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Orthodontic Extrusion — ORE Part 1 MCQ

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HardOrthodonticsOrthodontic ExtrusionORE Part 1

A 25-year-old patient presents with a vital upper premolar with a complicated crown-root fracture. On the palatal aspect, the fracture margin lies 3 mm subgingivally. The tooth has sufficient root length and is otherwise restorable, provided that a sound accessible margin can be created without unnecessary removal of supporting bone. Which management is most appropriate?

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Correct answer: E — Orthodontically extrude the tooth before restoration

Orthodontic extrusion is the best answer. It coronally repositions the tooth so that the palatal fracture margin becomes accessible for isolation and definitive restoration, while avoiding unnecessary removal of marginal bone. This is especially appropriate where the tooth is vital, has adequate root length and is otherwise restorable. Surgical crown lengthening can expose a margin, but may require osseous recontouring and is less conservative; it is not the preferred first choice in this scenario. Extraction is unjustified because restorability has been specified. Root canal treatment neither exposes the margin nor is indicated solely because of a fracture in a vital tooth. Composite bonding without margin exposure prevents predictable isolation, finishing and periodontal compatibility.

Reference: Hong et al. Conservative Approach for Traumatic Anterior Crown-Root Fractured Teeth by Orthodontic Extrusion using Customized Mini-Tube Appliance: A Clinical Review, 2023. https://pubmed.ncbi.nlm.nih.gov/38130430/