LAUSR

INTRODUCTION Outcome predictors for the restoration of endodontically treated teeth mainly include cavity wall integrity and the presence of 1.5 to 2 mm ferrule. However, in some clinical situations, the aforementioned predictors cannot be achieved. Three different techniques have been proposed to obtain an adequate ferrule respecting the supracrestal tissue attachment: surgical crown lengthening, orthodontic forced eruption and surgical extrusion. There is little published prospective data evaluating periodontal changes after surgical extrusion. Therefore, the aims of this study were to report the outcome of surgical extrusion in single-rooted teeth, to digitally evaluate soft tissue volumetric changes after surgical extrusion and to observe patient satisfaction regarding the treatment after a minimum 1 year. METHODS This prospective clinical study was carried out between 2017 and 2020. Thirteen patients referred for surgical extrusion met the following inclusion criteria: non-smokers, systemically healthy with at least 1 straight, single-rooted tooth with insufficient ferrule, a favourable tooth crown-root ratio and no periodontal pathology. Pre-operative clinical variables included: patient age, gender and phenotype, tooth number, tooth mobility, crown-root ratio, gingival index (GI), probing pocket depths (PD) at 6 sites, bleeding on probing (BOP), and mesial and distal interproximal papillae volume. Surgical extrusion was performed by a single operator who completed the root canal treatment/retreatment and restored the teeth with a crown. One year later, all patients were controlled and the following variables were recorded: tooth mobility, crown-root ratio, GI, PD, BOP, interproximal papillae aspect, soft tissue rebound (STR), periapical healing, marginal bone loss and patient-reported outcome measures of the treatment (PROMs). All variables were analysed using a descriptive method (mean, %). Wilcoxon test was used to evaluate pre- and post-operative clinical parameters at a significance level of 0.05. RESULTS At a mean follow-up period of 18.8 months, no teeth were extracted. Compared to pre-operative GI and BOP, a significant reduction was observed at 1-year post-surgery. Likewise, no significant differences in probing depths were shown and only 1 tooth presented a type-2 mobility. The mean STR of - 0.46 ± 0.69 mm. Overall, no significant interproximal papillae height loss was observed. Apical lesions were completely healed after surgery. Tooth crown-root ratio was favourable in all cases before extrusion, while in 3 cases it was appropriate (1 = 1), and only 1 case presented > 25 % of marginal bone loss during the follow-up period. The reported success rate was 92.3 %, and patients were generally satisfied with the outcome. CONCLUSIONS Surgical extrusion of single-rooted teeth was successful, with minimal or no soft tissue loss, and patients were satisfied with the surgical procedure and the aesthetic result.