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Orthodontic extrusion. By : hoda pouyanfar. Orthodontic forced eruption may be a suitable approach without risking the esthetic appearance in tooth fracture below the gingival attachment or alveolar bone crest.

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orthodontic extrusion

Orthodontic extrusion

By : hodapouyanfar


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

orthodontic extrusion1
Orthodontic Extrusion
  • Movement of a tooth by extrusion involves applying

traction forces in all regions of the periodontal ligament to stimulate marginal apposition of crestalbone.

  • 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
indications for orthodontic extrusion
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
contraindications to orthodontic extrusion
Contraindications to Orthodontic Extrusion
  • ankylosis or hypercementosis
  • root proximity and premature closure of embrasures
  • short roots
  • insufficient prostheticspace
  • 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 acuteinfection 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
  • 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
  • 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
periodontal effects
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
j can dent assoc 2004 70 11 775 80
J Can Dent Assoc 2004; 70(11):775–80
  • After coronal movement of the periodontal attachment

minor surgical correction

single fibrotomy

weekly fibrotomy

extrusion and endodontics
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

j can dent assoc 2004 70 11 775 802
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
extrusion and prosthodontics
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
choice of treatment
Choice of treatment

37 teeth


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

  • 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

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


Five years later

Three weeks after complete intrusion


The total extrusion time was 4months.

The extruded tooth was retained with the same arch wire for 12weeks 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.


complicated crown fracture in central

oblique crown-root fracture in lateral


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


9-year-old child

cervical root fracture

Calcium hydroxide pulpotomy for apexogenesis


The patient was examined

every 3 months during the follow-up period of

18 months