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References

Malmgren B, Cvek M, Lundberg M, Frykholm A Surgical treatment of ankylosed and infrapositioned reimplanted incisors in adolescents. Scand J Dent Res. 1984; 92:391-399
Day PF, Kindelan SA, Spencer JR Dental trauma: part 2. Managing poor prognosis anterior teeth – treatment options for the subsequent space in a growing patient. J Orthod. 2008; 35:143-155
Atwood DA Reduction of residual ridges: a major oral disease entity. J Prosthet Dent. 1971; 26:266-279
Rodd HD, Davidson LE, Livesey S, Cooke ME Survival of intentionally retained permanent incisor roots following crown root fractures in children. Dent Traumatol. 2002; 18:92-97
Malmgren B, Malmgren O, Andreasen JO Alveolar bone development after decoronation of ankylosed teeth. Endod Topics. 2006; 14:35-40
Malmgren O, Malmgren B Orthodontic management of the traumatized dentition, 4th edn. (eds). Oxford: Blackwell; 2007
Kinirons MJ, Gregg TA, Welbury RR, Cole BOI Variations in the presenting and treatment features in reimplanted permanent incisors in children and their effect on the prevalence of root resorption. Br Dent J. 2000; 189:263-266
Andreason JO, Borum MK, Jacobsen HL, Andreason FM Replantation of 400 avulsed permanent incisors. Part 4. Factors related to periodontal ligament healing. Endod Dent Traumatol. 1995; 11:76-89
Andreason JO, Hjorting-Hansen E Replantation of teeth. Part 1. Radiographic and clinical study of 110 human teeth replanted after accidental loss. Acta Odontol Scand. 1966; 24:263-286
Donaldson M, Kinirons MJ Factors affecting the time of onset of resorption in avulsed and replanted incisor teeth in children. Dent Traumatol. 2001; 17:205-209
Lindskog S, Blomlöf L Influence of osmolality and composition of some storage media on human periodontal ligament cells. Acta Odontol Scand. 1982; 40:435-441
Barrett EJ, Kenny DJ Survival of avulsed permanent maxillary incisors in children following delayed replantation. Endod Dent Traumatol. 1997; 13:269-275
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Trope M Clinical management of the avulsed tooth: present strategies and future directions. Dental Traumatol. 2002; 18:1-11
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Decoronation of ankylosed teeth: An Overview

From Volume 48, Issue 4, April 2021 | Pages 289-293

Authors

Jennifer A Lawson

BA, BDentSc, MFDS, MClin Dent, MPaed Dent

Paediatric Specialty Registrar, Sheffield Teaching Hospitals Trust

Articles by Jennifer A Lawson

Email Jennifer A Lawson

Ann Wallace

BDS, MFDS, MClinDent, MPaedDent

Specialty Registrar in Paediatric Dentistry, Charles Clifford Dental Hospital, Sheffield, S10 2SZ, UK

Articles by Ann Wallace

Halla Zaitoun

BDS, MFDS, MDentSci, FRCS(Paed)

Senior House Officer, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH.

Articles by Halla Zaitoun

Abstract

Severe traumatic dental injuries to permanent incisor teeth often result in replacement resorption following significant damage to the periodontal ligament. This leads to ankylosis and subsequent infra-occlusion of the traumatized tooth in a growing paediatric patient. Extraction of these teeth can lead to vertical bony defects that complicate restorative management of the edentulous space. Decoronation is a technique employed to preserve bone in the alveolar crest in an attempt to reduce these defects.

CPD/Clinical Relevance: This paper aims to remind readers of the processes of replacement resorption and ankylosis and introduces the use of decoronation for such teeth.

Article

Decoronation is a relatively simple technique that is used as an alternative to extraction in cases of infra-occluding permanent incisor teeth. It involves the removal of the coronal portion of a tooth and, if present, its entire root canal filling. It usually involves gingival mucoperiosteal flap elevation and subcrestal removal of the tooth crown, leaving the root in situ to undergo replacement resorption. This technique should not be confused with root submergence or ‘root burial’ which is the elective burial of a root when the crown has undergone substantial traumatic fracture, such as that in a crown-root fracture with or without pulpal exposure.

Decoronation was first described by Malmgren and colleagues in 1984, and was suggested as an alternative treatment to the extraction of ankylosed teeth.1,2 Routine extractions can result in 0.5-mm alveolar ridge height reduction annually, as well as horizontal bone width, particularly in the premaxilla region, which can compromise future prosthetic rehabilitation.3,4 Extraction of ankylosed anterior teeth can be more destructive, resulting in bony ridge deformities that can complicate future prosthetic treatment. Preserving the root acts as a matrix for new alveolar bone development during replacement resorption. Additionally, vertical alveolar bone is rebuilt during the eruption of the adjacent teeth.

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