Orthodontic Extrusion Of Subgingivally Fractured Tooth Using Mini-Tube Appliance

Subgingival fractures compromise the biologic width and complicate restorative treatment. In such cases, orthodontic extrusion can effectively expose the margin supragingivally, facilitating definitive restoration. A 23-year-old female presented with a chief complaint of a fractured tooth. Emergency access opening had been performed the previous day. Clinical and radiographic examinations revealed a complicated crown-root fracture of the maxillary left second premolar, with 0.5 mm buccal sub-crestal fracture. The treatment plan included orthodontic extrusion, followed by root canal treatment and crown restoration. A flexible resin wire splint (RWS) was maintained for four weeks due to alveolar bone fracture. After RWS removal, gingivectomy and temporary core build-up were performed. A Mini-Tube Appliance (MTA; HUBIT) with 0.12 Ni-Ti MTA wire was placed on #22-27, with a palatal fixed retainer on #26-27 to prevent adjacent tooth movement. Weekly monitoring and supracrestal fiberotomy were performed. A total extrusion of 3.5 mm was achieved. Following extrusion, root canal treatment was completed under rubber dam isolation, followed by fiber post and resin core restoration. A ceramic crown (MAZIC Duro, Vericom) and palatal retainer were placed. At 6-month follow-up, the patient reported no discomfort and the tooth remained stable without relapse. The MTA provides a predictable and esthetically favorable method for achieving rapid, stable extrusion. To minimize relapse and prevent coronal migration of gingival attachment, supracrestal fiberotomy is recommended during extrusion. Orthodontic extrusion using the MTA offers a predictable approach to managing subgingival fractures.