Endodontic management of submerged roots following complicated traumatic dental injury (TDI) in children and adolescents: A systematic review.

INTRODUCTION: The International Association of Dental Traumatology (IADT) guidelines include the use of decoronation for the management of complex crown-root fractures but do not outline how this technique is best employed. The aim of this review is to reach a consensus in the management of the root canal system in decoronated permanent teeth undergoing root submergence and to determine whether this has an impact on the success and survival of the retained root. MATERIALS AND METHODS: Search included databases MEDLINE via Ebsco, EMBASE via Ovid, Web of Science via Clarivate, PubMed via PubMed.gov, the Cochrane Library via Wiley, cited reference searching and hand searching of relevant journals. Two independent reviewers performed study selection, data extraction and risk of bias assessment using Joanna Briggs Institute (JBI) Critical Appraisal Checklist. RESULTS AND DISCUSSION: In total, 18 articles were included in qualitative analysis: 17 of these were case reports and one case series. A total of 37 teeth were treated with decoronation either using the Malmgren or an alternative protocol (root submergence following endodontic treatment with gutta-percha [GP] or a calcium silicate cement and vital root submergence). Limited evidence from this review suggests that immediate decoronation and vital root submergence are successful in apexogenesis and preserving alveolar bone. This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: registration number CRD42022316266).

Long-term prognosis after decoronation of avulsed teeth with replacement resorption: a report of three cases.

The complications of replacement resorption following tooth injury in growing children include infrapositioning of the tooth, tilting of the adjacent teeth, and alveolar ridge deformity. Decoronation is a conservative treatment method that facilitates bone preservation. The current case report focuses on the long-term preservation of alveolar ridge dimension following decoronation in three patients. Decoronation was performed prior to occurrence of the pubertal growth spurt, and the patients' ridge width and vertical apposition were monitored for at least 4 years. Timely intervention and regular monitoring are essential for maximization of the benefits of decoronation, a simple procedure that preserves esthetics and minimizes the need for further treatments. The importance of space management for prosthetic treatment has also been highlighted. The findings of this study show that infrapositioned teeth in growing children can be treated successfully using decoronation.

Interdisciplinary treatment of ankylosed upper central incisors with an anterior vertical ridge defect: A case report.

This case report describes the successful 10-years interdisciplinary treatment of ankylosed upper central incisors with an anterior vertical ridge defect. This treatment was challenging as ankylosis was present before the growth spurt. Orthodontic treatment in association with decoronation, a xenogeneic bone graft, an autogenous sub-epithelial connective tissue graft, and implant placement were performed to correct the vertical ridge defect and to re-establish appropriate function, gingival health, and aesthetics. Decoronation performed during the growth spurt was the key to avoiding alveolar ridge deformity.

When to save or remove implants in the smile zone: A clinical report of maxillary lateral incisor implants in malposition.

OBJECTIVE: The following is a clinical report addressing when to save or remove implants with esthetic deficiencies in the smile zone as well as the sequence and timing of interdisciplinary treatment. CLINICAL CONSIDERATIONS: Key factors in the decision-making process in treating implants in malposition are whether the implants are (1) in a reasonable restorative position, (2) free of disease, and (3) placed with adequate depth. This clinical report encompassed periodontal corrective surgery, non-surgical soft tissue sculpting through subgingival crown contour, material selection for definitive restorations, and cementation techniques for cement-retained restorations. CLINICAL SIGNIFICANCE: Knowledge and understanding of interdisciplinary treatment planning, sequencing, and respective techniques that can be implemented when confronting implants in malposition in the smile zone will allow the interdisciplinary team to achieve the desired esthetic restorative result.

A retrospective analysis of the optimal time and psychological impact of decoronation in children and adolescents.

