Short Lectures

Friday - May 14, 2021; 12.30-13.00:

Saturday - May 15, 2021; 12.00-13.00:

Saturday - May 15, 2021; 14.30-15.00:

Saturday - May 15, 2021; 16.30-17.00:

Friday, May 15, 2021, 12.30-12.40

History of tooth transplantation in Czech republic

MUDr. Martin Starosta, Ph.D.
Associate Professor, Collegium Dentalis, Olomouc and First faculty of medicine, Charles University, Prague, Czech Republic

The idea of replacing diseased or missing tooth has been around for millennia. One of the treatment possibility is tooth transplantation. The basic studies about tooth transplantation or rather autotransplantation ,was done in the last decade of the 20th century by Andreasen and Paulsen. What was the evolution of tooth transplantation in Czech republic? We made a research in czech dental literature through articles published in specialized journals: Zubní lékařství, Československé stomatologie, Praktické zubní lélařství, Česká stomatologie, Ortodoncie, LKS. The final results and conclusion will be discused in this lecture.

Friday, May 15, 2021, 12.40-12.50

Tooth autotransplantation tenting graft method for alveolar ridge augmentation: innovative technique and case series

Dr. Eduardo Yugo Suzuki, Dr. Thongnard Kumchai, Dr. Boonsiva Suzuki
Department of Orthodontics, Faculty of Dentistry, Bangkokthonburi University, Thailand

AIMS: The periodontal ligament (PDL) has the unique ability to perform osteoinduction. Moreover, this property can be significantly enhanced by the pre-application of orthodontic loading. The purpose of this study was to evaluate the effectiveness of using pre-loaded tooth autotransplantation (TAT) in combination with particulate bovine-derived xenograft and concentrated growth factors (CGF) membrane, in a “tenting” fashion, to augment severely atrophic alveolar ridge defects. The new augmented ridges are used for both TAT and orthodontic tooth movement.

MATERIALS: This prospective case study evaluated augmentation in five consecutive patients with severely resorbed alveolar ridges. Before augmentation, all alveolar sites were considered inadequate for TAT or orthodontic tooth movement. Horizontal ridge augmentation was performed using pre-loaded TAT to tent out the soft tissue matrix and periosteum for the adjacent particulate xenograft and CGF membrane. The ridges were evaluated using CBCT images at pre- and 3 months post-operative.

RESULTS: Successful alveolar ridge augmentation with adequate horizontal width for TAT and orthodontic tooth movement was obtained. Augmented ridges became a recipient site for TAT and orthodontic tooth movement. Linear analysis of the width and volume of the recipient area at different time points revealed a final average increase in width was 5.9 ± 2.2 mm and a volume gain of 8.5 ± 3.2 mm3. All augmented ridges had retained their functional and esthetic integrity at 1 year after original augmentation.

CONCLUSIONS: Alveolar ridge augmentation using the tenting of the periosteum and soft tissue matrix using pre-loaded TAT maintains space and minimizes resorption of the particulate xenograft volume. This innovative technique offers a predictable functional and aesthetic reconstruction of localized defects without extensive amounts of autogenous bone.

Friday, May 15, 2021, 12.50-13.00

The ways of 3D templates customization for bed preparation in the teeth autotransplantation

Dr. Kristina Badalyan1, Dr. Denis Parinov2, Dr. Alena Zengedinze2, Dr. Alina Martirosova2
1 I.M. Sechenov First Moscow State Medical University (Sechenov University)
2 Central Scientific Reseach Institute if Dentistry

