Surgical extrusion

It is not always necessary to perform heroic efforts to save severely damaged teeth, however, retaining a patient's natural tooth should be one of the main goals of dentists.

Saving severely compromised anterior teeth is possible by applying surgical extrusion techniques when the crown-root ratio allows it. The risk of root resorption or ankylosis is minimum.

✍🏻 Surgical extrusion is defined as the procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally.
The main principle is to place the affected tooth in a more coronal position for providing acceptable conditions to achieve the re-establishment of healthy supracoronal tooth structure. This last point is important to be able to create a good restoration, that will maintain the biologic width healthy.

Thus, this technique can be used successfully to treat severely damaged teeth, especially in the anterior esthetic zone.

👉🏻 Although different techniques have been suggested for clinical crown lengthening procedures to provide good conditions to restore severely damaged teeth, all of them have some limitations in aesthetic terms.

⛔️ In the aesthetic zone, crown lengthening requires a more complex diagnostic and planning process, because when choosing a surgical crown lengthening technique, special care should be taken or it could cause asymmetry of the gingival line.

⛔️ Surgical crown lengthening by gingivectomy can be used only when there is a sufficient amount of keratinized tissue and hyperplasia of the gingiva.

⛔️ The main disadvantage of the apically positioned flap surgery is its contraindication in the isolated esthetic zone. Also, extensive osseous resection.

⛔️ Repeated fiberotomy, the necessity of retention phase after extrusion and the tendency to relapse are the main disadvantages of orthodontic extrusion.

That’s why I decided to take a treatment option my patient can afford.

👉🏻 This case demonstrates upper left canine with a deep subgingival carious lesion almost without any ferrule.

👉🏻 The main steps involved in this technique :

1️⃣ the patient was instructed to rinse the mouth with 0.12% chlorhexidine for 1 week before the procedure, maintaining good oral hygiene.

2️⃣ luxation of the tooth using a straight elevator.

3️⃣ extrusion of the root with forceps.

4️⃣ immobilization of the tooth for 1 week in the new position using interdental sutures accompanied by followable composite.

⛔️ Although splinting is necessary, it is not advocated because splinting does not improve periodontal healing. Slight mobility during the periodontal healing period will be favorable for preventing resorption and ankylosis.

5️⃣ the patient was instructed to rinse the mouth with 0.12% chlorhexidine for the following 2 weeks after surgery.

6️⃣ analgesics and antibiotics were prescribed postoperatively and the sutures were removed after 10 days.

7️⃣ the patient was recalled for a checkup every 1 week for 1 month and then for every 1 month, and this will continue up to 6 months postoperatively.

8️⃣ clinical and radiographic examinations were performed to assess changes in the bleeding on probing, mobility, periapical bone formation and percussion sounds of the tooth were noted during the recall visits.

9️⃣ 2-3 weeks later temporary crowns may be used until there has been full healing and the gingival margin is in a stable position.

🔟 the definitive restoration will be done 6 months postoperatively.

Finally, this technique can be successfully applied with minimal chair-side procedures, no need of special surgical skills, good esthetics, low incidence of failure, and easy acceptance from the patient.

Still under follow-up recalls.
Check photos of recall visits & x-rays will be added.