Orthodontic Extrusion for Pre-Implant Site Enhancement: Principles and Guidelines

Background: Immediate implant placement has proven to be a successful and a predictable treatment modality. Nevertheless, immediate implant placement is indicated only in cases where soft and hard tissue conditions are considered ideal at the time of implant placement. Therefore, most implant procedures in the esthetic zone necessitate pre-implant, simultaneous and/or post-implant site enhancement procedures, i.e. augmentation procedures. For this purpose, several techniques and procedures have been proposed. One of the suggested approaches is orthodontic extrusion. While this approach has been originally introduced to save traumatized teeth from extraction, it has been suggested as a method to manipulate soft and hard tissues via gradual extrusion of a "hopeless" tooth and its periodontal apparatus, thereby enhancing the predictability of the implant site. A number of reports available in the literature describe orthodontic extrusion as a reliable method for pre-implant site enhancement. However, no standard protocols have been provided about the application of this technique. An overview about orthodontic extrusion would enhance the knowledge about different techniques as well as provide the clinicians with guidelines that can aid in decision-making and application of this approach. Purpose: The aim of this presentation is to provide an overview about the principles of pre-implant orthodontic extrusion, describe methods and techniques available and provide the clinicians with guidelines about its application. Material and methods: The literature database was searched for studies involving implant site enhancement via orthodontic extrusion of teeth deemed hopeless. Results: The current data is limited to case reports and case series and therefore, no clear guidelines about orthodontic extrusion could be obtained. The available reports, however, showed that orthodontic extrusion could be a reliable option to improve soft and hard tissue conditions prior to implant placement. Conclusion: Orthodontic extrusion can be implemented as a treatment alternative to enhance hard and soft tissue prior to implant placement. While the current literature does not provide clear guidelines, the decision making for a specific approach in orthodontic extrusion seems to be based on the clinician's preferences. Clinical studies are needed to verify the validity of this treatment option Keywords: implant site enhancement, implant site development, soft tissue enhancement, hard tissue enhancement, orthodontic extrusion, orthodontic extraction, forced eruption