BACKGROUND/AIMS: Decoronation offers one of the best and most predictable clinical outcomes for dentoalveolar ankylosis. The aim of this study was to determine the factors associated with the efficacy and psychological impact of decoronation for bone preservation. MATERIALS AND METHODS: The study included 42 paediatric patients with 42 infrapositioned replanted permanent teeth. Twelve of these teeth were decoronated. Variables such as the time of injury, stage of root development and the extent of infraposition were analysed. The vertical changes in the alveolar bone level of the decoronated teeth were assessed on radiographs using a three-point scoring system. Parents of 30 patients with teeth that were not decoronated completed a questionnaire addressing their considerations and concerns regarding the treatment of infraposition. RESULTS: Teeth with root development in stages 2 and 3 showed a significantly higher rate of severe infraposition during the follow-up visits. Decoronation was performed on 12 teeth within 1.5-5 years (mean 3.8 ± 1.3 years) after replantation and 11 of these cases developed a considerable alveolar bone level. The alveolar bone levels of boys and girls showed improvements of 2.2 and 3.2 mm, respectively. The optimal age for decoronation to have a considerable increase in bone level was 12.12 ± 0.83 years for boys and 11.25 ± 1.77 years for girls. Complicated treatments, followed by parents' lack knowledge regarding decoronation, children's fear, follow-up times, and cost were the major concerns regarding decoronation. CONCLUSION: The optimal time for decoronation should be decided after considering the age, gender, skeletal growth pattern, and the degree of infraposition at the time of decoronation.

Multiple Idiopathic Internal Root Resorption in an Adolescent: A Case R Multiple Idiopathic Internal Root Resorption in an Adolescent: A Case Report.

Internal root resorption (IRR) refers to a slow or rapid progressive resorption process that occurs in the pulp cavity of the tooth or the dentin of the root. IRR occurs as result of odontoclast action; in many cases, the pulp tissue exhibits chronic inflammation, and odontoblasts and predentin do not appear on the dentin wall near the pulp. Exact predisposing factors have not been clearly elucidated; therefore, it is difficult to identify reliable data on the prevalence of IRR because of its scarce occurrence and pathology. Reports have indicated that IRR is more common in the primary than in the permanent teeth. This case report discusses a 17-year-old girl with multiple idiopathic internal root resorptions of anterior permanent teeth in a short period of a time and its management.

Immediate post-operative rehabilitation after decoronation. A systematic review.

BACKGROUND/AIMS: Decoronation is currently considered the best treatment option for ankylosed teeth and discrepancies in the alveolar bone, particularly in childhood and adolescence. The loss of a front tooth creates aesthetic, functional, and psychological distress in patients and their parents. The aim of this study was to analyze the types of restorations provided after decoronation, their suitability, durability, and follow up until insertion of the final restoration. MATERIALS AND METHODS: A literature review was conducted using Ovid MEDLINE, Embase, and Web of Science to identify eligible articles. English language publications until August 9, 2018, were searched independently and cross-checked by two researchers online, in print, and in press. RESULTS: Of 618 articles screened, 10 included reports on 11 patients with detailed descriptions of 13 provisional restorations. Patients' ages at the time of decoronation were 8-15 years. Seven underwent avulsion and four intrusion. Removable partial denture (nine cases) was the most common restoration. In two cases, the restoration was provisional with a lingual bar with prosthetic crown and in two other cases with an adhesive bridge. Follow up ranged from 3 months to 5 years in nine patients. Two cases were followed until the permanent restoration was placed. CONCLUSIONS: The importance of long-term provisional restorations was disregarded by most authors. A multidisciplinary approach should take into consideration immediate-, mid-, and long-term rehabilitation of the decoronated tooth.

Treatment of avulsed immature permanent teeth in Beijing China: A retrospective comparison between 2008 and 2015.

BACKGROUND/AIMS: The diagnosis and treatment of dental trauma are developing rapidly in China. Therapeutic methods used to treat immature avulsed teeth remain a unique challenge in the clinical setting. The aim of this study was to compare the differences in the survival rate and management of avulsed teeth over two distinct periods. MATERIALS AND METHODS: Forty immature permanent avulsed teeth of 34 patients (28 boys, 6 girls) were included in this study between 1 July 2008 and 30 June 2009 (group 1, 17 teeth), and 1 January 2015 and 31 December 2015 (group 2, 23 teeth). The patients' mean age was 8.8 (range 7-11) years. The follow-up period ranged from 1.5 to 10 years (group 1/group 2, 1.5-10/1.5-3 years). Variables such as extra-alveolar time and storage media, stage of root development, splinting type, splinting duration, endodontic treatment and management of complications were studied. The variables were analysed in relation to post-operative pulp outcomes and periodontal healing. RESULTS: Pulp extirpation was performed in 36 teeth within 0-14 weeks (mean: 1.6 + 2.0). The incidence of ankylosis-related (replacement) resorption was 30.5% and that of infection-related (inflammatory) resorption was 22.5%. Pulp survival rate curves differed significantly between the two periods, indicating improvement (P < .05). Splinting type had changed between the study periods to more flexible splints. The use of storage media prior to replantation had also improved. Multivariate Cox proportional hazard regression showed a cumulative survival rate of 82.5% at 3 years and 29.4% at 10 years. CONCLUSION: A significant improvement was observed in the management and prognosis of avulsed teeth between 2008 and 2015.

