Surgical extrusion technique – S.E.T.

Surgical Extrusion Technique – S.E.T. – An alternative to dental implant

Surgical extrusion technique is a dental procedure that we use to save someone’s natural tooth. It is a fairly uncommon procedure due to the fact few doctors know about it.  The ideal tooth is broken at the gum line and is un-restorable in it’s current condition.  It needs to have a long enough root so that after the procedure the crown to root ratio is not too bad, preferably at least 1:1.  We need a straight single root that doesn’t have periodontal disease.  Hygiene and overall health is also a consideration.  We think this is a great treatment for a kid that is too young for a dental implant or someone older that doesn’t need it to last as long.  Surgical extrusion technique is in the literature as immediate surgical extrusion and partial exodontic technique, but the term P.E.T. is mainly a language translation issue.

surgical extrusion technique temporized

Perfect candidate for surgical extrusion technique. Too young for dental implant and we were able to temporize his tooth throughout the entire healing process with the use of nylon splinting. The steps and reasons for using nylon splinting are found below.

Is surgical extrusion technique only for front teeth?

No, we can also use this technique to save some back teeth as long as they have only a single root or the roots divide deep within the bone. The image below is a case of a lower premolar that we were able to save using the surgical extrusion technique.

surgical extrusion technique before and after

Premolar surgical extrusion technique

surgical extrusion technique root canal

Surgical extrusion technique on same tooth as above

Do you need to do a root canal on a surgical extrusion case?

The answer to that seems to be yes as all of the cases that exist in the literature do. However, I feel that for the right case a root canal is not a necessity. A young patient with an apex that is still open may be fine to just monitor.

surgical extrusion technique

Pre-op. Immediate after surgery and suture. After temporization day surgery (how she left) – made essix for this case to wear for 2 days and no splinting. Final (day of cementing).

P.E.T. partial exodontic technique

This is the same case seen above and yes I attempted to forgo the RCT. We’ll see how that decision plays out. I would bet against her not needing a RCT long term, but long term for this patient may not be in the cards.

This is Dr. Guazzi Paolo performing this procedure.  He is calling this technique a partial exodontic technique P.E.T.  I like the video.  I like the music too.

What is the cost for surgical extrusion technique (partial exodontic technique)?

We charge $780 (2017) for the surgical portion itself and that includes any temporary that we need to make for the tooth and any splinting. The tooth will still require a root canal, possibly a post, and a dental crown as well. If you have dental insurance it will cover some percentage of the procedure but that will depend on how good your dental plan is. The total cost without insurance from start to finish costs around $3500.

Steps that we take for surgical extrusion technique

  • Check probings of teeth in area and the general oral hygiene of patient.
  • Gently elevate tooth with the aim of at least 4mm of tooth above the crestal bone
  • Suture tight with a horizontal mattress.
  • You can leave the tooth free to “self-position” so as not to ankylosis or do a flexible splint with nylon wire (fishing line) as seen below.
  • No chewing in area, brush normal, and CHX for 2 weeks
  • No AB necessary, even if infected tooth.  Can if want though
  • You can make an essix to wear at night so the patient does not suck out the remaining tooth and swallow or aspirate it, but that is really not necessary.  Only need any essix made for a short time and only if no nylon splinting was done.
  • 1 week healing check and then a 2 month healing check with PA
  • Wait 2 months then RCT, post , crown etc
partial exodontic technique

Essix made for safety for first few nights by taking an impression with a pre-form crown in place over the fracture. Must ensure essix is not touching tooth after eruption.

What are the options for surgical extrusion technique temporization?

The temporization technique varies in the literature.  In the posterior you should not do anything except maybe an essix. In the anterior my personal opinion is that you can place an immediate temporary with or without an essix over it OR the you can lightly splint the temporary with nylon fishing wire.  You must be sure that the temporary tooth is not touching any other teeth IP, and also ensure not hitting during bite or any excursions. The immediate temporary I do exactly the same as a shrink wrap veneer temporary. Another method is to bond the remaining tooth to the other teeth IP just be sure to hollow out the tooth so no pressure is on the extruded portion of the tooth.

 

ADA Dental Code D7272: Tooth Transplantation for Surgical extrusion

This technique can be thought of as an intra-alveolar transplanted root.  The dental code D7272 does include any splinting if necessary.  We charge about $780 (2017) for this and that includes the temporary crown that we make as well as the splinting. D7272 is tooth transplantation (includes reimplantation from one site to another and splinting and/or stabilization)

Another alternative dental code is D7270. D7270 is the code for tooth re-implantation and/or stabilization of an accidentally evulsed or displaced tooth.  That also includes the splinting and/or stabilization.

Surgical Extrusion Technique, Immediate surgical extrusion and partial exodontic technique (P.E.T.) are all synonyms.

Depending on the journal you are reading or the language you are reading it in the name of this procedure varies. If you look at the research below the term Surgical Extrusion Technique is the most common, however, many dentists also know this as partial exodontic technique (P.E.T.).

Surgical Extrusion Technique, Immediate surgical extrusion and partial exodontic technique (P.E.T.) Research

Kahnberg had a bunch of studies on this back in the 80’s and 90’s including 1- year follow ups.

Calişkan 1999 Int J Endo

Kim 2004 Int J Perio and Rest Dent

Case report 18 month follow up Lee Dent Traumatology 2015 April

Paolo Gaetani and Paolo Guazzi in EC Dental Science 1.4 (2015): 164-166

Best Practices in Endodontics have a chapter by Chien and Patel on Immediate Surgical Extrusion (I think the word Immediate is redundant)

Patient take home sheet after surgical extrusion technique.

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