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O
rofacial trauma can result
in a wide spectrum of dental
injuries, ranging from
AB STRACT
enamel crown fractures with Background. Complicated tooth fractures can be the unfor-
good prognosis to complex injuries tunate result of orofacial trauma and can offer a therapeutic
with a less favorable long-term challenge for the dentist. A conservative solution for gaining
prognosis.1-5 To restore a tooth with supragingival sound tooth structure often includes orthodontic
a complicated crown fracture below forced eruption. Usually, this procedure is carried out by apply-
the cementoenamel junction, the ing extrusive force after placing a provisional acrylic Richmond
treatment alternatives may include crown on the tooth. However, this long-lasting dental treatment
orthodontic extrusion with or with- may jeopardize the coronal seal of the root canal space, leading to
out surgical crown lengthening.6-12 microleakage and endodontic failure.
This technique requires a multi- Case Description. Orthodontic forced eruption demands ap-
disciplinary approach combining plication of force to an attachment connected to the remaining
short clinical crown. In this article, the authors describe a case in
endodontic treatment, orthodontic
which they used a new technique for orthodontic forced eruption
extrusion (also called “forced erup-
of a traumatized tooth, using an extracanal attachment to apply
tion”) and prosthodontic coronal
extrusion force, and discuss its possible advantages and
restoration.7,11,13,14 Orthodontic
limitations.
extrusion facilitates exposure of the
Conclusions. An extracanal attachment approach for orthodon-
sound tooth margin with a healthy
tic forced eruption without compromising the obturated canal
biological width and usually is indi-
space can be a solution for posttraumatic crown fracture.
cated when the supragingival sound Practical Implications. The described procedure for forced
tooth structure is minimal.15-18 This eruption by using an extracanal pin attachment is efficient and
procedure emphasizes the practical convenient and does not require the clinician to apply force di-
problem of finding a reliable point rectly to the provisional crown. Therefore, during the application
of application of force to the remain- of force, there is less risk of loosening the provisional crown, and
ing root structure. If the clinically the canal space is kept intact with either the final restoration or
exposed tooth structure is large dressing material.
enough, the clinician can bond an Key Words. Forced eruption; crown-root fracture; orthodontic
orthodontic attachment (that is, an extrusion; dental trauma.
orthodontic bracket or button) to JADA 2013;144(8):910-913.
it, but this is not always possible.
When this article was written, Dr. Keinan was the head, Department of Endodontics, Medical Corps, Dental Center, Sheba Medical Center, Tel-Hashomer,
Israel, and an instructor, Department of Endodontics, Faculty of Dental Medicine, Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem.
He now is a visiting scholar, Department of Periodontics and Endodontics, University at Buffalo, State University of New York. Address reprint requests
to Dr. Keinan at Department of Endodontics, Faculty of Dental Medicine, Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
91120, e-mail iendo4u@gmail.com.
Dr. Szwec is an instructor, Department of Prosthodontics, Faculty of Dental Medicine, Hebrew University of Jerusalem and Hadassah Medical Center,
Jerusalem. He also maintains a private practice in Jerusalem.
Dr. Matas is an instructor, Department of Endodontics, Faculty of Dental Medicine, Hebrew University of Jerusalem and Hadassah Medical Center,
Jerusalem.
Dr. Moshonov is the acting chairman, Department of Endodontics, Faculty of Dental Medicine, Hebrew University of Jerusalem and Hadassah Medical
Center, Jerusalem. He also maintains a private practice in Tel Aviv.
Dr. Yitschaky is an instructor, Department of Orthodontics, Faculty of Dental Medicine, Hebrew University of Jerusalem and Hadassah Medical Center,
Jerusalem. He also maintains a private practice in Jerusalem.
the long-term success rate are remaining tooth Surg Oral Med Oral Pathol 1973;36(3):404-415.
16. Ingber IS. Forced eruption, part II: a method of treating
structure and fracture resistance.35-37 Research- nonrestorable teeth—periodontal and restorative considerations.
ers have demonstrated that the duration of J Periodontol 1976;47(4):203-216.
intracanal dressing, especially with calcium hy- 17. Stern N, Becker A. Forced eruption: biological and clinical
considerations. J Oral Rehabil 1980;7(5):395-402.
droxide, also may affect fracture resistance.38,39 18. Chambrone L, Chambrone LA. Forced orthodontic eruption of
The prudent clinician should consider all these fractured teeth before implant placement: case report. J Can Dent
aspects while planning treatment. Assoc 2005;71(4):257-261.
19. Ziskind D, Schmidt A, Hirschfeld Z. Forced eruption technique:
rationale and clinical report. J Prosthet Dent 1998;79(3):246-248.
ConclusionS 20. Villat C, Machtou P, Naulin-Ifi C. Multidisciplinary approach to
the immediate esthetic repair and long-term treatment of an oblique
This multidisciplinary technique of using an ex- crown-root fracture. Dent Traumatol 2004;20(1):56-60.
tracanal pin attachment to achieve orthodontic 21. Poi WR, Cardoso L de C, de Castro JC, Cintra LT, Gulinelli
forced eruption of a traumatized tooth appears JL, de Lazari JA. Multidisciplinary treatment approach for crown
fracture and crown-root fracture: a case report. Dent Traumatol
to be a promising procedure because it helps 2007;23(1):51-55.
keep intact the sealing of the endodontic filling 22. Saito CT, Guskuma MH, Gulinelli JL, et al. Management of a
material. n complicated crown-root fracture using adhesive fragment reattach-
ment and orthodontic extrusion. Dent Traumatol 2009;25(5):541-544.
23. Keinan D, Moshonov J, Smidt A. Is endodontic re-treatment
Disclosure. None of the authors reported any disclosures. mandatory for every relatively old temporary restoration? A narra-
tive review. JADA 2011;142(4):391-396.
The authors thank Dr. Yehuda Zadik, chief dental officer, Israel 24. Naumann M, Preuss A, Rosentritt M. Effect of incomplete
Defense Forces Medical Corps, and attending clinician, Department crown ferrules on load capacity of endodontically treated maxillary
of Oral Medicine, Hebrew University of Jerusalem and Hadassah incisors restored with fiber posts, composite build-ups, and all ce-
School of Dental Medicine, Jerusalem, for critically reading the ramic crowns: an in vitro evaluation after chewing simulation. Acta
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