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Decoronation – a conservative method to treat …

Dental Traumatology 2007; doi: Copyright Blackwell Munksgaard 2006. All rights reserved DENTAL TRAUMATOLOGY. Decoronation a conservative method to treat ankylosed teeth for preservation of alveolar ridge prior to permanent prosthetic reconstruction: literature review and case presentation Cohenca N, Stabholz A. Decoronation a conservative method to Nestor Cohenca1,2, Ayala Stabholz3. treat ankylosed teeth for preservation of alveolar ridge prior to 1. Department of Endodontics, School of Dentistry, University permanent prosthetic reconstruction: literature review and case of Washington, Seattle, WA, USA; Departments of 2 Endo- presentation. Blackwell Munksgaard, 2006. dontics and 3 Periodontology, Hebrew University Hadassah, Faculty of Dental Medicine, Jerusalem, Israel Abstract Avulsed teeth that are stored extraorally in a dry environment for >60 min generally develop replacement root resorption or ankylosis following their replantation due to the absence of a vital periodontal ligament on their root surface.

Decoronation – a conservative method to treat ankylosed teeth for preservation of alveolar ridge prior to permanent prosthetic reconstruction: literature review and case

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1 Dental Traumatology 2007; doi: Copyright Blackwell Munksgaard 2006. All rights reserved DENTAL TRAUMATOLOGY. Decoronation a conservative method to treat ankylosed teeth for preservation of alveolar ridge prior to permanent prosthetic reconstruction: literature review and case presentation Cohenca N, Stabholz A. Decoronation a conservative method to Nestor Cohenca1,2, Ayala Stabholz3. treat ankylosed teeth for preservation of alveolar ridge prior to 1. Department of Endodontics, School of Dentistry, University permanent prosthetic reconstruction: literature review and case of Washington, Seattle, WA, USA; Departments of 2 Endo- presentation. Blackwell Munksgaard, 2006. dontics and 3 Periodontology, Hebrew University Hadassah, Faculty of Dental Medicine, Jerusalem, Israel Abstract Avulsed teeth that are stored extraorally in a dry environment for >60 min generally develop replacement root resorption or ankylosis following their replantation due to the absence of a vital periodontal ligament on their root surface.

2 One negative sequelae of such ankylosis is tooth infra-positioning and the local arrest of alveolar bone growth. Removal of an ankylosed tooth may be difficult and traumatic leading to esthetic Key words: avulsion; ankylosis; Decoronation ;. bony ridge deformities and optimal prosthetic treatment guided bone regeneration; prosthetic rehabilitation;. interferences. Recently a treatment option for ankylosed teeth 2 implants named de-coronation' gained interest, particularly in pediatric Nestor Cohenca, Department of Endodontics, School dentistry that concentrated in dental traumatology. This article of Dentistry, University of Washington, POB 357448, Seattle, WA 98195-7448, USA. reviews the up-to-date literature that has been published on Tel.

3 : +1 206 543 5044. Decoronation with respect to its importance for future prosthetic Fax: +1 206 616 9085. rehabilitation followed by a case presentation that demonstrates e-mail: its clinical benefits. Accepted 28 September, 2005. The incidence of dental trauma has increased more likely to occur following car accidents, fights significantly during the last decades, in particular and sport activities. for anterior teeth of children and adolescents (1). Avulsion is defined as a complete separation of a The mean prevalence of dental and oral injuries tooth from its alveolus following a traumatic injury reported in the literature oscillated between 4% and which results in extensive damage to the pulp 33%, dependant on the sex and age of the patients and periodontal tissues (9).

4 Avulsed teeth comprise (2, 3). Most maxillofacial traumatic injuries occur 1 16% of all traumatic injuries of the permanent to the dentition alone (50%) or involve both the dentition (10). The avulsed tooth should be opti- dentition and adjacent soft tissue (36%) (4). The mally replanted into its original alveolus as early as overall age distribution of dental trauma shows an possible, although in most cases the replantation is incidence of for the first decade of life, carried out at the dental office or the emergency for the second decade, followed by a sharp decrease room hours after the injury. Immediately after in incidence thereafter (5 7). Factors that predispose replantation, an inflammatory process takes place in the young population to dental trauma include the periodontal tissues followed by re-organization protruded maxillary incisors and incompetent lips of the new attachment apparatus.

