Attractive magnets for orthodontic extrusion of crown-root fractured teeth

Effects of orthodontic tooth extrusion produced by different techniques, on the periodontal tissues: a histological study in dogs

Introduction: Managing crown-root fractured teeth can be challenging due to the extent of the subgingival fracture. The purpose of this report is to present a case on treating a crown-root fracture via intentional replantation with a 180-degree tooth rotation. Case Report: In this case a 19-year-old male patient presented with crown-root fractures of the maxillary central incisors. Intentional replantation with a 180-degree rotation, root canal treatment, post and core build up, followed by extra-coronal restorations was performed to maintain the natural dentition. Conclusion: Intentional replantation using 180-degree rotation can be a valuable treatment option for crown-root fractures. Other treatment options available for crown-root fractures include crown lengthening, and orthodontic or surgical extrusion. However, these forms of treatment can be time consuming, expensive, and esthetically compromising when compared to intentional replantation.

Introduction: Fractured maxillary anterior teeth often lead to esthetic, functional and phonetic problems. Crown-root fractures at cervical third area result in biological width violation and are challenging to treat. The treatment modalities involve exposing the cervical margins by means of surgical crown lengthening and/or orthodontic extrusion. Case Report: This paper reports a case of fractured maxillary anterior tooth at the coronal third level that was managed by forced orthodontic extrusion and intentional root canal therapy followed by esthetic rehabilitation. Conclusion: Out of the two available options, orthodontic extrusion, a much forgotten technique was utilized and proved to be a conservative and cost effective technique. Keywords: Biological Width, Cervical Third Fracture, Esthetic Rehabilitation, Orthodontic Extrusion

Background and Objectives: The key factor that enables osteoblastic activity and the formation of new bone, as well as gingiva, during orthodontic tooth extrusion (OE) is the periodontal ligament. The reaction of periodontal tissues associated with changes in the gingiva is a part of orthodontic tooth displacement. The aim of this study was to examine the effect of OE on the width of the zone of the keratinized and attached gingiva, the position of the mucogingival junction, and the height of the interdental papillae in the region where the OE was performed as well as in the adjacent region. Materials and Methods: This research included 28 adult patients (both orthodontically treated and untreated). The treated group included 15 patients, in whom orthodontic extrusion of the upper or lower frontal teeth was indicated and performed. The untreated group included 13 patients, with no previous or undergoing orthodontic treatment. Patients with periodontal disease and periodontal pockets in the frontal region and patients allergic to iodine were excluded from the study. Gingivomorphometric measurements were performed on two occasions in three groups of teeth (24 extruded and 30 agonist teeth in the treated patients; 66 teeth in the untreated patients). Statistical analysis of the obtained data was performed using the software package SPSS version 26.0. Results: Orthodontic extrusion induced changes in the position of the mucogingival line and an increase in the width of the keratinized gingiva. There were no statistically significant effects on the depth of the gingival sulcus, the attached gingiva width, or the height of the interdental papillae. Conclusions: Orthodontic tooth extrusion has an effect on the periodontium in the observed region. Vertical orthodontic force, directed towards the coronal plane, affects the surrounding soft oral tissues.

Management of crown-root fracture tooth by intra-alveolar transplantation with 180-degree rotation and suture fixation

