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Ankylosed Primary Molars, Andlaw (1974) Described Surface Defects from Bicuspids Preceded by Non-Ankylosed 11 Molars

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Ankylosed Primary Molars, Andlaw (1974) Described Surface Defects from Bicuspids Preceded by Non-Ankylosed 11 Molars PEDIATRICDENTISTRY/Copyright (~) 1980 The AmericanAcademy of Pedodontics/Vol. 2, No, 1 Ankylosedprimary mola.rs: Results and treatment recommendat,onsfrom an eight-year longitudinal study Louise Brearley Messer,B.D.Sc., L.D.S., M.D.Sc. Jay T. Cline, D.D.S., M.A. Abstract continues concomitantly with vertical alveolar bone growth,~,3 and the tooth is immobile to manual rock- A total of 263 ankyloscd primarymolars in 107 ing.4,5 children aged three to 12 years was studied for four years. Forty-six children remainedin the study for eight years. The etiology of the condition remains unknown. Extrinsic causative factors implicated are local me- Observationof affected dentitions showedthat the con- ~ ~ dition waslikely to recur. Threeclinical pa~ternsfor the chanical trauma, disturbed local metabolism, local- condition are described. Typically, maxillary molars be- ized infection, 6 chemical or thermal irritation 7 and came ankylosed earlier and demonstrated more severe tooth reimplantation, s Intrinsic factors cited include a in[raocclusion than mandibularmolars. Mandibularfirst genetic or congenital gap in the periodontal liga- molars usually remainedslightly or moderatelyin#a- ment. Since both erupting and exfoliating teeth show occluded; mandibularsecond molars and maxillary first alternating periods of resorption and deposition of and second molars showedprogressively severe infra- bone and cementum,° aberrant deposition of these tis- occlusion. Followingeither extraction or ex~oliation of the suesI° may produce an area of ankylosing tissue.Z, affected molars, the succedaneousbicuspids did not differ In a summaryof studies reporting the prevalence of in either coronal morphologyor in distribution of enamel ankylosed primary molars, Andlaw (1974) described surface defects from bicuspids preceded by non-ankylosed 11 molars. Mandibularfirst molars usually ex[oliated on a range from 1.3% to 38.5%. The differences were schedule; failure to employtimed extraction for severely attributed to ethnic factors, and also to differing diag- infraoccluded molars resulted in reduced alveolar bone nostic criteria. Amonghealthy Caucasian children of support [or the bicuspid. Treatment recommendations predominantly Scandinavian descent residing in the are developedbased .upon the molar type, clinical pattern, Minneapolis-St. Paul area of Minnesota, we reported and the severity of in#aocclusion. a prevalence of 6.9%.12 Contrary to studies reporting the mandibular second primary molar to be most fre- quently affected, 4,z3,1~ our studies and others have Introduction implicated the mandil3ular first primary molar most frequently. 1~,15,16 Multiple instances of ankylosis oc- Dental ankylosis may be defined as an anatomical cur as frequently as single instances, ~7 and a patient fusion of cementum with alveolar bone, occurring at 1 with one or two ankylosed teeth is likely to have other any time during the course of eruption. Occasionally, teeth become ankylosed later. 1°,1v Radiographically, the tooth may become ankylosed prior to emergence the zone of ankylosing tissue may not manifest as a into the oral cavity, or may ankylose during active localized obliteration of the periodontal ligament eruption before contact is made with the opposing space, since the zone may be only a microscopic re- dentition. 2 Clinically, the crown is located below the pair of cemental resorption by osteoid-like tissue con- occlusal plane, while the eruption of adiacent teeth tinuous~8-2° with the alveolar bone. The presence of ankylosed primary molar teeth Accepted: December3, 1979 may complicate the eruption and development of the PEDIATRIC DENTISTRY Vol. 2, No.1 37 permanent dentition. Typically, there is delayed ex- Purposes of Short-Term and Long-Term Studies zl foliation of affected teeth with subsequent compli- The purpose of the short-term study was to eluci- cations such as deflected eruption paths for adiacent date the characteristics of ankylosis of individual z or opposing teeth, impaction of succedaneous bicus- molars, ~vith respect to age at diagnosis, severity of 11 pids,% localized or generalized loss of needed arch infraocclusion, and distribution of the condition. 