5 The type of (8), whereas traumatic injuries among adults are healing is directly related to the duration of the Dental Traumatology 2007; 23: 87 94 87. Cohenca & Stabholz extraoral time as well as to the storage conditions of not prevent or delay the onset of replacement root the avulsed tooth prior to replantation (11, 12). resorption (23, 24). The treatment of avulsed teeth is divided into two Recent studies (25, 26) reported promising results stages: initially, an emergency treatment is provided in preventing root resorption using LedermixTM. immediately after the accident followed by a defin- Paste (Lederle Pharmaceuticals, Wolfrantshausen, itive treatment, which includes endodontic therapy, Germany) as an intracanal medication immediately crown restoration and clinical and radiographic after replantation of an avulsed tooth.

6 This endo- follow ups. The International Association of Dental dontic medication is based on steroids and anti- Trauma (IADT) and the American Association of biotics. It is suggested that Ledermix can diffuse Endodontists (AAE) have recently published thera- through the dentinal tubules causing the steroid to peutic guidelines for the management of traumatic decrease the local inflammatory response of the dental injuries (13, 14). These guidelines stressed the periodontium, thereby preventing further damage to importance of preconditioning the root of the avulsed the protective cemental layer against root resorption. tooth prior to its replantation in order to enhance the A root of a replanted tooth may continue to healing process of the periodontium.

7 However, teeth undergo replacement resorption until completely that are stored extraorally in a dry environment for replaced by bone preserving the surrounding alveo- more than 60 min generally develop replacement lar ridge volume. A resorptive process that results in root resorption or ankylosis following their replan- ankylosis allows the clinician the freedom of choice tation because of the absence of a vital periodontal as to the appropriate timing for tooth replacement ligament on their root surface (15, 16). and allows the postponement of the prosthetic After the initial inflammatory response following rehabilitation to a convenient time (27). In addition, tooth replantation, mesenchymal cells surrounding the rate of root resorption may be age dependant the denuded root compete to repopulate its surface.

8 Due to the rate of the patient's skeletal growth Bone cells (osteoblasts and osteoclasts) come into (28 30). Andersson et al. (29) demonstrated that direct contact with the root and initiate resorption of the rate of root resorption was higher in younger the dentin (osteoclasts) with a simultaneous forma- (8 16 years) than in older patients (17 39 years). tion of new bone (osteoblasts) in the affected area. The average time for a replanted tooth to resorb The process leads to the replacement of the dental ranges between 3 and 7 years in younger individ- tissues by bone (17, 18). Tronstad stated in 1988 uals, whereas in older patients replanted teeth may that progressive inflammatory root resorption can function for some decades or throughout life.

9 Be treated with a high rate of success; yet non- One of the negative sequela of tooth ankylosis is inflammatory replacement root resorption still its infra-positioning, which occurs as the result of the remains beyond our clinical competence (19) thus, local arrest of the surrounding alveolar bone growth no preventive or arresting measures of this pathosis concomitant to the continuous skeletal growth and can be taken. development. Such infra-positioning results in an Various storage media, antibiotics, growth fac- unaesthetic dento-gingival complex and might com- tors, enamel proteins as well as different condition- plicate future prosthetic rehabilitation. ing agents have been proposed to delay or prevent The most accepted treatment option of ankylosed post-traumatic root resorption in order to increase teeth has been their surgical removal which is the long-term success rate of avulsed teeth (20).

10 In frequently accompanied by traumatic alveolar bone 2001, the International Association of Dental tear, particularly in the presence of a thin maxillary Traumatology suggested, for the first time, the use buccal plate. As most cases of dental trauma and of Emdogain (hydrophobic enamel matrix proteins subsequent tooth replantation and ankylosis involve extracted from porcine developing enamel; Biora, the anterior maxilla, such traumatic extractions of Malmo, Sweden) for the treatment of avulsed teeth ankylosed teeth may lead to esthetic bony ridge that were kept in dry extraoral conditions and deformities and might interfere with optimal pros- replanted after 60 min. Emdogain , which was thetic treatment delivered. originally introduced for regeneration of lost peri- In 1984, Malmgren et al.


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