Single tooth osteotomy and distraction in the treatment of an ankylosed central incisor — a case report

Abstract Introduction Clinical practice encounters the unfortunate consequences of dental trauma. The avulsion of permanent teeth is seen in 0.5–3% of all dental traumatic injuries, and when re-implanted, a tooth can undergo ankylosis in the form of replacement resorption. When ankylosis of a maxillary incisor occurs in a pre-adolescent, the affected tooth gradually becomes infra-occluded with time, which results in severe local dentoalveolar disturbances in normal growth and development, along with aesthetic concerns that challenge orthodontic management. To achieve an ideal dental outcome, an interdisciplinary approach is often required. Aim To detail a case report of an infra-occluded ankylosed central incisor successfully treated with a single tooth osteotomy and distraction osteogenesis in conjunction with mechanotherapy to correct the osseous and gingival margins. Methods This combined orthodontic/surgical case report was completed in stages by (1) pre-surgical orthodontics to diverge the roots of the adjacent teeth from the surgical site, (2) a single tooth osteotomy followed by distraction osteogenesis, (3) postsurgery orthodontics, and (4) retention. Consent and complete records were obtained, including pre-treatment photographs, radiographs and cephalometric superimpositions over an eight-year period from initial presentation until retention. Results Distraction osteogenesis in combination with orthodontics successfully managed the dentoalveolar and soft tissue defect. If tooth replacement is eventually needed, donor site morbidity associated with conventional bone and soft tissue grafting procedures may be eliminated. Conclusion This combined interdisciplinary treatment is an effective alternative to bony and soft tissue augmentation procedures that may not be as predictable in restoring vertical and horizontal osseous and soft tissue defects resulting from severe infraocclusion of anterior teeth.