96 - Management of Ankylosed Primary Molars with Premolar Successors

Long, TD et al. 2013 JADA

Purpose of study: Systematic review of Advantages + Disadvantages of extraction vs. monitoring

Relatively common to find infraerupted primary molar that has stopped erupting vertically
 8-14% Prevalence in children 6-11 yrs old
 Primary mandibular molars are the most affected vs primary maxillary molars
o Debate in literature whether 1st or 2nd mandibular primary molars are the most
affected
 Because 1st Mandibular primary molar only shows slight infraocclusion
and typically exfoliates on schedule, clinicians may miss ankylosis and
note that 2nd mandibular primary molar is the most affected because it
is often more infraoccluded
 Exact etiology is not known – possibly due to genetics, excessive masticatory pressure
and local metabolism disturbance
Radiographically, appears as:
 Angular defect towards ankylosed tooth
 Step in occlusal plane
 Osteoid tissue between the tooth and the alveolar bone
However, it can be challenging because often only a small section of the root is affected

Percussion test- ankylosed tooth has high-pitched tone when struck with metal instrument
 Subjective test and reliability of this test is questioned
Ankylosed primary molars complications:
 Distal eruption of 2nd premolar
 Hooked or altered radicular shape of premolar underlying ankylosed tooth
 Shifting of midline towards side of infraoccluded tooth
Results:
Most present with mild-moderate infraocclusion
 For those with permanent successors: Monitor for 6-12 months from expected time of
exfoliation – most exfoliate spontaneously (96%) within 6 to 12 months of expected
exfoliation
 Primary second molars create more problems than primary first molars
o Because of the greater size difference between 2 nd primary molar and 2nd premolar
 Mesial component of eruptive force of permanent molars helps to close spaces resulting
from size differences between primary and permanent dentitions
 Annual increase of progression of infraocclusion of ankylosed primary teeth:
o 0.5 mm in mandible
o 0.8 mm in maxilla
Conclusions:
- Ankylosed primary molars often manifest with mild to moderate infraoclusion that worsens with
time
- Arch-length loss, alveolar bone defects and occlusal disturbances often are temporary in mild
infraocclusions and resolve once permanent successor erupts
- Conservative monitoring of ankysoled primary molars is recommended (6 months)
- To prevent impaction of the permanent succedaneous teeth, the clinician should consider
extractions with the appropriate space management:
 If permanent successor has altered path of eruption and will not resorb primary molar
 If primarily molar is severely infraoccluded with notable tipping of adjacent teeth that
prevents eruption of permanent successor – this can also lead to arch-length loss
 If the exfoliation time is significantly delayed