Autotransplantation of teeth is becoming more common practice in dental activity performed by dentists all around the world. The given method allows us to achieve long-term quality results and aesthetics. However, one of the main problems with the given method are the extreme demands for the manual skills of the person who is performing it, as well as, the timing. Another factor to consider is the mismatch of the anatomy of the donor tooth and the receiving bed. The key to success of this treatment is the maximum survival of cells of periodontal connection of tooth's root, which should be provided by the doctor’s fast work and minimisation of time that the tooth is present in the hole and reaching contact between bone walls accepted by bed and donor tooth. One of the solutions for the main problems that arise in auto transplantation of teeth is new high tech digital dental technology: 3D modelling and printing. With the help of creation of 3D-printed replicas, it is possible to formulate the anatomy of the accepting lodge for ensuring the greatest contact with the roots of the donor tooth. The model of the tooth is created on the basis of CBCT data in a program for digital three-dimensional modelling, printed and used during the operation. Second possibility that is use of piezosurgical devices as an instruments for the correction of the shape of the accepting bed, that allows you to reach your goal in the most non-painful and effective way. Through the use of three-dimensional modelling it is also possible to create individual nozzles for piezosurgical tips for transplanted tooth. After three-dimensional modeling, the nozzle is cast in a dental laboratory, and is used for the formation of the hole, which allows you to save even more operation time and to provide the highest accuracy and the area of fit of the periodontal ligament of the tooth, as well as its stability in the bed.

Saturday, May 15, 2021, 12.00-12.10

Adamantine Tissue Autograft an alternative rehabilitation treatment for tooth transplantation

Dr. Alberto Teramoto Ohara
Clinical Professor Department of Orthodontics, Universidad Tecnológica de México & Universidad Latinoamericana, Mexico City, Mexico.

In almost all transplantation cases, after surgical procedure the crown of the teeth need to be reshaped to provide function and esthetics into its new arch position. The traditional way to get it is with either composite resin or porcelain laminate veneer, however those materials do not possess the ideal natural properties of a dental tissue, for this purpose the most achievable biocompatible material for replacement this dental structure must be the same natural enamel tissue.

Saturday, May 15, 2021, 12.10-12.20

Smart Springs: A simple method to upright impacted mandibular third molars

Dr. Boonsiva Suzuki, Dr. Eduardo Yugo Suzuki
Department of Orthodontics, Faculty of Dentistry, Bangkokthonburi University, Thailand

AIMS: Mandibular third molars are the most suitable donors for replacing a missing tooth by means of tooth autotranplantation (TAT). However, since they are routinely encountered impacted, they are difficult to retrieve and, therefore, unsuitable as donor teeth. This study introduces the development of Smart Springs to allow the controlled uprighting of impacted mandibular third molars (iM8s), therefore allowing their simple extraction.

PATIENTS AND METHODS: Sixty patients were enrolled and divided into three groups. In the miniscrew implant (MI8) group (n = 20), Smart Springs were anchored to miniscrews to apply uprighting forces to the iM8s. In the minimally invasive braces (MIB) group (n = 20), patients had the iM8s uprighted with aid of a reinforced MIB. In the control group (n = 20) iM8s were removed by traditional methods. Panoramic radiographs were recorded at the beginning (T0) and by the end of the iM8 uprighting (T1). Treatment duration for uprighting iM8s and total surgical time to extract the iM8s were recorded. Measurements of iM8 displacement and inclination were performed using custom-made software (Smart’n Ceph).

RESULTS: All teeth were uprighted successfully. An average of 8 ± 2.5 weeks was necessary to upright the iM8s. The application of orthodontic force was significantly shorter in the MI8 group (6 weeks) than in the MIB group (8 weeks). No significant difference in the extraction duration between the MIB (1.4 ± 4.1 minutes) and MI8 (2.2 ± 2.1 minutes) groups was observed. No postoperative pain or discomfort was observed. In contrast, in the control group (28.4 ± 10.5 minutes) patients had experienced varying degrees of facial swelling,postoperative pain and trismus. The symptoms persisted for two to eight weeks.

CONCLUSIONS: Smart Springs anchored to either MI or MIB can minimize trauma to the iM8 thus allowing atraumatic extraction with benefits for TAT.

Saturday, May 15, 2021, 12.20-12.30

Enhanced periodontal ligament following orthodontic tooth movement

Dr. Pattarin Promchaiwattana, Dr. Boonsiva Suzuki, Dr. Eduardo Yugo Suzuki, Dr. Suttichai Krisanaprakornkit
Department of Orthodontics, Faculty of Dentistry, Bangkokthonburi University, Thailand; Center of Excellence in Oral and Maxillofacial Biology, Faculty of Dentistry, Chiang Mai University, Thailand

AIM: Mandibular third molars are frequently-used donor teeth for autotransplantation (TAT), however, they usually present in impacted positions, making them unsuitable for TAT. Applying orthodontic force to donor tooth before TAT leads to increased periodontal ligament (PDL) width, simplified extraction, and reduced risk of root resorption after TAT. This study aimed to examine amounts of PDL tissue on root surfaces of extracted third molars after applying an uprighting force, and to examine amounts of PDL attachment at tension and compression sites after uprighting.

