Australian Dental Journal 2004;43:(1):28-31

Fracture of a tooth below the gingival attachment

or crest of the alveolar bone presents a very difficult

restorative problem.

Fractured teeth are often considered hopeless and are extracted.

Crown lengthening procedures (electrosurgery of the

gingival margins or periodontal surgery) are attempted.

Orthodontic extrusion, also referred to as forced eruption, has been suggested as an alternative to periodontal crown lengthening which involves the removal of supporting alveolar bone and can compromise aesthetics.

A 10 year old boy came to the dental clinic 20 hours after he had fallen and injured his upper anterior teeth.

CLINICAL EXAMINATION:

Laceration of the upper lip with moderate oedema.

The maxillary left central incisor had a transverse fracture of the crown.

The maxillary right central incisor and left lateral incisor also had fractures of their crowns.

Radiographic examination verified the presence of the fracture of the maxillary left central incisor.

The mobile crown portion was removed.

The remaining portion of the tooth (the root portion) was below the alveolar crest.

Root canal therapy was carried out immediately to the

maxillary left lateral incisor. A root canal filling was

performed on the maxillary left central incisor.

Calcium hydroxide dressings were placed as apical root formation was not yet complete. It was

decided to extrude the tooth orthodontically.

A screw post was cemented to the fractured tooth.

Elastic thread was applied from the screw post to the specially designed vestibular arc of the Hawley appliance for the extrusion of the tooth.

The patient was examined every four days to check and reactivate the elastic thread.

Both clinically and radiographically there was clear evidence of about 5 mm extrusion of the tooth(root).

Approximately six weeks later the active treatment was ended. There were no complications during or after the orthodontic treatment.

After completion of the extrusion, a post core was performed.

The tooth was restored with a veneer crown constructed over the post core.

The fractured incisal portion of the right central incisor was restored with a composite resin using the acid etch method.

The fractured maxillary left lateral incisor was restored with a jacket crown.

The patient was examined two years after treatment.

The stability of the crowns can be seen clinically and radiographically.

An interdisciplinary approach to treatments of routine dental problems has been recognized for a long time. endodontist, an orthodontist, and a prosthodontistparticipated in the dental management of a patient with a subgingivally fractured maxillary permanent left central incisor. It is clear that without such cooperative action the prognosis would not have been good.

In many cases, forced orthodontic eruption provides a useful alternative to extraction or extensive periodontal surgery. Adjacent teeth need not be prepared for fixed prostheses and alveolar bone is conserved.

CASE REOPRT BY: Ilken Kocadereli, DDS, PhD

Fugen Tasman, DDS

Sibel Bashan Guner, DDS, PhD