A Clinical Decision Tree for Preserving versus Extracting a Compromised Tooth with Extensive Subgingival Caries or Crown Fractures
Regeneration, Reconstruction & Restoration (Triple R),
Vol. 9 (2024),
1 January 2024
https://doi.org/10.22037/rrr.v9.44150
Abstract
One of the most challenging issues in the field of dentistry is to decide whether to preserve or extract a compromised tooth with subgingival caries/crown fractures. Several patient-related factors (i.e. biological, behavioral, or financial factors), tooth-related factors (i.e. periodontal, endodontic, or restorative factors), and the role of the tooth in the overall treatment plan should be considered to make the most accurate decision. This article has focused on the decision-making process related to the management of compromised teeth with subgingival caries/crown fractures. Based on the current scientific evidence and clinical experience of the authors, an algorithm has been suggested to simplify this process of decision. In the first step, compromised teeth were classified as single-root or multi-root groups. “Crown-to-root ratio” (C/R ratio), and “apical extension of caries to the crestal bone” were considered the main clinical parameters in the decision-making process for single-root and multi-root teeth, respectively. We do not recommend restoring the compromised teeth if the C/R ratio is more than 1 (for single-root teeth) or if the extension of caries has reached the alveolar bone crest (for multi-root teeth). For maintainable single-root teeth, there are three treatment options to provide space for the re-establishment of supracrestal soft tissue attachment (previously named as biologic width) between the future restorative margin and underlying crestal bone. These approaches include: surgical crown lengthening (SCL), orthodontic forced eruption (OFE), and deep marginal elevation (DME). For multi-root teeth, SCL and DME are usually the procedures of choice. Multi-root teeth are not amenable to OFE due to the heavy orthodontic forces needed for extrusion. We also discussed the indications and limitations related to each treatment option. Further studies should be conducted to evaluate the external validity of this decision tree.
Keywords: Decision trees; Decision making; Tooth fractures; Dental caries; Tooth extraction.
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References
Kulkarni S. Dental Implants or Root Canal Treatment-The Restorative Advantage.
Stomatologica M. Treatment planning of damaged teeth: to recover or to extract?. Minerva Stomatologica. 2017 Sep 22.
Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health and quality of life outcomes. 2010 Dec;8(1):1-1.
Liaw K, Delfini RH, Abrahams JJ. Dental implant complications. InSeminars in Ultrasound, CT and MRI 2015 Oct 1 (Vol. 36, No. 5, pp. 427-433). WB Saunders.
Holm‐Pedersen P, Lang NP, Müller F. What are the longevities of teeth and oral implants?. Clinical oral implants research. 2007 Jun;18:15-9.
Cárcamo-España V, Cuesta Reyes N, Flores Saldivar P, Chimenos-Küstner E, Estrugo Devesa A, López-López J. Compromised teeth preserve or extract: A review of the literature. Journal of Clinical Medicine. 2022 Sep 8;11(18):5301.
Ovaydi-Mandel A, Petrov SD, Drew HJ. Novel decision tree algorithms for the treatment planning of compromised teeth. Quintessence International. 2013 Jan 1;44(1).
Avila G, Galindo‐Moreno P, Soehren S, Misch CE, Morelli T, Wang HL. A novel decision‐making process for tooth retention or extraction. Journal of periodontology. 2009 Mar;80(3):476-91.
Greenstein G, Greenstein B, Cavallaro J. Prerequisite for treatment planning implant dentistry: periodontal prognostication of compromised teeth. Compendium of continuing education in dentistry (Jamesburg, NJ: 1995). 2007 Aug 1;28(8):436-6.
Fan J, Nunn ME, Su X. Multivariate exponential survival trees and their application to tooth prognosis. Computational statistics & data analysis. 2009 Feb 15;53(4):1110-21.
Samartzi TK, Papalexopoulos D, Ntovas P, Rahiotis C, Blatz MB. Deep margin elevation: a literature review. Dentistry Journal. 2022 Mar 14;10(3):48.
Alghulikah K, Alsulaiman NA, Al Ibrahim HS, AlYamany RM, Alqahtani NH. Deep margin elevation for indirect restorations: a systematic review. J Pharm Res Int. 2021;33(37B):23-30.
Gupta G, Gupta R, Gupta N, Gupta U. Crown lengthening procedures-A review article. IOSR-JDMS. 2015 Apr;14(4):27-37.
Mulla SA, Patil A, Mali S, Jain A, Sharma D, Jaiswal HC, Saoji HA, Jakhar A, Talekar S, Singh S. Exploring the Biological Width in Dentistry: A Comprehensive Narrative Review. Cureus. 2023 Jul 18;15(7).