SUBJECT: Fifteen mesio-angulated mandibular third molars from 15 patients, planned for orthodontic extraction, were uprighted using springs connected to miniscrews, while 15 non-opposing and fully erupted mandibular third molars from the other 15 patients, received no force application, served as controls.

METHODS: Altered angulation of uprighted teeth was assessed from panoramic radiographs. They were uprighted to an angulation, which enabled a simple extraction. All 30 molars were stained with toluidine blue to determine percentages of stained PDL on the root surfaces. The percentages of overall stained PDL areas, on three portions (cervical, middle, apical), and on four surfaces (buccal, lingual, mesial, distal) were compared between uprighted and control teeth.

RESULTS: The mean percentage of stained PDL on the loaded teeth was greater than that on the unloaded teeth (p<0.05). The mean percentages of stained PDL were significantly increased at cervical and middle thirds, and buccal, mesial and distal surfaces of the loaded teeth compared to those of the unloaded teeth, whereas the apical third and lingual surface, corresponding to the compression sites, showed no significant increase.
Conclusions: Orthodontic tooth movement results in the PDL enhancement on all radicular surfaces. The application of orthodontic force before tooth extraction may be beneficial for increasing the success rates of TAT.

Saturday, May 15, 2021, 12.30-12.45

The use of CBCT guidance for tooth autotransplantation in children – Part I: 3D planning in the artificial intelligence era, 3D printing and 3D patterns of healing

Dr. Mostafa EzEldeen1,2, Dr. Jan Wyatt2, Dr. Pierre Lahoud1, prof. Dr. Maria Cadenas de Llano-Pérula3,prof. Dr. Reinhilde Jacobs1,4
1 OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery
2 Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Leuven
3 Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
4 Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden

INTRODUCTION: Tooth autotransplantation (TAT) offers a viable biological approach to tooth replacement in children. To enhance the outcome predictability of the TAT procedure, a cone-beam computed tomographic (CBCT)- guided surgical planning and transfer technique has been developer.

OBJECTIVES: To optimize the CBCT scanning protocol to achieve a dose as low as possible and to maintain sufficient image quality specific for tooth autotransplantation planning and follow-up, to develop a tooth segmentation tool based on convolutional neural networks (artificial intelligence), to evaluate the 3D patterns of healing after transplantation.

METHODS: A general linear mixed model was fit to combine image quality parameters and radiation effective dose (ED) from 18 different exposure protocols in order to rank and compare all the protocols examined in the study. Pre and post-operative CBCT images (n= 44, follow-up period = 1-10 years) were analyzed using a novel method analyzing 3D hard tissue change of transplanted teeth then subjected to principal component analysis (PCA) and cluster analysis.

RESULTS AND CONCLUSION: The ED for the pre-operative scan can be reduced to the range of 74.6-157.9 µSv. ED for the post-operative scan can be reduced to the range of 24.2-41.5 µSv. The following measurements were extracted from the 3D analysis: root hard tissue volume (RV), root length (RL), apical foramen area (AFA), and mean and maximum dentin wall thickness (DWT). PCA identified the mean DWT, RV, and maximum DWT as the parameters best describing tissue change after TAT. Cluster analysis applied to the variables chosen by the PCA classified the CBCT group into 4 distinct clusters revealing different patterns of post-TAT tissue healing. A considerable reduction in the pediatric effective dose can be achieved while maintaining sufficient image quality for tooth auto-transplantation planning and follow-up using elaborated dose optimization protocols.

Saturday, May 15, 2021, 12.30-12.45

The use of CBCT guidance for tooth autotransplantation in children– Part II: Surgical technique, follow-up, short and long-term treatment outcome

Dr. Jan Wyatt1, Dr. Mostafa EzEldeen1,2, prof. Dr. Maria Cadenas de Llano-Pérula1, prof. Dr. Reinhilde Jacobs2,3
1Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Leuven
2OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology KU Leuven and Oral and Maxillofacial Surgery
3Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden

INTRODUCTION: Tooth autotransplantation (TAT) offers a viable biological approach to tooth replacement in children. To enhance the outcome predictability of the TAT procedure, a cone-beam computed tomographic (CBCT)-guided surgical planning and transfer technique has been developed.