Effectiveness of decoronation technique in the treatment of ankylosis: A systematic review.

BACKGROUND: Dentoalveolar ankylosis in growing patients is complex leading to continuing root replacement resorption, tooth infra-position, or may even affect the development of alveolar ridge and adjacent teeth. 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. OBJECTIVE: To primarily assess the efficacy of bone width and height preservation around ankylosed permanent teeth following decoronation. METHODS: Pubmed, Embase, Ovid Medline, Thomson's ISI Web of Science and Cochrane library were searched from the year 1984 up to May 2015. Two authors conducted the data extraction. To eliminate publication bias, Open Grey literature and Pro-quest Dissertation Abstracts and Thesis database was also consulted. RESULTS: Through our strict selection criteria, only 12 articles were considered for eligibility. No randomized controlled trials were identified. Only one retrospective cohort study, four case series and seven case reports, were analyzed. CONCLUSIONS: Following decoronation, preservation of ridge height and ridge width were both noted. To maximize the benefits of decoronation, a timely and wellmonitored intervention is required. Treatment in patients, who have surpassed pubertal growth peaks, may not yield maximum effective treatment outcomes.

Long-term follow up of 103 ankylosed permanent incisors surgically treated with decoronation--a retrospective cohort study.

BACKGROUND/AIM: Decoronation is a technique developed in 1984 to remove ankylosed teeth and increase marginal bone levels in young, growing individuals. This retrospective cohort study evaluates marginal bone development after decoronation in relation to gender and age at treatment. MATERIALS AND METHODS: The study evaluated all 95 patients with 103 ankylosed permanent incisors treated with decoronation at the Eastmaninstitutet Department of Pediatric Dentistry during 1978-1999. Mean age of the patients was 10.7 years (6.8-17.8) at the time of trauma and 14.9 years (9.3-22.0) at decoronation. The mean follow-up period was 4.6 years (1.0-19.3 years). The study evaluated development of the marginal alveolar bone level with a three-point scoring system: 1 = Unchanged or reduced alveolar bone level, 2 = A moderate increase in alveolar bone level, and 3 = A considerable increase in alveolar bone level. The final group for statistical evaluation comprised 75 patients: 56 boys and 19 girls who had only one tooth decoronated. Kappa statistics showed almost complete agreement between the two observers (κ = 0.90). RESULTS: Bone level changes were significantly correlated (P < 0.05) to gender and age at treatment. In decoronations performed after the age of 16, bone levels were unchanged or reduced, while decoronations performed at a mean age of 14.6 years in boys and 13 years in girls yielded a considerable increase in bone levels. CONCLUSION: This study indicates that age at decoronation is an important factor for favorable development of the alveolar ridge and that decoronation should be performed earlier in girls.

Bone morphology after delayed tooth replantation - case series.

The purpose of this report was to describe the morphological changes in the alveolar bone after delayed replantation of avulsed teeth using three dimensional cone-beam computed tomography in 11 during the time period 2003-2012. The radiographic observations revealed the following: Delayed replantation results in ankylosis-related replacement root resorption; the resorption is delayed or arrested around the cervical area superior to the alveolar crest. The buccal bone is reduced in thickness but not the palatal bone. The buccal bone resorption of the alveolar crest progresses approximately to the root canal space of the ankylosed root. Delayed replantation does not completely maintain the bone volume. The buccal profile of alveolar bone in the maxillary anterior region is depending on teeth with viable periodontal ligament.

The Outcome of Decoronation in Severe Cases of External Cervical Root Resorption in Young Patients.

This study examines decoronation as a treatment option for teeth with progressive external cervical root resorption (ECR). Six young patients aged 9.5-13, with a total of nine incisor teeth affected by ECR due to previous dental trauma, were treated by decoronation. Six teeth were classified as class 4 and two as class 3, according to Heithersay's classification. Another tooth with class 2 resorption also had a perforation. After decoronation, all cases showed favorable outcomes during a follow-up period of 2.5-8 years. The procedure halted the progression of ECR and promoted vertical and horizontal ridge development above the submerged root. Decoronation can be considered for the successful treatment of advanced cases of ECR in young patients.

