Adverse events of surgical extrusion in treatment for crown-root and cervical root fractures: A systematic review of case series/reports

Ahmed Elkhadem, Sharon Mickan, Derek Richards

Research output: Contribution to journalReview articleResearchpeer-review

23 Citations (Scopus)

Abstract

Background: Crown-root and cervical root fractures constitute a restorative challenge due to sub-gingival position of the fracture margin. Surgical tooth extrusion is one of the treatment options. There is uncertainty regarding the prognosis of such treatment modality. Objective: To assess adverse events of surgical tooth extrusion in the treatment for crown-root and cervical root fractures in permanent teeth. Methods: PubMed, Embase, and Google Scholar were searched through 15th of June 2012. Search was limited to English and Arabic languages. Reference list of relevant studies were hand-searched. Grey literature was searched using Open Grey. Two review authors independently extracted data, while only one assessed trial quality using 8-point methodological index for non-randomized studies (MINORS) scale. A sensitivity analysis was performed to exclude studies with suspected patients' duplicates. Results: Eleven case reports and eight case series involving 226 patients with 243 teeth were identified. No randomized controlled trials were found. The mean quality score for all case series was 9 suggesting a fair quality, while that of all case reports was 5 suggesting poor quality. Non-progressive root resorption is the most common finding following surgical extrusion with an event rate of 30% (95% CI 24.6-36.7%). This is followed by low event rates of tooth loss (5%), slight mobility (4.6%), marginal bone loss (3.7%), and progressive root resorption (3.3%). No ankylosis occurred to any extruded tooth, while severe tooth mobility showed negligible overall event rate of 0.4%. Conclusion: The available evidence suggests that surgical tooth extrusion is a valid technique in management of crown-root and cervical root fracture of permanent teeth. Minimal adverse events and good prognosis are expected. Further, surgical extrusion can be considered as a treatment option in teeth suffering sub-gingival decay.

Original languageEnglish
Pages (from-to)1-14
Number of pages14
JournalDental Traumatology
Volume30
Issue number1
DOIs
Publication statusPublished - 1 Feb 2014
Externally publishedYes

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Orthodontic Extrusion
Crowns
Tooth
Root Resorption
Tooth Mobility
Tooth Fractures
Ankylosis
Tooth Loss
Therapeutics
PubMed
Uncertainty
Language
Randomized Controlled Trials
Bone and Bones

Cite this

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title = "Adverse events of surgical extrusion in treatment for crown-root and cervical root fractures: A systematic review of case series/reports",
abstract = "Background: Crown-root and cervical root fractures constitute a restorative challenge due to sub-gingival position of the fracture margin. Surgical tooth extrusion is one of the treatment options. There is uncertainty regarding the prognosis of such treatment modality. Objective: To assess adverse events of surgical tooth extrusion in the treatment for crown-root and cervical root fractures in permanent teeth. Methods: PubMed, Embase, and Google Scholar were searched through 15th of June 2012. Search was limited to English and Arabic languages. Reference list of relevant studies were hand-searched. Grey literature was searched using Open Grey. Two review authors independently extracted data, while only one assessed trial quality using 8-point methodological index for non-randomized studies (MINORS) scale. A sensitivity analysis was performed to exclude studies with suspected patients' duplicates. Results: Eleven case reports and eight case series involving 226 patients with 243 teeth were identified. No randomized controlled trials were found. The mean quality score for all case series was 9 suggesting a fair quality, while that of all case reports was 5 suggesting poor quality. Non-progressive root resorption is the most common finding following surgical extrusion with an event rate of 30{\%} (95{\%} CI 24.6-36.7{\%}). This is followed by low event rates of tooth loss (5{\%}), slight mobility (4.6{\%}), marginal bone loss (3.7{\%}), and progressive root resorption (3.3{\%}). No ankylosis occurred to any extruded tooth, while severe tooth mobility showed negligible overall event rate of 0.4{\%}. Conclusion: The available evidence suggests that surgical tooth extrusion is a valid technique in management of crown-root and cervical root fracture of permanent teeth. Minimal adverse events and good prognosis are expected. Further, surgical extrusion can be considered as a treatment option in teeth suffering sub-gingival decay.",
author = "Ahmed Elkhadem and Sharon Mickan and Derek Richards",
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Adverse events of surgical extrusion in treatment for crown-root and cervical root fractures : A systematic review of case series/reports. / Elkhadem, Ahmed; Mickan, Sharon; Richards, Derek.

