Surgical Orthodontic Treatment of Skeletal Mandibular Protrusion with Multiple Impacted Ankylosed Teeth Treated with Alveolar Corticotomy.

AIM: To present a case of skeletal mandibular protrusion with multiple impacted ankylosed teeth, which were treated with conventional orthognathic surgery and alveolar corticotomy, respectively. BACKGROUND: Tooth ankylosis is characterized by the fusion of a root surface with the surrounding alveolar bone. Various treatment modalities for tooth ankylosis have been developed and are used commonly in the clinic. Corticotomy is defined as the application of intentional surgical injury to the cortical bone to mobilize a tooth with the adjacent bone and soft tissues. The corticotomy technique has been improved in recent years to avoid possible risks such as periodontal damage, tooth devitalization, and osseous necrosis due to an inadequate blood supply. CASE DESCRIPTION: A female patient aged 16 years and 3 months was diagnosed with anterior crossbite and the impaction and ankylosis of multiple canines. After the confirmation of ankylosis, alveolar corticotomy was performed on the maxillary left and mandibular right canines. After 6 months of traction (patient age, 19 years and 7 months), both canines had extruded successfully. After the completion of preoperative treatment, bilateral intraoral vertical ramus osteotomy was performed to correct the anterior crossbite involving a skeletal mandibular protrusion. The amounts of mandibular setback on the right and left sides were approximately 7 and 5 mm, respectively. The total treatment period was 55 months. Acceptable occlusion with a balanced profile was maintained over a 5-year retention period, indicating the long-term stability and success of the treatment. CONCLUSION: Our results indicate that alveolar corticotomy should be considered to facilitate the treatment of multiple impacted ankylosed teeth. CLINICAL SIGNIFICANCE: This report proposes an efficacy of alveolar corticotomy for extrusion of impacted ankylosed teeth.

Pixel gray measurement for the diagnosis of dental ankylosis in cone beam computed tomography images.

OBJECTIVE: The aim of this study was to investigate dental ankylosis in unerupted or partially erupted teeth by using cone beam computed tomography (CBCT) to quantify pixel intensity. STUDY DESIGN: In total, 157 CBCT images from individuals with a total of 206 unerupted or partially erupted teeth with suspected ankylosis were evaluated. CBCT images were analyzed for the presence of ankylosis by 2 oral radiologists by quantifying mean pixel intensities (analysis 1) and variations in pixel intensities (analysis 2) in normal and ankylosed regions. The association between ankylosis and demographic and tooth-related factors was also examined. RESULTS: Ankylosis was diagnosed in 57 teeth (27.7%). The diagnosis was established with all 3 multiplanar reconstruction views in 22 of these teeth (38.6%). In analysis 1, a higher pixel intensity was observed in areas with ankylosis compared with normal periodontal ligament (PDL) density as a result of bone deposition in this region, which is characteristic of ankylosis (P < .001). In analysis 2, reductions in pixel intensity were greater in the PDL areas than in the ankylosed areas. Ankylosis was significantly associated with the anterior teeth, the maxillary arch, single-rooted teeth, and impacted teeth (P ≤ .026). CONCLUSIONS: Our results suggest that CBCT measurement of pixel intensity may be useful for the diagnosis of ankylosis.

Diagnosis of alveolodental ankylosis in unerupted canines: one of the answers to why the canine does not come

ABSTRACT Introduction: Teeth frequently fail to erupt and situations arise that prevent the canines from reaching the occlusal plane. Objective: Discourse about the three situations in which the canine does not reach the occlusal plane, and remains unerupted; and at the same time, point how to make a safe diagnosis of alveolodental ankylosis - one of the three causes -, based on tomography. Conclusions: Ankylosis occurs in impacted teeth by atrophy of the periodontal ligament, including the epithelial rests of Malassez. The tomographic signs of alveolodental ankylosis in unerupted canines are the interruption of hypodense periodontal space, discontinuity of the lamina dura and its continuity with the root surface, which gradually loses its regular shape.

