ESCUELA DE ESTUDIOS GENERALES

“Año del Bicentenario del Perú: 200 años de Independencia”

AREA:
Health Sciences

TEACHER:
Lizama Mendoza, Victor Enrique

MEMBERS:

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COURSE:

English IV

2021
 DEDICATION

We dedicate this work to all those people who matter most to

us and for which we make the sacrifice, every day, to get
ahead and have something better in life. Fathers, mothers,
brothers, sisters, uncles, aunts, partners, sons, daughters
and also for ourselves so that what we suffered today is a
satisfaction in tomorrow.

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DENTAL ANKYLOSIS

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 INDEX

1. INTRODUCTION....................................................................................................04

2. ORIGIN...................................................................................................................05

3. DEFINITION...........................................................................................................05

4. CAUSES.................................................................................................................06

5. CLASSIFICATION.................................................................................................07

6. SYMPTOMS...........................................................................................................07

7. DIAGNOSIS AND TREATMENTS

7.1. DIAGNOSIS....................................................................................................08

7.2. TREATMENT AND MEDICATIONS..............................................................09

8. COMPLICATIONS…..............................................................................................10

9. CONCLUSION.......................................................................................................11

10. BIBLIOGRAPHIC REFERENCES.......................................................................12

11. ANNEXES….........................................................................................................13

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1. INTRODUCTION

The origin of dental ankylosis so far is unknown. But, it was Bloch-Jorgensen

(1929) the first to describe this pathology. Where the majority of later investigations
mention that dental ankylosis usually occurs, probably, in children. It is an eruption
anomaly, where the union of the alveolar bone with the dentin is involved, causing an
occlusion of the periodontal ligament.

Dental ankylosis does not present a definite cause, therefore there are
various theories with approaches such as structural, functional, bad habits and
hereditary. In addition, it is classified according to the damage it has caused as mild,
moderate and severe. On many occasions, the size, location and even the two-
dimensional nature of the radiographs make the diagnostic process difficult, which is
why many authors recommend a clinical diagnosis. In general, it all depends on the
condition in which the dental ankylosis is found in the patient.

This pathology, in most cases, does not present symptoms in the patient. A
more detailed examination, such as an x-ray, is needed to identify its presence. In
both children and adults with dental ankylosis, misalignment of the upper and lower
teeth can be seen, as well as dental immoviality. This monograph reviews the origin,
definition, factors that cause dentoalveolar ankylosis, its clinical implications,
diagnostic means and therapeutic alternatives, focusing on the causes and early
diagnosis in primary dentition.

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2. ORIGIN

There is no exact consensus about the occurrence of dental ankylosis. Some

of these appearances can occur due to trauma, congenital or infection (1). However,
Bloch-Jorgensen (1929) was the first to describe this pathology, calling it “retained
deciduous teeth” in a radiographic study of infra-occlusions (2).

Bierdman in 1962 in New York, publishes a publication about the treatment

and diagnosis of ankylated teeth. Where he mentions that ankylosis in primary teeth
is 10 times more likely than in permanent teeth. He also noticed that ankylosis occurs
more in the jaw and also observed a higher incidence in the molar region during the
process of moving from primary, temporary, to mixed teeth. Where it is an
intermediate step to have permanent teeth. Based on the Krakowiak study in 1978,
the prevalence of dental ankylosis in primary molars was 3.7%. This author evaluated
2234 children, it is also presented found that the first molar is the one with the highest
frequency of this alteration. In the study of Zúñiga et al in 2004 in Madrid. Regarding
the distribution of infra-occlusions in the primary dentition, it was found that 10.48%
of the population studied had ankylosis, 44.9% of the children presented 1 molar
with this alteration and 40.4% showed 2 involved molars. Regarding the age range, it
was observed that the majority of children were 6 and 8 years old and the teeth that
presented a higher percentage of this condition were the first lower right molar with
40.1% and the first lower left molar, with 27.9% (3).

Studies also show an incidence of ankylated primary teeth that ranges

between 1.5-9.9% of the child population; without much difference between the
sexes. Ankylosis usually occurs in mixed teeth, primary and permanent teeth
together, at the age of 6-11 years. The prevalence being inversely proportional to
age, that is, more common in children. And the severity is proportional to age;
Consequently, it is milder when it occurs in young children, whereas when it occurs in
older children, the situation becomes problematic (4).