Restoration of traumatic teeth with complicated crown root fracture poses many challenges to the clinicians. When the fracture line is below the level of gingiva, the prognosis of such fractured tooth is considered questionable or hopeless. Treating such cases is also challenging as they are associated with loss of ferrule and compromised biological width. Preservation of such diseased natural teeth usually involves a multi-disciplinary approach involving endodontic therapy, periodontal crown lengthening and / or orthodontic extrusion followed by prosthetic rehabilitation. Tooth injuries and complicated tooth fractures especially in the aesthetic region pose a great challenge to the clinician.1 When the fracture line extends at or below the level of cement enamel junction, the prognosis of such tooth is considered questionable or hopeless; they are usually associated with the loss of ferrule and compromised biological width, and therefore restoration of such teeth becomes a great challenge. To ensure functional longevity, endodontically treated teeth with less coronal structure must have at least 5 mm of tooth structure coronal to the crestal bone. Three milli meters of tooth structure is needed to maintain a healthy soft tissue complex, and 2 mm of coronal tooth structure incisal to the preparation finish line is necessary to ensure structural integrity.2 There are mainly two reasons why a tooth extraction should be avoided: Structural reasons and psychological stress associated with extraction. Psychological stress can be in the form of financial stresses associated with extraction and rehabilitation of the same and fear of post-traumatic pain. Extraction of tooth is also followed by aesthetic challenges as it may lead to hard and soft tissue resorption as the healing architecture is unpredictable. In this case report a simple yet effective treatment is presented for a 21-year-old female patient with a chief complaint of clinical tooth fracture in relation to 44. After thorough clinical and radiographic examination, it was decided to reinforce the use of flexible glass fibre post and incorporate the same as tags to engage E chain to facilitate orthodontic tooth extrusion followed by prosthetic rehabilitation. The purpose of this case report is to describe the use of a simple chair side technique for a tooth fractured at the level of cementoenamel junction (CEJ) with forced tooth eruption.

Multidisciplinary approach for management of traumatic subgingival crown-root fractured central incisor: A case report - IJCE- Print ISSN No: - 2581-9534 Online ISSN No:- 2581-8988 Article DOI No:- 10.18231/j.ijce.2020.006, IP Indian Journal of Conservative and Endodontics-IP Indian J Conserv Endod

Objective: The aim of this study is to investigate whether orthodontic extrusion movements have negative effects on the periodontal tissues, and to detect the relationship between orthodontic tooth extrusion and the width of the keratinized gingiva.Materials and Methods: Fourteen upper canines of seven patients having different Angle classifications were selected for the study. According to the abnormal position of those canines they were subjected to orthodontic extrusion forces in order to bring them back to a normal level within the dental arch and, therefore, to correct the abnormality. Plaque index, probing depth, gingival index, papillary bleeding index and keratinized gingiva width were measured around the examined canines at baseline, one month, 3 months and 6 months after the initiation of the extrusion movements.Results: The values of plaque index and gingival index increased significantly during the whole period of study, whereas the probing depth and papillary bleeding index values did not show any important differences. A very slight increase in the keratinized gingiva width of about 0.14 mm was detected at the examined teeth after 6 months compared to baseline without any statistical significance.Conclusion: No negative effects on the periodontal tissues were noted around the canines during the application of orthodontic tooth extrusion. A very slight increase of the keratinized gingiva width was detected at the examined teeth after 6 months comparing to baseline without any statistical significance.

Root resorption

Introduction: Anterior crossbite is a major aesthetic and functional concern to parents during the developmental stage of a child. Anterior crossbite is the lingual positioning of the maxillary anteri­or teeth in relationship to the mandibular anterior teeth. There are several methods for solving this problem. In this case report we present the treatment with a removable lingual plane. The aim of the following case report is to present the achieved good results after the early treatment of an anterior crossbite. Materials and Methods: This report describes the treatment of an 8-year-old girl in the Department of Orthodontics, Faculty of Dental medicine, Medical University - Varna. Diagnostic data was gathered from clinical photographs, cast models from intraoral impressions, cephalometric analysis based on lateral cephalograms and panoramic radiographs. Results: We established a crossbite of tooth 21 and laterodeviation. According to lateral cephalomet­ric analysis the patient has a retroclination of the upper central incisor on the left. There was suffi­cient mesiodistal width to achieve labial movement of the maxillary tooth. To align the maxillary an­terior central incisor and correct the crossbite, a removable acrylic appliance with posterior occlusal surfaces was used. A screw incorporated in the appliance was activated by 0.25 mm every 4 days for 12 days. After these 12 days the crossbite was corrected. Conclusion: There are many treatment options available for the correction of crossbites according to the number and site of the teeth/tooth involved, the stage of the dentition and its etiology. Based on the results presented here, a removable appliance with a screw may be considered the first choice of treatment to correct anterior dental crossbite of one incisor. This method is a safe, cost effective, rap­id and easy alternative for the treatment of an anterior crossbite.

