ISSN 0975-8437

INTERNATIONAL JOURNAL OF DENTAL CLINICS 2010: 2(3)27-30

REVIEW ARTICLE

Management of Supra-erupted Posterior Teeth- A Review

Sudhindra Mahoorkar, Shivakumar.N.Puranik, Arvind Moldi, Ramesh Chowdhary, Baswakumar Majge

Abstract Supraerupted posterior tooth is one of the common clinical findings in dental practice. Delayed replacement of lost teeth often leads to extrusion of the opposing teeth into the edentulous space, which leads to masticatory insufficiency and TMJ disorders. When prosthesis is planned on the opposing edentulous area, re-establishing a functional posterior occlusion requires a comprehensive dental treatment plan. If the dentoalveolar extrusion is not severe, it is possible to recapture the space by performing Coronoplasty & intentional endodontic treatment of the supraerupted tooth. When the extrusion is moderate, orthodontic intrusion can be done and the extrusion is great, a prosthetic rehabilitation is impossible and removal of the teeth is often proposed. This paper gives a brief review of the various treatment modalities discussed in the literature to manage supraerupted posterior teeth. Key words: Supraerupted Teeth, Coronoplasty, Intentional Endodontics, Temporary Anchorage Device. Received on: 07/05/2010 Accepted on: 18/06/2010

Introduction The partial dentate state may be the fate of many elderly dentate patients in the future, as the prevalence of edentulousness decreases in the population (1). The main positional change to be expected in unopposed teeth, retained root stump and carious teeth is over eruption. Kiliaridis et al (2) identified that over eruption >2 mm occurred in 24% of unopposed teeth, with 18% having no 2. to evaluate the size of the pulp and the dento-alveolar structure, 1. Enameloplasty can effectively reduce occlusal discrepancy in a moderately extruded tooth. Approximately 1-2 mm of enamel can be removed in many situations. At times the reduction of a single cusp improves the occlusal plane (4). If the tooth does not lend itself to Enameloplasty, the placement of an extra coronal cast metallic restoration is indicated. The degree of reduction is limited as much or more by the clinical crown length of the tooth as by the size of the dental pulp (4). 3. Intentional Root Canal treatment of tooth with perfectly vital pulp may be necessary in cases of hyper erupted tooth or drifted teeth that must be reduced so drastically that the pulp is certain to be involved (5).

demonstrable over eruption at all (3). In other words, 82% demonstrated some over eruption (1). If we replace the edentulous area with the prosthesis, without correcting the supra-erupted teeth, it may lead to inefficiency in the masticatory function due to improper distribution of masticatory force, deviation in the mandibular movement and problems in the Temporomandibular Joint. Treatment Modalities: Before we plan the different treatment modalities, we should have a mounted diagnostic cast and a very good radiograph

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4.

Molar intrusion can be achieved successfully with orthodontic TADS (Temporary Anchorage Devices) re-establishing a functional posterior occlusion & reducing the need for prosthetic crown reduction (6).

Nine steps of Coronoplasty: 1. Remove retrusive pre-maturities and eliminate the deflective shift from Retruded Cuspal Position (RCP) to Inter Cuspal Position (ICP) 2. Adjust ICP to achieve stable, simultaneous, multi-pointed, widely distributed contacts. 3. Test for excessive contacts (fremitus) on the incisor teeth. 4. Remove posterior protrusive supra contacts and establish contacts that are bilaterally distributed on the anterior teeth. 5. Remove or lessen mediotrusive (balancing) interferences.

5.

Orthognathic surgical procedures. A Posterior Segmental Osteotomy can be effective in correcting the problem. If it is a dento-alveolar extrusion (7).

6.

Extraction of the tooth, in case of the alveolar bone support is lost, i.e. in cases of furcation involvement.

Coronoplasty (Enameloplasty): Correction of the occlusal supra contacts are by; a) Grooving correcting the grooves and fissures, b) Spherodizingrestores the bucculingual width of the occlusal surface to normal dimension. c) Pointing- restores the cusp point contours (8). In Coronoplasty elimination of deflective occlusal contacts through selective reshaping of the occlusal surfaces of teeth, which result in more favorable distribution of occlusal forces. Objective of occlusal treatment are; 1. To direct the occlusal forces along the long axis of the teeth. 2. To attain simultaneous contact of all teeth in centric relation. 3. To eliminate any occlusal contact on inclined planes to enhance the the teeth. 4. To have centric relation coincide with the maximum inter-cuspation position. 5. To arrive at the occlusal scheme selected for the patient (9). positional stability of

6.

Reduce

excessive

cusp

steepness

on

the

laterotrusion (working) contacts. 7. 8. 9. Eliminate gross occlusal disharmonies. Recheck tooth contact relationships. Polish all rough surfaces(8).

