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Restoring the unrestorable! Developing coronal tooth tissue with a minimally invasive surgical extrusion technique

A Correction to this article was published on 25 October 2019


Surgical extrusion is a recognised treatment option for teeth that have insufficient coronal tooth structure remaining due to deep caries, resorption or traumatic injury. However, the technique has not been widely adopted, arguably because extraction of a severely compromised tooth may be difficult to achieve in a gentle and predictable way. In this paper, we present our novel approach to surgical extrusion and subsequent management of teeth using a vertical extraction system (Benex), which has become the method of choice in the authors' practice for many teeth that would otherwise be deemed unrestorable. We describe the clinical procedure in detail and discuss the advantages and disadvantages compared to alternative approaches, including surgical crown lengthening and orthodontic extrusion.

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  1. 1.

    Oikarinen K S, Stoltze K, Andreasen J O. Influence of conventional forceps extraction and extraction with an extrusion instrument on cementoblast loss and external root resorption of replanted monkey incisors. J Periodontal Res 1996; 31: 337-344.

  2. 2.

    Caliskan M K, Turkun M, Gomel M. Surgical extrusion of crownrootfractured teeth: a clinical review. Int Endod J 1999; 32: 146-151.

  3. 3.

    Das B, Muthu M S. Surgical extrusion as a treatment option for crown-root fracture in permanent anterior teeth: a systematic review. Dent Traumatol 2013; 29: 423-431.

  4. 4.

    Krug R, Connert T, Soliman S, Syfrig B, Dietrich T, Krastl G. Surgical extrusion with an atraumatic extraction system: A clinical study. J Prosthet Dent 2018; 120: 879-885.

  5. 5.

    Elkhadem A, Mickan S, Richards D. Adverse events of surgical extrusion in treatment for crown-root and cervical root fractures: a systematic review of case series/reports. Dent Traumatol 2014; 30: 1-14.

  6. 6.

    Saund D, Dietrich T. Minimally-invasive tooth extraction: doorknobs and strings revisited! Dent Update 2013; 40: 325-326, 328-330.

  7. 7.

    Muska E, Walter C, Knight A et al. Atraumatic vertical tooth extraction: A proof of principle clinical study of a novel system. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116: e303-e310.

  8. 8.

    Hong B, Bulsara Y, Gorecki P, Dietrich T. Minimally invasive vertical versus conventional tooth extraction: An interrupted time series study. J Am Dent Assoc 2018; 149: 688-695.

  9. 9.

    Kelly R D, Addison O, Tomson P L, Krastl G, Dietrich T. Atraumatic surgical extrusion to improve tooth restorability: A clinical report. J Prosthet Dent 2016; 115: 649-653.

  10. 10.

    Schmid, I. Kräftemessungen bei Zahnextraktionen mit dem Benex®-Extraktor [German]. Zurch: University of Zurich, 2010. Dissertation.

  11. 11.

    Krastl G, Gugger J, Deyhle H, Zitzmann N U, Weiger R, Müller B. Impact of adhesive surface and volume of luting resin on fracture resistance of root filled teeth. Int Endod J 2011; 44: 432-439.

  12. 12.

    Büttel L, Krastl G, Lorch H, Naumann M, Zitzmann N U, Weiger R. Influence of post fit and post length on fracture resistance. Int Endod J 2009; 42: 47-53.

  13. 13.

    Naumann M, Schmitter M, Frankenberger R, Krastl G. "Ferrule comes first. Post is second!" Fake news and alternative facts? A systematic review. J Endod 2018; 44: 212-219.

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Correspondence to Thomas Dietrich.

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Dietrich, T., Krug, R., Krastl, G. et al. Restoring the unrestorable! Developing coronal tooth tissue with a minimally invasive surgical extrusion technique. Br Dent J 226, 789–793 (2019).

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