ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Decoronation Technique for the Treatment of Trauma-Based Ankylosis Results in Favorable Alveolar Ridge Preservation
Clinical Question In the young patient with an infrapositioned incisor due to ankylosis following trauma, does decoronation result in more favorable alveolar bone preservation as compared to extraction?
Clinical Bottom Line For the ankylosed permanent tooth, treatment with decoronation has been shown to increase alveolar ridge dimensions in the growing child and adolescent. This is supported by an uncontrolled clinical trial and case series that demonstrate positive alveolar bone level changes following decoronation, with stable long-term maintenance of alveolar bone until dental implant placement can be completed.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25808297Malmgren/201575 patients/75 ankylosed permanent incisors.Uncontrolled clinical trial
Key resultsSignificant increases in alveolar bone levels were demonstrated in boys with mean age of 14.6 and girls with mean age of 13, emphasizing the relationship between treatment age and favorable alveolar ridge development. Moderate to considerable alveolar bone changes were seen in 75% of patients treated with decoronation. Of the decoronation patients receiving dental implants, 78% required no ridge augmentation prior to placement. Statistical analysis for this study used nonparametric correlation, gamma statistics, and a t-test, all with a significance level of P < 0.05.
#2) 24238443Lin/201312 patients/12 ankylosed maxillary anterior incisors.Case series
Key resultsOne year following decoronation, the average bucco-palatal ridge width was narrower by 1.67 ± 1.12 mm, in comparison to the healthy contralateral incisor. Despite the reduction in alveolar ridge dimensions, the average loss of alveolar bone is significantly less than the reduction seen following single tooth extractions (Schropp et al., 2003). Statistical analysis for the bucco-palatal dimension of the alveolar bone was evaluated by the paired t test, with a significance level of P = .004.
#3) 23439048Malmgren/2013Review
Key resultsThe method of decoronation to remove an ankylosed tooth and preserve alveolar bone was presented, as well as guidelines for intervention based on patient age and growth patterns.
Evidence Search decoronation[All Fields] AND ankylosed[All Fields]
Comments on
The Evidence
Validity: Although these articles are of low level evidence, they provide substantial findings in support of the decoronation technique. Due to the study design and sample size studied, it is recommended that additional larger comparative studies or controlled clinical trials be conducted to expound upon current findings. Overall, these articles demonstrate good evidence to justify the use of decoronation as a means to preserve bone in preparation for future dental implant placement in patients with trauma-induced ankylosis.
Applicability It is important for dental practioners to recognize the early manifestations of ankylosis and treatment options for patients with this condition. Decoronation is a simple and conservative treatment option that offers predictable success in the treatment of trauma-based ankylosis in young children and adolescents. Treatment planning should involve a team approach, along with careful analysis of the timing of decoronation in relation to the patient’s age and growth patterns. In addition, immediate extraction of these teeth should be avoided due to increased risk for loss of alveolar bone volume and need for future surgeries.
Specialty/Discipline (Endodontics) (General Dentistry) (Oral Surgery) (Pediatric Dentistry)
Keywords Decoronation, trauma, alveolar ridge preservation, implants
ID# 2922
Date of submission: 10/10/2015spacer
E-mail MILLERA7@livemail.uthscsa.edu
Author Amber Miller, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Anibal Diogenes, DMD, PhD
Faculty mentor/Co-author e-mail DIOGENES@uthscsa.edu
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