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

Abstract

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.

Decoronation - a treatment option of an ankylosed permanent tooth in children and adolescents

“…Furthermore, the still present interdental fibers between ankylosed tooth and the adjacent ones cause tipping of the adjacent teeth as they continue to erupt. In the growing patient, progressive replacement resorption not only leads to the inevitable loss of the traumatized tooth but also affects the alveolar bone formation and the eruption of adjacent teeth [7,8].…”

“…The ankylotic tooth should be monitored regularly, without any intervention, unless tilting of adjacent teeth or moderate infraposition develops. The progression of infraposition depends on the age, gender, and skeletal growth pattern of the patient [8]. Cases with severe infraposition of ankylosed teeth indicate serious aesthetic and functional disturbances.…”

Flapless Decoronation: A Minimally Invasive Approach

“…[17,20]. Although several publications presented some modification of the decoronation procedure, especially without vertical incisions, all of them included a mucoperiosteal flap [21][22][23][24]. In the presented technique, we sought to eliminate the mucoperiosteal flap, in order to allow a minimally invasive, faster, and more comfortable decoronation procedure for the child and parents, as well as potentially easier post-operative healing and better patient and parent compliance with the procedure.…”

“…In general, it is recommended to remove an ankylosed tooth before severe infraocclusion and tilting of neighboring teeth development [27], which may result in unsatisfactory esthetic consequences [24]. However, ankylotic tooth extraction will be followed by significant dimensional changes to the alveolar ridge contour [28][29][30][31][32].…”

“…Young patients who experience dental trauma are required to undergo several invasive dental and medical procedures. The study by Zhang et al, evaluating the psychological impact of decoronation in children and adolescents, demonstrated that child fear of the treatment had the highest score among the major causes of stress and its severity while choosing to proceed with decoronation [24].…”