Periodontal tissue reactions to T. Berglundh\ C. P.

Marinello^
J. Lindhe', B. Thilander' and
B. Liljenberg'

orthodontic extrusion ^Department of Periodontology, Faculty of

Odontology, University of Gotiienburg,
Gothenburg, Sweden; ^Department of Fixed
and Removable Prosthodontics, Faculty of
An experimental study in the dog Odontology, University of Zurich, Zurich,
Switzerland; ^Department of Orthodontics,
Faculty of Odontology, University of
Gothenburg, Gothenburg, Sweden

Berglundh T, Marinello CP, Lindhe J, Thilander B and Liljenberg B: Periodontal

tissue reactions to orthodontic extrusion. An experimental study in the dog. J Clin
Periodontol 1991; 18; 330-336.

Abstract. Orthodontic tooth extrusion is used at crown lengthening procedures

or in conjunction with periodontal therapy aimed at ehminating or reducing angular
bone defects. A technique for orthodontic extrusion combined with resection of
the supracrestal attachment fibers (fiberotomy) was recently proposed as an
adjunct to certain restorative procedures. The aim of the present investigation
was to analyze reactions of the periodontal tissues to orthodontic extrusion when
combined with fiberotomy. In 5 beagle dogs, the mesial roots of the 2nd, 3rd and
4th hemisected mandibular premolar were used as target roots while the distal
roots served as reference units. After a basehne examination, an orthodontic
extrusion device (stent) was installed and reactivated at 2-week intervals during an
8-week period of active tooth movement. Immediately following the installation
of the stent and once every 2nd week, the target roots were exposed to fiberoto-
my. After the active period, the teeth were retained in their new position for a
period of 8 weeks. Chnical, radiographical and histological measurements were
performed. The results from the investigation demonstrated that orthodontic
extrusion combined with supracrestal fiberotomy resulted in a coronal displacement
of the tooth and was associated with pronounced recession of the gingival margin
and extensive loss of connective tissue attachment. The degree of gingival
recession and the amount of loss of connective tissue attachment were, however,
less extensive than the amount of tooth extrusion. Thus, repeated fiberotomy Key words: attachment loss; clinical measure-
obviously failed to entirely prevent coronal migration of the attachment appar- ments; extrusion; fiberotomy; gingivitis; his-
tometrical measurements; orthodontic forces.
atus. It was also observed that undesired attachment loss had occurred at the
reference roots. Accepted for publication 6 June 1990

Orthodontic tooth extrusion is a term (1953), Reitan (1967) documented that compared to non-extruded controls, the
used to describe the forced movement (i) extrusion resulted in bone apposition infiammation of the gingival tissue was
of erupted teeth in the vertical plane by at the apex as well as at the alveolar less pronounced, the periodontal
the utilization ofmoderate forces. It has crest of the relocated tooth and (ii) the pockets less deep, but also that ex-
been suggested that extrusion of single alveolar crest of a healthy periodontium trusion resulted in apposition of crestal
teeth may be employed as an adjunctive would maintain a normal (1-2 mm) re- bone. It was suggested that extrusion of
measure in periodontal therapy aimed lationship with the cemento-enamel teeth with advanced periodontal disease
at eliminating or reducing angular bone junction. Batenhorst et al. (1974) repor- (i) may move a subgingival microbiota
defects without compromising the ted that extrusive tooth movement in into a supragingival position and thus
periodontal attachment apparatus of the monkey not only resulted in appo- (ii) may have a therapeutic effect on
neighboring teeth (Ingber 1974 & 1976, sition of crestal bone but, in addition, periodontitis.
Potashnick & Rosenberg 1982, Kocha- generated an increase of the width of Pontoriero et al. (1987) and Kozlows-
vi & Stern 1983, Biggerstaff et al. 1986, the attached gingiva. ky et al. (1988) devised a technique for
Seibert & Lindhe 1989). , , . Van Venrooy & Yukna (1985) used a tooth extrusion which combined ortho-
The effect of orthodontic extrusion dog model to assess the effect of ortho- dontic force apphcation with resection
on the periodontal tissues has been as- dontic extrusion of teeth associated with of the supracrestal attachment fibers (fi-
sessed in both clinical studies and ani- advanced periodontal disease. The au- berotomy). The combined procedure
mal experiments. Early studies by, e.g., thors extruded teeth a distance of 3-4 was performed in a series of chnical
Oppenheim (1940), Ritchey & Orban mm and observed that at the test teeth. cases and was found to promote the
 Periodontal reactions to extrusion 331