3. DEFINITION

Dentoalveolar Ankylosis is an eruption anomaly, which involves the fusion of

the alveolar bone with the cementum or dentin, generating obliteration of the
periodontal ligament and loss of continuity (5). Sometimes cement and dentin have
the possibility of being absorbed and replaced by bone tissue. Histologically, the
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 replacement by calcified tissue of the periodontal ligament can be seen, joining the
tooth directly to the bone, stopping or preventing tooth eruption (5). This variation can
occur throughout the eruption of the teeth, once the tooth is in occlusion or even
throughout the physiological root resorption process. In addition, vertical growth and
development of the alveolar bone is impaired by reducing elevation and preventing
eruptive displacement of the damaged tooth as adjacent teeth continue their usual
vertical movement. Infraocclusion is a direct effect of ankylosis, where the tooth will
remain below the occlusal plane, giving the impression of being submerged (5).
Regarding its prevalence, the literature reviewed reports that the mandibular first
primary molars more frequently show ankylosis, continuous with mandibular second
molars, maxillary first molars and maxillary second molars. In persistent dentition, this
variation is not very recurrent and can be found as a consequence of reimplantation
in cases of avulsions or severe trauma, and it can also appear at any time in life, and
it does not have a defined etiology (6).

4. CAUSES
Dental Ankylosis does not present a specific cause, but there are several
sources that relate irregularities at the oral level with the appearance of this anomaly.
One of them is in relation to the periodontal ligament which is a non-synovial joint of
the gonphosis type located between the bone and the tooth, which allows the latter to
be given some movement, its irregularity occurs when there is a deviation from its
position Initially, also when there is a certain trauma at the bone level which affects
the movement of this ligament and therefore the consequence of the union between
the tooth and bone.

Another theory is about an alteration at the level of the tissues present in the
tooth which, in addition, can also be generated due to an incorrect process that
includes the malfunction of the incident metabolism in the periodontal ligament
membrane, which generates progressive loss of dentin and cement by the action of
osteoclasts, also called rhizalysis, present this action in primary teeth.The most
influential theory is that of the genetic factor by an autosomal-dominant transmission
between relatives, this due to various evaluations seen among the members of a
family or family circle. (5) Finally, another theory would be related to the bad habit of
exerting pressure by the tongue on the upper or lower growing tooth, which would still
generate the contact between tooth and bone. However, the etiology or specific
cause is still in scientific research.

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5. CLASSIFICATION

Dental Ankylosis is a dental anomaly, in which there is loss of continuity of the

periodontal ligament, which leads to the union of the alveolar bone with the cement
or dentin (5). Therefore, based on the severity of the infraocclusion, dental ankylosis
has been classified as:

● Mild Dental Ankylosis: It is measured with respect to the occlusal

plane with the neighboring teeth, at this level, when comparing the tooth with the
adjacent teeth, it is 2 mm below the plane.

● Moderate Dental Ankylosis: When the presence of proximal contact

with adjacent teeth is observed clinically.

● Severe Dental Ankylosis: When the tooth is below the proximal

contact of the adjacent teeth or submerged in the gingival tissue and is only visible
radiographically; that is, when the tooth has not erupted and there is no proximal
contact with the teeth next to it (7).

In most cases, Dental Ankylosis is usually asymptomatic (7). Therefore, when

diagnosed by the dentist, it is necessary to perform different diagnostic tests, such as
an X-ray. Likewise, research reports that 61.3% of dentoalveolar ankylosis cases
present mild infraocclusion, and 30.4% moderate to severe (8).

6. SYMPTOMS

Dental ankylosis usually has no symptoms and is usually discovered when

the dentist performs a more detailed examination of the teeth using a radiographic
examination. The first indications to ensure that a patient has this pathology of dental
ankylosis are the following (9).

● When suffering from this pathology, the permanent tooth is blocked

when the primary teeth are fused with the jawbone. Likewise, there is poor
alignment between the upper and lower teeth, as well as the presence of
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dental infraocclusion.

● Another symptom is dental immobility, in child patients it can be seen

when the child is in the phase of replacement of temporary teeth, that is, their
milk teeth begin to emerge for the arrival of their permanent teeth; where the
ankylated tooth does not have any type of mobility or exfoliation symptoms
while the rest of the teeth undergo a series of changes moving so that the
definitive ones appear (10).

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 ● In adult patients who start orthodontic treatment, the orthodontist will notice
the presence of this pathology after the first weeks of treatment, since as
most of the teeth are correctly placed, it will be possible to show which is
ankylated faster (See Annex 2).

