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CASE REPORT
Year : 2019  |  Volume : 37  |  Issue : 2  |  Page : 214-217
 

Alveolar ridge preservation in a growing patient with decoronation: One-year follow-up


Department of Pedodontics and Preventive Dentistry, HP Government Dental College and Hospital, Shimla, Himachal Pradesh, India

Date of Web Publication26-Jun-2019

Correspondence Address:
Dr. Astha Jaikaria
Room Number 310, Third Floor, Department of Pedodontics and Preventive Dentistry, HP Government Dental College and Hospital, IGMC, Shimla - 171 001, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_242_18

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   Abstract 


Dentoalveolar ankylosis in growing patients is associated with continuing replacement root resorption, tooth infrapositioning, and the local arrest of alveolar bone growth. While extraction of ankylosed teeth might be associated with bone loss, decoronation of the offending tooth (removal of crown portion and instrumentation of pulp canal to stimulate bleeding) has been suggested as a more conservative approach of bone preservation until definitive implant placement is planned. This is a case presentation of a 14-year-old patient who presented with root resorption in relation to the left maxillary central incisor such that decoronation with a prosthetic tooth replacement was decided as the treatment option.


Keywords: Decoronation, dentoalveolar ankylosis, replacement resorption


How to cite this article:
Jaikaria A, Thakur S. Alveolar ridge preservation in a growing patient with decoronation: One-year follow-up. J Indian Soc Pedod Prev Dent 2019;37:214-7

How to cite this URL:
Jaikaria A, Thakur S. Alveolar ridge preservation in a growing patient with decoronation: One-year follow-up. J Indian Soc Pedod Prev Dent [serial online] 2019 [cited 2019 Nov 12];37:214-7. Available from: http://www.jisppd.com/text.asp?2019/37/2/214/261342





   Introduction Top


The incidence of dental trauma has increased significantly during the last decades, in particular for anterior teeth of children and adolescents.[1] Factors that predispose the young population to dental trauma include protruded maxillary incisors and incompetent lips.[2]

Dental/dentoalveolar ankylosis refers to an anatomical fusion of cementum with alveolar bone, occurring at any time during the course of eruption,[3] although traumatic injuries to teeth have been suggested as the primary etiological factor. Ankylosis in adults is not a major problem. However, ankylosed teeth in a growing patient should not be left untreated because the rate of replacement root resorption is more rapid and eventually, the affected tooth crown will fall off as it is deprived of root support. As the affected tooth is restricted to respond to the natural eruptive process, sequela of ankylosis can range from a mild localized infraposition of the tooth to a more severe form, resulting in an unesthetic ridge deformity and tilting of adjacent teeth.[4]

Several attempts to manage ankylosed teeth in growing children have been proposed.[5] Malmgren, in 1984, introduced a more conservative treatment option, which was termed decoronation.[6] Decoronation involves a coronectomy of the ankylosed tooth beneath the level of the cementoenamel junction and instrumentation of the pulp canal to stimulate bleeding at the periapical area. Through its potential role in bone preservation or bone augmentation, invasiveness of implant surgery, at a later date, has been claimed to be minimal.

It has been shown to preserve the vestibular-palatal width of the alveolar bone for years, while at the same time allowing for vertical growth.[7] Following complete crown removal, the existing root canal filling is removed to prevent foreign body reaction and intentionally filled with blood to promote additional replacement resorption from its internal aspect, whereas the external replacement resorption continues without interruption. The mucoperiosteal flap is sutured over the decoronated root, leaving it to be gradually fully resorbed.[8],[9]


   Case Report Top


A 14 year old female patient presented to the department with a complaint of nonesthetic maxillary right central incisor. Dental history revealed that 2 years back, the patient had a history of trauma. Based on the patient's records, the injury caused the extrusion of her maxillary left central incisor combined with subluxation of the maxillary right central incisor. The extruded tooth was repositioned by manual pressure, and the teeth were splinted with a flexible orthodontic wire and a composite resin for 2 weeks. One year after the trauma, during a routine follow-up examination of the patient, pulp necrosis of the maxillary central incisors was diagnosed and root canal treatments were performed accordingly.

Clinical examination of the patient at presentation to our clinic 2 years after trauma revealed an infra-occlusion of the maxillary left central incisor as shown in [Figure 1]. The tooth was clinically asymptomatic, and no sensitivity to percussion or tenderness to palpation was observed. A metallic sound was noted upon percussion.
Figure 1: Preoperative frontal view of the patient showing infraocclusion with relation to 21

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Radiographical examination showed replacement root resorption of the maxillary left central incisor [Figure 2]. The periapical tissues surrounding the maxillary right central incisor were in the process of healing without evidence of replacement root resorption. The adjacent teeth were asymptomatic and responded normally to thermal and electric pulp stimuli. A diagnosis of replacement root resorption of the maxillary left central incisor was made. The treatment plan included decoronation of the maxillary left central incisor followed by modified Maryland bridge to restore the esthetics until completion of the patient's developmental growth in an attempt to place an implant-supported porcelain crown.
Figure 2: Preoperative intraoral periapical radiograph of the patient

