Management and Follow-up of Orthodontic Forced Extrusion: A Case Report. [English translation-Original in Spanish]

Abstract

This clinical case focuses on the diagnosis and treatment of forced eruption in a patient with dental trauma. Objective To propose a multidisciplinary treatment alternative which allows to increase dental structure through forced extrusion and subsequently rehabilitate it in function and aesthetics. Methods: The case of a 78-year-old male adult patient, healthy and without pathological history, attended the clinic of the Orthodontics and Dentomaxillofacial Orthopedics Specialty, referred by an Endodontics specialist, is described due to canine crown-radicular fracture. upper right, fixed bridge abutment with three units. In the intraoral examination, he presented a cervical fracture of the crown of the upper right canine. As a first step, endodontic treatment was performed on the tooth and placement of an intracanal support abutment (emptied endopost), in order to improve orthodontic traction. This adjunct consisted of a cast post with  perforations. We proceed to place fixed appliances in the upper arch with the MBT technique (slot 0.022), from the right molar to the left canine with indirect and passive cementation (with the slots of the brackets aligned). Immediately afterwards, a 0.019 x 0.025 stainless steel rectangular archwire was placed with an extrusion bend at the level of the upper right canine. In the same fold, a helix-type loop was adapted that functioned as a support to place the passive ligature (lace back). Results: The treatment carried out on this patient is  satisfactory, contributing to his general state of health, improving his self-esteem. Conclusion: Here, all the advantages offered by forced orthodontic extrusion were taken advantage of, even in an elderly patient, achieving a traction of four millimeters, which was achieved thanks to the use of light and controlled extrusive forces on the affected dental organ. With the described treatment modality, crown lengthening can be achieved without the need for bone resection, which allows for correct prosthetic rehabilitation, restoring function and aesthetics to the injured tooth and providing comprehensive benefit to the patient.