Surgical Extrusion Technique – S.E.T. – An alternative to dental implant
Surgical extrusion technique is an 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. 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 is 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 I think P.E.T. might be mainly a language translation thing.
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 we take for surgical extrusion
- Check probings of teeth in area and the general oral hygiene of patient.
- 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 tooth is not touching any other teeth IP, also ensure not hitting during 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 then a 2 month healing check with PA
- Wait 2 months then RCT, post , crown etc
Surgical Extrusion Technique Temporization
The temporization technique varies in the literature. My personal opinion is that you can place an immediate temporary with an essix over it OR the you can lightly splint the temporary 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 is 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 an accidentally evulsed or displaced tooth. That also includes the splinting and/or stabilization.
Surgical Extrusion Research
Kahnberg had a bunch of studies on this back in the 80’s and 90’s including 1- year follow ups.
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.