Abstract
OBJECTIVE: The restoration of teeth with deep subgingival fractures poses a significant challenge, often requiring extensive interventions such as orthodontic extrusion or implant therapy. This manuscript aims to introduce and describe the substance-gain extrusion technique (SGET) as a minimally invasive alternative that enables the preservation of natural dentition while optimizing biological and esthetic outcomes. By combining SGET with the biologically oriented preparation technique (BOPT), this approach seeks to address both functional and soft tissue stability concerns, providing a predictable restorative solution. CLINICAL CONSIDERATIONS: A 66-year-old patient presented with a failed anterior bridge and required a treatment approach that minimized surgical interventions due to pre-existing medical conditions. Tooth 11 was extracted and replaced with an immediate implant, while tooth 21 was managed with SGET with the Benex system to achieve controlled coronal extrusion. Following stabilization, a fiber post and composite core were placed, and the tooth was prepared according to BOPT principles before final restoration with a zirconia crown. The contralateral incisor was rehabilitated with an implant-supported crown. Clinical and radiographic evaluations at 6 months demonstrated successful preservation of the natural tooth with favorable esthetic and functional outcomes. Radiographs confirmed stable marginal bone levels, and the final photographs showed excellent soft tissue integration and patient satisfaction. CONCLUSIONS: The combination of SGET and BOPT provides a minimally invasive, cost-effective, and time-efficient alternative to implant therapy in cases involving significant tooth structure loss. Although long-term clinical data remain limited, this approach shows promise in preserving natural dentition, enhancing soft tissue stability, and achieving predictable esthetic results.