Implications of Post-Traumatic Treatment of Immature Maxillary Incisors.

The aim of this review was to discuss traumatic dental injuries in view of their treatment implications to provide an evidence-based resource for clinicians when planning treatment for traumatised immature maxillary incisors. Dental trauma to immature maxillary incisors can result in various complications, such as critical fractures, resorptions, or ankylosis, and might lead to tooth loss. Traumatised teeth may exhibit various unaesthetic discolourations as a result of different dental trauma sequelae or materials used for treatment. All of the above can influence patients' social experience, including self-esteem, confidence, eating and speaking abilities, as well as proper development and growth of the jaw bones. Treatment of traumatised immature incisors should focus not only on the acute phase but on the long-term consequences. Any time gained with the tooth in the jaw bone, free of infection, is an achievement, as it allows normal growth and development. All these aspects are discussed in this narrative review, and an evidence-based summary resource is suggested for clinicians to use when planning treatment for traumatised immature maxillary incisors.

[Aesthetic rehabilitation of a case of maxillary fibrous dysplasia in a child]. / Réhabilitation esthétique d'un cas de dysplasie fibreuse maxillaire chez l'enfant.

Fibrous dysplasia (FD) is a rare, congenital, benign bone disorder in which healthy bone tissue is replaced by abnormal scar-like (fibrous) connective tissue. The lesions may affect one or more bones, including the jawbones. A 13-year-old girl visited the dentist for failed eruption of her left maxillary permanent teeth and facial asymmetry. Radiological analysis revealed impactions of the permanent teeth in hypertrophic, hyperdense, weakly trabeculated bone tissue. To restore the aesthetics of the smile, a treatment combining decoronation and bonded restorations was performed. FD enlargement would slow down after puberty, allowing for long-term therapies. But there is no information about implantology in this type of bone lesion. The aesthetic and functional consequences of a maxillary FD should be managed as soon as possible. Treatment involves a multidisciplinary team and follow-up care into adulthood.

Flapless Decoronation: A Minimally Invasive Approach.

Traumatic injuries to the permanent dentition are most common in children. In severe dentoalveolar injuries, especially avulsion and intrusion, dentoalveolar ankylosis is a common complication, leading to adverse effects on the developing alveolar bone and interfering with the eruption of the adjacent teeth. The decoronation procedure was suggested in 1984 to reduce these side effects related to ankylosis. The objective of the current publication is to describe a minimally invasive, flapless decoronation procedure aimed to minimize and simplify the surgical procedure of decoronation, and ease its clinical acceptance, particularly in young children. The technique is described in a detailed protocol and demonstrated in two cases. Under local anesthesia, the dental crown is removed, and the root is reduced by 1.5-2.0 mm apically to the marginal bone crest. The root canal content is then removed, allowing it to fill with blood. The socket is coronally sealed with a porcine-derived collagen matrix (PDCM) sutured using the "parachute" technique over the resected root, allowing close adaptation to the surrounding soft tissue. In conclusion, the presented technique of flapless decoronation is a modification of the classic decoronation procedure, which can be used as a minimally invasive technique to simplify the surgical procedure and the post-operative process.

Traumatized teeth: clinical practice guideline for the interim management of teeth with various poor prognosis scenarios in growing patients.

OBJECTIVES: Many treatment options accepted for unsalvageable traumatized teeth in adults would seem contraindicated in children and adolescents. Instead, growing patients need interim restorative measures, thus extensively preserving their local bone and soft tissue structures and, ideally, preparing the involved site for later definitive restoration while they transform to skeletal maturity. This narrative topic review addresses the interim management in case of very deep intra-extra-alveolar fractures, extensive infection-related root resorption, tooth ankylosis, and anterior tooth loss in growing patients, and seeks to empower the clinician to select the appropriate treatment approach. DATA SOURCES: The literature up to 2021 was reviewed based on several scoping searches on PubMed and the Cochrane Library using relevant terms. Due to the complexity of the topic (with various poor prognosis scenarios and the differing therapeutic options), a systematic review was deemed inappropriate. CONCLUSION: Suitable interim treatment options include extrusion of teeth showing deep intra-extra-alveolar fractures, and decoronation of ankylosed teeth as well as resin-bonded fixed dental prostheses, natural tooth pontics, and primary tooth autotransplantations after tooth loss. The interim management options described in this article represent compromises chosen in the absence of better alternatives after a careful risk-benefit analysis. However, if adequately performed, the presented treatment options have the potential to achieve the temporary restoration of function and esthetics in growing patients. Close clinical and (if appropriate) radiologic monitoring of these patients is considered mandatory to ensure early detection of possible complications that might jeopardize or could render impossible subsequent therapeutic measures. (Quintessence Int 2022;53:722-731; doi: 10.3290/j.qi.b3236409; Modified from a previously published article (in German) Quintessenz 2022;73(2):162-169).