RESUMO Introdução: Muitas vezes, a erupção falha, e ocorrem situações que impedem que os caninos cheguem até o plano oclusal. Objetivos: Discorrer sobre quais as três situações nas quais o canino não chega até o plano oclusal, permanecendo não irrompido e, ao mesmo tempo, destacar como se diagnosticar com segurança uma dessas três causas, a anquilose alveolodentária, a partir da tomografia. Conclusões: A anquilose em dentes não irrompidos ocorre pela atrofia do ligamento periodontal, incluindo os Restos Epiteliais de Malassez. Os sinais tomográficos de uma anquilose alveolodentária em caninos não irrompidos são a interrupção do espaço periodontal hipodenso, a descontinuidade da lâmina dura e a sua continuidade com a superfície radicular, que, gradativamente, perde sua regularidade.

Lower incisor extraction therapy in a complex case with an ankylosed tooth in an adult patient: A case report.

This case report describes a successful orthodontic therapy of an adult female treated by mandibular central incisor extraction and vestibular fixed appliances. The patient presented a skeletal Class I with normodivergent facial pattern, Class II subdivision dental relationship, extremely deep Curve of Spee and severe overbite. Moreover, during the treatment, the upper left first molar does not respond to orthodontic forces due to tooth ankylosis, augmenting the difficulty of this case. Despite this, a good occlusal relationship on both sites and an optimal extraoral outcome have been achieved after a 26-months therapy. To our knowledge no case report with such entity of Curve of Spee with contemporary tooth ankylosis has been presented.

Diagnosis of alveolodental ankylosis in unerupted canines: one of the answers to why the canine does not come.

INTRODUCTION: Teeth frequently fail to erupt and situations arise that prevent the canines from reaching the occlusal plane. OBJECTIVE: Discourse about the three situations in which the canine does not reach the occlusal plane, and remains unerupted; and at the same time, point how to make a safe diagnosis of alveolodental ankylosis - one of the three causes -, based on tomography. CONCLUSIONS: Ankylosis occurs in impacted teeth by atrophy of the periodontal ligament, including the epithelial rests of Malassez. The tomographic signs of alveolodental ankylosis in unerupted canines are the interruption of hypodense periodontal space, discontinuity of the lamina dura and its continuity with the root surface, which gradually loses its regular shape.

Aberrantly elevated Wnt signaling is responsible for cementum overgrowth and dental ankylosis.

Vertebrate teeth are attached to the jawbones using a variety of methods but in mammals, a fibrous connection is the norm. This fibrous periodontal ligament (PDL) allows teeth to move in the jawbones in response to natural eruptive forces, mastication, and orthodontic tooth movement. In some disease states the PDL either calcifies or is replaced by a mineralized tissue and the result is ankylosis, where the tooth is fused to the alveolar bone. To understand how the PDL maintains this fibrous state, we examined a strain of mice in which tooth movement is arrested. DaßcatOt mice express a stabilized form of ß-catenin in DMP1-positive alveolar bone osteocytes and cementocytes, which results in elevated Wnt signaling throughout the periodontium. As a consequence, there is an accrual of massive amounts of cellular cementum and alveolar bone, the PDL itself calcifies and teeth become ankylosed. These data suggest that to maintain its fibrous nature, Wnt signaling must normally be repressed in the PDL space.

Delayed tooth reimplantation with 4-year follow-up: the management of ankylosis during facial growth.

This case report describes the consequences of delayed (24 hours) reimplantation of an avulsed maxillary central incisor, findings over a 4-year follow-up period, and the management of ankylosis during facial growth. After a traumatic event, a 10-year-old boy was taken to a hospital emergency department due to injuries to his face, including avulsion of the maxillary left central incisor. Despite the short amount of time before arriving at the hospital (10 minutes) and use of the correct storage medium (milk), the tooth was not reimplanted, and the parents did not receive instructions to seek dental treatment. The next day, the child was brought to a dental school because he objected to the loss of his tooth. The treatment chosen was delayed tooth reimplantation. At the 1-year follow-up, the reimplanted tooth was infraoccluded, and periapical radiography revealed signs of ankylosis and initial replacement root resorption. At the 2- and 3-year follow-up examinations, resorption and infraocclusion of the central incisor had progressed. In this case, the delayed reimplantation resulted in ankylosis that had a significant clinical impact due to the patient's facial growth. Direct resin restoration of the reimplanted tooth was therefore performed 3 years after trauma. Despite continued resorption and infraocclusion of the tooth observed 4 years posttrauma, the esthetic, low-cost treatment was well accepted, and the patient's quality of life was improved until definitive treatment can be performed.