OBJECTIVES: To evaluate the outcome of CBCT-guided autotransplantation technique. To compare the outcome of CBCT-guided surgical planning and transfer technique for tooth autotransplantation versus conventional autotransplantation.

METHODS: Total of 65 pediatric patients received CBCT-guided TAT in the period between 2007-2019. A controlled prospective clinical trial design was followed including a total of 88 subjects in whom 100 teeth were included following. The study group (n= 44, mean age 10.7 ± 1.1 years) underwent CBCT imaging for surgical planning and transfer via stereolithographic tooth replica fabrication, the historical control group (n= 44, mean age 10.6 ± 1.3 years) was subjected to conventional autotransplantation.

RESULTS AND CONCLUSION: Overall survival rate for the CBCT-guided TAT was 92% and success rate was 86% compared to an 84% survival rate and a 78% success rate for the conventional group. Differences between both groups were not statistically significant (P > 0.05). The PDL and pulp-healing rates for the CBCT group were 86% and 92%, respectively, compared to 82% and 88% for the conventional group. Differences between both groups were not statistically significant (P > 0.05). The use of the tooth replica reduced the number of repeated attempts of repositioning the donor tooth to 0 to 3 attempts for the CBCT group compared to 4 to 7 attempts for the conventional group. TAT is a viable option for permanent tooth replacement in children and adolescents. The CBCT-guided approach simplified the surgery and increased the predictability of the treatment.

Saturday, May 15, 2021, 12.45-12.55

Use of Computer-aided planning and rapid prototyping in autotransplatation of teeth in children

Dr. Deise Cunha1, Dr. Renata Pittella Cancado, Ph.D.2, Dr. Marcos Flavio Ambrosio2, Dr. Marco Masioli, Ph.D.2, Dr. Ana Dilza Viana Barroso2
1 Brasileira de Odontologia- ES

INTRODUCTION: Autotransplantation of immature teeth has good survival rates, and has benefits over osseointegrated implants in the growing child, but is very technique sensitive.

PURPOSE: This study has the goal to describe the advantages in planning and execution of autotransplanted teeth with the use of Cone-bean tomography, computer-aided planning and rapid prototyping of the donor teeth, surgical splint and post-operative dental protection plate.

METHODS: In young children with the loss of anterior superior teeth an orthodontic treatment was accomplished with the intend to prepare the receptor site. All this children had immature premolars that could be selected as the donor teeth. After that a Cone-bean tomography and an intra-oral scanning was done to produce a Dicon and a STL archive. These two archives were combined with the VistaDent 3D Pro 2.1 software. With this material a web conference was set via Skype with the orthodontist, the oral and maxillofacial surgeon and the technician of the prototyping company where the virtual planning were done. At this moment the donor teeth was select and the template of this teeth was prototyped along with the surgical splint. These two gadgets were used to more accurately prepare the donor site and to reduce the time between the removal of the premolar selected and its implantation. This surgical splint also was able to avoid post surgical occlusal trauma though the correct planned position of the teeth. All this advantages were able to reduce surgical time. Besides that an post operative dental protection plate was made and installed. This acetate plate was made after a post operative intra oral scanning.

FINAL CONSIDERATION: This accurate virtually predesigned surgical templates could improve the prognosis of the autotranplantation in the future by full implementation of recommended guidelines, ensuring an atraumatic surgical protocol.

