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Ankylosis. Part III: Treatment of Children with Permanent Ankylosis

As mentioned in parts I and II of the series of articles about ankylosis, several factors must be taken into account when choosing the appropriate treatment option for ankylosed tooth. When diagnosing ankylosis in a child, these factors are important to evaluate before treatment.

Factors include:

Is ankylosed tooth temporary or permanent
Patient age / ankylosis onset
Patient age at time of diagnosis
Patient gender
The location of the affected tooth
Smile type
A patient at the age of 15 turned to a dentist with an ankylosed tooth 1.1.

When she was 11 years old, there was a complete dislocation of the tooth 1.1. The tooth was outside the oral cavity for about an hour, after which it was re-implanted. The patient and her family wanted to improve aesthetics. As you can see in the photo, the cutting edge of the incisor and the gingival margin are located more apically compared to adjacent teeth.

Patient with tooth ankylosis
Probably, tooth ankylosis occurred at the age of 11 to 12 years
The patient is now 15 years old
Female patient
Before you understand what should be done, there are several questions that need to be answered:

How fast does resorption occur? As can be seen on the radiographs brought by the patient, the resorption process progresses very slowly.

Where is the smile line? The patient has a very low smile line and the free marginal gum is not visible.
At what stage of growth does resorption occur? The growth process in girls ends at the age of 17 years. Given that the patient is now 15 years old, the completion of the growth phase is expected.
Treatment options and problems associated with ankylosed tooth:
Treatment options:

Tooth extraction and subsequent implantation
Subluxation of teeth and orthodontic reduction
The use of segmental osteotomy for orthodontic tooth movement in the desired area
Preservation of a tooth in its current position and restoration of aesthetics
In case of tooth extraction, the patient will require augmentation of hard tissues. Also, the patient will need a temporary replacement of the tooth with any design until she is 17 years old to install the implant. The disadvantage of this treatment option for the patient and her family is that it will be a very difficult period in their life.

Subluxation of the tooth and subsequent orthodontic movement to the desired position will have limited success depending on the degree of ankylosis. This treatment option usually works best on teeth that have only partial or point ankylosis.

The use of segmental osteotomy to change the position of a tooth with ankylosis can be successful depending on the surgical approach, but can also be very problematic, since there is a possibility of segment necrosis.

And if you leave the ankylosed tooth in its current position and improve the aesthetics by correcting the incisal edge? Will this create more problems?

So we know that:

Replacement resorption is slow (therefore, the process can last another 5-10 years)
The patient is 15 years old and she is close to the completion of the growth phase (therefore, the defect caused by ankylosis should not increase markedly)
The patient has a low smile line (therefore, the gingival contour is not visible)

Although the tooth could be removed now for subsequent implantation, it was decided to save the tooth and restore part of the incisal edge with composite material.

The patient and her family knew that restoration was a temporary solution and that tooth extraction and implant placement would be required in the future. The moment when this happens depends on the degree of progression of resorption. In this patient, the tooth functioned for another 10 years before its removal was required.

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