
2Private professional, Modena, Italy
Monoradicular teeth (or biradicular ones with non divergent roots) with crown destruction up to the iuxta or sub gingival level, due to carie or fracture. PET is more indicated in the upper arch where the bone is less dense compared to the lower one, with less risk of fracture of the root during the extraction, but can be used even on the mandibular teeth in selected cases. As well known, to be able to rebuild a tooth with iuxta or sub gingival loss of substance, it is needed to restore an adequate “biological width”, that is the vertical space between the bone ridge and the level of the healthy dental substance necessary for the epithelium - connective tissues attachment. It has been demonstrated that this space changes in relation to the subjects (thin or thick biotype) and to the position, however it measures an average value of 2.73 mm sulcus included (Gargiulo). Moreover it is needed a further vertical space to obtain the “ferule effect”, the 360 degrees space surrounding the root necessary to the closure and the correct retention of the prosthetic crown. This must be at least 2 mm high (Galen, Mueller). So it can be deduced that, since having a tooth to be extruded of 4 - 5 mm the length of the root must be such to allow this without to cause loss of stability. These rules are valid for the PET but also for the more known techniques of “Crown lengthening” (CL) and “Rapid orthodontic extrusion” (ROE), techniques to whom the PET is proposed as alternative, as well as the extraction followed by the replacement of the tooth with an implant. The advantages against the CL are:
- Not creating difference in level of the gingival margins in esthetic areas;
- Not removing support to the interested tooth and, above all, to the neighbouring teeth, even for a future implantology;
- Greater operative simplicity;
- Reduced healing time;
- Not need an orthodontic device to be mounted;
- Not need of periodic fibrotomy;
- Reduced time of treatment and restraint with less number of sessions.
- Maintenance of the natural tooth;
- Less complexity;
- Sharply reduced treatment time or mostly similar;
- Easier achieving of a natural esthetic, especially in case of surgery on the anterior teeth;
- Creation of a “future site” useful for a following implant surgery, increasing the apical available bone for the primary stabilization of the implant and for obtaining a more adequate crown – radicular diameter to the future implant diameter, Last and not less important advantage compared to all the previous techniques is definitely the cost effectiveness, apart a better acceptance by the patients due to the less injury.
PET is based upon the studies and the observations about the “dental reimplantation” [1-3], in fact it is very similar to the intentional reimplant, only that the tooth should not to be completely extracted from the dental socket, though it could happen and not cause any worsening of the prognosis, but simply dislocated, moved more coronally and then stabilized into the new position. The technique of surgical extrusion was first described in 2004 by Korean authors [4]. They performed their technique elevating a gingival flap. Ten years later was reported a case report of surgical extrusion of multiple teeth with crown–root fractures [5]. The peculiarity of the PET, conversely, is that it is a flapless technique. The periodontal ligament is teared when the luxation is performed but, having a good repairing regenerating potential, it heals and restabilizes the tooth in the new position in the time of 60 days. At the same time reforms a new epithelium connective attachment apparatus. More time is requested for the apical bone regeneration, but this has not any clinical relevance if the root length inserted in the bone is adequate. If an intentional reimplant roots, it is very likely that even a tooth treated with PET roots. Due his indications, a tooth to be treated with PET has always to be treated from the endodontic point of view, but this does not affects the repair potentiality of the periodontal ligament. The original protocol contemplates to defer the endodontic treatment after the periodontal healing, but someone prefer to perform it previously to reduce the possible infective complications in case of pulp necrosis or to remove the pain in case of pulp vitality.
Plexis anaesthesia is performed both in the upper arch and in the lower one. It is preferable to avoid intra ligamentous anaesthesia to not cause ischemia of the periodontal tissues with possible suffering or necrosis of them. A fibrothomy is performed with very thin scalpels, then a very gentle, slow dislocation is done with equally thin levers (those created to extract roots to be replaced by an immediate implant are very suitable for this purpose). Also extraction forceps can be used very slowly always controlling the strength applied to not damage the alveolar bone edge until the tooth is mobilized. When the dislocation is achieved, the extrusion is automatic. In the original protocol of Dr. Guazzi the technique is performed without elevate any gingival flap, to reduce the most the suffering of the hard and soft tissues, even if are possible similar outcomes to be achieved with a surgical access.
General: Are the same contraindicating other oral surgeries: scompensed diabetes, serious coagulation troubles, biphosphonate assumption, ischemic cardiopathy etc.
Local: Too short rooted teeth not guaranting a long lasting stability are not candidate for PET, like curve rooted teeth that, being extruded, could divert too mesially or distally or laterally, so to make difficult a correct rebuilding of the abutment; occlusal patterns like deep bite or too short clinical crowns not achieving an adequate inter occlusal space such that allow the coronal repositioning of the root.
