Ankylosis. Part IV: Using Deconorization
As a rule, when choosing a method for treating permanent ankylosed teeth in children, it is recommended that they be removed before the final growth of the jaws. Then, subsequent teething during growth will not create a significant defect in hard and soft tissues. However, attempting to remove ankylosed teeth can be a difficult task.
In this example, a 11-year-old boy was injured in his upper jaw when he was 10 years old. Subsequently, tooth ankylosis 1.1 was formed.
As can be seen on the x-ray, the resorption of the root occurs at a significant rate, given that the injury was about a year ago. However, during this time there were no significant changes in the incisal region and marginal gums. Given this, the tooth must be observed. Parents are informed about the need for dynamic observation in order to timely remove the tooth before the formation of a significant defect in hard and soft tissues. Parents’ attention should be focused on this, since if the patient does not appear at the next follow-up examination, treatment will be more difficult. At the age of 12 years, a noticeable change in the position of the incisor and marginal gums.
Decoration as a solution
It was at this moment that it was decided to remove the ankylosed tooth before the next phase of growth. Mamlgren and his team described the method of deconvolution in a similar clinical situation in a 2006 article. (Figure 3). Instead of removing all fragments of the tooth, only the crown of the tooth about 1 mm below the bone crest is removed during deconstruction.
This will allow the periosteum to grow above the remaining root, creating a periosteal jumper between adjacent teeth above the toothless crest and the underlying root. The creation of a periosteal jumper will ensure the development of the crest in a vertical direction in a toothless place due to the pressure created by the eruption of neighboring teeth. And at the same time, the root remaining in the bone tissue will continue to undergo substitutional resorption.
The technique of the operation of deconvolution was modified and began to additionally include the creation of a cavity inside the root, in addition to removing the crown of the tooth under the bone crest. The advantage of this technique is that resorption will occur at a higher rate, since it will be observed both on the inner and the outer surface of the root.
The complexity of the treatment of patients who have ankylosed tooth extraction is to ensure its temporary replacement until bone growth ceases (especially in males whose growth may not be completed by 21-22 years). However, if the patient is ready for implantation, the height of the ridge is relatively good, which makes the management of the ridge more predictable for the implant or the intermediate part of the bridge.