PMC9984820_01
Sequence of the treatment performed. A) Initial clinical condition showing the absence of the crowns of teeth 11 and 21; B) and C) Removable orthodontic appliance with anterior loops to direct the extruding force; D) Exposed crowns with buttons bonded to their vestibular surface; E) and F) Front and occlusal views of the orthodontic appliance activated with orthodontic elastic, after suturing the flap; G) Position of teeth 11 and 21, 14 weeks after starting the extrusive movement; H) Postoperative period of 2 weeks after surgical correction of the gingival anatomy; I) Clinical condition after 10 years of follow-up
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F1
The intraoral clinical examination showed the absence of teeth 11 and 21 (Figure 1A). It had two loops in the anterior section to direct orthodontic forces toward the long axes of the intruded teeth (Figures 1B and 1C). After elevating the flap, enamel and dentin fractures were observed at the incisal edges of both teeth (Figure 1D). Products, St. Paul, USA) and bonding composite resin system (Transbond XT; 3M Unitek, Monrovia, California, USA) (Figure 1D). Sorocaba, Sao Paulo, Brazil) (Figures 1E and 1F). Systemic antibiotic therapy was prescribed (amoxicillin, 500-mg capsules-1 capsule every 8 h for 7 days) along with daily mouthwashes with antiseptics (Colgate Periogard; Colgate Palmolive Ltda., Sao Paulo, SP, Brazil).  Proper extrusion of the teeth was achieved 8 weeks after activation of the appliance (Figure 1G). Due to extrusion, it was necessary to correct the gingival architecture by gingivectomy (Figure 1H). Clinically, normal mobility and a gingival sulcus depth of 2 mm were observed in the treated teeth (Figure 1I).
Radiographic images; A) Periapical radiograph showing severe intrusion of teeth 11 and 21, with completely formed roots and closed apical foramen; B) Odontometry of tooth 11 during endodontic treatment; C) 10-year radiographic control, showing the integrity of the periodontal ligament and minor horizontal loss of the alveolar bone
IEJ-14-89-g002.jpg
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F2
The roots were completely formed with closed apical foramens (Figure 2A). Root canals were then instrumented and filled with calcium hydroxide and propylene glycol paste (Biodinamica, Ibipora, Parana, Brazil) (Figure 2B). Minor horizontal bone loss in the cervical region, maintenance of the periodontal ligament, and integrity of the root surface were radiographically detected in the 10-year postoperative control teeth (Figure 2C).