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
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
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).
2. 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).

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4. Molar intrusion can be achieved successfully Nine steps of Coronoplasty:

with orthodontic TADS (Temporary Anchorage 1. Remove retrusive pre-maturities and eliminate
Devices) re-establishing a functional posterior the deflective shift from Retruded Cuspal
occlusion & reducing the need for prosthetic Position (RCP) to Inter Cuspal Position (ICP)
crown reduction (6). 2. Adjust ICP to achieve stable, simultaneous,
5. Orthognathic surgical procedures. A Posterior multi-pointed, widely distributed contacts.
Segmental Osteotomy can be effective in 3. Test for excessive contacts (fremitus) on the
correcting the problem. If it is a dento-alveolar incisor teeth.
extrusion (7). 4. Remove posterior protrusive supra contacts and
6. Extraction of the tooth, in case of the alveolar establish contacts that are bilaterally distributed
bone support is lost, i.e. in cases of furcation on the anterior teeth.
involvement. 5. Remove or lessen mediotrusive (balancing)
interferences.
Coronoplasty (Enameloplasty): Correction of the
6. Reduce excessive cusp steepness on the
occlusal supra contacts are by; a) Grooving
laterotrusion (working) contacts.
correcting the grooves and fissures, b) Spherodizing-
7. Eliminate gross occlusal disharmonies.
restores the bucculingual width of the occlusal
8. Recheck tooth contact relationships.
surface to normal dimension. c) Pointing- restores the
9. Polish all rough surfaces(8).
cusp point contours (8). In Coronoplasty elimination
Molar Intrusion by Orthodontic Treatment:
of deflective occlusal contacts through selective
Orthodontic Temporary Anchorage Devices
reshaping of the occlusal surfaces of teeth, which
(TADS) provide a minimally invasive treatment
result in more favorable distribution of occlusal
alternative, one that does not require the patients
forces.
compliance, for molar intrusion.

Objective of occlusal treatment are; True molar intrusion can be achieved

1. To direct the occlusal forces along the long axis successfully with orthodontic TADs (Titanium-Alloy

of the teeth. Mini Screw, ranging from 6 to 12 millimeters in

2. To attain simultaneous contact of all teeth in length and 1.2 to 2 mm in diameter, that is fixed to
centric relation. bone temporarily to enhance orthodontic anchorage),

3. To eliminate any occlusal contact on inclined re-establishing a functional posterior occlusion and

planes to enhance the positional stability of reducing the need for prosthetic crown reduction.

the teeth. TADs should be inserted into a region with

4. To have centric relation coincide with the high bone density and thin keratinized tissue. The

maximum inter-cuspation position. location chosen should be the optimal one in terms of

5. To arrive at the occlusal scheme selected for the both the patients safety and biomechanical tooth

patient (9). 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
orthodontically, by other methods, such as (10) anchorage device (TAD) orthodontically. The scope
Inter-maxillary device of orthodontics is expanding. TADs have allowed the
Sectional mechanics orthodontist to overcome anchorage limitations and
Removable appliance perform difficult tooth movements predictably and

Trans-palatal bar with minimal patient compliance.

Anchorage from mini-plates

Affiliations of Authors: 1. Dr. Sudhindra Mahoorkar,
Mini-screws (TADS) MDS, Professor and Head of the Department, 2. Dr.
Magnets Shivakumar.N.Puranik, MDS, 3. Dr. Arvind Moldi, MDS,
Orthognathic Surgical Procedure: Posterior 4.Ramesh Chowdhary, MDS, 5. Dr. Baswakumar Majge,

Segmental Osteotomy: This is a simple but strict MDS, Department of Prosthodontics, S.Nijalingappa

technique, without which one can achieve a good Institute of Dental Sciences & Research (SNDC), Sedam
Road, Gulbarga, Karnataka, India.
surgical outcome but a poor final occlusion. Some
distortions can occur at any stage of surgery. Thus,
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Address of Corresponding Author
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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