Digital orthodontic extrusion system for complex crown-root fracture of anterior teeth: A technique report

Elsevier

Available online 22 March 2023

The Journal of Prosthetic DentistryAuthor links open overlay panel, , , Abstract

Patients with traumatic dental injuries commonly present in clinical practice with complex crown-root fractures. Prosthodontic treatment of such patients may be unsuccessful because of the violation of the supracrestal tissue attachment, making their management challenging. Minor tooth movement is an effective solution to extruding the residual root but may require referral to an orthodontist. The purpose of this technique was to present a digital orthodontic system including a 3-dimensional virtual patient technique, a computer-aided design and computer-aided manufacture (CAD-CAM) resin facial veneer-retained pontic, and a zirconia post as an orthodontic appliance for tooth extrusion in the esthetic zone. This veneered pontic may also serve as an interim prothesis. The appliance provides a precise design for the direction and extent of orthodontic extrusion.

Section snippetsTechnique

An 18-year-old woman whose maxillary central incisors were affected by complex crown-root fractures asked to retain the defective teeth. She had an increased anterior horizontal overlap and molar angle class I relationship, and both incisors had received endodontic therapy (Fig. 1).

1. Use a tissue contouring system (PerFect TCS; Coltène) to expose the palatal surface of the residual roots. Prepare the root canals with a P drill (Peeso Reamers; MANI) and make the maxillary and mandibular

Discussion

Orthodontic extrusion is an efficient treatment with a low risk of root resorption compared with surgical extrusion.12 Different orthodontic appliances can achieve minor tooth movement, including the Nance palatal arch, segmental arch, and removable aligner, with different anchorage sources.13,16 In the esthetic zone, the orthodontic appliance needs to meet multiple requirements, including being esthetically pleasing, controllable, and accurate. In addition, its design and manufacture should be

Summary

A digital orthodontic extrusion system for complex crown-root fracture of maxillary incisors in the esthetic zone is presented. The system includes a 3-dimensional virtual patient design, CAD-CAM veneer-retained pontic, and zirconia post. Veneer-like wings on adjacent abutments provide anchorage for the extrusion and a coupled structure designed for precise extrusion. Overall, this technique preserved complex crown-root fractured teeth with excellent esthetics and periodontal stability (Fig. 9).

Acknowledgments

The authors thank JADE Digtal Dental for their CAD-CAM support, and Implanteeth (Implanteeth Shanghai Medical Technology Ltd) for their digital technique support.

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© 2023 by the Editorial Council for the Journal of Prosthetic Dentistry.

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