Surgical extrusion technique – S.E.T.

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

Ideal tooth is broken at gum line and un-restorable in current condition.  Needs to have a long enough root so after procedure the crown to root ratio is not too bad, preferably at least 1:1.  Want a straight single root=anterior or premolar and not have periodontal disease/perio abscess.  Hygiene and overall health should also be considered.  I think this would be a great treatment for a kid that is too young for a dental implant or someone older that doesn’t need something for a whole lot longer.  It can also be found named in literature as immediate surgical extrusion and partial exodontic technique, but I think P.E.T. might be mainly a language translation thing.

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).

surgical extrusion technique xray

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.

Steps that I take for surgical extrusion

  • Check perio with probings
  • Extrusion/partial extraction of tooth.  Aim to get 4mm above the crestal bone
  • Suture tight use 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)
  • I do a shrink to fit temporary on the tooth (steps found below)
  • Ensure not touching any other teeth IP or opposing in bite or any excursions
  • No chewing in area, brush normal, and CHX for 2 weeks
  • No AB necessary, even if infected tooth.  Can if want though
  • Make essix to wear at night – ASAP – so don’t swallow first night.  Only needed if no splinting of any kind and many do not even do this.
  • 1 week healing check and 2 month healing check with PA
  • Wait 2 months then RCT, post , crown etc

Surgical Extrusion Technique Temporization

The manner with which these are temporized is different in the literature.  My personal opinion is that an immediate temporary can be placed and an essix made to cover it OR the temporary can be lightly splinted with nylon fishing wire.  Another method is to bond the remaining tooth to the other teeth IP.  You must hollow out the tooth and ensure no pressure on the extruded tooth.

Code D7272: Tooth Transplantation for Surgical extrusion

This technique can be thought of as an intra-alveolar transplanted root.  The code includes any splinting that is done.  We charge about $750 for this and that includes the temporary crown that we make as well as the splinting.

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

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)

Bryan Bauer, DDS, FAGD     
630-665-5550                                                           

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