Methods: Proper root canal treament was carried out. The patient and his parents wished for an esthetic, metal-free restoration of the lost tooth structure. The main part of the left incisor was perserved, but the crack on the right incisor extended about 3 mm subgingivally. Therefore, in the first phase the right central incisor was extruded using rapid orthodontic extrusion until all tooth margins layed supragingivally. The tooth was splinted for 2 months as a retention phase. Afterwards perodontal plastic surgery was performed to correct the discrepancy of the gingival margin which occured as a consequence of forced eruption. FRC Postec Plus posts (Ivoclar Vivadent) were used to stabilize the restorations and a provisional crown was placed to stabilize the soft tissue. After 2 months the teeth were definitely restored. The left incisor was built up directly using composite material (IPS Empress Direct, Ivoclar Vivadent), while the right, extruded incisor was built up with a core material followed by the placement of an all-ceramic crown (IPS Empress II, Ivoclar Vivadent).
Results: After orthodontic extrusion and the surgical recontouring of the altered gingival margin the precondition for an esthetic rehabilitation was created. By applying two different restoration methods – the direct with a composite material, and the indirect using an all-ceramic crown – an esthetic outcome was achieved.
Conclusion: Rapid orthodontic extrusion as a simple, safe, and fast technique to reestablish biological width. It is possible to combine direct and indirect restoration modalities to achieve pleasant results.