Diagnosis of tooth ankylosis using panoramic views, cone beam computed tomography, and histological data: a retrospective observational case series study.

Objectives: The aim of this study was to determine whether cone beam computed tomography is a reliable radiological method to diagnose tooth ankylosis. Materials and methods: A series of teeth clinically diagnosed as ankylosed were collected after extraction in a private practice from 2009 to 2015 and analyzed retrospectively. Inclusion criteria comprised permanent molars extracted due to failed tooth eruption in the absence of any visible mechanical obstruction, existing panoramic view (PV), and cone beam computed tomography (CBCT) and histological sections of sufficient quality. The CBCT scans and PVs were evaluated twice for signs of ankylosis by two independent observers using the following score: clear signs, possible signs, and no signs. The histological sections were evaluated and graded similarly to the radiographs by a specialist blinded to the radiographs and treatment. Results: Out of an initial group of 22 patients, 9 subjects with 10 affected teeth were included for final evaluation. The age ranged from 8.3 to 17 years. No agreement was seen in comparing the PV scores to the histological sections. Fair to moderate agreement was seen in comparing the CBCT scores to the histological sections. All histologically confirmed ankylosis were detected in CBCT by both observers but some false positive results were found. Limitation: Only a small sample size was available as the disorder is rare. It is difficult to distinguish ankylosis from primary failure of eruption. Conclusion: CBCT images can be a useful adjunctive diagnostic tool to diagnose ankylosed teeth, but cannot be recommended as a single diagnostic modality as false positive results were found.

A Technique for Utilizing Ankylosed Teeth for Anchorage.

We present a novel method of reinforcing anchorage by utilizing ankylosed teeth. This technique provides simple solutions in otherwise challenging and complex cases.

Relocation of Infrapositioned Ankylosed Teeth: Description of Orthodontic Bone Stretching and Case Series.

Different treatments have been proposed to manage the consequences of ankylosed teeth. This clinical report, which includes several different clinical conditions, describes an orthodontic bone-stretching procedure that can be used to relocate ankylosed teeth. The orthodontic bone-stretching technique involves only partial osteotomies, without the mobilization or repositioning of the alveolar segment, combined with orthodontic forces. The applied force facilitates tooth movement to the occlusal plane and can modify the axis of the ankylosed tooth. This relocation is possible because of a bone-stretching phenomenon in the surgical area. In all of the cases, relocation of the ankylosed teeth was successfully performed and the gingival margins were corrected to improve the esthetic results.

Non-prep restoration of an ankylosed incisor: a case report.

Dental restorations without tooth preparation are among today's more advanced treatment options. This article presents the case of a young man who was treated with a non-prep laminate veneer that provided 3.5 mm of incisal elongation. A Photoshop assessment and functional evaluation, as well as a wax-up and mock-up, were used during pre-prosthetic planning. A combination of pressable and feldspathic ceramics was used as a restorative material, which was applied to the tooth surface without any preparation of dental hard tissue. An ideal functional and esthetic restoration was achieved thanks to close collaboration between the patient, the dentist, and the technician.

Complete pre-eruptive idiopathic crown resorption.

The purpose of this paper was to present the unique case of complete pre-eruptive idiopathic crown resorption, few of which have ever been reported, because most have concerned partial idiopathic crowns. Crown resorption affects only a part of the crown and begins when crown mineralization is complete, leading to hypomineralization of the teeth. Treatment usually consists of restorative/endodontic care or extraction. A 12-year-old-boy presented with complete idiopathic resorption of the permanent mandibular left third molar and secondary failure of eruption of the permanent mandibular left first molar. The finding was incidental during routine radiographs for orthodontic treatment and was documented using cone beam computed tomography and computed tomography (one-mm slices). Follow-up, using a panoramic radiograph, occurred after one year, confirming the absence of the third molar. No preventive or therapeutic regimen is known.