Sharma A, Rahul GR, Gupta B, Hafeez M. Biological width: No violation zone. European Journal of general dentistry. 2012 Sep;1(03):137-41.
Juloski J, Radovic I, Goracci C, Vulicevic ZR, Ferrari M. Ferrule effect: a literature review. Journal of endodontics. 2012 Jan 1;38(1):11-9.
Majzoub ZA, Romanos A, Cordioli G. Crown lengthening procedures: A literature review. InSeminars in Orthodontics 2014 Sep 1 (Vol. 20, No. 3, pp. 188-207). WB Saunders.
Lang NP, Lindhe J, editors. Clinical periodontology and implant dentistry, 2 Volume Set. John Wiley & Sons; 2015 Mar 25.
Newman MG, Facd D, Klokkevold PR, Dds MS, Elangovan S, Dmsc BD, Kapila Y. Newman and Carranza's Clinical Periodontology and Implantology E-Book. Elsevier Health Sciences; 2023 Jun 5.
Jameson LM, Malone WF. Crown contours and gingival response. The Journal of Prosthetic Dentistry. 1982 Jun 1;47(6):620-4.
Grimoud AM, Gibbon VE, Ribot I. Predictive factors for alveolar fenestration and dehiscence. Homo. 2017 May 1;68(3):167-75.
Karateew ED, Newman T, Shakir F. Crown Lengthening and Prosthodontic Considerations. Advances in Periodontal Surgery: A Clinical Guide to Techniques and Interdisciplinary Approaches. 2020:193-205.
Kermanshah H, Najafrad E, Valizadeh S. Forced Eruption: Alternative Treatment Approach to Restore Teeth with Subgingival Structure. Case Reports in Dentistry. 2022;2022.
Mugri MH, Sayed ME, Nedumgottil BM, Bhandi S, Raj AT, Testarelli L, Khurshid Z, Jain S, Patil S. Treatment prognosis of restored teeth with crown lengthening vs. deep margin elevation: a systematic review. Materials. 2021 Nov 8;14(21):6733.
Sarfati A, Tirlet G. Deep margin elevation versus crown lengthening: biologic width revisited. Int J Esthet Dent. 2018 Sep 1;13(3):334-56.
Farhadi E, Omrani LR, Estedlal T, Ahmadi E. Deep Margin Elevation With Resin-modified Glass Ionomer in Posterior Adhesive Indirect Restorations Based on Biomimetic Principles: A Case Report. Avicenna Journal of Dental Research. 2022 Dec 7;14(4):190-3.
Ong M, Tseng SC, Wang HL. Crown lengthening revisited. Clinical Advances in Periodontics. 2011 Nov;1(3):233-9.
Mokbel N, Kassir AR, Naaman N, Megarbane JM. Root Resection and Hemisection Revisited. Part I: A Systematic Review. International Journal of Periodontics & Restorative Dentistry. 2019 Jan 1;39(1).
Parashis A, Tripodakis A. Crown lengthening and restorative treatment in mutilated molars. QUINTESSENCE INTERNATIONAL-ENGLISH EDITION-. 1994 Mar 1;25:167-.
Park SY, Shin SY, Yang SM, Kye SB. Factors influencing the outcome of root‐resection therapy in molars: A 10‐year retrospective study. Journal of periodontology. 2009 Jan;80(1):32-40.
Bresser, R.A.; Gerdolle, D.; van den Heijkant, I.A.; Sluiter-Pouwels, L.M.A.; Cune, M.S.; Gresnigt, M.M.M. Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region. J. Dent. 2019, 91, 103227.
Dietschi, D.; Spreafico, R. Evidence-based concepts and procedures for bonded inlays and onlays. Part III. A case series with long-term clinical results and follow-up. Int. J. Esthet. Dent. 2019, 14, 118–133.
Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 update. Journal of Oral and Maxillofacial Surgery. 2009 May 1;67(5):2-12.
Yoneda T, Hagino H, Sugimoto T, Ohta H, Takahashi S, Soen S, Taguchi A, Toyosawa S, Nagata T, Urade M. Bisphosphonate-related osteonecrosis of the jaw: position paper from the allied task force committee of Japanese society for bone and mineral research, Japan osteoporosis society, Japanese society of periodontology, Japanese society for oral and maxillofacial radiology, and Japanese society of oral and maxillofacial surgeons. Journal of bone and mineral metabolism. 2010 Jul;28:365-83.
Chesterman J, Chauhan R, Patel M, Chan MY. The management of traumatic tooth loss with dental implants: part 1. British Dental Journal. 2014 Dec 5;217(11):627-33.
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