Central Incisor Ankylosis in Children & Adolescents: Extraction, Distraction or Autotransplantation?

Central incisor ankylosis in children due to injury presents a severe therapeutic problem. If it appears at a very early age, it leads to gradual reinclusion. As a result, an aesthetic handicap and more importantly bone loss vertically in the site of the central incisor occur – this can constitute a severe problem for future implantation. The difference in the vertical level of bone in the ankylosed tooth and the adjacent teeth can be 8-10mm with an adolescent growth spurt. This is difficult to solve by vertical augmentation before implantation.

The authors show individual cases with different diagnostics leading to individual solutions. There are several possible solutions to this problem, especially in childhood. The solution most often used is to extract the ankylosed tooth and close the space by a medial shift of the neighbouring teeth, followed by reconstruction of the lateral incisors into the shape of the central incisors. Another variant is the autotransplantation of teeth from the maxilla or mandible into the site of the central incisor. If a distinct reinclusion of the tooth is already present, both of these variants are suitable.

This paper directs attention to the distraction of a bone block with the ankylosed tooth by a fixed appliance. This unconventional solution – possible only after the patient is fully grown – allows the vertical bone level to be restored together with soft tissues in the vicinity of the tooth.

Learning Objectives:

• Identify ankylosis and choose right solution of treatment.
• Use distraction osteogenesis as a solution of ankylosed central incisor and know important details of the procedure.
• Use autotransplantation of premolars to region of central incisor and know benefits and risk factors of the procedure.