Wang, Tun-Jan1, Matsumoto, Kensuke2, Korostoff, Jonathan1, Fraiman, Howard P.1
1University of Pennsylvania School of Dental Medicine, Department of Periodontics
2Private Practice/ Former Instructor
Full-coverage restoration of teeth fractured at or below the gingival margin requires sufficient supracrestal tooth structure to accommodate the biologic width and provide an adequate ferrule. This often necessitates surgical crown lengthening that potentially compromises the periodontal attachment on the fractured and adjacent teeth. In this case report we demonstrate an alternative approach involving orthodontic extrusion to treat fractured tooth #12 without impacting the attachment on adjacent teeth or compromising the esthetic outcome.
MethodsA 50-year-old female patient was referred for treatment of fractured and endodontically treated #12. The horizontal fracture was situated approximately 1 mm apical to the gingival margin on the palatal aspect of the tooth. After consultation with an endodontist and discussion of multiple treatment plans, she opted for orthodontic extrusion with the possible need for a minor surgical procedure. Prior to initiating therapy, phase I periodontal therapy was performed and she was placed on a 3-month maintenance recall regimen. Forced Eruption Non-prescription brackets were bonded to #’s 11, 12 ,13 and 14 with the bracket on #12 positioned 2 mm apical to those on the adjacent teeth. A 0.14-inch Nitinol round wire was inserted and ligated in placed. Occlusal reduction was done to provide space for eruption. After 4 weeks, sufficient eruption was achieved. Teeth were stabilized for 2 months. A periapical radiograph confirmed extrusion of the tooth along with the adjacent crestal bone. Periodontal Surgery Full-thickness buccal and palatal flaps were elevated followed by removal of the secondary flap and residual interproximal tissue. Limited ostectomy and osteoplasty were done on the proximal surfaces of #12 to provide adequate crown length and restore positive crestal architecture. Flaps were approximated with sutures yielding positive hemostasis.
Results8 weeks after the surgical procedure uneventful healing was observed. A core build-up was done. The tooth was reprepared with adequate ferrule. At 14 weeks post-surgery, a digital impression was made with a CEREC Omnicam. A monolithic zirconia crown was fabricated and delivered 17 weeks post-surgery. The patient was pleased with the outcome.
ConclusionThis case reports demonstrates that orthodontic extrusion in conjunction with minor osseous surgery allows restoration of subgingivally fractured teeth without compromising the periodontal attachment on adjacent while at the same time providing a highly esthetic result.