Management of severly ankylosed primary molars: Case report

Abstract

Dental ankylosis is produced by the loss of continuity of the periodontal ligament allowing the union of the alveolar bone with the cement. It is more prevalent in the primary dentition (1.3 and 8.9%), with no difference between sexes, affecting mostly primary lower first molars. It interferes with eruptive processes and vertical growth of the alveolar bone leaving the ankylosed teeth  below the occlusal plane. This may cause loss of the arch perimeter, inclination of adjacent teeth, loss of space and alterations in chewing. Dental developmental abnormalities can occur jointly, combining the presence of ankylosed teeth and supernumerary teeth Objective: To report a clinical case regarding severely ankylosed primary molars and upper mesionens. Case presentation: 7-year-old female patient, with diastema between 11 and 21 due to presence of supernumerary in the midline (mesiodens) and low insertion of the labial frenum. She presented severe ankylosis of 65 and 85, vertical alveolar defect and mesial inclination of 26 and 46, shortening of the arch perimeter and apical position of tooth buds 25 and 45. Volumetric images are performed to determine the position of the supernumerary tooth and the degree of ankylosis of the primary teeth. Treatment of choice was odontectomy of supernumerary tooth and ankylosed primary teeth 65 and 85, under general anesthesia. Interceptive orthodontic treatment with distalizing screws for 46 and 26 was planned.  Conclusion: timely treatment of ankylosed primary teeth is essential in order to avoid negative effects on maxillary growth and development, avoid malocclusion and impaction of permanent successor.