● The ankylated tooth remains submerged in the gums compared

to the tooth next to it. In children we observe that the tooth affected by
ankylosis will be below the others. (See Annex 2) Likewise, in older patients
we will observe from the beginning of treatment that the affected tooth is at a
lower level than the rest. The ankylated tooth usually appears smaller, little
erupted or even submerged. (See annex 2)

7. DIAGNOSIS AND TREATMENTS

7.1. DIAGNOSIS
The diagnosis of this pathology must be carried out clinically or generally
radiographically, being perhaps the most important or remarkable radiographic
diagnosis of these two, either panoramic or periapical, this allows the main signs of
this anomaly to be observed. It implies losses in the periodontal ligaments or
absence of the area in which it develops.
Some of the limitations that Ankylosis presents to be diagnosed are: small
area, location of the vestibular or lingual area, including this the two-dimensional
nature of the radiography prevents adequate visualization. This is why some authors
recommend a clinical diagnosis.

As part of the diagnosis of Ankylosis, the state in which it is found should be

classified according to the case of the patient examined. The classifications can be:
mild, moderate and severe. The first is measured with respect to the occlusal plane
in conjunction with the neighboring teeth, in this category the studied tooth is 2mm
below the plane compared to its adjacent ones (See Annex 2).

In the second category, the contact that exists between adjacent teeth is
outstanding, generating spaces susceptible to acquiring some type of complications
due to caries or another factor (See Annex 2). While the severe category occurs
when the tooth is below the proximal meeting of the adjacent teeth or is submerged
in the gingival tissue, for which it is mostly observed and detected by an X-ray (see
Annex 2).

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 The highest percentage of these reports is in cases of mild dental ankylosis,
with 61.3%. Meanwhile, 30.4% represent moderate to severe dental ankylosis cases
(7). There are other techniques for the detection of Ankylosis, such as computed
tomography (CT), provides interesting images regarding the pathological lesions of
the patient to be treated, this type of information being extremely important, since
thanks to She will be able to decide what type of diagnosis to obtain, and even more,
it will determine the type of treatment to be used.

Nuclear Magnetic Resonance (MRI) is a technique that avoids ionizing

radiation, making it the most widely used technique for detecting ankylosis of the
temporomandibular joint (TMJ). This technique also provides us with anatomical and
functional information, which makes it a key tool to detect this pathology (3).

7.2. TREATMENT AND MEDICATIONS

Depending on the severity of the ankylosis, the dentist may choose different
ways to approach the problem. Thus, the treatment of can go through letting the tooth
evolve by itself or intervening through surgery. The recommended management of
ankylated baby teeth includes their extraction to ensure the development and
eruption of permanent teeth, and even surgery to expose, protect or reposition the
emerging tooth.(8)

Treatment options for permanent ankylated teeth depend on the development,

severity of the malocclusion, and the size of the residual root. If your prognosis is
associated with significant root resorption, it is irremediable and must be replaced
with a prosthesis.
● Mild cases: If there are hardly any alterations at the occlusal level and the
permanent tooth has a normal development, the most common is to wait for
the tooth replacement process to complete itself.
● Severe ankylosis: If the tooth If the ankylosed tooth interferes with the
eruptive process and involves negative repercussions on the bite, the dentist
will prescribe a combined surgery and orthodontic treatment. In the first place,
the surgeon will proceed to the extraction of the deciduous tooth - milk -
Subsequently, the orthodontist may choose to place a space maintainer to
ensure the eruption of the final tooth in the correct position. On the contrary, in
the event that dental ankylosis affects a permanent tooth, no action by the
dentist will be necessary.

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 On other occasions, if there is a vertical discrepancy and therefore a lack of
occlusion, the piece can be restored with filling materials or a fixed prosthesis.
Another option is the surgical dislocation of the ankylated tooth, thus breaking the
bony bridge of the ankylosis, causing the appearance of a new fibrous inflammation
tissue and allowing its placement through orthodontics.(8)
This pathogenesis does not usually cause discomfort or pain, but when diagnosed
there are cases in which an extraction is necessary, for which it is necessary to take
anti-inflammatory and anti-infection drugs.

8. COMPLICATIONS

This kind of dental disease can influence both primary and persistent
dentition. It can appear at any moment of its development, managing to cause the
immersion of the tooth or even, in certain situations, its root resorption. Dental
ankylosis is less damaging to permanent molars than to primary molars(11).

● Once the stage of tooth development is over, adaptive changes stop.

Throughout the infantile and pre-pubertal growth, the ankylated teeth remain
submerged without influencing the adjacent teeth.

