terms and Conditions

Fig. 6 Clinical case on using fixed appliance for an extrusive action of a hopeless tooth. Journal of Prosthodontic Research 2016 60, 145-155DOI: (10.1016/j.jpor.2016.02.004) Copyright © 2016 Japan Prosthodontic Society Terms and Conditions

Fig. 7 Combined method of a rubber band and a fixed wire used for extrusion (a). The rubber band runs around the wire and attaches to the hock of the cemented post (b). Journal of Prosthodontic Research 2016 60, 145-155DOI: (10.1016/j.jpor.2016.02.004) Copyright © 2016 Japan Prosthodontic Society Terms and Conditions

Fig. 8 Summary of workflow for implant-site enhancement by means of orthodontic extrusion. Journal of Prosthodontic Research 2016 60, 145-155DOI: (10.1016/j.jpor.2016.02.004) Copyright © 2016 Japan Prosthodontic Society Terms and Conditions