A laboratory fabricated fixed appliance for extruding anterior teeth with subgingival fractures.

Traumatized anterior teeth with subgingival fractures of the crown and root can be restored successfully after orthodontic extrusion. A technique is described which involves the use of a localized fixed appliance made of rectangular wire. The appliance is fabricated in the laboratory prior to bonding to the teeth with composite resin. The simple design of the appliance makes it easy to manage and esthetically acceptable to patients. If a tooth is to be saved, which as a result of trauma has a subgingival fracture involving the crown and root, it requires treatment of a multidisciplinary nature including endodontics, orthodontics, periodontics, and restorative dentistry. Since Heithersay (1973) reported a combined endodontic-orthodontic technique for the extrusion of a traumatized tooth, various methods have been described in order to adequately expose sound tooth substance for the finishing of the margins of the final coronal restoration (Heithersay and Moule 1982). These techniques require endodontic therapy to have been performed previously. In addition, it is recommended that the fractured segment of the crown be removed to facilitate fixation of an intra-radicular device for the attachment of the active component which is responsible for applying the extrusive force to the tooth. Removal of the fractured portion of the crown generally results in hemorrhage of the gingival tissues which were attached to that part of the tooth, hence, obstructing the operating field and preventing adequate isolation of the root canal. This problem can be overcome if the fractured coronal fragment is left in situ. This can be achieved by using pins plus composite resin (Spasser 1977) or composite resin alone (Mader 1987). The recently introduced dentin bonding agents also can be used (Ludolow and LaTurno 1985). When the active component is a spring (Fournies 1981) or even a magnet (McCord and Harvie 1984), they require a removable appliance to be fitted. Localized appliances (Simon et al. 1987) and full-arch fixed appliances (Wolfson and Seiden 1975) incorporate an elastic band or an elastic ligature. Removable appliances are bulky and require considerable patient cooperation which is not always available, especially in young children. These problems can be overcome by the use of a fixed appliance. However, considerable chairside time and specialized materials are required to fabricate and fit a fixed appliance. A simple fixed appliance is described that can be fabricated easily in the laboratory and fitted to the crown of the fractured tooth utilizing materials routinely available in the dental office.