21 length, and tipping of adiacent teeth over the anky- Dentitions in the long-term study were used to losed primary molar or supraeruption of opposing study the sequelae of ankylosis with respect to over- ]~,2~,2z teeth. These sequelae may result in malocclu- retention of the primary molar, and the clinical and sion. radiographic appearance of the succeeding bicuspid In the past, the treatment of ankylosed primary in comparison with other bicuspids preceded by non- -° molars has been largely empirical. Luxation, restor- ankylosed primary molars in the same dentitions. ing the tooth to occlusion ~vith a variety of techniques and materials, -0~,°’3 and extraction,~,z°, zl have all been Diagnosis of Ankylosis utilized. While the literature contains many anecdotal The diagnosis was based upon two essential cri- reports of the relative success of these treatment ap- teria: proaches, clear documentation of indications, contra- (1.) The entire occlusal surface of the primary indications and possible sequelae is lacking. In order molar was located at least 1 mmbelow the to develop more rational bases for treatment, a two- expected occlusal plane as judged from the part clinical investigation comprising a short-term nearest adjacent non-ankylosed teeth in the (four-year) study and a long-term (eight-year) study same5 quadrant. was designed. A group of affected dentitions was fol- (2.) The molar was immobile when subiected man- lowed longitudinally with periodic examinations, ra- ually to a rocking movement,4 in contrast to diographs and study models, until complete erup- other (non-exfoliating) primary molars in the tion of all bicuspids, permanent cuspids, and perma- dentition. nent second molars. No attempt was made by the The emission of a sharp clear sound on percussion investigators to dictate treatment of the ankylosed was not an essential criterion because of its subiec- molars by the attending dentists in order that cur- tivity, a9 Radiographic evidence of bony union was rently-employed treatment regimes would be used un- not~z required because of its variability. hindered. Distribution of Primary Molars The short-term study group comprised 107 denti- Study Design tions (45 males; 62 females) which at first examina- tion contained a total of 191 ankylosed molars (Table Study Population 1). The group included six sibships each containing A total of 107 healthy Caucasian children of pre- two affected children. Thirty-five dentitions each dominantly Scandinavian descent, ranging in age from contained a single ankylosed molar and 72 dentitions three to 12 years and possessing one or more anky- each showed two or more affected molars. The 107 losed primary molars, was studied in the Pediatric ¯ dentitions were studied for four years, during which Dentistry Clinic of the University of Minnesota time 31 dentitions (29~) showed a recurrence School of Dentistry. Using periodic clinical and radio- ankylosis involving a further 72 primary molars (Ta- graphic observations, the history of each ankylosed ble 1 ). primary molar (test molar), and non-ankylosed pri- Thereafter, the long-term study group contained 46 mary molar in each dentition was followed and ob- dentitions (23 males; 23 females; three sibships each servations recorded on these teeth and their succeed- with two affected children) totalling 116 ankylosed ing bicuspids. molars (Table 1).~ These were followed for eight The majority of children received their dental care years. No additional diagnoses were made during throughout the study at the clinics of the University the second four years of the study. For this group, of Minnesota School of Dentistry; the remainder at- the bicuspids preceded by non-ankylosed primary tended private dentists for regular dental care. In all molars in the same dentitions were pooled as a com- instances, the ankylosed molar either was ob.served parison group. These teeth were distributed as fol- periodically, or extracted and appropriate space lows: mandibular first: 9.8; mandibular second: 48 (a maintenance instituted. No tooth was treated by lux- further three teeth were congenitally absent); maxil- ation; only ankylosed teeth with congenitally-missing lary first: 86; and maxillary second: 86 (a further two bicuspids ’were restored’ to occlusion with stainless teeth were congenitally missing). Since many of the steel crowns. dentitions had contralateral molars affected with ANKYLOSEDPRIMARY MOLARS 38 Messerand Cllne Table 1. Distribution of ankylosedprimary molars in i07 affected dentitions (short- and long-termstudies) Time of No. Ankylosed Primary Molars Study diagnosis Md 1st Md 2nd Mx 1st Mx 2nd Total Short term at first exam 131 37 16 7 191 at later exam 18 40 5 9 72 Total 149 77 21 16 263 Long term at first or later exam 64 41 7 4 116 ankylosis, teeth could not be pair-matched for com- aminedin order to identify distribution characteristics parisons. Therefore, the findings for each group of for the condition. ankylosed molars were compared with those for the corresponding group of pooled non-ankylosed molars. Data Collected in Long-TermStudy Data Collected in Short-Term Study Overretention of Ankylosed Primary Molars A molar was deemed overretained if it was still in Age at Diagnosis of Primary Molar Ankylosis position, and immobile, after the contralateral non- The age of each child at the time
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