Crown-root and cervical root fractures present a restorative challenge due to sub-gingival position of the fracture margin. . A number of treatment approaches have been proposed, crown lengthening, intentional re-implantation, re-attachment of the coronal fragment to root surface, root extrusion (orthodontic or surgical) or extraction.   Two reviews have recently been published ( Das et al and Elkhadem et al ) . Das et al were looking to evaluate surgical extrusion as a treatment modality for management of crown– root fractures in permanent anterior teeth.  While Elkhadem et al were focusing on adverse events that could accompany surgical extrusion, namely tooth ankylosis, root resorption, tooth mobility, tooth loss, and marginal bone loss.

Both reviews undertook searches involving more than one database with Das also hand searching some relevant journals.  Elkhaden included both English and Arabic languages studies while Das used only English.  Both reviews considered a broad range of study designs.  The Elkhaden review specifically excluded in vitro and animal studies. The Das review included one study conducted in dogs.  Elkahaden used the methodological index for non-randomized studies (MINORS) to assess study quality

• Das included 26 case series, case reports and one  animal study while Elkahaden included 19 studies (8 case series and 11 case reports).
• The Das review provides a qualitative summary of the results
• Elkahaden conducted some statistical analysis.
  • Non-progressive root resorption was the most common finding following surgical extrusion with an event rate of 30% (95% CI 24.6–36.7%).
  • With 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%.

The authors of both reviews concluded

that surgical tooth extrusion is a valid technique in management of crown–root and cervical root fracture of permanent teeth.

Comment

Both these review provide good summaries of the available literature on this procedure including largely the same studies. However, a concern with the original studies is that there is the potential for both selection and reporting bias, which should be taken into account. Both reviews highlight the need for further more robust studies to garner high-level evidence on this approach to managing crown-root and cervical root fractures. These review provide a good starting point for future research.

Conflict of Interest: The Dental Elf is an author on the Elkhaden et al review.

Links

Das B, Muthu MS. Surgical extrusion as a treatment option for crown-root fracture in permanent anterior teeth: a systematic review. Dent Traumatol. 2013 Jun 26. doi: 10.1111/edt.12054. [Epub ahead of print] PubMed PMID: 23802693.

Elkhadem A, Mickan S, Richards D. Adverse events of surgical extrusion in treatment for crown-root and cervical root fractures: a systematic review of case series/reports. Dent Traumatol. 2013 Jun 25. doi: 10.1111/edt.12051. [Epub ahead  of print] PubMed PMID: 23796195.