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Tooth impaction is a dental anomaly which is defined as cessation of eruption of tooth. It is caused by a physical barrier in the eruption path or abnormal position of the tooth. Impaction of permanent second molar is not a common condition. Early detection and treatment of impaction reduces the risk of complications associated with this condition. There are several treatment options for impacted tooth which depends on the degree of tooth inclination as well as the required tooth movement. The present case report presents a case of 14-year-old male patient with mesially impacted permanent second molar. The case presents the surgical and orthodontic management with orthodontic extrusion and uprighting of concerned impacted tooth.

Background: Crown root fractures are usually caused by severe horizontal trauma, involving enamel, dentine, and cementum, and continue down to the gingival margin. One of the most common areas affected by trauma in the mouth is maxillary central incisors. Case Presentation: A10-year-old boy fractured his maxillary central incisors. The fracture line involved the pulp and extended subgingivally on the palatal aspect invading the biologic width. The procedure used to manage this case included endodontic treatment of residual teeth and surgical extrusion to move the fracture line above the alveolar bone. Finally, the teeth were restored with composite build-up. Conclusion: During 24-month follow-up period, the teeth did not show any signs of root resorption. Therefore, surgical extrusion is recommended as a treatment option for crown/root fractures.

For restorations on teeth involving invasion of the supracrestal tissue attachment (biological width), as well as for lack of ferrule effect, crown lengthening is required for long-term periodontal health and success of the restoration. In the same fashion, site development is often necessary prior to implant placement in order to provide optimal peri-implant soft and hard tissue architecture conducive to future esthetics and function. Orthodontic extrusion, also known as forced eruption, has been developed and employed clinically to serve the purposes of increasing the clinical crown length, correcting the periodontal defect, and developing the implant site. In order to provide comprehensive guidance on the clinical usage of this technique and maximize the outcome for patients who receive the dental restoration, the currently available literatures were summarized and discussed in the current review. Compared to traditional crown lengthening surgery, forced eruption holds advantages of preserving supporting bone, providing improved esthetics, limiting the involvement of adjacent teeth, and decreasing the negative impact on crown-to-root ratio compared to the traditional resective approach. As a non-invasive and natural technique capable of increasing the available volume of bone and soft tissue, forced eruption is also an attractive and promising option for implant site development. Both fixed and removable appliances can be used to achieve the desired extrusion, but patient compliance is a primary limiting factor for the utilization of removable appliances. In summary, forced eruption is a valuable treatment adjunct for patients requiring crown lengthening or implant restorations. Nonetheless, comprehensive evaluation and treatment planning are required for appropriate case selection based upon the known indications and contraindications for each purpose; major contraindications include inflammation, ankylosis, hypercementosis, vertical root fracture, and root proximity. Further studies are necessary to elucidate the long-term stability of orthodontically extruded teeth and the supporting bone and soft tissue that followed them.

We analyze how the interaction between two hydrophobic surfaces in water depends on the amount of dissolved gas. At equilibrium there is, for a truly hydrophobic surface with contact angle θ > 90°, a long range attractive force. The attraction is due to the formation of a gaseous film between the surfaces. For a completely degassed sample the gas consists of water vapor and the range of the force is of order 500 nm at ambient conditions. In the other extreme where the water is saturated with gas with respect to the atmosphere the range of the equilibrium force is determined by the hydrostatic pressure and it diverges as the distance between the surface setup and the air−water interface goes to zero. It is generally considered that the formation of a gaseous film is a kinetically very slow process so that one in practice stays on the metastable liquid branch until an instability appears at short separations. For the particular case of formation and stability of oil in water emulsions in the absence of stabilizer a degassing will affect at least two crucial steps in the process. In the formation of droplets, new interfaces are formed and separated from short distances. The presence of dissolved gas, in both oil and water, facilitates the formation of gas bubbles between the surfaces. Furthermore, the lifetime of gas bubbles adsorbed on the interface is substantially prolonged in the presence of dissolved gas and they can act as nucleation centers for the formation of a gaseous lens between two oil droplets at re-encounters.