● Ankylosis does not allow the vertical or transverse development of the

bone surrounding the ankylosing tooth, while in adjacent teeth not damaged
by ankylosis, the alveolar bone continues to develop commonly.

● Ankylosis implies a sequence of alterations in the proper dental

development in case it damages a piece of milk.

● Fusion of the root with the alveolar bone makes tooth replacement

impossible or significantly delays it. For this reason, it impairs the usual
development of the dental eruption process and also the vertical increase of
the alveolar bone(11).
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In addition, this anomaly can cause various occlusion problems and cause bite
discomfort:

1. Infraocclusion of the affected tooth: This involves that the tooth erupts to a
lower degree than the rest of the denture, so there is no contact with the parts
of the other arch (local open bite).

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 2. Malpositions of the other teeth: Faced with the lack of proximal contact, the
parts tend to lean towards the space left by the damaged tooth.

Each of these alterations make early diagnosis and timely action by the specialist
essential. Thus, the consequences of ankylosis in our dental health are minimized.

9. CONCLUSION

Dentoalveolar Ankylosis in primary dentition is a frequent alteration, they also

usually appear in mixed dentition, which presents a multifactorial etiology, that is, the
presence of various causes in replacement of a specific etiology; however, the
hereditary cause is more consolidated thanks to the investigations carried out. Dental
ankylosis generates fusion between the tooth and the alveolar bone due to the
obliteration of the periodontal ligament. The origin of dental ankylosis is unknown at
the moment, but even so, investigations have been able to note that dental ankylosis
is more frequent in children. The diagnosis must be made clinically, since it cannot be
noticed with the naked eye, it is painless, assessing the absence of mobility and the
appearance of being submerged and radiographically with periapical and panoramic
radiographs. Ankylated teeth have various consequences at the dentoalveolar and
occlusal level, such as loss of arch perimeter, inclination of adjacent teeth, alteration
of the occlusal plane and obstruction of the eruption path of permanent teeth, it can
also stop normal tooth growth, causing It is at a lower level than the other teeth. The
therapeutic alternatives currently are very varied and should be aimed at preventing
and controlling occlusal alterations secondary to this dental alteration. The treatment
decision should be based on the clinical and radiographic findings, the severity of the
infraocclusion, the root development of the permanent successor and the occlusal
repercussions of each patient, therefore early diagnosis and treatment are of great
importance to minimize the aforementioned alterations.

We remind the reader that it is very important to consult a dentist, as well as

dental ankylosis there are also other illnesses of this nature that can be painless in
nature, but that in the long run can have greater consequences. For this reason,
good oral hygiene and frequent visits to the dentist are recommended for good oral
health.

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10. BIBLIOGRAPHIC REFERENCES

1. Cardozo MA, Hernández JA. Diagnóstico y manejo de la anquilosis dentoalveolar.

Revista de Odontopediatría Latinoamericana [Internet]. 2021 Feb 8 [cited 2021 May
5];5(2):11. Available from:
https://www.revistaodontopediatria.org/index.php/alop/article/view/5
2. García Sánchez, Á., Cano Durán, J., Ordoñez Fernández, E., & Serrano Sánchez, V.
(2017). Estudio de la anquilosis dental en una población infantil. Revista
Complutense de Ciencias Veterinarias, 11(1), 24–28.
https://doi.org/10.5209/rccv.55177
3. Molina D, Aguayo P, Ulloa C, Iturriaga V, Bornhardt T, Saavedra M.
Temporomandibular joint ankylosis: a review. Avances en Odontoestomatología
[Internet]. 2013 [cited 2021 May 5];29(5):239–44. Available from:
https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-12852013000500003
&lng=en&nrm=iso&tlng=en
4. Rivas Blanco, A. (2016). Anquilosis alveolodentaria de dientes temporales.
Estomathology, I(1), 29. https://idus.us.es/xmlui/handle/11441/6183
5. Casián Adem, Jorge. Anquilosis preeruptiva de un segundo molar primario. Reporte
de un caso. Rev ADM [Internet]. 2021 [cited 2021 May 4];46–9. Disponible en:
https://pesquisa.bvsalud.org/portal/resource/pt/lil-175526
6. Anquilosis dental Causas y tratamiento [Internet]. Ferrus&Bratos. 2021 [citado 1 de
mayo de 2021]. Disponible en:
https://www.clinicaferrusbratos.com/odontologia-general/anquilosis-dental/
7. Dias C, Quadrado L, Fontanella V, and Borba de Araujo F. Vertical alveolar growth in
subjects with infraoccluded mandibular deciduous molars. Am J Orthod Dentofacial
Orthop 2012;141:81-6.
8. Smileline clinic. What is Dental Ankylosis [Internet].Dental health, 2019 [Cited 04
may 2021]. Disponible en: https://www.orto.org/que-es-la-anquilosis-dental/
9. Sanitas.En qué consiste la anquilosis dental: ENVISAT. [Internet]. [Cited 04 may
2021]. Disponible en:
https://www.sanitas.es/sanitas/seguros/es/particulares/biblioteca-de-salud/salud-dent
al/anquilosis-dental.html
10. Qué es la Anquilosis dental [Internet]. Orto.org. 2020 [citado el 5 de mayo de 2021].
Disponible en: https://www.orto.org/que-es-la-anquilosis-dental/
11. Anquilosis dental,causas y tratamiento [Internet]. Clinicaferrusbratos.com. 2021
[citado el 5 de mayo de 2021]. Disponible en:
https://www.clinicaferrusbratos.com/odontologia-general/anquilosis-dental
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11. ANNEXES

