Dr Yukitoshi Kaiya
The effect of orthodontic extrusion and root submergence technique
Background:
The aim of this presentation is to explain how I revived gum tissue and bone using the orthodontic extrusion method. Decrease in hard or soft tissue of the aesthetic area is a considerably serious condition for the patient. In addition to this, it is difficult to restore and return to the original condition. Procedures necessary for this require highly advanced technical skills, diagnosis, materials and length of time. If both hard and soft tissue are lacking, it is easy to imagine procedures are even more complicated. In this situation what method is best for restoring both hard and soft tissue for best results ? There are many solutions to this but this presents the best method, the orthodontic extrusion method. This method has been mentioned in Salama and other dentists’ papers as effective for increasing hard and soft tissue and inflicting very low amounts of stress on the patient.
Materials & Method:
First take off the deficient prosthesis from the teeth. Keep the hooks in place and also the correction wire by attaching to the front or back side of teeth and extrude in the direction the teeth are growing. Every month extrude the teeth by 1 millimeter. It is important to extrude the teeth one millimeter more than the final goal position. The purpose of this is to increase hard and soft tissue. Also it is necessary to keep the teeth in the final position for approximately the same duration of time it took to reach the goal position. The purpose of this is to retain the amount of increased soft tissue and especially the hard tissue. After the orthodontic period to retain the increase of hard tissue, place a mixture of bovine and autologous bone on gaps and defected areas of the natural teeth. In the case of implants, place the bone mixture in the gaps between the vandal bone and the implant. When placing the bone mixture in the gaps the positions of the implants are very important. The reason for this is to avoid tissue recession and aesthetic disadvantages. As is also stated in Grunder’s paper regarding implants, at minimum 2 millimeter space is necessary between the implant head and vandal bone. Regarding the depth of the implants, the minimum depth should be 3-4 millimeters from the final clinical cervical line. For the implant access holes in the frontal area they should be facing the direction of the basal tubercle. The correctness distance of space, depth of implant, access holes are extremely important to consider for success. To increase the amount of soft tissue, remove soft tissue from the palatal area and transplant to the front side of the implant.
Results and Conclusions
By achieving the difficult process of increasing hard and soft tissue and improving vertical loss of approximately 6 millimeters, which was lost due to various causes, an extremely complicated aesthetic defect was greatly improved. This improved condition is currently being maintained with no problems. There are many other ways to increase hard tissue however for both soft and hard tissue, this method is extremely effective. The treatment period may be longer but the damage and stress is much less than bone augmentation. Also by using low torque of 1 millimeter per month and leaving the position in place for the same duration teeth were extruded, success of final results is assured. For this total procedure only a minimal amount of materials is needed, including the natural materials of the patient. The minimal materials and low stress procedure results in low damage, therefore is suited for patients of a wide age range. This orthodontic, surgical and prosthesis procedure has been done by only a general practice dentist. It has minimal damage, uses minimal materials, can be undergone by a wide range of patients, delivers definitive results and can be done by a general practice dentist.
Int J Periodontics Restorative Dent. 1993 Aug;13(4):312-33.
The role of orthodontic extrusive remodeling in the enhancement of soft and hard tissue profiles prior to implant placement: a systematic approach to the management of extraction site defects.
Salama H, Salama M.
Int J Periodontics Restorative Dent. 2005 Apr;25(2):113-9.
Influence of the 3-D bone-to-implant relationship on esthetics.
Grunder U, Gracis S, Capelli M.
Int J Periodontics Restorative Dent. 2010 Oct;30(5):503-11.
Three-dimensional bone and soft tissue requirements for optimizing esthetic results in compromised cases with multiple implants.
Ishikawa T, Salama M, Funato A, Kitajima H, Moroi H, Salama H, Garber D.
