Forced Eruption Prior to the Placement of an Esthetic Restoration

How often have you had patients come in and ask if you could just straighten one tooth to give them a better-looking smile? It’s a fact that most adults are unwilling to undergo complete orthodontic care. Yet, many of them would love you to do something to improve the way their teeth look. Fortunately, there are many minor tooth movement procedures that you can do that will give your patients the esthetic result they are looking to achieve. In this, and succeeding issues of Aurum Ceramic/Classic News, we will explore some of the more common orthodontic procedures used every day to help you give your patients the beautiful smile they want.

Today, it is not uncommon to see patients with severely broken down teeth that appear unrestorable. Fractures that are below the crest of the bone and teeth that have extensive recurrent decay are just a few of the problems we face daily.

There are several common methods available to manage a tooth that is severely broken down. These include extraction of the remaining root followed by a prosthetic replacement, and techniques to expose sound tooth structure such as osseous surgery. Surgical exposure of sound tooth structure is fraught with compromise. Gingival and osseous surgery cannot be limited to the involved tooth and must be extended to adjacent teeth in order to blend the gingival and osseous contours. The ultimate result is a sacrifice of supporting bone on several uninvolved teeth. This can cause root sensitivity, expose furcation, and in some cases, can involve the maxillary sinus. When crown lengthening is done in an anterior region, it can result in unaesthetic open embrasures and long clinical crowns.
Extracting a tooth may appear to be a simple solution. But tooth extraction can cause a decrease in the height and thickness of the alveolar bone. This makes it much more difficult to accomplish an esthetic restorative result regardless of whether you utilize an implant or place a fixed partial denture. Whether you plan to do an osseous surgery or extract a tooth, forced eruption is often an important first step to help achieve the best esthetic result.

Forced eruption can be defined as an orthodontic movement in a coronal direction through the application of gentle, continuous forces. Specifically when a root segment is forcefully erupted, the forces stretch the gingival and periodontal fibers producing a coronal shift of gingiva and bone. If done slowly, the gingiva and supporting bone will follow to a position that is further coronal than the adjacent teeth. These gingival and osseous changes can be used to manage many restorative problems.

In the example shown here, tooth #8 is missing and tooth #9 has a vertical fracture making it unrestorable. Just extracting tooth #9 would cause a decrease in the height and thickness of the alveolar bone, making it impossible to achieve an esthetic result without performing ridge augmentation surgery. Instead a removable forced eruption appliance, that included a tooth to replace tooth #8, was used to coronally shift the gingiva and bone until it esthetically matched the existing pontic site. Once this was accomplished, #9 was extracted and the area was allowed to heal. This cosmetic orthodontic procedure was finished in six weeks.

Facial view of an esthetically compromised anterior ridge		Active interim partial used to erupt tooth #9 while maintaining esthetics.
Forced Eruption in progress. Slowly extruding the tooth will improve the bony ridge.		Forced Eruption completed. This tooth has almost been completely erupted.
Tooth # 9 extracted.		After healing, the ridge is nicely shaped and ready for placement of an esthetic bridge.