Ankylosis in growing persons results in the stop of alveolar growth.the ankylosed tooth gets into an infra-position.neighbored teeth may be tilted, and dispositioned. The infra-position also results in a more or less dramatic vertical tissue deficit, which is still one of the biggest challenges in dental implantology. The life expectancy for ankylosed teeth in growing persons is about 3 to 7 years.
The aesthetic appearance may be considerably changed. However, the perception and the judgment/rating of such compromises may be dependent on a variety of factors, like usual appearance of the members of group/society (itself dependent on factors like access to dental treatment, including factors like level of income, wealth fare, insurance system).
Related questions: how much difference is accepted? When turns an acceptable deviation into an ugly state? Do people suffer from their appearance, and to what extent? Is the self perception different to that of the group/society/family?
Is a severe infra-position better or worse than a missing tooth?
(Just some ideas, I don't have any background except they I have to handle these cases clinically, to decide what I shall propose to my patients - which is sometimes delicate)
The simplest and most rewarding thing from apatients perspective is just to add some direct resin composite to the ankylosed tooth to make it appear as long as the matching tooth beside it.
If the other teeth continue to leave it behind as development occurs you can add extra composite to the tip as often as required to the length and width to make the ankylosd tooth appear as a mirror image of the adjacent (usually central incisor ) tooth.
An ankylosed tooth can be regarded as an implant during normal growth and development and it is probably more sensible psychologically,technically and biologically than a partial denture or multiple adhesive bridges .
Hi, Martin,
thanks for your answer.
In fact, up to now I try to avoid what you propose, for this results in vertical bone deficiencies, which are difficult to handle. I prefer transplants, if ever possible; and decoronation (rare) and orthodontic space closure. These are very demanding treatments for young patients.
However, I don't have many experiences with patients treated according to your proposal. Can you provide some information whether patients are satisfied? Do they complain about their - somewhen - very long tooth? Do you have experiences with the treatment if a tooth in infraposition is lost?
From an aesthetic point of view an infra-positioned tooth can be psychologically depriving. I agree with Dr. Kelleher. The immediate solution would be to lengthen the crown by composite veneering. The veneering can be satisfactory to the patient, cost effective and serve for a well maintained prognosis too.
On a long term a 3 unit fixed prosthesis may be a good treatment plan or if suited, an immediate short dental implant can be used post surgical extraction of the ankylosed tooth.
http://www.ncbi.nlm.nih.gov/pubmed/20212407
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