1. Orthodontic extrusion
By : hoda pouyanfar

2. Orthodontic forced eruption may be a suitable approach without risking the esthetic appearance in tooth fracture below the gingival attachment or alveolar bone crest.
Extrusion of such teeth allows elevating the fracture line above the epithelial attachment and so the proper finishing margins can be prepared.
Restoration after orthodontic eruption may present a more conservative treatment choice in young
J Can Dent Assoc 2004; 70(11):775–80

3. Orthodontic Extrusion
Movement of a tooth by extrusion involves applying
traction forces in all regions of the periodontal ligament to stimulate marginal apposition of crestal bone.
Because the gingival tissue is attached to the root by connective tissue, the gingiva follows the vertical movement of the root during the extrusion process. Similarly, the alveolus is attached to the root by the periodontal ligament and is in turn pulled along by the movement of the root.
J Can Dent Assoc 2004; 70(11):775–80

4. Indications for Orthodontic Extrusion
for treatment of a subgingival or infraosseous lesion of the tooth between the cementoenamel junction and the coronal third of the root (caries, oblique or horizontal fractures, perforations caused by a pin or Post , internal or external root resorption), especially when there are esthetic considerations
for treatment of a restoration impinging on the biological width
for reduction of angular bone defects and isolated periodontal pockets
for preimplant extraction to maintain or re-establish the integrity of an alveolar ridge
for orthodontic extraction where surgical extraction is contraindicated (chemotherapy or radiotherapy)
for treatment of trauma or impacted teeth(canines)
J Can Dent Assoc 2004; 70(11):775–80

5. J Can Dent Assoc 2004; 70(11):775–80

6. Contraindications to Orthodontic Extrusion
ankylosis or hypercementosis
root proximity and premature closure of embrasures
short roots
insufficient prosthetic space
exposure of the furcation.
the presence of chronic, uncontrollable inflammatory lesions, including combined endodontic-periodontic lesions and fractured roots;
an inability to control inflammation and acute infection that would adversely affect healing and the overall response to treatment
an absence of attachment apparatus because forced eruption only relocates the existing attachment, it does not create a new attachment
J Can Dent Assoc 2004; 70(11):775–80

7. J Can Dent Assoc 2004; 70(11):775–80

8. Advantages
conservative procedure that allows retention of a tooth without the disadvantages of a fixed bridge
does not involve loss of bone or periodontal
support, as commonly occurs during extraction
Avoid resection of bone of the teeth adjacent to the tooth
this simple technique requires a relatively easy movement of the tooth.
J Can Dent Assoc 2004; 70(11):775–80

9. Disadvantages Wearing an orthodontic device esthetic problems
oral hygiene
duration of treatment (4 to 6 weeks of extrusion and 4 weeks to 6 months of retention for implant cases in which tissue and bone remodelling are the objectives)
periodontal surgery
J Can Dent Assoc 2004; 70(11):775–80

10. Periodontal Effects
Orthodontic extrusion forces coronal migration of the root and increases the bone ridge as well as the quantity of attached gingiva , in particular when weak to moderate forces are applied.
The amount of attached gingiva is increased through eversion of the sulcular epithelium, appearing first as immature nonkeratinized tissue (known as“red patch”) and then as keratinized tissue; the process of keratinization requires 28 to 42 days.
J Can Dent Assoc 2004; 70(11):775–80

11. J Can Dent Assoc 2004; 70(11):775–80

12. After coronal movement of the periodontal attachment
J Can Dent Assoc 2004; 70(11):775–80
After coronal movement of the periodontal attachment
minor surgical correction
weekly fibrotomy
single fibrotomy

13. J Can Dent Assoc 2004; 70(11):775–80

14. Extrusion and Endodontics
Treated endodontically to prevent sensitivity and exposure of the pulp during the occlusal reduction required during the extrusion.
calcium hydroxide
Pulpectomy
extrusion force of 50 g
preimplant extraction
1 week
odontoblastic degeneration
4 weeks
J Can Dent Assoc 2004; 70(11):775–80
pulpal fibrosis

15. Pulp prolapse would be due to ischemia secondary to rapid movement
J Can Dent Assoc 2004; 70(11):775–80
pulpal reaction would differ depending on the diameter of the apical foramen
Pulp prolapse would be due to ischemia secondary to rapid movement
During rapid extrusion, a pseudo-apical lesion appears, which must be differentiated from a true lesion of endodontic origin

16. Extrusion and Prosthodontics
The mesiodistal diameter of the root, which is naturally
“strangled” at the cementoenamel junction of single-rooted teeth, is reduced with progression of the extrusion (especially in the case of conical roots), which involves expansion of interproximal gingival embrasures.
The contour shape of the crowns must not be exaggerated to compensate for this reduction in diameter .
Similarly, embrasures should not be filled to prevent an overcontour, which could adversely affect the marginal periodontium.
J Can Dent Assoc 2004; 70(11):775–80

17. J Can Dent Assoc 2004; 70(11):775–80

21. Choice of treatment 37 teeth re-eruption with forceps at the day of
the injury and splinted with wire and composite for 2–6 weeks
7 teeth
Repositioned orthodontically (two teeth within 1 week and five teeth after 1–8 months)
7 teeth

22. Results Re-eruption occurred in 35 out of 37 teeth 2 teeth → ankylosis
both necrosis and the external root resorptions occurred more often in orthodontically and surgically repositioned teeth than in the non- repositioned teeth

24. Condition 5 days after injury, before start of
endodontic treatment. A gingivectomy was performed to gain access to the root canal
Partial re-eruption 1 month later.
Pulp canal is filled temporarily with calcium hydroxide
Complete re-eruption and permanent root filling 10 months after trauma

25. Three weeks after complete intrusion
Five years later

27. 20-year-old male

31. The total extrusion time was 4 months.
The extruded tooth was retained with the same arch wire for 12 weeks to prevent any relapse. At the end of a 12-week retention period, gingivectomy and fiberotomy were performed for lingual margin exposure and better esthetics.

34. A 21-year-old white woman

35. complicated crown fracture in central
oblique crown-root fracture in lateral

37. A temporary root canal therapy using a
calcium hydroxide dressing was immediately performed on both incisors, which were then sealed with a glass ionomer cement

43. 9-year-old child
cervical root fracture
Calcium hydroxide pulpotomy for apexogenesis

45. extrusion of 2–3 mm was obtained within
6–8 weeks

46. The patient was examined
every 3 months during the follow-up period of
18 months

48. After 3-year follow-up

49. Thank you