A treatment decision-making model for infraoccluded primary molars S. L. EKIM & S. HATIBOVIC-KOFMAN International Journal of Paediatric Dentistry 2001; 11: 340–346
Jul 16, 2015
A treatment decision-making model for infraoccluded primary molars
S. L. EKIM & S. HATIBOVIC-KOFMAN
International Journal of Paediatric Dentistry 2001; 11: 340–346
The objective
• to clarify the literature’s findings and provide guidelines for decision-making during the long-term treatment planning of infraoccludedprimary molars.
Definition
Infraocclusion is a clinical term describing a tooth depressed below the occlusal plane.
Other terms used and create a sense of confusion :-
Submergence, secondary retention, ankylosis, impaction, reimpactionand incomplete eruption.
Aetiology
• By far, dental ankyloses is thought to be the major aetiologicalmechanism of infraocclusion.
Prevalence
• Studies report prevalence rates of infraocclusion to be from 1.3% to 8.9% of the population with a significantly higher incidence between siblings
• Primary mandibular molars are affected more than 10 times as often as primary maxillary molars.
Radiographic presentation
• Limited
• Radiographs are two-dimensional and that ankylosis can be microscopical
• Studies found :-
• Osteoid tissue deposited in the furcation area.
• teeth without successors showed ankylosis in the vicinity of the apex
Clinical presentation
• It tends to be bilateral with cases of with multiple instances of ankylosis, showing similar degrees of infraocclusion.
Classification :-
• ‘slight’ :- between the occlusal surface and the interproximal contact
• ‘moderate’ :- being within the occlusal-gingival dimensions of the interproximal contact point.
• ‘severe’ :- being anywhere below the interproximal contact point.
• A high-pitched tone on percussion - inconsistent diagnostic tool, heard
when at least 20% of the root surface is ankylosed.
• loss of mobility only occurs when more than 10% of the root surface is ankylosed
• Observing extensive root resorption on an immobile tooth is very suggestive
of ankyloses.
• Most infraoccluded primary molars with a permanent successor have been shown to exfoliate normally by the erupting successor resorbing the area of fusion .
• However, extensive bony ankylosis may prevent normal exfoliation, causing future alignment problems .
• Studies note a 6 month delay as an acceptable exfoliation schedule for ankylosed primary molars and that degree of infraocclusion is not related to amount of delay.
Other clinical signs
• Incomplete alveolar process development.
• lack of normal mesial drift.
• non-response to orthodontic forces.
• Retained primary teeth without a successor.
• a depressed tooth with tipping adjacent teeth.
• supereruption of opposing teeth.
• lateral open bite .
• higher frequency of crossbites.
Treatment decision-making model of infraoccluded primary molars without successors.
potential for ridge defects