ankylosed toothSpear released a new problem-based Study Club module.

In “Managing Ankylosed Teeth,” Dr. Gregg Kinzer describes the etiology of ankylosis and explores the clinical information necessary to develop an effective treatment plan. Five treatment options for ankylosed teeth are discussed, as well as the rationale for selecting the appropriate option.

Through this module, Study Club members will learn:

  • What is the cause of replacement resorption (ankylosis)
  • How to evaluate and diagnose ankylosed teeth
  • Which treatment parameters need to be evaluated
  • What are the different treatment options for managing ankylosed teeth

This is an advanced case and is best for Study Clubs that have been a group for more than two years. Study Club members will be eligible for three continuing education credit hours for each module they complete. 


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Commenter's Profile Image Cynthia S.
June 27th, 2016
Read the previous articles on anklosed teeth,good background. I am commenting as an Oral Surgeon who treats these, I do not recommend subluxation of a submerged or impacted tooth it will cause or accelerate the ankylosis. Ortho can be tried it will tell you if the tooth is truly anklylosed. However waiting 5-10 years in a patient only excaberates the problem and leaves me with less to restore, the problem is just being delayed. The teeth are harder to remove as the patient ages and they have to be ground out. Regeneration of new bone and soft tissue is optimal in younger patients and these cases always need grafting once growth is complete. Timing and presentation is key. I don't see the value in single tooth osteotomy these are rarely performed due to the complication rate. The implant comparison is true on the lack of a PDL however an implant does not continue to resorb over time. The best treatment is removal, staged hard and soft tissues grafting to allow blood supply to establish itself. In an older patient who presents with this then I think the composite disguise is warrented. Unfortunately delaying treatment makes the surgeons job harder, and can compromise the result.Timing and coordination with the oral surgeon should be impleted early in the treatment plan. My college age students have breaks in their schedule and with excellent provionalization understand this and don't delay treatment. Thanks for reading Dr Cynthia Satko, study club leader, Chicago. Value T.
Commenter's Profile Image Benjamin R.
June 28th, 2016
This is response is from Dr. Greggory Kinzer: Thank you very much for your comments. I appreciate your view points and would like to address just a few areas for clarification. I agree with your first statement as I also do not recommend subluxation as a treatment option (the reason being that you have no way of knowing if it is a “spot” ankylosis or more of a the entire general surface area of the tooth). However, given that this treatment option is covered in the literature, I felt it was important to at least include it. I also want to be clear that removal of ankylosed teeth in growing patients is "typically” always recommended as growth and development tend to increase the difficulty of the situation due the the vertical defect that is created. However, if the tooth becomes ankylosed past the growth phase, the patient has the option of proceeding with treatment now or delaying the therapy. It has been our experience that although removal of the tooth is highly likely at some point in the future, we have no problem leaving the tooth in place until symptoms are present (which generally occurs when the resorption gets into the area of the attachment) if the patient wants to delay treatment. As the body is replacing the tooth structure with bone….in a sense, these patients are creating their own bone graft. It is true that the teeth need to be “ground” out rather than "conventionally extracted” and although it may take them more time, I’m not sure that it is a problem that creates a contraindication for our interdisciplinary treatment team….and I don’t believe it compromises our final result. In fact, the reality is that even if every bit of root structure isn’t removed from the bone, this will not impede integration and most likely will itself turn into bone over time. It is generally understood that often there can be more than one treatment option and more than one way to proceed with treatment without sacrificing the final outcome. In addition, it must be noted that there can be both advantages and disadvantages to “delaying” the treatment of ankylosed teeth in a non-growing patient. Advantages: The treatment performed will have a shorter time to survive; Potentially better final result as implants/surgical techniques/materials continue to improve; Provide the patient time to manage expense; Patient views you as an ally attempting to help them. Disadvantages: Potential for an emergency event, depending on the situation; Potential for the tooth to negatively impact the bone or adjacent teeth;| Loss of current production $$$. Again, thank you for your comments.