Saturday, May 15, 2021, 14.30-14.40

Autotransplantation and complications: case presentations

Dr. Manuela Daian1, Dr. Michalis Pantaleon1, Dr. Anna Louropoulou2, Anastasios Pantaleon3
1 Orthodontie Oud-Beijerland
2 ParoRotterdam
3 Danube Private University

During the years, autotrasplantation has proved to be a reliable treatment method. The possibility of treating young patients with the help of autotransplantation has a major advantage: the autotransplanted tooth promotes bone formation and can be used in growing patients. In the past years, autotransplantation has been widely performed, and many publications have reported that the survival rate of transplanted teeth may be as high as 90% (Andreasen JO, Paulsen HU, Schwartz O). However, some undesirable complications, such as root resorption or dentoalveolar ankylosis, still exist. Many factors influence the result, such as: the developmental stage of the tooth, donor type, adequacy of bone support at the recipient site, the duration of extraoral exposure of the donor tooth during surgery, damage to the root cementum and the periodontal ligament, and the experience of the oral surgeon (Schwartz, O, Ahlberg, K.) The results of Yusuke Suzakia et al also showed that the increase of root resorption coincided with the disruption of the PDL attached to the root after extraction. The larger the exposed root surface was, the more extensively the root resorption or dentoalveolar ankylosis might occur (Andreasen JO, Lindskog S et al). In addition, cementoblasts are involved in the regeneration of resorbed tooth substances. Thus, the extraction of teeth with a thinner PDL may also injure the cementoblasts, which results in the inhibition of repair of the root after replantation (Sasaki T et al). Our clinical experience has showed that after autotransplantation careful monitoring of the pulp and PDL healing is very important. However, in some cases, the patients experienced a transitory ankylosis and in some cases the teeth failed to respond to the orthodontic forces, thus an alternative treatment plan had to be followed.

Saturday, May 15, 2021, 14.40-14.50

Autotransplantations of impacted teeth,indications and treatment limits

MUDr. Karin Klimo Kaňovská1, doc. MUDr. Pavlína Černochová, Ph.D.2, Bc. Miroslava Fuchsová3
1 Department of Oral surgery, Dental Clinic,Faculty of Medicine,Masaryk University, Brno, Czech Republic
2 Department of Orthodontics, Dental Clinic,Faculty of Medicine,Masaryk University, Brno, Czech Republic
3 Faculty of Medicine, Masaryk University, Brno, Czech Republic

Impaction of the teeth is one of the most common diagnoses we deal within orthodontics and orthodontical surgery.In most cases we use the method of surgical exposure but if is indicated one of methods,that can be used is a method of autotransplantation.We can use it in the situations of anomally placed impacted canines,where is not possible to do succesfully exposure to subsequent inclusion in the dental arch. In these cases we have been using for more than 15 years for the succesfull autotransplantation a biomodel,that is created based on the parameters obtained from CT analysis. The biomodel is made of sterilizable resin and helps us to create an artificial dental socket without damage of periodontal ligaments of the autotransplant. This method significantly reduces the risk of complications,espacially ankylosis.In rhe case of unfinished development of the root of the transplanted tooth,its endodontic treatment is even not necessary. Authors on several occasions show indications and contraindications of this method and results within the period of more than 15 years.

Saturday, May 15, 2021, 14.50-15.00

Success criteria and methods for evaluating the success of autotransplanted teeth

Fernanda Nunes, MSc.1, Dr. Joao BG Intra, Ph.D.1, Dr. Marcos Frozoni, Ph.D.2, Armelindo Roldi1, Natalia Coutinho1
1 Brazilian Association of Dentistry
2 Faculdade Sao Leopoldo Mandic

OBJECTIVE: to discuss the ideal criteria and methods to evaluate the success rate of autotransplanted teeth for the anterior region of the maxilla

MATERIAL and METHODS: a retrospective study carried out in 33 patients, who had 44 teeth autotransplanted to the anterior region of the maxilla. Patients were evaluated through medical records, clinical and radiographic examination, according to the following success criteria: absence of pain (spontaneous and provoked), absence of severe periodontitis, absence of periapicopathy, absence of internal and external resorption, absence of ankylosis, and root development.

RESULTS: 44 teeth were autotransplanted, being 12 upper premolars, 31 lower premolars and 1 canine. Most were transplanted to replace upper central incisor teeth lost by trauma, and 1 replaced the lateral incisor due to agenesis. The follow-up period ranged from 6 months to 25 years. The age of patients at the time of surgery ranged from 7 to 15 years. The success rate obtained was 79.6%. One tooth was lost and 43 teeth were present, some with signs of failure. In the analysis of medical records, some computed tomography scans were present, helped in the diagnosis of failure.

