When a crown fails: A case for orthodontic extrusion.

Problem: We had an unaesthetic and failing crown and inflamed gums that are not level with each other.

Solution: Orthodontic movement (a combination of braces and clear aligners) and replacing the crown.

Outcome: We obtained improved aesthetics and gingival health!

Initial photo:  Gingival/gum inflammation next to the crowned tooth (#9).  The gingival levels are not even.  The crown is longer, wider, a different shade.  (Right photo marked for length reference)

Braces start photo: The wire Is bent and will pull this tooth down. By moving the crown of the tooth down with orthodontic extrusion**, we hoped we could heal the gums and bring them to the same level.


**Extrusion of a tooth (slowly and controlled “extraction” of the tooth in very small amounts)

We did this with braces.  Slowly the tooth will move down millimeter by millimeter.  As a bonus, as we move the tooth down, the bone levels may “grow down” and can improve as well, which is what we were hoping for and obtained here.


Final braces photos: We still have the old crown in here, but you can see the gums have already improved in shape and color and they are also level.  The length of the crowns are the same length because we have filed down the one as we moved it.  (Right is marked for length reference)

Final photo: With a new crown**.  The size and shape is much closer to the natural tooth.  The gums are level and the gingival inflammation is gone!  (Very mild redness can be noted as this picture was the same day the crown was placed).


**Special thanks to Dr Jeffrey Dunwell who worked with us throughout the process.  We did regular cleanings with special attention to the tissue in this area.  But also, how beautiful, and natural is this crown that he did.  In office same day, no temporary crowns needed.


For dental professionals:  We extruded the tooth with braces for 3 months.  As I extruded I was reducing the crowns incisal edge and lingual surface and recontouring the teeth for esthetics.  After we finished active extrusion, I removed the braces and placed a gingival bevelled attachment and used uLAB in house aligners for retention and alignment.  When the old crown was removed, we could see a fracture at the crown margin that was likely causing the inflammation.  But because we were able to move this margin down we were able to resolve all of the inflammation with a new margin and a new crown.  The probing’s went from 5mm+ down to normal levels.


Summarized treatment plan: Orthodontic treatment with Braces and clear aligners, Polishing/recontouring of the edges of the teeth for symmetry and shape.  In office whitening.  Crown placement.  12months total.

Initial March 2022. Prior to orthodontic treatment

Progress July 2022. After orthodontic extrusion

March 2023: Post Orthodontics, prior to crown

March 2023: Day of Crown placement



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