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After parental consent was obtained, rinsing was done with 0.2% chlorhexidine gluconate (Hexidine, ICPA Health Products Limited, Mumbai, India). Local anesthesia (total quantity of LA mentioned for all the blocks and infiltration in total) was administered, and an intrasulcular incision around the treated tooth with mesial and distal submarginal releasing incisions was performed to avoid the interproximal papillae. A full-thickness buccal mucoperiosteal flap was elevated exposing the tooth and the labial cortical plate [Figure 3]. The palatal tissue was left intact. The crown was decoronated, and the root canal filling was removed. The root canal was then alternately instrumented and rinsed with saline until bleeding from the surrounding tissues filled the empty root canal [Figure 4]. Porous deproteinized bovine bone mineral particles were applied into the osseous defect and the surrounding alveolar bone. The flap was released and sutured using nonresorbable 6-0 sutures [Figure 5].
Figure 3: Elevated full-thickness buccal mucoperiosteal flap

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Figure 4: Bleeding from the surrounding tissues was induced that filled the empty root canal

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Figure 5: Flap was released and sutured

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The patient was seen every 2 weeks until soft-tissue healing was clinically completed, and radiographs were taken 4 months postoperatively to assess residual root resorption [Figure 6]. Healing of the treated site was uneventful.
Figure 6: Postoperative intraoral periapical radiograph after 4 months

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After 1 year, post-and-core build-up was done for right maxillary central incisor followed by tooth preparation for resin-bonded restoration on the left maxillary lateral incisor as shown in radiograph [Figure 7].
Figure 7: Postoperative intraoral periapical radiograph after 1 year with post-and-core preparation with relation to 11

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Occlusal clearance of 0.5 mm was established. Concave reduction on the entire cingulum surface was done to give lingual clearance of 0.5 mm at a distance of 1.5–2 mm from the incisal edge [Figure 8]. Two or three countersinks were given in the cingulum to compensate for limited tooth preparation, and modified Maryland bridge was delivered to the patient [Figure 9].
Figure 8: Tooth preparation done for modified Maryland bridge

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Figure 9: Postoperative frontal view of the patient after cementation of modified Maryland bridge

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   Discussion Top


Although orthodontic movement will preserve more bone than surgical extraction, such treatment is not predictable. Moreover, the root canal filling material that remains entrapped in the bone may jeopardize a future implant-based rehabilitation treatment.[10] Andersson et al. demonstrated that the rate of root resorption was higher in younger (8–16 years) than in older patients (17–39 years). The average time for a replanted tooth to resorb ranges between 3 and 7 years in younger individuals.[11]

In our case, the treatment plan included decoronation and ridge augmentation in order to preserve the remaining bone and to increase the horizontal and vertical dimensions of the alveolar ridge. Blood clot-filled residual root will conduct the formation of new bone from the available osteoprogenitor cells to replace it gradually.

This procedure enables us to avoid a later costly invasive surgical procedure to augment the alveolar ridge for the placement of implant-supported porcelain crown which can replace the Maryland bridge in future.


   Conclusion Top


Decoronation can effectively preserve ridge height around the ankylosed teeth and help in the restoration of esthetics taking into consideration the future treatment requirements of the patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Andreasen JO, Andreasen FM. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 3rd ed. Copenhagen: Munksgaard; 1994. p. 383-425.  Back to cited text no. 1
    
2.
Brin I, Ben-Bassat Y, Heling I, Brezniak N. Profile of an orthodontic patient at risk of dental trauma. Endod Dent Traumatol 2000;16:111-5.  Back to cited text no. 2
    
3.
Owen TL. Ankylosis of teeth. J Mich State Dent Assoc 1965;47:347-50.  Back to cited text no. 3
    
4.
Peretz B, Absawi-Huri M, Bercovich R, Amir E. Inter-relations between infraocclusion of primary mandibular molars, tipping of adjacent teeth, and alveolar bone height. Pediatr Dent 2013;35:325-8.  Back to cited text no. 4
    
5.
Andersson L, Malmgren B. The problem of dentoalveolar ankylosis and subsequent replacement resorption in the growing patient. Aust Endod J 1999;25:57-61.  Back to cited text no. 5
    
6.
Malmgren B, Cvek M, Lundberg M, Frykholm A. Surgical treatment of ankylosed and infrapositioned reimplanted incisors in adolescents. Scand J Dent Res 1984;92:391-9.  Back to cited text no. 6
    
7.
Filippi A, Pohl Y, von Arx T. Decoronation of an ankylosed tooth for preservation of alveolar bone prior to implant placement. Dent Traumatol 2001;17:93-5.  Back to cited text no. 7
    
8.
Malmgren B. Decoronation: How, why, and when? J Calif Dent Assoc 2000;28:846-54.  Back to cited text no. 8
    
9.
Malmgren B, Malmgren O. Rate of infraposition of reimplanted ankylosed incisors related to age and growth in children and adolescents. Dent Traumatol 2002;18:28-36.  Back to cited text no. 9
    
10.
Odman J, Gröndahl K, Lekholm U, Thilander B. The effect of osseointegrated implants on the dento-alveolar development. A clinical and radiographic study in growing pigs. Eur J Orthod 1991;13:279-86.  Back to cited text no. 10
    
11.
Andersson L, Bodin I, Sörensen S. Progression of root resorption following replantation of human teeth after extended extraoral storage. Endod Dent Traumatol 1989;5:38-47.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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    Abstract
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