Orthodontic Extrusion for the Rehabilitation of a Severely Compromised Tooth: A Clinical Case Report

The rehabilitation of teeth with severe structural compromise remains a major clinical challenge, especially in the anterior region, where esthetics and periodontal integrity are crucial. Achieving an adequate ferrule effect is essential for long-term restoration success. Orthodontic extrusion represents a conservative alternative to surgical crown lengthening, which may otherwise jeopardize gingival architecture. This case report presents the management of a 65-year-old male with a fractured maxillary canine (tooth 23) that had previously served as a bridge abutment. Radiographic evaluation revealed a fractured endodontic post and minimal remaining coronal structure. Given the favorable root length and bone support, slow orthodontic extrusion was selected over surgical crown lengthening to preserve esthetic harmony. Before extrusion, an adhesive fiber-reinforced biobase was built using polyethylene fiber (Ribbond ® ) and short fiber-reinforced composite resin (EverX ® , GC), following a biomimetic protocol. Orthodontic traction was applied with a closed elastic chain anchored to a passive wire supported by the adjacent provisional implant restoration. Orthodontic extrusion successfully re-established the ferrule effect while maintaining gingival symmetry. The adhesive fiber-reinforced restoration provided internal support without the need for an intra-radicular post, thereby preserving the weakened root. This case highlights how the combination of controlled orthodontic extrusion and biomimetic adhesive reinforcement offers a minimally invasive, functional, and esthetically predictable approach for the rehabilitation of structurally compromised teeth.