Tooth ankylosis
Diagnostic methods of tooth ankylosis include the use of clinical examinations, x-ray and cone beam computerized tomography (CBCT).
[5] Early orthodontic interception is also confirmed to be effective in promoting the recovery of the lost space as well as allowing the eruption of the teeth.
[8] Since ankylosis may hinder the normal development of teeth, early diagnosis and intercession is important to avoid further progression and deterioration of the situation.
In light of the situation, early interceptive orthodontic treatment is confirmed to be effective in promoting the recovery of the lost space as well as allowing the eruption of the teeth.
Ankylosis usually initially occurs on the labial and lingual root surfaces making radiographic detection in the early stages difficult.
Other factors, such as age, sex, site of infection may also lead to the occurrence of specific signs and symptoms, but their roles are not well-studied and evaluated.
This process will stop with the appearance of root fractures and shed crown, and changes in dentition, especially the anterior teeth, can be observed in this stage.
[citation needed] For moderate and severe conditions in growing subjects, symptoms such as functional impairment due to loss of occlusal contacts which results from the reduced vertical distance of the ankylosed teeth, and shift in dental midline associated with tipping of adjacent teeth towards the affected tooth, are likely to be developed.
[citation needed] Genetic factors may also be involved in causing the disease, which is supported by the occurrence of ankylosed molars, either in primary or permanent dentition, in close relatives.
[3] In healthy teeth, the periodontal ligament (PDL) fibroblasts block osteogenic cells within the periodontium by releasing locally acting regulators.
Ankylosis initiates with extensive necrosis of the periodontal ligament with formation of bone which will invade the denuded root surface area.
This migration and repopulation process, termed replacement resorption, will continue and thus the teeth root will become fused with the bone tissue adjacent to it.
[4][5] The feasibility of using cone beam computed tomography to diagnose ankylosed teeth is also explored and discussed in a recent research article.
[5] Therefore, it is impossible to identify ankylosis in some areas using x-ray, for instance, buccal or lingual root surface[citation needed].
To overcome such difficulty, cone beam computerized tomography (CBCT) is adopted to provide a 3-dimensional image for better clinical inspection of ankylosis.
[7] In a recent research article, a retrospective cohort study was conducted where a wide range of teeth clinically diagnosed as ankylosed were collected and analyzed.
[7] The histological sections of each tooth obtained from the CBCT scan were then evaluated by two specialists blinded to the details of the research to ensure the fairness and objectivity of the result.
However, it is not recommended to treat CBCT image as the sole model in the identification of ankylosed teeth unless the false positive results are being eliminated.
[7] Ankylosis and primary fail of eruption (PFE) give similar symptoms, since in both cases a targeted tooth is positioned not vertically and unresponsive to orthodontic force applied[citation needed].
[11] For non-growing patients, decoronation is generally not recommended because the growth of alveolar bone may be inadequate for a future tooth implant[citation needed], and therefore is said to not give ideal treatment outcomes.
In surgical luxation, after the bridge of ankylosis is broken mechanically, the tooth is positioned slightly away from its original site and allowed to erupt with a temporary insertion of a splint or an orthodontic appliance.
[5] Tooth repositioning can also be performed by osteotomy and distraction osteogenesis in cases where surgical luxation fails, or as alternatives.
Infraocclusion severity, bone resorption, location of the target tooth as well as dentist's preference all affect the option for treatment.
