Use of fiberglass CAD-CAM post-and-core for rapid orthodontic extrusion of anterior tooth – Case Report

This report describes the restoration of an anterior fractured tooth with a fiberglass CAD-CAM post-and-core followed by rapid orthodontic extrusion. The post space was prepared, the post-and-core was luted and a interim crown was luted to allow the tooth extrusion through the use of orthodontic buttons and elastic rubber bands. A lithium disilicate glass-ceramic crown was luted and the case was followed up after 6 and 12 months.

Interdisciplinary Orthodontic Treatment to Reestablishment Smile Function and Aesthetics

Extrusive tooth movements are an important resource in orthodontic treatment and allow the manipulation of teeth and periodontal tissues. They can be performed quickly or slowly, depending on the patient’s need. Rapid extrusion is indicated for cases in need of prosthetic preparation or restoration, where the bone and gingival tissues are intact, such as horizontal and oblique fractures, coronary or external root resorption, iatrogenic perforations (trepanations) and the presence of subgingival caries. The aim of this study is to describe the treatment of a patient who had a coronary fracture of the right upper central incisor, with a limit located 1 mm above the level of the bone crest. Rapid orthodontic extrusion was performed, to restore biologic distances and allow the preparation for prosthesis. It started with partial differentiated bonding of a fixed orthodontic appliance to the upper arch, to allow for a 3mm orthodontic extrusion. At the end of the extrusion, periodontal surgery was performed to increase the clinical crown and endodontic treatment. After these procedures, the case was concluded with the fixed prosthesis installation. The realization of an integrated planning allowed the restoration of aesthetics, with preservation of the functional periodontal limits for the patient. Keywords: Tooth Movement Techniques. Orthodontic Extrusion. Crown Lengthening. ResumoOs movimentos dentários extrusivos constituem um recurso importante no tratamento ortodôntico e permitem a manipulação dos dentes e dos tecidos periodontais. Eles podem ser realizados de forma rápida ou lenta, dependendo da necessidade do paciente. A extrusão rápida está indicada para casos com necessidade de preparo protético ou restauração, onde os tecidos ósseo e gengival encontram-se íntegros, tais como fraturas horizontais e oblíquas, reabsorções coronárias ou radiculares externas, perfurações iatrogências (trepanações) e presença de cárie subgengival. O objetivo deste trabalho é descrever o tratamento de uma paciente que apresentava fratura coronária do incisivo central superior direito, com limite localizado 1mm acima do nível da crista óssea. Realizou-se extrusão ortodôntica rápida, com a finalidade de restabelecer as distâncias biológicas e permitir o preparo para prótese. Iniciou-se com colagem diferenciada parcial de aparelho ortodôntico fixo no arco superior, para permitir a extrusão ortodôntica de 3mm. Ao término da extrusão, realizou-se cirurgia periodontal para aumento da coroa clínica e tratamento endodôntico. Após esses procedimentos, o caso foi finalizado com a instalação da prótese fixa. A realização de um planejamento integrado permitiu o restabelecimento da estética, com preservação dos limites periodontais funcionais para a paciente.Palavras-chave: Técnicas de Movimentação Dentária. Extrusão Ortodôntica. Aumento da Coroa Clínica.

Orthodontic Extrusion vs. Surgical Extrusion to Rehabilitate Severely Damaged Teeth: A Literature Review

The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common treatment choice. However, the survival rate for implants is inferior to teeth, even if severely damaged but properly treated. In order to reestablish a physiological supracrestal tissue attachment of damaged teeth and to arrange an efficient ferrule effect, three options can be considered: crown lengthening, orthodontic extrusion and surgical extrusion. Crown lengthening is considered an invasive technique that causes the removal of part of the bony support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth. The aim of the present narrative review is to compare advantages, disadvantages, time of therapy required, contraindications and complications of both techniques.

The “Prosthetic Orthodontic Approach”: An Application of the Biologically Oriented Preparation Technique Protocol

In this study, three cases involving patients who required multidisciplinary treatment for the aesthetic and functional rehabilitation of the maxillary or mandibular arch are described. In particular, an indication for preprosthetic orthodontic treatment, such as orthodontic extrusion, tooth realignment, correction of malocclusion, and diastemata closure, was present in all cases. Preprosthetic orthodontic treatment to resolve these issues before the restorative procedures was proposed; however, all patients refused preprosthetic orthodontic treatment. Thus, to restore aesthetics and function, solely a feather-edge prosthetic protocol has been used. The biologically oriented preparation technique was used to prepare the teeth that were moved in the established direction by preparing the abutment more on one side than the opposite. This so called “prosthetic orthodontic approach” allowed resolving clinical issues that would typically require preprosthetic orthodontic treatment, such as complete clinical crown loss, occlusal vertical dimension loss, tooth misalignment, malocclusion, tooth agenesis, and severe multiple diastemata. The degree of reciprocal movement of the prepared teeth achievable through this approach was minor and not comparable to a traditional wide-range orthodontic movement. Besides, the technique resulted in a modification of the gingival tissues and improvement of their thickness although it is unclear what effect this technique has on the gingival biotype. None of the patients had prosthetic or periodontal complications for at least 12 months following the procedure. Gingival health was excellent, and the prosthetic procedure did not affect the pulp survival of the vital teeth. The biologically oriented preparation technique used with a prosthetic orthodontic approach can effectively manage complicated cases without the need for preprosthetic orthodontics.

A Multidisciplinary Approach to the Management of inadequate clinical crown of Maxillary Central incisor: A Clinical Report

Introduction: Anterior tooth fracture is the most commonly presenting clinical condition during routine dental practise. Restoration of such tooth is challenging task due to fracture position and amount of remaining coronal tooth structure. Tooth fracture at or below the gingival level usually have a poor prognosis. Treatment options for such clinical conditions range from tooth extraction to prosthodontic rehabilitation with surgical crown lengthening and/or orthodontic extrusion. This clinical report describes a multidisciplinary approach for management of such cases by the orthodontic forced eruption and clinical crown lengthening followed by the final restoration with indirect resin customized post core and crown.

Glass Ionomer Subgingival Matrix Technique to Restore a Tooth with Severe Root Resorption for Implant Site Development

Here, we present the multidisciplinary, patient-specific management of a patient with severe external root resorption and bone loss in a maxillary anterior tooth. The tooth was provisionally noninvasively restored with glass ionomer subgingival matrix in preparation for forced orthodontic extrusion, papillary preservation, and implant placement. This approach enables clinicians to control infection within and around the resorbed tooth and then to use it as an anchor for slow forced tooth eruption to correct bone and mucogingival deformities. Aesthetic and functional outcomes were clinically and radiographically satisfactory. The advantages and disadvantages of this technique are discussed.