Outline
• • • • " • - " v • : - • • • . ' . , . ; • • •

Right side: Orthodontic extrusion

Left side: Orthodontic extrusion with supracrestal fiberotomy

4 0 8 16 weeks
Plaque control Plaque control Plaque control
PREPARATORY PERIOD hi ACTIVE PERIOD 1 RETENTION PERIOD M
BASELINE

Endodontic treatment. Notch preparation Clinical examination

Root separation of Clinical examination Biopsy
4P4,3P3,2P2 Extrusion force applied

Fiberotomy and activation every 2nd week

Fig. 1. Outline of the experiment. 5 beagle dogs were used. The 2nd, 3rd and 4th mandibular premolars were rootfilled and hemisected 4
weeks prior to baseline. Plaque control was performed during the entire course of the experiment. At baseline, notch preparation and clinical
examination were performed. Extrusion forces were applied on all mesial roots and supracrestal fiberotomy was performed at the left side.
During the following 8 weeks (active period), the force was reactivated every 2nd week. At these time intervals, the fiberotomy procedure
was repeated at the left side. During the retention period (8 weeks), the roots were retained in their position. At the end of the retention
period a clinical examination was performed and biopsies harvested.

extrusion of single teeth but to prevent extrusion is combined with fiberotomy. cal surfaces of each mesial root and in-
the concomitant coronal migration of The aim of the present investigation cluded assessments of (i) the distance
the periodontium. A predetermined was to analyze reactions of the perio- between the occlusal surface of the me-
portion of the tooth hereby became ex- dontal tissues to orthodontic extrusion sial root and the extrusion apphance,
posed and became accessible for re- when combined with supracrestal fiber- (ii) the probing pocket depth, (iii) the
storative procedure. Pontoriero et al. otomy. probing attachment level (measured
(1987), Kozlowsky et al. (1988), Sie- from the occlusal surface), and (iv) the
bert & Lindhe (1989) suggested that the width of the keratinized gingiva. In ad-
Material and Methods
combined technique could be used as an dition, standardized radiographs of the
alternative to osseous resection pro- Five beagle dogs, about 12 months old mandibular premolar region were ob-
cedures aimed at "crown lengthening". and with clinically healthy periodontal tained. In order to identify the level of
So far, however, no histological obser- conditions, were used in the study. The the gingival margin a notch was pre-
vations have been presented which de- outline of the experiment is dehneated pared at the interproximal surfaces of
scribe periodontal tissue alterations, in Fig. 1. Throughout the entire course all root units. Following the baseline
(e.g., (i) recession of gingival margin, of the period of monitoring the dogs examination, extrusion forces were ap-
(ii) change of probing depth and pocket were subjected to tooth cleaning. At the plied on all the mesial root units {•^2^c[i,
depth, (iii) loss of connective tissue start of the preparatory period (Fig. 1) ^^To., and 4P4m). The coil springs were
attachment and crestal bone), which ob- the mandibular 2nd, 3rd and 4th pre- reactivated every 2 weeks during the fol-
viously are induced when orthodontic molars (2P2,3P3 and 4P4) were root-filled lowing 8 week period (active period.
and hemisected. The mesial root of each Fig. 1).
premolar was selected as test unit, while In the left jaw quadrant, the mesial
the corresponding distal root served as roots (P2ni, P3m, and P4m) were, in ad-
control (reference) unit. At Baseline, dition, exposed to supracrestal fiberoto-
i.e., 4 weeks after hemisection, an ex- my. This procedure included an incision
trusion device was installed in both sides made in the gingival sulcus, which sev-
of the lower jaw. A silver stent which ered the supracrestal attachment appar-
employed the canines and the first mo- atus between the cemento-enamel junc-
lars as abutment teeth was inserted. tion (CEJ) and the alveolar bone crest
Closed coil springs (Elgiloy 009 x 032, (BC). The incision included the entire
Rocky Mountain®, USA) were attached circumference of the root and was made
with steel hgatures introduced in pre- with the use of a knife (Bard-Parker®;
pared canals of the mesial roots and no. 15). The fiberotomy procedure was
joined with the silver stent (Fig. 2). The repeated at the mesial root units of the
Fig. 2. Clinical photograph of the experimen-
tal tooth region at the right side (baseline)
coil springs were activated by a con- lower left jaw every 2nd week during
illustrating the orthodontic appliance includ- trolled extension procedure which pro- the active period (Fig. 1).
ing the coil springs attached to the mesial duced a force of 5-10 g. A basehne At the end of the active period the
roots and to the silver stent. examination was performed at the buc- amount of root extrusion was assessed
332 Berglundh et al. H • '-

