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.
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″)