Forced eruption prior to implant placement

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Posted on By william kobza In Orthodontics

My patient has an upper first bicuspid with significant vertical defects on the mesial and distal surfaces. If the tooth were extracted, this would result in an osseous defect that would require significant bone regeneration to create a useable site for an implant. In addition, the extraction and subsequent grafting may not result in an implant site with gingival tissue architecture in harmony with the adjacent teeth.

This seems like a perfect situation to use forced eruption of the hopeless bicuspid to coronally move the bone and gingival tissue and create a more ideal implant site.

I have used this technique with other patients and have referred them to an orthodontist. However, the treatment usually takes 9-12 months to complete, not the 3-4 months discussed by speakers like Dr. Henry Salama.

Can someone provide some lit references that detail / outline the technique for ortho extrusion that takes 3-4 months to complete?


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3 Comments

Hi Bill, My original 1993 article on Orthodontic Extrusion for bone and soft tissue site development prior to implant placement answers most of your questions.
In summary:
a) If you are going to erupt a tooth more than 2mm, its best that you have a pulpotomy or endondontic therapy performed ahead of time.
b) Only use light forces: 25-50 gr. We often utilize Nitinol wires, 0.14 or 0.16
c) Utilize mechanics that allow for approximately 1mm of eruption every 2 weeks.
d) Selectively grind the tooth to be erupted so that the tooth has a minimum of 1mm of clearance with the opposing arch to allow the tooth to erupt without being subjected to occlusal trauma. Its also the reason we do prophylactic end prior to tx, because if one erupts a tooth 5mm, they are likely to grind approximately 5mm of the tooth occlusal and assures that they end up in the pulp during tx resulting in hyper-sensitive and unhappy patient requiring emergency endodontics.
e) always overcorrect the defect; i.e. over erupt by 1mm from what you think you need.
f) Stabilize the final orthodontic result for 8-12 weeks to allow for full mineralization prior to flapping, extraction and implant placement.

The reason orthodontists take much longer is related to how many of them run their practice with predominantly young patients being seen every 6 weeks rather than every 2. Also, unfortunately, many orthodontists are not happy, or even averse to, having to grind teeth down. Therefore, without creating adequate clearance for a tooth to erupt, the tooth in question is more likely to be in trauma and unable to erupt because the opposing arch is preventing it. Hope that helps, Henry


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Dr. Salama, thank you for your very informative summery. It`s great that your article from 1993 is to be found on dental xp.
Best regards
Snjezana


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Periodontally compromised teeth are a common problem observed in adults, and the extraction is a viable solution in some of these situations. When prosthetic rehabilitation with implants take place after the extraction, orthodontic extrusion may convert the tooth indicated for extraction into a useful tooth. A 48-year-old woman's chief complaint was the esthetics of her maxillary incisors with advanced periodontal disease. The incisors were orthodontically erupted to augment the bone topography for implant recipient sites and prosthetic rehabilitation. Three implants were selected and inserted in a single surgical procedure without any complications. A 10 months follow-up showed that the implants were stable with the prosthetic crowns preserving the surrounding soft tissues, and improving overall aesthetics and function. Get full detail at http://etoms.com


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KLS Martin
BTI