In: Dental Traumatology, Vol. 30, No. 1, 01.02.2014, p. 1-14.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Adverse events of surgical extrusion in treatment for crown-root and cervical root fractures

T2 - A systematic review of case series/reports

AU - Elkhadem, Ahmed

AU - Mickan, Sharon

AU - Richards, Derek

PY - 2014/2/1

Y1 - 2014/2/1

N2 - Background: Crown-root and cervical root fractures constitute a restorative challenge due to sub-gingival position of the fracture margin. Surgical tooth extrusion is one of the treatment options. There is uncertainty regarding the prognosis of such treatment modality. Objective: To assess adverse events of surgical tooth extrusion in the treatment for crown-root and cervical root fractures in permanent teeth. Methods: PubMed, Embase, and Google Scholar were searched through 15th of June 2012. Search was limited to English and Arabic languages. Reference list of relevant studies were hand-searched. Grey literature was searched using Open Grey. Two review authors independently extracted data, while only one assessed trial quality using 8-point methodological index for non-randomized studies (MINORS) scale. A sensitivity analysis was performed to exclude studies with suspected patients' duplicates. Results: Eleven case reports and eight case series involving 226 patients with 243 teeth were identified. No randomized controlled trials were found. The mean quality score for all case series was 9 suggesting a fair quality, while that of all case reports was 5 suggesting poor quality. Non-progressive root resorption is the most common finding following surgical extrusion with an event rate of 30% (95% CI 24.6-36.7%). This is followed by low event rates of tooth loss (5%), slight mobility (4.6%), marginal bone loss (3.7%), and progressive root resorption (3.3%). No ankylosis occurred to any extruded tooth, while severe tooth mobility showed negligible overall event rate of 0.4%. Conclusion: The available evidence suggests that surgical tooth extrusion is a valid technique in management of crown-root and cervical root fracture of permanent teeth. Minimal adverse events and good prognosis are expected. Further, surgical extrusion can be considered as a treatment option in teeth suffering sub-gingival decay.

AB - Background: Crown-root and cervical root fractures constitute a restorative challenge due to sub-gingival position of the fracture margin. Surgical tooth extrusion is one of the treatment options. There is uncertainty regarding the prognosis of such treatment modality. Objective: To assess adverse events of surgical tooth extrusion in the treatment for crown-root and cervical root fractures in permanent teeth. Methods: PubMed, Embase, and Google Scholar were searched through 15th of June 2012. Search was limited to English and Arabic languages. Reference list of relevant studies were hand-searched. Grey literature was searched using Open Grey. Two review authors independently extracted data, while only one assessed trial quality using 8-point methodological index for non-randomized studies (MINORS) scale. A sensitivity analysis was performed to exclude studies with suspected patients' duplicates. Results: Eleven case reports and eight case series involving 226 patients with 243 teeth were identified. No randomized controlled trials were found. The mean quality score for all case series was 9 suggesting a fair quality, while that of all case reports was 5 suggesting poor quality. Non-progressive root resorption is the most common finding following surgical extrusion with an event rate of 30% (95% CI 24.6-36.7%). This is followed by low event rates of tooth loss (5%), slight mobility (4.6%), marginal bone loss (3.7%), and progressive root resorption (3.3%). No ankylosis occurred to any extruded tooth, while severe tooth mobility showed negligible overall event rate of 0.4%. Conclusion: The available evidence suggests that surgical tooth extrusion is a valid technique in management of crown-root and cervical root fracture of permanent teeth. Minimal adverse events and good prognosis are expected. Further, surgical extrusion can be considered as a treatment option in teeth suffering sub-gingival decay.

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U2 - 10.1111/edt.12051

DO - 10.1111/edt.12051

M3 - Review article

VL - 30

SP - 1

EP - 14

JO - Endodontics and Dental Traumatology

JF - Endodontics and Dental Traumatology

SN - 0109-2502

IS - 1

ER -