CONCLUSION: Tooth autotransplantation is a viable treatment for replacing anterior teeth in young patients. The success criteria for tooth autotransplantation should be discussed and standardized by the scientific community. The computed tomography exam must be inserted in the methodology of success assessment.

Saturday, May 15, 2021, 16.30-16.40

A Clinical research of surgical uprighting for impacted lower second molar

Yusuke Matsuzawa, DDS.,Ph.D., Tetsuro Yamashita, DDS., Ph.D.
Department of Oral and Maxillofacial Surgery, Keiyukai Sapporo Hospital

PURPOSE: Surgical uprighting is one of the treatment options for impacted lower second molars. However, although there are several case reports. We conducted this study to understand the actual situation of surgical uprighting and to clarify the treatment results.

MATERIALS AND METHODS: We surveyed patient’s outline and treatment result for cases which performed surgical uprighting at Hokkaido University Hospital and Keiyukai Sapporo Hospital from 2011 to 2018. For the cases of Hokkaido University Hospital, we evaluated with X-ray picture. The inclination angle of the tooth axis before and after operation on the orthopantomogram was measured. And the improvement rate of inclination angle were calculate.

RESULTS :The subjects were 22 cases and 27 teeth. The age at operation was 12 years and 3 months to 19 years and 11 months. The case that performed two times of surgical uprighting was six. The stage of root development according to the Moorrees’s classification at the time of operation was 9 teeth in stage 5, 11 teeth in stage 6, and 7 teeth in stage 7. The impacted state was 21 teeth with mesial inclination, 2 teeth with lingual inclination, and 4 teeth with infraocclusion. Two cases were devitalized after operation. The X-ray evaluation was performed in 14 teeth in 12 cases. The preoperative inclination angle was 31 to 80° (average 52.1°), the postoperative inclination angle was 1 to 56° (average 36.3°), and the improvement rate was 12.1 to 96.8% (average 44%).

DISCUSSION: Surgical uprighting is short treatment duration and has the advantage of being able to cope with cases in which orthodontic uprighting is difficult, but also has drawbacks such as the need for surgery and the possibility of devitallization. In this study, two cases were devitallized, and a quarter of the cases required twice operations, but generally good results were obtained.

Saturday, May 15, 2021, 16.40-16.50

Autotransplantation into the atrophied alveolar process of the distal segment of the mandible

MDDr. Michal Novosad1, MUDr. Ivo Marek, Ph.D.1,2, MDDr. Lenka Ježková1
1 Stomatologic centre Břeclav, Czech Republic 2 Department of Orthodontics, Palacký University, Olomouc, Czech Republic

The autotransplantation of a tooth into an atrophied alveolar process presents many difficulties. Success requires a suitable indication, as well as correct surgical protocol, including careful follow up. To avoid possible complications of the surgical procedure, it is necessary to respect the morphology of the root and the anatomy of the locus into which the tooth is to be transplanted. In patients whose lower dental arches are shortened due to tooth extraction, the change caused by atrophy is particularly prominent; and the same applies to changes in the soft tissues, with attached gingiva disappearing. Horizontal atrophy of the alveolar process is often accompanied by vertical bone loss. When the bone on offer is so limited, surgery and the subsequent fixation of the tooth is more difficult. However, using the correct surgical procedure, it is possible to perform autotransplantation even into an atrophied alveolar process, thus avoiding implantation and augmentation. Using several examples, the authors demonstrate the indications, the step-by-step surgical procedures, and the difficulties involved in transplanting a tooth into a shortened lower dental arch.

Saturday, May 15, 2021, 16.50-17.00

Intra-alveolar transplantation : surgical extrusion

MUDr. Ladislav Gregor, Dr.Med.Dent., Ph.D.
Dentální klinika Sorriso, Brno, Czech Republic

Surgical extrusion should be considered as a treatment option when thinking about restorability of teeth that have insufficient coronal tooth structure remaining due to deep caries, resorption or traumatic injury.We would like to describe our approach to the surgical extrusion including also the prosthodontic management in detail and discuss the advantages and disadvantages compared to alternative approaches, including surgical crown lenghtening and orthodontic extrusion.

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