Abstract
Statement of problem
Teeth deemed nonrestorable because of inadequate ferrule and extensive structural loss, often from deep caries, fractures, or resorptive defects, are routinely planned for extraction and implant placement. Long-term clinical outcome data for a standardized surgical extrusion workflow designed to regain restorability while maintaining biologic stability are limited.Purpose
The purpose of this clinical study was to assess clinical outcomes of surgical extrusion using the Seif surgical extrusion protocol (SSEP) as a tooth preservation alternative to extraction in severely compromised teeth initially considered nonrestorable, with a follow-up of up to 7 years.Material and methods
This retrospective single-operator cohort included 201 consecutive teeth (January 2019 to November 2025) managed with a standardized workflow (SSEP), including atraumatic axial-rotational mobilization, splinting with flowable composite resin, delayed endodontic treatment when indicated, and definitive restoration after soft tissue maturation. Follow-up was up to 7 years (range, 6 months to 7 years). The primary outcome was tooth survival (retention in function). Secondary outcomes were biologic complications, including clinically evident periodontal breakdown and clinical and radiographic evidence of periapical pathology, ankylosis, or replacement resorption assessed clinically and on available follow-up radiographs. Clinical success was defined as survival without clinically evident periodontal breakdown and without clinical radiographic evidence of periapical pathology, ankylosis, or replacement resorption.Results
At the most recent follow-up, 193 of 201 teeth were retained and functional (clinical success 96.02%; 95% CI, 92.3 to 98.0). All failures (n=8; 3.98%) occurred within the first year and were attributed to unfavorable crown-root ratio after overextrusion, root fracture in structurally compromised roots, early splint debonding with traumatic loading, or poor oral hygiene. No clinically or radiographically evident ankylosis was detected, and no radiographic findings consistent with replacement resorption were observed on follow-up radiographs when available.Conclusions
In a large consecutive series of severely compromised teeth initially considered nonrestorable and planned for extraction, surgical extrusion using the SSEP achieved high rates of retention in function with biologic stability during a follow-up of up to 7 years, supporting the protocol as a tooth preservation option that expands restorative decision-making.