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Microscopic Aspects in Dentoalveolar Ankylosis

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Microscopic Aspects in Dentoalveolar Ankylosis MICROSCOPIC ASPECTS IN DENTOALVEOLAR ANKYLOSIS OF PERMANENT TEETH Veronica Mercuţ1, Sanda Mihaela Popescu1, Ileana Cristiana Petcu1, Oana Gângu2, Răzvan Mercuţ3, Monica Scrieciu1, Horia Octavian Manolea1, Andreea Gabriela Nicola1, Marina Olimpia Amărăscu1, Luminiţa Dăguci1 1University of Medicine and Pharmacy of Craiova, Faculty of Dental Medicine, Department of Dental Prosthetics and Oral Rehabilitation 2University of Craiova, Faculty of Mechanics 3University of Medicine and Pharmacy, Faculty of Medicine, Department of Plastic Surgery Corresponding author: Răzvan Mercuţ, [email protected], Ileana Cristiana Petcu, [email protected] ABSTRACT Dentoalveolar ankylosis represents the fusion of cement to the alveolar bone with obliteration of the periodontal space. The aim of the study is to describe the macroscopic and microscopic appearance of dentoalveolar ankylosis in order to establish the nature of the connection between the dental roots and the alveolar bone. Material and methods: The study was performed on 7 extracted teeth, one monoradicular (canine) and six pluriradicular teeth in which at the time of extraction the presence of an alveolar bone fragment attached to the root was observed. For macroscopic identification of tooth ankylosis lesions, we used photographs made with Canon DSLR 600EOS. Evaluation of dentoalveolar ankylosis lesions was performed by microscopic analysis using the Nikon SMZ745T stereomicroscope recommended for both industrial and biomedical applications. Results and discussions: Microscopic analysis revealed features of the root surface affected by ankylosis, features of the bone tissue attached to the root surface and the nature of the connection between the two components of ankylosis. Conclusions: The microscopic study established that there are areas where ankylosis is complete with the disappearance of periodontal space and areas where ankylosis is incomplete. Keywords: dentoalveolar ankylosis, microscopic aspect. INTRODUCTION 6]. The installation of dentoalveolar In a simplistic way, dentoalveolar ankylosis during tooth eruption determines ankylosis represents the fusion of the locally the insufficient development of the cementum to the alveolar bone with the alveolar process with the tooth in obliteration of the periodontal space. infraposition [7,8]. In addition, Another definition states that ankylosis is a dentoalveolar ankylosis could produce disorder of tooth eruption, caused by the insufficient sagittal development of the fusion of the dentine or cementum with the dental arch, by altering the position of alveolar bone and the disappearance of neighbouring teeth on the arch by tilting periodontal ligaments by replacing them them and creating retentive spaces on their with alveolar bone [1, 2, 3]. Histologically, proximal faces that may favour the tooth ankylosis is defined as the fusion of formation of periodontal defects [3,9]. the root surface (cement or dentin) with Pithon and Bernandes [3] associated the surrounding alveolar bone [4]. dentoalveolar ankylosis with an uneven Ankylosis could occur before, during or occlusion and vicious habits. According to after tooth eruption in the oral cavity [5, Moataz Alruwaithi et al. [10] there was a 84 high probability of tooth ankylosis six multiple rooted teeth (five upper third presence in an alveolar intruded tooth or in molars and one lower first molar with a replanted tooth, as a consequence of the separated roots as a consequence of the reaction of the surrounding bone or of the carious process). The canine was the single replacement root resorption. tooth left on the maxillary arch and it had a There is some confusion in the literature Ni-Cr cast post and core with a great between ankylosis and its consequences, angulation between root and crown, a sign namely infraocclusion, intrusion, that occlusal forces did not occur in the incomplete eruption [11], or with external long axis of the tooth. During the dentate root resorption. External root replacement period, the patient was diagnosed with resorption represents a physiological dental crowding. From the 6 molars (five remodelling of the alveolar bone with upper third molars and one lower first replacement of the cementum or dentin of molar), one upper third molar with the a dental root [12]. Replacement root largest attached bone fragment was for a resorption may accompany dentoalveolar long period of time an abutment for a long ankylosis [4]. bridge with three pontic units (1 premolar Dentoalveolar ankylosis was classified as a and two molars). All of these teeth were dental disease for the first time in ICD-10 considered unrecoverable due to periapical Version: 2016 [13]. pathological