by radiographical and clinical means. most apical cell of the dento-gingival The results from the clinical meas-
The extruded roots were retained in epithelium (JE), i.e., the histological urements performed at Baseline and at
their position for a period of 8 weeks pocket depth. the end of the retention period are de-
(retention period. Fig. 1). The clinical (ii) JE to the most coronal part of the scribed in Table 1. At the non-fibero-
examination performed at Baseline was alveolar bone crest (BC), i.e., the height tomy side the mesial roots had been
repeated and radiographs from the of supraalveolar connective tissue extruded a distance of 4.5 mm. The
mandibular premolar regions were ob- attachment. corresponding extrusion at the fibero-
tained towards the end of the retention (iii) the cemento-enamel junction tomy side was 4.3 mm. While the buc-
period. (CEJ) to JE, i.e., loss of connective cal gingival pockets" at the non-fibero-
The animals were sacrificed, the man- tissue attachment. tomy side remained unchanged in
dibles removed and divided into one left (iv) the most apical part of the notch depth during the 16 weeks of experi-
and one right portion. Following fix- in the root surface to GM, i.e., amount ment, there was at the fiberotomy
ation and decalcification the left and of gingival recession. roots a significant deepening of the
right jaw quadrant were further disected pockets; from an average of 0.9 mm at
into one mesial and one distal portion, basehne to 2.3 mm at 16 weeks. At
Results
including the roots of 2P2nad, 3P3m and both sides of the mandible the 16
Clinical observations
3P3d, 4P4md respectively (Fig. 3). The weeks of experiment had resulted in si-
four tissue portions, i.e., 4P3Pd, 3Pm2P, The clinical examination performed at ginificant amounts of probing attach-
P2P3m, and P3dP4, from each dog were the end of the retention period revealed ment loss. Thus, at the buccal surface
embedded in paraffin and cut in mesio- that all mesial root units were extruded of the mesial root units the probing
distal direction with the microtome set when compared to the adjacent distal attachment level had increased from
at 5 [mv. The sections were stained in roots. The gingival margin which ex- 3.6 mm to 5.1 mm (non-fiberotomy
hematoxyhn-eosin or Mallory's connec- hibited a scalloped outhne at the non- side) and from 3.4 mm to 6.2 mm (fib-
tive tissue stain. From each tissue por- fiberotomy side followed a more erotomy side). At the non-fiberotomy
tion 3 sections, 20 yum apart, represent- straight course at the roots exposed to side the width of the keratinized gin-
ing the central part of the roots, were fiberotomy (Fig. 3). Most of the buccal giva, measured at the buccal surface of
analyzed in the hght microscope (magn. and interproximal gingival units showed the mesial roots, had increased an av-
xl60). The following distances were signs of overt inflammation and bled on erage of 0.6 mm.
measured (Fig. 4). gentle probing to the base of the buccal In the radiographs obtained at 16
(i) the gingival margin (GM) to the and interproximal pocket. weeks, the following observations were
made (Fig. 5):
• at the non-fiberotomy side "osseous
funnehng or lipping" (Pontoriero et al.
1987) was observed at the mesial and
distal surface of the extruded roots. No

NOTCH
GM.

