What Is an Ankylosed Tooth?
An ankylosed tooth occurs when the root of a tooth is permanently attached to the bones of the jaw. In Greek, ankylosis means a lack of mobility. Generally, the root portion of a tooth is connected to the jaw bone by fibers called the periodontal ligament. But, an ankylosed tooth is directly connected to the bone because of the missing periodontal ligament. This periodontal ligament acts as a shock absorber to reduce the impact of forces on the bone and keeps the tooth fixed to the bone.
An ankylosed tooth cannot be differentiated from a normal tooth by looks, but sometimes, it may be lower or higher than the gum line. For example, ankylosis can occur when the teeth are still growing out of the gums. If such a condition occurs, the tooth is usually lower because the growth has been halted in mid-process.
What Is the Mechanism Behind an Ankylosed Tooth?
Ankylosiscan occur due to the necrosis of the periodontal ligament. Following necrosis, bone formation will be along the denuded root surface area. Trauma and avulsion of teeth are the primary causes of injury. After avulsion, if the tooth is kept in a dry environment for a critical time, cell death can be on the root surface. The chances of reattachment of periodontal ligament to the affected area are also less than 20 %, thus leading to ankylosis.
The trauma of the tooth can happen in variable degrees, distribution, and forms. If the damage to the root surface is more than 20 %, it is followed by a reactive inflammatory response, which starts the healing process. This can lead to an area of cementum-devoid root surface. This area is susceptible to faster bone-forming cells that migrate and multiply. The infectious stimuli present in the root canal, such as bacterial endotoxins, pass from the root canal through the dentinal tubules and accessory canals to the external root surface, inducing inflammation-mediated resorption of the tissues of the root and adjacent bone.
How Is an Ankylosed Tooth Calcified?
Depending on the degree of severity, ankylosis can be classified as follows:
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Mild Ankylosis - The tooth is a maximum of two millimeters below other teeth or in infra occlusion.
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Moderate Ankylosis - The tooth infra erupts, but still, there will be some type of contact with the adjacent teeth.
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Severe Ankylosis - Normally, in this type of ankylosis, the teeth do not erupt and are concealed within the jawbone.
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What Are the Causes of an Ankylosed Tooth?
There are different causes of an ankylosed tooth, including:
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Tooth or jaw bone infection and inflammation.
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Tooth injury or damage.
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Gum disease that has been left untreated.
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The pressure of the tongue directly on a particular tooth.
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Genetics also play an important role in developing ankylosed teeth.
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Mechanical damage to the cementoenamel junction.
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Spaces between the membranes of the adjacent tooth.
What Are the Symptoms of an Ankylosed Tooth?
The main symptoms of ankylosed teeth are:
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An ankylosed tooth is generally shorter than the adjacent tooth as if it has not emerged fully.
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Reduced number of teeth due to the absence of eruption of an ankylosed tooth.
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Normal teeth have a very minute degree of mobility, but an ankylosed tooth completely lacks mobility.
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A dental midline shift is possible to occur.
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Retention of a deciduous tooth.
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Crooked formation of teeth or misalignment of the teeth on the affected jaw can be seen.
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The under-eruption of an ankylosed tooth will produce an over-eruption of the tooth in the opposing jaw.
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Abnormality in the enamel of the tooth.
What Are the Problems Associated With an Ankylosed Tooth?
Ankylosis can cause many issues like spacing, abnormal positions of adjacent teeth, and misalignment and trigger other associated problems with eruption and development of the jaws.
A few potential complications that can occur from an ankylosed tooth are:
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The inclination of adjacent teeth.
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Loss of space.
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An ankylosed tooth does not occlude with the teeth of the opposing arch.
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Malocclusions like localized open bites or crowded teeth.
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Problem with chewing.
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If an ankylosed tooth is a milk tooth, retention of the upcoming permanent tooth within the jawbone can happen.
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Facial skeletal structure deformation.
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Relative mandibular prognathism (big mandible).
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Posterior open bite (backmost upper and lower teeth not touching each other upon clenching).
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Midline shift (line between the central incisors of upper and lower teeth do not coincide).
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Vertical growth of the alveolar bone can be affected.
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An increased risk of periodontal disease and tooth decay can occur due to poorly positioned teeth, making oral hygiene difficult.
How Is Dental Ankylosis Diagnosed?
In most cases, an ankylosed tooth can be diagnosed during an oral examination. The affected ankylosed tooth will often be shorter than the other tooth. A dentist may also tap on the tooth surface; the tooth that is fused to the bone will have a different sound than the rest of the teeth. A dental X-ray can also be used as a form of diagnosis.
What Is the Treatment for Ankylosed Teeth?
The treatment of the ankylosed teeth depends on thenature, position, and state of the ankylosed tooth or teeth.In the case of ankylosed primary teeth, the most accepted treatment includes removing the ankylosed tooth for the development and eruption of the permanent teeth. It is then followed by surgery to expose and reposition the emerging permanent tooth.
Few other treatment techniques include:
Orthodontic Treatment - The treatment helps to ensure the proper positioning and alignment of an ankylosed tooth.
Luxation - In this procedure, the mechanical breakage of the ankylosed teeth is done without compromising the blood vessels at the apex. It is done using appropriate forceps by firmly grasping the tooth and gently rocking it in a backward and forward and side-by-side direction. After this process, the periodontal ligament is restored to allow eruption.
Corticotomy - It is a surgical procedure in which a small piece of surgically cut bone is used to reposition the ankylosed tooth.
Ostectomy - Localized ostectomy is a procedure in which the affected osseous (the tissues that have turned to bone) tissue is cut. This method works only if the ankylosis is in the crestal area because other positions will not be readily accessible to surgery.
Conclusion:
Malocclusions, an improper eruption of the tooth, facial skeletal structure deformation, and periodontal diseases are dental issues caused by an ankylosed tooth. Hence, a proper dental checkup and treatment are required at the earliest opportunity to avoid mishaps for a healthy oral cavity.
