Flapless Decoronation: A Minimally Invasive Approach

Abstract

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.

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

“…Five studies were excluded as the full text was not available in English, two were conference abstracts, 23 did not report on root submergence and four articles were review articles describing the decoronation technique. In total, 18 articles were included in the qualitative analysis 12,14,15,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] (Figure 1). Seventeen of the 18 included articles were case reports, 12,14,15,[20][21][22][23][24][25][26][27][28][29][31][32][33][34] and one was a case series.…”

“…In total, 18 articles were included in the qualitative analysis 12,14,15,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] (Figure 1). Seventeen of the 18 included articles were case reports, 12,14,15,[20][21][22][23][24][25][26][27][28][29][31][32][33][34] and one was a case series. 30…”

“…• 18 teeth were treated following the Malmgren protocol 9 for decoronation and management of the root canal system following TDI and a diagnosis of ankylosis associated with infraocclusion. 12,[20][21][22]24,[26][27][28][29][31][32][33][34] This protocol involved removing any previous material(s) from the root canal system and encouraging blood from the apical tissues to fill the empty canal at the time of root submergence. The rationale for this approach is that the resorbing root acts as a scaffold for new bone development, maintaining alveolar bone for future prosthodontic rehabilitation.…”

“…Two teeth were decoronated and submerged before being covered using a round porcine-derived collagen matrix (PDCM). 34 Regarding the placement of a coronal barrier following endodontic treatment and prior to submergence, both teeth managed with a root filling material had a glass ionomer cement (GIC; GC Fuji IX GP) barrier placed over the obturation. 23,25 Following D&RS, five patients received an upper removable denture to replace the missing tooth crown.…”

“…Of the 18 articles, 11 clearly stated maintaining or increasing alveolar bone as an outcome, either through radiographs or clinically, looking at the alveolar profile. 12,15,20,21,23,[27][28][29][30]32,34 Two cases of vital root submergence had no treatment other than irrigating over the exposed root and suturing. These cases reported deposition of dentine over the pulp and continued root growth/closure.…”