EXTRUSION ROOT REFERENCE ROOT

Fig. 4. Schematic drawing demonstrating the

landmarks which were used for assessment of
the linear distances measured in the histologi-
cal sections: (1) the gingival margin (GM)
to the most apical cell of the dento-gingival
epithelium (JE), i.e., the histological pocket
depth; (2) JE to the most coronal part of the
alveolar bone crest (BC), i.e., the height of
supraalveolar connective tissue attachment;
(3) the cemento-enamel junction (CEJ) to JE,
i.e., loss of connective tissue attachment; (4)
Fig. 3. Photographs illustrating the fixated and decalcified right and left portion of the the most apical part of the notch in the root
mandible. The dissection line is marked (hatched line). y . T .> ;^;: r • i- «-.; surface to GM, i.e., gingival recession.
 Periodontal reactions to extrusion 333

Table 1. Results (mm) from the clinical measurements; the distance between the stent and the root (STENT-Root) the probing depth
(PROBING D.) the probing attachment level (PROBING A.L.) and the width of the keratinized gingiva (WIDTH KER. G.) obtained at
baseline and at 16 weeks on the right and the left side; mean value (x) and standard deviation (S.D.); the change from baseline to 16 weeks
and the difference between the right and the left side; mean value (x), standard deviation (S.D.) and standard error (S. E.)
Non-fiberotomy, right side (mm) Feberotomy left side (mm)
Difference:
Baseline 16 weeks Change Baseline 16 weeks Change right side - left side
X SD X SD X SD SE X SD X SD X SD SE X SD SE
STENT-ROOT 7.4 1.1 2.9 0.9 -4.5 0.5 0.3* 6.9 1.1 2.7 1.1 -4.3 2 1* 0.2 3.1 1.5
PROBING D. 1.1 0.2 1.2 0.5 0.1 0.6 0.3 0.9 0.2 2.3 0.5 1.4 0.5 0.3* -1.3 0.4 0.2*
PROBING A.L. 3.6 0.6 5.1 1.1 1.5 1.3 0.6* 3.4 0.3 6.2 0.6 2.8 0.5 0.2* -1.3 1.4 0.7
WIDTH KER.G. 3.4 0.2 4 0.3 0.6 0.2 0.1* 3.6 0.1 3.9 0.2 0.3 0.2 0.2 0.3 0.3 0.2
Significance within 95% confidence limit.

such change of the architecture of the the histological pocket depth and the
Discussion
bone crest was observed at the fiberoto- height of the supraalveolar connective
my side; tissue differ between the extruded and The results from the present investiga-
• at the fiberotomy side the supracres- the non-extruded reference root. tion demonstrated that orthodontic
tal portion of the extruded roots was The distance between the CEJ and JE forces can be used to accomplish ex-
markedly longer than the correspond- describes the amount of attachment loss trusion of single teeth in the dog model.
ing portion of the non-extruded roots that the root surface has been exposed The process of extrusion which resulted
(reference units). This difference be- to. The extruded roots at the non-fiber- in a 4 mm vertical displacement was
tween the mesial and distal roots was otomy side had lost an average of 276 accompanied by periodontal tissue re-
much less pronounced at the non-fib- ^m (S.D. 266 //m) of attachment, while cession and remodelhng. Thus, in the
erotomy side. the corresponding attachment loss at present model it was observed that con-
the fiberotomy side amounted to 1054 comitant with the coronal displacement