Replacement Resorption in Children: The Root of All Evil?

Replacement resorption is a common complicating factor in teeth that have been avulsed or intruded. Poor short- and long-term management of dental injuries in children can have a significant impact on a child's dental function, aesthetics and ultimately their quality of life. This article aims to provide clarity on the physiological process of replacement resorption, the clinical presentation and an overview of interceptive treatment that is available.

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

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.

Long-term management of an ankylosed young permanent incisor replanted within 2 h of avulsion: A case report with a 10-year follow-up.

Tooth avulsion is a severe form of luxation injury that involves damage to both the pulp and the periodontal ligament. Avulsed teeth need to be replanted immediately in order to restore esthetics and function. Delayed replantation often results in ankylosis of the tooth which is a common sequela following avulsion injuries. An ankylosed tooth with a necrotic periodontal membrane does not move along with a growing alveolus leading to an arrest in height and width of the alveolar bone causing the tooth to be infraoccluded in a growing individual. This case report describes the multidisciplinary treatment and long-term management of an avulsed permanent central incisor in an 8-year-old child with delayed replantation.

Management of ankylosed teeth using the decoronation technique: integrative literature review and case report

ABSTRACT Introduction: The decoronation technique has been described in literature since 1984 and, based on the available results, it can lead to considerable benefits for the repair and rehabilitation of ankylosed teeth. Based on these reports, one could expect that this procedure would be well known by the dental community. However, this fact does not seem to be true, and this procedure is not widely used. Methods: The objective of this paper is to present appropriate literature that discusses decoronation and evaluate the perspectives of the procedure, both in relation to the technique and the long-term benefits for the patient. An integrative literature review at PubMed, ScieELO, and Lilacs databases was performed using the keywords "decoronation", "ridge preservation decoronation", "decoronation ankylosis". In addition, a case report will be presented to demonstrate the technique in a systematic and detailed manner. Results: Considering the inclusion criteria, 27 articles that present consistency regarding decoronation were selected. Conclusion: There is scarce availability of scientific works related to the topic, to corroborate and discuss the technique. The present paper reinforces the benefits of this procedure, and revisit decoronation, attempting to provide a possible treatment for ankylosed teeth in growing patients.

RESUMO Introdução: A técnica de decoronação é descrita na literatura desde 1984 e, com base nos resultados disponíveis, pode trazer benefícios consideráveis para o reparo e reabilitação de dentes anquilosados. Com base nesses relatos, seria esperado que esse procedimento fosse bem conhecido pela comunidade odontológica. No entanto, isto não parece ser verdadeiro e esse procedimento não é amplamente utilizado. Objetivo: O objetivo deste artigo é apresentar literatura adequada que discuta a decoronação e avalie as perspectivas do procedimento, tanto em relação à técnica quanto aos benefícios em longo prazo para o paciente. Métodos: Foi realizada revisão integrativa da literatura nas bases de dados PubMed, SciELO e Lilacs, utilizando as seguintes palavras-chave: "decoronation", "ridge preservation decoronation", "decoronation ankylosis". Além disso, um relato de caso demonstrará a técnica de maneira sistemática e detalhada. Resultados: Considerando os critérios de inclusão, foram selecionados 27 artigos que apresentam consistência quanto à decoronação. Conclusão: Há escassa disponibilidade de trabalhos científicos relacionados ao tema para corroborar e discutir a técnica. Esse artigo reforça os benefícios desse procedimento e revisa a decoronação na tentativa de fornecer um possível tratamento para dentes anquilosados em pacientes em crescimento.