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Ankylosis in Young Patients

Highlights

In this CDA Oasis Conversation, Dr. Isabel Mello speaks about ankylosis in young patients and the treatment options that exist, including the decoronation technique.

Ankylosis usually occurs after trauma injures a tooth, such as avulsion. Oftentimes, the tooth would experience a long extra-oral drying period that leads to the death of the periodontal ligament cells.

To diagnose ankylosis, a good dental history should be taken. The history is usually indicative of trauma to the area. However, other signs include: tooth discolouration, non-vital tooth, previous endodontic treatment, no mobility as well as a high-pitched percussion sound. Radiographs may show areas with and without the PDL space.

Treatment option

In adults with ankylosed teeth, regular monitoring is important. If replacement resorption takes place, the tooth should be extracted. 

In young patients, extraction is not favoured, as bone resorption will take place and limit options for restoring the area as the patient grows. If the tooth is left in place, the bone continues to grow as the patient grows which leads to infra-occlusion which is also less esthetically appealing.

Decoronation is another treatment option when there is 1 mm or more of infra-occlusion. Here, the crown of the ankylosed tooth is removed along with any endodontic filling material that may be present. The root of the tooth is left in place and replacement resorption takes place and new bone is laid down.

In the future, once the patient is old enough to have a fixed prosthesis or implant, treatment via decoronation proves to be an advantage.  Most times, additional bone grafts are not required as adequate bone was preserved in the previously ankylosed tooth’s site.

Full Interview (7.53″)

 

 

2 comments

  1. Removing the crown is many times NOT the best treatment in a growing child. That is why as Pediatric Dentists we can use composites to temporarily restore the aesthetics until further treatment can be done as they get older. We see and treat this condition quite regularly in growing children and follow them for many years.

  2. Hello, great little discussion but just a minor clarification as the terminology could be more accurate. The term is Intentional Coronectomy (not decoronation as happened to poor King Edward VIII) and from a surgical point of view it is a treatment of last choice. Simply labeling a tooth ankylosed is also not helpful in diagnostic accuracy. If a tooth is submerged or unerupted the reasons are many including ankylosis secondary to trauma, impaction due to physical obstruction or even primary failure of eruption secondary to genetic parathyroid abnormalities.
    Recommendation is either attempted forced orthodontic eruption or complete extraction. In either case the space left behind needs to be addressed with a space maintainer or retainer as the adjacent teeth will tip into the edentulous space. Leaving the roots in the hope that less of a bone graft is needed later in life is problematic. We recommend extraction of the entire tooth and some bony preservation with possible re grafting at maturity. Intentional Coronectomies do have a placed but we recommend that they be reserved when damage to local anatomic structures may create a greater risk of complications (ie IAN proximity)

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