Ankylosis. Part II: Treatment of adults with tooth ankylosis
It is known that the root of an ankylosed tooth usually undergoes resorption and subsequent replacement with bone tissue. In addition, if ankylosis occurs before the growth and development of the jaw is complete, a defect in hard / soft tissue will be present in the area of the affected tooth.
However, if tooth ankylosis has formed after growth is complete, this may not affect the position of hard and soft tissues.
Clinical case 1. The patient is over fifty years old, her tooth is ankylosed 2.1. Given the position of the marginal gum and the incisal edge of the tooth compared to other teeth in the arch, it is obvious that it became ankylosed shortly before the completion of the growth of the jaw.
Clinical case 2. A patient at the age of 30 years has 2.1 ankylosis of the tooth, but the gingival margin is at the same level as the central incisor next to it. This indicates that ankylosis formed after completion of the growth of the jaw. (Figure 2)
When planning treatment of an ankylosed tooth in an adult, it should be borne in mind that such a tooth does not need to be removed just because it is ankylosed. If you understand, tooth ankylosis is not so different from an osteointegrated implant. The decision on whether to save or remove the ankylosed tooth and the possibility of restoration will depend on the aesthetics of the defect in hard and soft tissues, as well as the rate at which resorption occurs in the area of the ankylosed tooth.
If the chosen treatment is to preserve the tooth with ankylosis, there are several options:
· Tooth restoration and preservation of its current position;
· Subluxation of the tooth and orthodontic reduction;
· Movement of ankylosed tooth using segmental osteotomy.
If the patient has a low smile line — or the position of the gingival margin is correct — and the rate of resorption is slow, preserving and restoring the ankylosed tooth in its current position is a simple way to improve aesthetics. However, with this type of treatment, the prognosis of the tooth is unknown. Since the progression of resorption can reach such an extent that the only treatment option is to remove it.
In the area of ankylosed tooth 2.1 there is a migration of the gingival margin, however, the effect on the overall aesthetics is insignificant due to the patient’s low smile.
Given that resorption was slow – tooth ankylosis formed before the growth of the jaw – and the patient is now about 50 years old, the treatment plan was to simply restore the edges of incisors 1.1, 2.1, 2.2 with composite material. Composite restorations were made approximately 10 years before resorption reached a level requiring tooth extraction 2.1.
If ankylosed tooth is an aesthetic problem, resorption progresses, tooth extraction is recommended. Depending on how the subsequent replacement of the defect will be carried out: with a single implant or partial denture, the area of the extracted tooth will need to be corrected by increasing the volume of hard or soft tissues.