Forced eruption for preservation of a deeply fractured molar

Abstract

Background: The treatment of deeply fractured and irreparably damaged teeth often confronts the dentist with a complex problem: Besides extraction, re-implantation and surgical crown lengthening, forced eruption is a reasonable differential alternative.

History and clinical findings: In the following case a second lower molar was deeply fractured as a result of an internal granuloma. The tooth had undergone endodontic treatment and had been shortened to alveolar bone level, as the patient had refused extraction.

Therapy: A forced eruption with fibrotomy was performed using an unphysiologically high force. The buccal teeth (canine to first molar) served as the anchorage unit. The mechanics consisted of a lever arm activated to 230 cN. The duration of extrusion was 8 weeks. The tooth was subsequently hemisectioned and provided with an abutment, and the two posts were distalized because of root crowding and moved apart from each other. This was followed by an 8-week retention period, after which the finished crown could be inserted.

Conclusions: The technique of forced eruption accompanied by fibrotomy enabled the roots to be elongated by ca. 4 mm without apposition of alveolar bone. This permitted restoration with physiologic gingival conditions, eliminating the need for surgical crown lengthening with marginal ostectomy or tooth extraction.