[im (S.D. 330 [im). The attachment loss of the tooth (i) some recession of the
at the reference roots varied between gingival margin occurred, (ii) the width
Histologicai observations
16 ^m and 122 //m. In both the non- of the attached gingiva increased, (iii)
The results from the histometrical meas- fiberotomy side and the fiberotomy side minor amounts of periodontal tissue
urements are reported in Table 2. The this difference between the extruded and attachment was lost, but (iv) new bone
histological pocket depth, i.e., the dis- non-extruded roots was statistically sig- was deposited at the crest of the alveolar
tance between GM and JE, varied in the nificant. process. When orthodontic extrusion
4 different root units examined between The distance between the notch and was combined with supracrestal fibero-
745 and 1105 /zm. The height of the the gingival margin (GM) was at the tomy, the coronal displacement of the
supracrestal connective tissue (JE-BC), reference roots in the non-fiberotomy tooth was associated with more pro-
varied in the same units between 1026 side 66 //m, i.e., the margin of the gin- nounced, albeit intended, recession of
and 1238 /^m. Neither at the non-fibero- giva was close to the lower border of the gingival margin and more extensive
tomy side nor at the fiberotomy side did the notch prepared in the root surface loss of connective tissue attachment
following installation of the extrusion than when the tooth movement was per-
device. At the extruded roots at the non- formed without fiberotomy. Since, how-
fiberotomy side, the corresponding dis- ever, the degree of gingival recession
tance was significantly longer and and the amount of loss of connective
amounted to 516 /^m. At the fiberotomy tissue attachment were less extensive
side the notch-GM distance was 1577 than the amount of tooth extrusion, in
^m (extruded roots) and 279 fjxn. (refer- the present model, repeated fiberotomy
ence roots). Furthermore, this differ- obviously failed to entirely prevent cor-
ence between the roots was statistically onal migration of the attachment appar-
significant. atus.
A further analysis of the measure- In the present investiation, it was ob-
ments revealed that the mesial roots at served that orthodontic extrusion with-
the fiberotomy side had been extruded out adjunctive fiberotomy at most sites
a longer distance and lost significantly studied induced remodelling and some
more attachment than the correspond- compensatory coronal "growth" of the
ing roots at the non-fiberotomy side. periodontium. Thus, while the experi-
Also the reference roots of the fiberoto- mental roots were forced to extrude an
Fig. 5. Radiographs obtained at the end of average distance of 4.5 mm, the probing
my side had become displaced more and
the retention period of the right side (a), and
lost more attachment than the corre- depth remained unchanged and the gin-
the left side (b) illustrating one extrusion- (E)
and one reference (R) root. The level of the sponding roots of the non-fiberotomy gival margin receded at distance of only
alveolar bone is marked (arrow). side. 0.5 mm. This finding is in agreement
 334 Berglundh et al.