Molar Intrusion by Orthodontic Treatment: Orthodontic Temporary Anchorage Devices (TADS) provide a minimally invasive treatment alternative, one that does not require the patients compliance, for molar intrusion. True molar intrusion can be achieved successfully with orthodontic TADs (Titanium-Alloy Mini Screw, ranging from 6 to 12 millimeters in length and 1.2 to 2 mm in diameter, that is fixed to bone temporarily to enhance orthodontic anchorage), re-establishing a functional posterior occlusion and reducing the need for prosthetic crown reduction. TADs should be inserted into a region with high bone density and thin keratinized tissue. The location chosen should be the optimal one in terms of both the patients safety and biomechanical tooth movement. Bone density and soft-tissue health are the key determinants that affect stationary anchorage and mini screw success (6).

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Extruded

posterior

teeth

can

be

intruded

Molar intrusion can be achieved by temporary anchorage device (TAD) orthodontically. The scope of orthodontics is expanding. TADs have allowed the orthodontist to overcome anchorage limitations and perform difficult tooth movements predictably and with minimal patient compliance.
Affiliations of Authors: 1. Dr. Sudhindra Mahoorkar,

orthodontically, by other methods, such as (10) Inter-maxillary device Sectional mechanics Removable appliance Trans-palatal bar Anchorage from mini-plates Mini-screws (TADS) Magnets Surgical Procedure: Posterior

MDS, Professor and Head of the Department, 2. Dr. Shivakumar.N.Puranik, MDS, 3. Dr. Arvind Moldi, MDS, 4.Ramesh Chowdhary, MDS, 5. Dr. Baswakumar Majge, MDS, Department of Prosthodontics, S.Nijalingappa Institute of Dental Sciences & Research (SNDC), Sedam Road, Gulbarga, Karnataka, India.

Orthognathic

Segmental Osteotomy: This is a simple but strict technique, without which one can achieve a good surgical outcome but a poor final occlusion. Some distortions can occur at any stage of surgery. Thus, we believe that using an acrylic splint as a surgical guide is mandatory to achieve a good final occlusion. The interim denture and/or the placement of an orthodontic arch wire prevents the risk of movement in transverse and vertical dimension (11). Conclusion Muller De Van stated that the preservation of that which remains is of utmost importance and not the meticulous replacement of that which has been lost (12). This statement holds true in case of management of supraerupted teeth. Because

References: 1. Craddock H. An investigation of overeruption of posterior teeth with partial occlusal contact. Journal of Oral Rehabilitation 2007; 34(4): 246-50. 2. Kiliaridis S, Lyka I, Friede H, Carlsson G, Ahlqwist M. Vertical position, rotation, and tipping of molars without antagonists. The International Journal of Prosthodontics 2000;13(6):480-6. 3. Craddock H, Youngson C, Manogue M, Blance A. Occlusal changes following posterior tooth loss in adults. Part 1: a study of clinical parameters associated with the extent and type of supraeruption in unopposed posterior teeth. Journal of

invariably the moment we see a small amount of supra-eruption, we still go ahead with replacement of the opposing edentulous area with an RPD or FPD which leads to occlusal disharmony and consequently TMJ Disorders. When the dentoalveolar extrusion is not too severe, it is possible to recapture space by performing Coronoplasty or intentional endodontic treatment of the supra-erupted teeth. When the extrusion is too great, a prosthetic rehabilitation is impossible and removal of teeth is often proposed. A more conservative treatment can be achieved by performing Segmental Osteotomy of guilty segment.

Prosthodontics 2007;16(6):485-94. 4. Stewart K, Rudd K, Kuebker W. Clinical removable partial prosthodontics. Implant

Dentistry1983;2(1):94-112. 5. Ingle J, Glick D. Differential diagnosis and treatment of dental pain. Endodontics;4:524-49. 6. Kravitz N, Kusnoto B, Tsay T, Hohlt W. The use of temporary anchorage devices for molar intrusion.

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The Journal of the American Dental Association 2007;138(1):56. 7. Meningaud J, Pitak-Arnnop P, Corcos L, Bertrand J. Posterior maxillary segmental osteotomy for mandibular implants placement: case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology2006;102(5):e1-e3. 8. Carranza F, Newman M, Glickman I. Clinical periodontology: WB Saunders Company; 1996.

technique. American Journal of Orthodontics and Dentofacial Orthopedics1996;110(5):466-8. 11. Erverdi N, Usumez S, Solak A. New generation open-bite treatment with zygomatic anchorage. Journal Information2006;76(3):519-26. 12. DeVan M. The nature of the partial denture foundation: suggestions for its preservation. The Journal of Prosthetic Dentistry1952;2(2):210-8. Address of Corresponding Author

9. Rosenstiel S, Land M, Crispin B. Dental luting agents: a review of the current literature. The Journal of Prosthetic Dentistry1998;80(3):280-301. 10. Kucher G, Weiland F. Goal-oriented positioning of upper second molars using the palatal intrusion

Dr. Sudhindra Mahoorkar, MDS, Professor and Head of the Department, Department of Prosthodontics, S. Nijalingappa Institute of Dental Sciences & Research, Sedam Road, Gulbarga, Karnataka, INDIA. Ph: +91.9845288144 E-mail:drsudhindramds@gmail.com

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