Decoronation of an ankylosed permanent incisor: alveolar ridge preservation and rehabilitation by an implant supported porcelain crown.

Replacement resorption and ankylosis are frequently diagnosed following severe dental trauma. The complications that may develop as a result of ankylosis of a permanent incisor in children and adolescent include: esthetic compromise, orthodontic complications because of: arch irregularity; lack of mesial drift; tilting of adjacent teeth, arch length loss and local arrest of alveolar ridge growth. To avoid such complications, an ankylosed tooth should be removed before the changes become so pronounced that they compromise future prosthetic treatment. The purpose of this article was to present a case of preservation of the alveolar ridge for implant rehabilitation by utilizing decoronation for the treatment of a young permanent central incisor. An implant was inserted, without any bone augmentation procedures, followed by prosthetic porcelain crown rehabilitation. We conclude that treatment of an ankylosed young permanent incisor by decoronation may maintain the alveolar bone ridge width, height and continuity, and facilitate future rehabilitation with minimal, if any, ridge augmentation procedures.

Decoronation for the management of an ankylosed young permanent tooth.

Replacement resorption rate is a variable process, and is dependent on age, basal metabolic rate, extra-alveolar time, treatment prior to replantation, amount of root dentin, severity of trauma, and extent of periodontal ligament necrosis. In patients 7-16 years old a tooth is lost 3-7 years after the onset of root resorption. The complications that may develop as a consequence of ankylosis of a permanent incisor in children are due to the inevitable early loss of the traumatized tooth and local arrest of alveolar bone development. An ankylosed tooth should be removed before the changes become so pronounced that they compromise future prosthetic treatment. The treatment options may involve: interceptive regenerative treatment, early extraction of the ankylosed tooth, orthodontic space closure, intentional replantation, extraction of the ankylosed tooth followed with immediate ridge augmentation/preservation, auto-transplantation, single tooth dento-osseous osteotomy, and decoronation. The purpose of this article was to review the considerations involved in the decision-making concerning the use of the decoronation technique for the treatment of a permanent incisor diagnosed as ankylosed.

Clinical solutions for developmental defects of enamel and dentin in children.

Developmental defects of enamel (DDE) are frequently observed in pediatric dental patients. Proper diagnosis may improve the clinician's dental care. The purpose of this article is to present the clinical management of some common dental defects: (1) hypoplasia; (2) diffuse and demarcated opacities; (3) fluorosis; (4) amelogenesis imperfecto (Al); and (5) dentinogenesis imperfecto (DI). The comprehensive management of DDE in children and adolescents should include: (1) active follow-up and observation involving oral hygiene instructions; and (2) dietary consultation. Preventive care should be individually tailored according to the patient's risk-assessment analysis. The treatment of DDE involves an approach that includes several disciplines, including: (1) pediatric dentistry; (2) orthodontics; (3) perioprosthetics; and (4) psychology. A close follow-up is essential to achieve long-term success.

A novel multidisciplinary approach for the treatment of an intruded immature permanent incisor.

The optimal treatment for intruded permanent teeth has not yet been determined. The ideal treatment option is the one with the lowest probability of developing complications such as external root resorption and marginal bone loss. Each case should be considered individually, bearing in mind the severity of the intrusion, the stage of root development, and tooth mobility. Management of an intruded permanent tooth may consist of: (1) observation for spontaneous eruption; (2) surgical crown uncovering; (3) orthodontic extrusion (with or without prior luxation of the intruded tooth); (4) and partial surgical extrusion, immediately followed by orthodontic extrusion and surgical repositioning. The purpose of this article was to review the treatment options for intruded immature permanent incisors, and to present a new modality of an elective internal strengthening of the immature root weakened by external root resorption. A case of an intrusive luxation injury in a 7 1/2-year-old child and the resulting complications utilizing this technique is described. This is the first known report in the pediatric dentistry literature of performing an elective (preventive) internal strengthening of an immature root weakened by severe external inflammatory resorption. The child was followed for 5 years with an excellent clinical outcome. This technique should be considered for treatment of immature permanent teeth with thin cervical root dentin and external or internal root resorption due to trauma or caries.

IgG antibody levels to Porphyromonas gingivalis and clinical measures in children.

BACKGROUND: Periodontopathic clinical markers are poorly understood in the pediatric population. Several studies have proposed Porphyromonas gingivalis (P. gingivalis) and an antibody response to the microorganism as factors in periodontal tissue destruction in children. The objective of this study was to examine the prevalence of P. gingivalis in dental plaque and of serum immunoglobulin G (IgG) antibody levels to P. gingivalis, and their relationship to periodontal clinical measures in children. METHODS: Thirty-one subjects, aged 20 to 163 months, participated in this study. Clinical measures examined included gingivitis, plaque, alveolar bone height, age, gender, ethnicity, medical status, caries, and IgG antibody levels to P. gingivalis. Five ml of blood was collected for serum analysis, and IgG antibody levels to P. gingivalis were determined by using enzyme-linked immunosorbent assay. Plaque samples were examined for the presence of P. gingivalis by DNA-DNA checkerboard. Data were analyzed on a person-level basis for relationships to serum IgG antibody levels to P. gingivalis and on a site-specific level for relationships to the presence of P. gingivalis in plaque. RESULTS: A majority (77%) of the subjects were systemically healthy, non-white (74%), and did not have detectable P. gingivalis in their plaque. Fifty-two percent of the subjects had positive serum IgG antibody levels to P. gingivalis. Based on univariate linear regression, factors related to IgG antibody levels to P. gingivalis (P<0.05) included age, average gingival index (GI), average probing depth, and number of teeth with alveolar bone crest to cemento-enamel junction (ABC-CEJ) distances >2 mm. When all clinical measures were considered together, only age remained statistically significantly related to serum IgG antibody levels to P. gingivalis. CONCLUSIONS: Age is one of the most important factors in the development of the immune response to putative microorganisms such as P. gingivalis in children. The role of IgG as a time-sensitive measure of periodontal health in children needs to be investigated further.