Table 2. Results (/zm) from the histometrical measurements; the various distances measured are described in Fig, 4; mean value (x) and
standard deviation (S,D,); the difference between the extrusion and reference roots on each side and the difference between the right and the
left side; mean value (x), standard deviation (S,D,) and standard error (S,E,)
Difference
Non-fiberotomy, right side (/zm) Fiberotomy, left side Cum) right side - left side
Difference: Difference
Extrusion- Extrusion-
Extrusion Reference Reference Extrusion Reference Reference Extrusion root Reference root
X SD X SD X SD SE X SD X SD X SD SE X SD SE X SD SE
GM-JE 745 166 1105 298 -360 315 157 993 390 877 205 116 504 252 248 363 181 228 181 90
JE-BC 1210 211 1026 79 184 282 141 1238 172 1043 226 195 236 118 -28 166 83 - 1 7 206 103
CEJ-JE 276 266 16 14 260 158 79* 1054 330 122 29 932 333 166* -778 444 222* - 1 0 6 26 13*
NOTCH-GM 516 126 66 31 450 112 65* 1577 463 279 233 1298 676 338* -1061 622 311* - 2 1 3 194 112
* Significance within 95% confidence limit.

with data presented from case reports mo & Talari 1976, Ainamo 1978) and examination demonstrated that loss of
(Ingber 1974 & 1976, Delivanis et al, demonstrates that (i) the marginal peri- attachment (CEJ-JE; Table 2) had oc-
1978, Stern & Becker 1978, Potash- odontium migrates with the erupting curred at the approximal surfaces of
nick & Rosenberg 1982, Kochavi & tooth, and (ii) the mucogingival junc- both the extruded and the reference
Stern 1983, Biggerstaff et al, 1986, Pon- tion remains stable. roots at the non-fiberotomy side; x =
toriero et al, 1987, Kozlovsky et al, The results from the analysis of the 276 fim, S,D, 266 nm, (extruded roots)
1988, Seibert & Lindhe 1989) and ani- histoiogical sections of the extruded and X = \6 ^m, S,D, 14 //m (reference
mal experiments (Batenhorst et al, 1974, teeth confirmed the clinical fmdings and roots), A further analysis of the data,
Simon et al. 1980, Van Venrooy & Yu- revealed that the height of the supracre- however, revealed that this loss of con-
kna 1985) and demonstrates that ortho- stal attachment remained stable during nective tissue attachment was confmed
dontic extrusion is a means by which the process of extrusion. This obser- to 1 reference root in 1 dog and 2 ex-
the position of the gingival margin and vation is in agreement with data re- truded roots in 2 of the 5 dogs.
the bone crest may be changed without ported from previous experiments in the Extrusion combined with fiberotomy
undue encroachment of the supracrestal monkey and the dog by e,g,, Batenhorst is a treatment procedure aimed at ac-
attachment apparatus. et al, (1974) and Simon et al, (1980) and complishing controlled vertical tooth
Extrusion of single teeth (roots) also demonstrates that "vertical" extrusion movement without coronal displace-
resulted in an increase of the width of of teeth can be accomplished without ment of the gingiva and supracrestal
the zone of attached gingiva. This ftnd- inflicting major undue damage to the connective tissue and without crestal
ing confirms observations reported pre- periodontal attachment apparatus. bone apposition (Pontoriero et al, 1987,
viously (Batenhorst et al, 1974, Aina- The results from the histoiogical Kozlovsky et al, 1988), In the present
study it was observed that at sites where
extrusion was performed in combi-
nation with fiberotomy, (i) the roots
were dislocated on the average 4,3 mm
in vertical direction, while the gingival
margin receded a distance of 1,6 mm,
(ii) the induced attachment loss
amounted to 1054 imv, and (iii) the zone
of the attached gingival increased on the
average 0,3 mm. In other words, the
circumferential fiberotomy procedure,
repeated every 2 weeks, only in part
managed to prevent the coronal mi-
gration of the periodontal attachment
apparatus. In the successful cases de-
scribed by Pontoriero et al. (1987) the
fiberotomy procedure was repeated
once weekly, and in the 4 cases de-
scribed by Kozlovsky et al, (1988) the
supracrestal incisions were performed
every 2 weeks but were combined with
root surface curettage. Based on the
above observations there are reasons to
suggest that, in the present dog model,
Eig. 6. Mesio-distal sections of the interproximal periodontal tissues between an extrusion (E) initial healing of the severed supracres-
and a reference (R) root representing the right side (a) and the left side (b). tal connective tissue may have in part
 Periodontal reactions to extrusion 335