processes. A signed informed According to Hadi [4], establishing the consent was obtained for all patients, prior diagnosis of dentoalveolar ankylosis is to dental extractions. For all these teeth, difficult when less than 20% of the root the clinical and radiological examination surface is affected, since the percussion did not indicate the presence of sound is not pathognomonic, the tooth has dentoalveolar ankylosis. The diagnosis a reduced mobility and radiological image was made after the dental extractions, is inconclusive. Clinically, we encountered when the examination of the extracted situations in which teeth with ankylosis teeth highlighted the alveolar bone presented mobility, but the OPG fragments attached to the dental roots. All radiological examination did not showed a dental alveolus were sutured. Extracted dentoalveolar ankylosis. In these cases, the teeth were flushed with water and placed diagnosis has been established after in 10% hydrogen peroxide solution for 72 extraction, when together with the root of hours. This method was used to ensure that the respective tooth we have removed a a possible thickening of the periodontal fragment from the alveolar bone, attached ligaments that would have caused the by the root. alveolar bone fragments to be removed The objective of the study is to describe along with the tooth, to be identified and the macroscopic and microscopic aspect of removed. Subsequent microscopic the dentoalveolar ankylosis in order to evaluations were done. The positioning of establish the nature of the connection the teeth for analysis was done according between the dental roots and the alveolar to the protocol followed in other studies bone. [14,15]. MATERIAL AND METHODS For macroscopic identification of tooth The study included 7 extracted teeth, of ankylosis lesions, we used photographs which one single root tooth (canine) and made with Canon DSLR 600EOS. 85 Microscopic examination images which can be further processed in The evaluation of dentoalveolar ankylosis the form of: topographic maps, 3D profile lesions was performed by microscopic of the 2D surface and measurements analysis using the Nikon SMZ 745T related to these images. The (Nikon, Japan) stereomicroscope stereomicroscope belongs to the recommended for both industrial and "COMING" Research Center of the biomedical applications. This device has a Faculty of Mechanics, University of magnification of 75X and a working Craiova. It has improved technical features distance of 115 mm, which allows with Soft NIS-A EDF (Extended Depth of optimum visualization of the ankylosis Focus Plug-In) and Soft NIS-A AMEAS lesions in the studied teeth. Also, the (Auto Measurement Plug-In) that enabled Nikon SMZ745T stereomicroscope allows us to obtain high quality images needed to the acquisition of 2D and 3D images. The analyse dentoalveolar ankylosis lesions. acquisition of 2D images is done through The study was approved by the Ethical the optical system and can be stored and Committee of the University of Medicine further processed using NIS-A-AMEAS and Pharmacy of Craiova, Romania software that allows the processing of the RESULTS acquired image (linear measurements; Direct examination of the 7 ankylosed curves of angular lines of surface; static teeth, after being held in 10% hydrogen data; profiles of the analyzed surfaces, peroxide for 72 hours, revealed that in the etc.). The successive acquisition of 2D canine the alveolar bone fragment was images and their recomposition to obtain a detached from the root as a consequence of 3D image of the samples was done with the decomposition of the organic the NIS-A-AEDF software. With the help component of the periodontal ligaments of this program, different areas of interest (Fig. 1a and b). of the analysis sample can be studied in 3D Fig. 1. Macroscopic aspects of superior canine immediately after extraction (a), and after tooth keeping in H2O2 10% for 72 h (b). Microscopic examination was done for the particularities of the root surface affected 6 molars for which the bone fragments by ankylosis, particularities of the bone remained attached by the root. tissue attached to the root surface and the Microscopic analysis revealed nature of the connection between the two 86 components of dental ankylosis. The study Macroscopically, after the extraction of the highlighted the microscopic aspects upper third molar used as the distal relevant for the lesion of ankylosis, in this abutment for a long bridge, it was case microscopic aspects of the upper three observed that part of the alveolar bone molar used as abutment and from the from the apical half of the root was unified lower one, with separated roots. with the root (Fig. 2a and b). Fig. 2. Macroscopic aspects of an upper third molar used as an abutment for a dental bridge, with ankylosis (a, b). Optical
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