30 May 2023

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Orthodontic or surgical extrusion: which is the best option to

By Arianna Bianchi

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Clinicians often find themselves having to rehabilitate severely compromised dental elements. However, since we are in what Clark and Levin refer to as “the era of dental implants,” the extraction of a very damaged tooth and its replacement with an implant represents a common therapeutic choice.

It is also necessary to underline how the survival rate of implants is lower than that of teeth, even if severely damaged but adequately treated.

Basically, three options are possible to treat these types of dental elements: crown lengthening, orthodontic extrusion and surgical extrusion.

Crown lengthening is considered an invasive technique, which causes the removal of part of the bone support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth.

Materials and methods

In a study published in the International Journal of Environmental Research and Public Health in September 2021, a bibliographic search is presented using the PubMed database and the keywords used, to analyze both orthodontic and surgical extrusion, were orthodontic extrusion, orthodontic forced extrusion, orthodontic forced eruption and surgical extrusion.

No filter was applied regarding patient age, gender and country. Original English-language articles and reviews describing one or both techniques were selected based on title and abstract.

Results

A total of 57 articles on surgical extrusion, 52 on orthodontic extrusion, four on splint effect, nine on biological width and 16 articles on surgical crown lengthening were selected.

After screening of all the texts, 12 articles were found to be suitable for the synthesis of the results, for which the advantages, disadvantages, indications, contraindications and complications of each technique were analyzed.

Conclusions

Both surgical and orthodontic extrusion can be used successfully in the treatment of severely compromised teeth. According to the synthesis of the literature, the authors recommend performing surgical extrusion if there is a need to solve endodontic problems that cannot be treated with traditional orthograde endodontic techniques or as an alternative to the extraction of teeth that cannot be restored.

Instead, it is preferable to choose orthodontic extrusion if a highly predictable treatment is required, if an orthodontic device is already present and if it is necessary to preserve the vitality of the tooth or treat teeth that are not compatible with an atraumatic extraction.

A future perspective to pursue is a combined technique, which can merge the advantages of both techniques.

For more information: "Orthodontic extrusion vs. surgical extrusion to rehabilitate severely damaged teeth: a literature review."