prevented the intended root "elonga- mesialen Wurzein des zweiten, dritten und ment dentaire en direction coronaire et etait
tion" to occur. vierten hemisezierten Pramolaren als Test- liee a une recession marquee du rebord gingi-
wurzeln benutzt, wahrend die distalen Wur- val et une perte etendue d'attaehe conjoncti-
The placement of the silver stents and
zein als Kontrollen dienten. Nach einer Ein- ve. Le degre de la recession gingivale et la
the coil springs made tooth cleaning dif- perte d'attaehe conjonctive etaient cependant
gangsuntersuchung wurde ein kieferorthopa-
ficult. Thus, even though toothbrushing disches Gerat (stent) angebracht und alle 2 plus limites que l'extrusion dentaire obtenue.
was performed on a daily basis, it was Wochen wahrend einer achtwochigen Phase Les fibrotomies repetees ne pouvaient done
not possible to keep the dentition free der aktiven Zahnbewegung nachjustiert. So- manifestement pas empecher entierement la
from supra and subgingival plaque for- fort nach Eingliederung des Extrusionsgera- migration coronaire de l'appareil d'attaehe.
mation. As a consequence, gingivitis de- tes und einmal alle zwei Wochen wurden die On observait aussi qu'il se produisait une
veloped at most experimental units and, Testwurzeln einer Faserdurchtrennung unter- perte d'attaehe indesirable sur les racines de
in addition, at some roots the plaque zogen. Nach der Phase der aktiven Zahnbe- reference.
wegung wurden die Zahne in ihrer Position
induced gingival lesion was associated
fur acht Wochen retiniert. Klinische, rontge- References
with loss of connective tissue attach- nologische und histologische Messungen
ment. Plaque-dependent attachment wurden durchgefuhrt. Die Ergebnisse der Ainamo, A. (1978) Infiuence of age on the
loss was more pronounced at the refer- Untersuchung zeigten, daB die orthodon- location of the maxillary mucogingival
ence roots at the fiberotomy side than tische Extrusion, kombiniert mit der Resek- junction. Journal of Periodontal Research
at the non-fiberotomy side. The reason tion der supraalveolaren Easern, in einer Ver- 13, 189-193.
for this discrepancy can only be specu- lagerung des Zahnes nach koronal resultierte Ainamo, J. & Talari, A. (1976) The increase
lated upon. Obviously, the incisions per- und mit einer ausgepragten Gingivarezession with age of the width of attached gingiva.
formed every 2 weeks may have induced sowie starkem Verlust an bindegewebigem /. of Periodontal Research 11, 182-188.
Attachment verbunden war. Das AusmaB an Batenhorst, K. E., Bowers, G. M. & Willi-
a swelling of the marginal gingival
Gingivarezession und der Verlust von binde- ams, J. E. (1974) Tissue changes resulting
which involved not only the tissue at the gewebigem Attachment waren jedoch weni- from facial tipping and extrusion of inci-
experimental units but also the reference ger stark als die Extrusion des Zahnes. Auf sors in monkeys. Journal of Periodontology
roots. This enhanced gingival infiam- diese Weise gelang es offensichtlich nicht, 45, 660-668.
mation may have facilitated subgingival mittels wiederholter Easerdurchtrennung die Biggerstaff, R. H., Sinks, J. H. & Carazola,
plaque formation and established con- koronale Wanderung des Zahnhalteappara- J. L. (1986) Orthodontic extrusion and bio-
ditions conducive for "experimental tes vollstandig zu verhindern. Es wurde auch logic width realignement procedures:
periodontal tissue breakdown" (Lindhe beobachtet, daB bei den Kontrollzahnen un- methods for reclaiming nonrestorable
gewollter Attachmentverlust auftrat. teeth. Journal of the American Dental As-
et al. 1975, Ericsson et al. 1975) which
in this 4-month experiment resulted in sociation 111, 345-348.
about 0.1 mm of attachment loss. Delivanis, P., Delivanis, H. & Kuftinec, M.
(1978) Endodontic-orthodontic manage-
The overall results of the present ex- Resume
ment of fractured anterior teeth. Journal
periment on extrusion of single teeth Reaction des tissus parodontaux a I'extrusion of the American Dental Association 97,
combined with fiberotomy suggest that orthodontique. Etude experimentale chez le 483-485.
(i) the root elongation intended was in chien Ericsson, I., Lindhe, J., Rylander, H. & Oka-
part compromized by coronal growth L'extrusion orthodontique des dents est utili- moto, H. (1975) Experimental periodontal
of the attachment apparatus, (ii) the in- see pour obtenir un allongement de la cou- breakdown in the dog. Scandinavian Jour-
fiammation induced by improper ronne ou lors d'un traitement parodontal vi- nal of Dental Research 83, 189-192.
sant a eliminer ou reduire des lesions osseuses Ingber, J. S. (1974) Eorced eruption, part II.
plaque control and repeated mechanical
angulaires. Une methode combinant l'extru- Journal of Periodontology 45, 199-206.
injury caused undesired and uncon-
sion orthodontique a la resection des fibres Ingber, J. S. (1976) Eorced eruption, part 1.
trolled attachment loss at neighboring supra-crestales de l'attache (fibrotomie) a ete Journal of Periodontology 47, 203-216.
teeth. proposee recemment comme adjuvant lors- Kochavi, D. & Stern, N. (1983) Crown
qu'on pratique certaines restaiirations. La lengthening procedure. Part I. Clinical as-
presente etude se propose d'analyser les reac- pects. Compendium of Continuing Edu-
tions des tissus parodontaux a l'extrusion or- cation in Dentistry 4, 347-354.
Zusammenfassung
thodontique lorsqu'elle est combinee a une Kozlowsky, A., Tal, H. & Liebermann, M.
Reaktionen der parodontalen Gewebe nach or- fibrotomie. Chez 5 chiens Beagle, les racines (1988) Eorced eruption combined with gin-
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tischer Extrusion mit Easerdurchtrennung zu trusion orthodontique combinee a une fibro- tive Dentistry 1, 3 1 ^ 3 .
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