Mokgok Station Dental Clinic: A Broken Tooth Beneath the Gum Line — Can It Be Saved Without Extraction? Root Canal Treatment with Orthodontic Extrusion

Hello.

I’m Yeo Sang-ho, a dentist at Mokgok Station Dental Clinic and a smile designer who can help turn your wishes into a beautiful smile.

These days, with the advancement of AI, it has become easy to search for medical information.

“An earlier root canal-treated tooth broke.”

“The crown came off, and it looks like the tooth broke too.”

In situations like these, many people first look up information through AI searches or the internet.

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However, most search results lack accurate information, so in many cases they recommend “extraction followed by an implant.”

But in actual clinical practice, there are still ways to save the tooth.

Just because a tooth restored with a prosthesis has broken does not mean extraction is always necessary.

Several factors must be evaluated comprehensively, including the condition of the root, the location of the fracture, and how deep it extends below the gums.

Today, I’d like to look at what treatment approaches are possible in such situations through a real case.

Initial visit

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In the sample photo prepared at Mokgok Station Dental Clinic, there is a bridge prosthesis in the anterior teeth area that has come off.

A bridge is a prosthetic method that uses the teeth on both sides as abutments to fill the space of the missing tooth in the middle.

Teeth #11 and #22 are being used as abutment teeth, replacing tooth #21 (the missing tooth).

An X-ray examination is performed to determine the cause of the dislodgement.

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On the radiograph, severe secondary caries (recurrent decay) is observed in the abutment teeth, especially tooth #22.

The tooth structure beneath the prosthesis has been significantly damaged by decay, which is the direct cause of the prosthesis coming off.

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In general, in cases like this, there is not enough tooth structure remaining above the gum line, so extraction is considered.

However, if you analyze the radiograph carefully, the root length is maintained in good condition.

If the root is healthy and long enough, there is a possibility of preserving it.

The problem is that the decayed area has progressed deep below the gums, making it difficult to secure enough space for prosthesis fabrication.

What is the treatment plan?

At Mokgok Station Dental Clinic, I would like to introduce a method that can be used in this situation: orthodontic extrusion.

Orthodontic extrusion is a procedure in which orthodontic force is applied to a natural tooth to move the root upward toward the gum line.

With this method, the fractured portion of the tooth located deep below the gums can be brought up above the gum line.

As the root moves upward, healthy tooth structure becomes exposed above the gums, creating sufficient space for prosthesis fabrication.

The treatment plan can be summarized step by step as follows.

First,

Root canal treatment of tooth #22

Second, root movement through orthodontic extrusion (about 7 weeks)

Third, stabilization period after extrusion is completed

Fourth, fabrication of a new bridge prosthesis

Orthodontic extrusion generally takes about 6 to 8 weeks.

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Because the movement speed can cause root resorption or periodontal tissue damage, it is safest to proceed slowly at about 1 mm per month.

After extrusion is completed, a stabilization period of 2 to 3 weeks is needed.

During this period, the periodontal tissues reorganize, and the bone and ligaments around the root stabilize.

After sufficient stabilization, the final prosthesis is fabricated.

How is the process carried out?

First, root canal treatment for tooth #22 is performed.

Even if the tooth had previously undergone root canal treatment, reinfection is often present, so the inside of the root canal is disinfected and filled again.

Example photo

Once the root canal treatment is completed, a device for orthodontic extrusion is attached.

The orthodontic appliance works by bonding a bracket to the tooth and using the adjacent teeth on both sides as anchorage to apply a vertical traction force.

After the appliance is placed, activation is carried out through regular visits over about 7 weeks.

In general, the patient visits every 2 to 3 weeks to adjust the orthodontic force and check the amount of movement.

During the extrusion process, as the tooth moves upward, the gingival tissue also follows along and moves upward.

Once the 7-week extrusion period is completed, the orthodontic appliance is removed and a stabilization period follows.

During this period, a temporary prosthesis is placed to maintain the tooth’s position and allow the surrounding tissues to recover.

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When stabilization has been achieved, preparation is performed for the final bridge.

The extruded tooth #22 now has enough tooth structure exposed above the gums, creating ideal conditions for prosthesis fabrication.

Tooth #11 is also prepared together to make a new bridge.

A precise restoration is possible through digital impression taking.

Through a treatment process lasting about 10 weeks, the natural tooth can be preserved without extraction.

Orthodontic extrusion takes time, but it has the advantage of preserving the natural tooth.

Compared with implants, natural teeth have a periodontal ligament, so you can feel sensation during chewing, and they also help prevent bone resorption.

After the final bridge prosthesis is placed, regular checkups are important.

Every 6 months, an X-ray examination should be performed to check the condition of the root and the surrounding bone tissue, and to inspect whether secondary caries has developed at the prosthesis margin.

Oral hygiene management is also essential.

The space beneath the bridge must be carefully cleaned using dental floss or interdental brushes.

Through regular checkups and proper care, the preserved natural tooth can be maintained for a long time.

I hope this information was helpful to you, and I’ll end the post here.

This was Yeo Sang-ho, dentist at Mokgok Station Dental Clinic. Thank you for reading this long post.

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