Decoronation followed by dental implants placement: fundamentals, applications and explanations

Abstract

Dental arches areas with teeth presenting dentoalveolar ankylosis and replacement root resorption can be considered as presenting normal bone, in full physiological remodeling process; and osseointegrated implants can be successfully placed. Bone remodeling will promote osseointegration, regardless of presenting ankylosis and/or replacement root resorption. After 1 to 10 years, all dental tissues will have been replaced by bone. The site, angulation and ideal positioning in the space to place the implant should be dictated exclusively by the clinical convenience, associated with previous planning. One of the advantages of decoronation followed by dental implants placement in ankylosed teeth with replacement resorption is the maintenance of bone volume in the region, both vertical and horizontal. If possible, the buccal part of the root, even if thin, should be preserved in the preparation of the cavity for the implant, as this will maintain gingival tissues looking fully normal for long periods. In the selection of cases for decoronation, the absence of microbial contamination in the region - represented by chronic periapical lesions, presence of fistula, old unconsolidated root fractures and active advanced periodontal disease - is important. Such situations are contraindications to decoronation. However, the occurrence of dentoalveolar ankylosis and replacement resorption without contamination should neither change the planning for implant installation, nor the criteria for choosing the type and brand of dental implant to be used. Failure to decoronate and use dental implants has never been reported.

The use of decoronation in cases of post-traumatic replacement resorption – a literature review

“…Wykazano, że wprowadzenie implantów w kontakcie z tkankami korzenia nie zmniejsza odsetka powodzeń (7). Ze względu na wspólne pochodzenie filogenetyczne tkanek zęba i kości, wprowadzenie implantu w miejscu, w którym zostały resztki korzenia nie ma negatywnego wpływu na proces wgajania wszczepu (16). Opublikowano przypadki opisujące dekoronację z natychmiastową implantacją u pacjentów z zaawansowaną prior to orthodontic treatment showed remains of roots of tooth 11.…”

“…The introduction of implants in contact with root tissues has been demonstrated not to reduce the success rate (7). As the tooth and bone tissues have a common phylogenetic origin, the insertion of an implant into the place where there are residual root tissues has no negative impact on the implantation process (16). There are publications of cases describing decoronation combined with immediate implantation in patients with advanced replacement resorption and completed growth (32).…”

“…Similar outcomes are observed when implantation is delayed. There are no reports of implant failures in patients after decoronation (16).…”

“…U pacjentów, u których zdiagnozowano cechy stanu zapalnego, takie jak przetoka czy obecność przewlekłych zmian okołowierzchołkowych, powinno się odstąpić od wykonania dekoronacji. Aktywna zaawansowana choroba przyzębia również stanowi przeciwwskazanie do przeprowadzenia tego zabiegu (16). that the process is less advanced, so in case of doubts, CBCT should be considered.…”

“…Decoronation should not be performed in patients diagnosed with such inflammatory features as a fistula or the presence of chronic periapical lesions. Active advanced periodontal disease is also a contraindication for this procedure (16).…”