Annex 1

Table 1: 20 cases of ankylosis can be found, with a total of 40 ankylosed primary molars and
17 presented infra-occlusion.

Review chart in: https://revistas.ucm.es/index.php/RCCV/article/download/55177/50250

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Table 2: The table was elaborated with the respective systematic review of the languages
that should be used for interpretation.

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Available in:
https://idus.us.es/bitstream/handle/11441/61839/TFG%20ASUNCI%D3N%20RIVAS.pdf;jses
sionid=8786D0256ABB421D0ECAF09742EFF91F?sequence=1&isAllowed=y

Table 3: Choice of treatment for dental ankilosis.

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Table 4: Proportion of the population that presented infraocclusion.

Table 5: Percentage of underocclusions by number of teeth.

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 Table 4: Percentage of underocclusions by millimeters and affected tooth.

Available in:
https://www.odontologiapediatrica.com/wp-content/uploads/2018/06/2011PROTRAUMAPER
Mluxs.pdf

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 Figure 1. Percentage of infraocclusions according to age.

Figure 2:. Percentage of infraocclusions in each of the affected molars.

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Figure 3: Percentage of the magnitude of infraocclusions expressed in millimeters.

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Annex 2

Image 1: Patient undergoing orthodontic treatment.

Image 2: Shows the presence of a child's ankylosed tooth.

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Image 3: Ankylosed primary tooth with decreased vertical growth of the alveolar bone.

Image 3: Ankylosed tooth

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 Image 4: Mild dental ankylosis

Image 5: Moderate dental ankylosis

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Image 6: Severe dental ankylosis

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Annex 3

Video 1: Ankylosis

Available in: https://www.youtube.com/watch?v=CoCUfkifXNs

Video 2: “ANCLAJE INDIRECTO SOBRE DIENTE ANQUILOSADO”

Available in: https://www.youtube.com/watch?v=0SkSHA_BzSM&t=4s

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EVIDENCES

● Aguilar Collanqui María Fernanda: Make the introduction, the definition of

dental ankylosis, the conclusion and the bibliographical references. Also, support in
final details of the monograph.
● Becerra Ramos, Fiorela Tatiana: Make the introduction, the classification of
dental ankylosis, the conclusion and the bibliographical references. Also, support in
final details of the monograph.
● Cabanillas Retuerto, Angie Rosaly: Make the introduction, the
complications of dental ankylosis, the conclusion and the bibliographical references.
Also, support in final details of the monograph.
● Ccoicca Vargas, Patricia Lizeth : Make the introduction, the causes of
dental ankylosis, the conclusion and the bibliographical references. Also, support in
final details of the monograph.
● Misahuaman Bedon, Rosa Maribel: Make the introduction, treatment and
medication of dental ankylosis, conclusion and bibliographical references. Also,
support in final details of the monograph.
● Poma Aquino, Luz Milagros: Make the introduction, the symptoms of dental
ankylosis, the conclusion and the bibliographical references. Also, support in final
details of the monograph.
● Quispe Oscco Coraya Lucero: Make the introduction, the diagnosis of
dental ankylosis, the conclusion and the bibliographical references. Also, support in
final details of the monograph.
● Salazar Moreno, Diego Alejandro: Make the introduction, the origin of dental
ankylosis, the conclusion and the bibliographical references. Also, support in final
details of the monograph.

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EVIDENCES

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