Coronectomy of two neighbouring ankylosed mandibular teeth--a case report.

INTRODUCTION: Intentional partial odontectomy or coronectomy is primarily advocated in situations with intimate relationships between the roots of the tooth indicated for extraction and the inferior alveolar nerve (IAN). The aim of this report was to present a patient with two neighbouring infraoccluded teeth in the right mandible indicated for extraction prior to prosthetic rehabilitation, which were coronectomied as to prevent injuring of the IAN and causing iatrogenic fracture of the mandibular body. CASE REPORT: Coronectomy of both teeth was performed as recommended in the literature. The patient had no special discomfort after the operation or deficit in sensitive nerve function, and the wound healed uneventfully. The patient was followed regularly during a 2-year period. CONCLUSION: The presented case suggests coronectomy as quite beneficial solution for avoiding serious problems (injuring of the IAN and possible fracture of the mandible) and making feasible forthcoming prosthetic rehabilitation.

Bone morphology after delayed tooth replantation - case series.

The purpose of this report was to describe the morphological changes in the alveolar bone after delayed replantation of avulsed teeth using three dimensional cone-beam computed tomography in 11 during the time period 2003-2012. The radiographic observations revealed the following: Delayed replantation results in ankylosis-related replacement root resorption; the resorption is delayed or arrested around the cervical area superior to the alveolar crest. The buccal bone is reduced in thickness but not the palatal bone. The buccal bone resorption of the alveolar crest progresses approximately to the root canal space of the ankylosed root. Delayed replantation does not completely maintain the bone volume. The buccal profile of alveolar bone in the maxillary anterior region is depending on teeth with viable periodontal ligament.

An unusual case of severe primary molar infraocclusion.

Dentoalveolar ankylosis is described as the direct union between root cementum/dentin and alveolar bone. Its etiology is unknown, and conflicting opinions have been presented to explain it. Late detection of ankylosed primary teeth may cause serious problems to the occlusion and generally demands a more complex treatment approach. The purpose of this report is to present an unusual case of severe infraocclusion of the primary maxillary right second molar associated with a posterior crossbite in a 6-year-old child. The initial treatment option was tooth extraction, but the tooth resumed eruption spontaneously. After correction of the posterior crossbite and a 1-year follow-up, the tooth remained in occlusion and the permanent successor was developing without problems. From this unusual outcome, it may be concluded that further investigation of this anomaly of eruption is needed.

Idiopathic ankylosis-resorption: diagnosis and treatment.

Dental ankylosis involves the fusion of root to bone. The idiopathic form occurs spontaneously before the eruption of the tooth concerned. Etiology is unknown. As the tooth becomes part of the bone-remodeling process, it is gradually resorbed and is replaced by bony tissue. The process is quite rapid and weakens the tooth. Thus, early diagnosis makes it possible to perform a graft in optimal conditions, this being the only means of severing the ankylosis and achieving adequate eruption. In some rare cases, the ankylotic point of fusion can be reached surgically and can be eliminated before orthodontic traction is initiated.

Effect of surgical exposure technique, age, and grade of impaction on ankylosis of an impacted canine, and the effect of rapid palatal expansion on eruption: A prospective clinical study.