The most fearsome complication is the fracture of the root during its luxation. If it happens, it has to go on with a post extractive implant. A less frequent complication is the partial fracture of the alveolar ridge; its amount has to be assessed so to decide if to go on with PET or to extract the tooth and to change the procedure. Usually the PET brings excellent outcomes if the indications are observed and the descripted above technique is respected. Practically any failure, loosening or fracture has been noticed in a clinical experience of nine years.
- Bender IB and Rossman LE. “Intentional replantation of endodontically treated teeth”. Oral Surgery, OralMedicine, Oral Pathology, Oral Radiology 76.5 (1993): 623630.
- Dryden JA and Arens DE. “A viable alternative for selected cases”. Dental Clinics of North America 38.2 (1994): 325353.
- McFarland B. “Intentional extraction and reimplantation of the same tooth”. Dentistry Today 24.11 (2005): 136-138.
- Kim CS., et al. “Surgical extrusion technique for clinical crown lengthening: report of three cases”. International Journal of Periodontics & Restorative Dentistry 24.5 (2004): 412421.
- Lee JH and Yoon SM. “Surgical extrusion of multiple teeth with crown root fractures: a case report with 18months follow up”. Dental Traumatology 31.2 (2014): 150-155.
Journal Menu
PubMed Indexed Article
EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.
PMID: 31143884 [PubMed]
PMCID: PMC6536005
EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.
PMID: 31565701 [PubMed]
PMCID: PMC6764777
EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.
PMID: 27747317 [PubMed]
PMCID: PMC5065347
EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?
PMID: 31460519 [PubMed]
PMCID: PMC6711478
EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?
PMID: 30215059 [PubMed]
PMCID: PMC6133253
EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.
PMID: 30417173 [PubMed]
PMCID: PMC6226033
EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.
PMID: 30264037 [PubMed]
PMCID: PMC6155992
EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.
PMID: 30198026 [PubMed]
PMCID: PMC6124505
EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.
PMID: 30294723 [PubMed]
PMCID: PMC6169793
EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs
PMID: 29285526 [PubMed]
PMCID: PMC5743211
EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique
PMID: 29911204 [PubMed]
PMCID: PMC5999047
EC Microbiology
Macrophages and the Viral Dissemination Super Highway
PMID: 26949751 [PubMed]
PMCID: PMC4774560
EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.
PMID: 27390782 [PubMed]
PMCID: PMC4933318
EC Microbiology
Reactive Oxygen Species in HIV Infection
PMID: 28580453 [PubMed]
PMCID: PMC5450819
EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population
PMID: 26280024 [PubMed]
PMCID: PMC4533840
EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis
PMID: 28066845 [PubMed]
PMCID: PMC5214344
EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology
PMID: 28936490 [PubMed]
PMCID: PMC5604476
EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia
PMID: 28713879 [PubMed]
PMCID: PMC5510658
EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature
PMID: 28133641 [PubMed]
PMCID: PMC5267489
EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling
PMID: 29333536 [PubMed]
PMCID: PMC5766278
EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.
PMID: 31032493 [PubMed]
PMCID: PMC6483108
EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.
PMID: 30957099 [PubMed]
PMCID: PMC6448571
EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.
PMID: 30101228 [PubMed]
PMCID: PMC6086333
EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.
PMID: 31080964 [PubMed]
PMCID: PMC6508883
EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.
PMID: 31093608 [PubMed]
PMCID: PMC6513001
EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.
PMID: 31552397 [PubMed]
PMCID: PMC6758937
EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.
PMID: 31681909 [PubMed]
PMCID: PMC6824723
EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.
PMID: 31681910 [PubMed]
PMCID: PMC6824726
EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.
PMID: 31528859 [PubMed]
PMCID: PMC6746603
EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?
PMID: 31276119 [PubMed]
PMCID: PMC6604646
EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.
PMID: 31406965 [PubMed]
PMCID: PMC6690616
EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.
PMID: 31517314 [PubMed]
PMCID: PMC6741290
EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.
PMID: 31633124 [PubMed]
PMCID: PMC6800226
EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.
PMID: 29662969 [PubMed]
PMCID: PMC5898812
EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.
PMID: 30215058 [PubMed]
PMCID: PMC6133268
News and Events
January Issue Release
We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the January issue of respective journals and can be viewed in the current issue pages.
Submission Deadline for January Issue
Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the January issue of respective journals. Submissions are accepted on/before January 30, 2021.
Certificate of Publication
Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.
Best Article of the Issue
Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.
Certifying for Review
Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.
Latest Articles
The latest articles will be updated immediately on the articles in press page of the respective journals.
Immediate Assistance
The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk