Restoring the "Unrestorable": Minimally Invasive Surgical Extrusion with the Benex Extraction System

Published August 3, 2026 by Deutsche Dental Technologien

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A standout clinical paper published in the British Dental Journal (BDJ) highlights exactly this: a minimally invasive surgical extrusion technique using the Benex extraction system.

The Challenge: Deep Subgingival Lesions and "Unrestorable" Teeth

Teeth with insufficient coronal structure due to deep caries, fractures, or resorption are often deemed non-restorable because restoration margins would violate the biologic width. Traditional options include:

• Surgical crown lengthening — Predictable but can lead to unfavorable gingival architecture and aesthetics.
• Orthodontic extrusion — Preserves tissue but is time-consuming, costly, and aesthetically challenging during treatment.
• Extraction and replacement — The most common route, but one that many clinicians (and patients) would prefer to avoid.

The BDJ paper, titled "Restoring the unrestorable! Developing coronal tooth tissue with a minimally invasive surgical extrusion technique", presents a compelling alternative.

The Solution: Benex Extraction System-Assisted Surgical Extrusion

Authors Thomas Dietrich and colleagues describe using the Benex extraction system (from Helmut Zepf Medizintechnik) for intra-alveolar transplantation — repositioning the root coronally in a single visit.

Key advantages of the Benex extraction system approach:

• Applies purely vertical forces via a self-tapping screw anchored in the root canal, avoiding socket expansion and minimizing trauma to the periodontal ligament (PDL) and alveolar bone.
• Enables gentle handling of the root (the screw acts as a convenient handle).
• Allows thorough inspection of the root outside the socket when needed (e.g., narrow roots, high forces, trauma cases).
• Facilitates immediate stabilization with splinting and subsequent restorative work.

The technique has become the method of choice in the authors' practices for many non-molar teeth that would otherwise be extracted.

Step-by-Step Clinical Procedure (Summary)

1. Caries removal — Assess remaining sound tooth structure and plan for adequate ferrule (ideally ≥2 mm supragingival).
2. Screw hole preparation — Similar to post-space prep; use Benex diamond-coated drills carefully to minimize tissue loss.
3. Screw insertion — Prefer sharp, new screws for extrusions to reduce fracture risk.
4. Support tray & extractor placement — Ensures ideal force vector and protects adjacent teeth.
5. Controlled extrusion — Gradual vertical pull until desired coronal position is achieved.
6. Repositioning & splinting — Secure with wedges and composite/wire splint; proceed with core build-up (often using the Benex-prepared canal for post retention) and final restoration.

The paper includes excellent clinical photos and radiographs showing before/after cases, including full ceramic crown outcomes at 12 months.

Benefits vs. Alternatives

• Faster and more predictable than orthodontics in many cases.
• Better aesthetics than crown lengthening in the anterior zone.
• Bone and soft tissue preservation — Ideal for future implant planning if needed.
• Lower risk of root resorption compared to conventional extraction methods due to reduced PDL trauma.

Limitations and considerations (as discussed in the paper):

• Not suitable for all teeth (e.g., molars, divergent roots, severe curvatures, or hypercementosis).
• Risk of procedural failure (reported ~14% in related extraction cohorts, potentially lower for selected extrusion cases).
• Requires proper case selection and familiarity with the Benex extraction system.

Why This Matters for Your Practice

This technique expands the possibilities for tooth preservation, aligning perfectly with modern conservative and minimally invasive dentistry. The Benex extraction system makes surgical extrusion reliable and practical where conventional methods fall short.

📄 Read the full open-access paper here: BDJ Clinical Paper – Benex Extraction System Surgical Extrusion

🛒 Shop the system: If you're already using the Benex extraction system or interested in incorporating it into your workflow, explore our range of Benex Extraction Systems and accessories — or browse all our collections for the full range of German-engineered dental instruments.

💬 Join the conversation: Have you tried surgical extrusion with the Benex extraction system? Share your experiences in the comments — we'd love to hear how this technique is making a difference in practices around the world!

📚 Keep learning: Stay tuned to our blog for more clinical insights and product highlights from the forefront of German dental innovation.

Related resources: Product Library · Helmut Zepf Literature · Busch Catalogs

Manufacturer literature: Benex catalog (PDF) · Benex Extraction System flyer (PDF) · Benex III flyer (PDF) — more in our Surgical Instrument Library.