INTRODUCTION: This study had 2 aims: (1) to assess whether the surgical exposure technique, the patient's age, and the grade of impaction are associated with ankylosis of the impacted canine; and (2) to investigate the effect of rapid palatal expansion on an impacted canine's automatic eruption. METHODS: The sample for this prospective longitudinal study consisted of 118 orthodontic patients (72 female, 46 male) who were treated surgically and orthodontically by the first author (S.I.K.) over 18 years. The patients' ages at the beginning of therapy ranged from 11.2 to 46.1 years. They had 157 impacted canines (150 maxillary, 7 mandibular), grouped in 7 categories (grades I-VII) according to their radiographic position in the orthopantomogram at the onset of treatment. Univariate and multivariate generalized estimating equation logistic regression analyses were used to assess the effect of the predictors of interest on ankylosis. (In this research, a broad definition of "ankylosis" was used, to include impacted canines immobilized a priori or during traction, due to all the possible causes that could contribute to immobilization, such as all types of external tooth resorption and other known or unknown factors.) RESULTS: Thirty-eight canines erupted spontaneously after space gaining, and the other 119 were treated surgically with an open (57 cases) or a closed (62 cases) exposure technique. Eleven canines of the 119 that were treated surgically had ankylosis, either a priori or during orthodontic traction. The percentages of ankylosis were 3.5% in the open technique and 14.5% in the closed technique. Evidence of statistical association was found between age and ankylosis, grade of impaction and ankylosis, and rapid palatal expansion and automatic eruption of the impacted canine. CONCLUSIONS: Evidence of an association between exposure technique and ankylosis was found. Additionally, there was evidence that the grade of impaction and the patient's age are significant predictors of ankylosis, as is the use of rapid palatal expansion a predictor of automatic eruption.

The usefulness of three-dimensional imaging for prognostication in cases of intentional tooth replantation.

This paper describes the utility of three-dimensional (3D) images obtained with cone beam computed tomography (CBCT) for prediction of successful clinical outcome in two cases of intentional tooth replantation (IR). IR was performed for teeth affected by vertical root fracture and root perforation with local application of blood clot and oxy-tetracycline antibiotic. High-resolution 3D images demonstrated no evidence of ankylosis, but did reveal the presence of alveolar bone regeneration, suggesting a good long-term prognosis. Our observations in these cases suggested that local application of the above two materials might help to induce the regeneration of lost periodontal tissues in IR.

Root surface treatment using diode laser in delayed tooth replantation: radiographic and histomorphometric analyses in rats.

UNLABELLED: BACKGROUND AIM: The aim of this study was to evaluate, by radiographic and histomorphometric analyses, the effects of high-power diode laser irradiation on the root surfaces of delayed replanted rat teeth. MATERIAL AND METHODS: Maxillary right incisors were extracted from 60 Wistar rats and kept dry for 60 min. Subsequently, the root canals were prepared and filled with calcium hydroxide paste. According to the root surface treatment before the replantation, the teeth were assigned to four groups (n = 15): G1 (negative control) - no root surface treatment; G2 (positive control) - treated with 2% sodium fluoride solution; G3 - irradiated with a high-power diode laser (810 nm, continuous mode, 1.0 W, 30 s); and G4 - irradiated with a diode laser using the same parameters as those used for G3 but in pulsed mode. The rats were euthanized after 15, 30, and 60 days of replantation. The specimens were digitally radiographed and processed for histomorphometric analysis to determine the average root resorption areas and to evaluate the histological events. RESULTS: The percentage of root resorption was in the following order: G1 > G2 > G4 > G3. Both histomorphometric and radiographic analyses showed significantly lower means (P < 0.05) of the occurrence of root resorption in the irradiated groups (G3 and G4) when compared to the control groups (G1 and G2). Replacement resorption and ankylosis were observed in histological sections only after 30 and 60 days; however, such events were not observed in G3. CONCLUSION: Root surface treatments with high-powered diode laser irradiation prior to delayed replantation reduced the occurrence of external root resorption compared to no treatment or sodium fluoride treatment at up to 60 days.

Management of avulsed permanent incisors with closed apices and prolonged extraoral dry time.

This article reports the clinical management and outcome of two avulsed permanent incisors that were kept dry for 42 hours. Dental trauma guidelines were followed and clinically successful outcomes were seen until seven months of follow-up. The factors contributing to successful management of this case despite the extreme clinical circumstances were attributed to pulp extirpation prior to replantation, doxycycline soak, fluoride soak, and timely endodontic treatment. Recent advances and alternate treatment modalities reported in literature are evaluated in the discussion.