Decoronation as an approach to treat ankylosis in growing children

There is no greater treatment challenge for the dental practitioner than the scenario resulting when an immature permanent anterio tooth in a young and growing child becomes ankylosed following traumatic injury. In such cases the clinician has few good treatment options because there is no known therapy to reverse ankylosis. At the same time, without treatment the ankylosed tooth poses both developmental and esthetic problems because it will not erupt further nor will it allow the alveolar bone to grow and develop and follow the eruption of adjacent teeth. This review article will present the most commonly recommended treatment options for this clinical challenge. Of the possible options, a decoronation procedure offers one of the best and most predictable clinical outcomes. This procedure involves the removal of the crown of an ankylosed tooth, leaving the root in its alveolar socket in situ. It has been shown that performing this procedure at the appropriate time allows for the facio-palatal width of the alveolus to be maintained for years, while allowing additional vertical growth of the alveolus. The long-term goal of this procedure is allow for the placement of an implant after growth completion in such a manner that the esthetic outcome is maximized, while allowing for an implant placement procedure that is both easier and more predictable. (Pediatr Dent 2009;31:123-8).