Alveolar bone development after decoronation of ankylosed teeth

Decoronation of ankylosed teeth in infraposition was introduced in 1984 by Malmgren and co-workers (1). This method is used all over the world today. It has been clinically shown that the procedure preserves the alveolar width and rebuilds lost vertical bone of the alveolar ridge in growing individuals. The biological explanation is that the decoronated root serves as a matrix for new bone development during resorption of the root and that the lost vertical alveolar bone is rebuilt during eruption of adjacent teeth. First a new periosteum is formed over the decoronated root, allowing vertical alveolar growth. Then the interdental fibers that have been severed by the decoronation procedure are reorganized between adjacent teeth. The continued eruption of these teeth mediates marginal bone apposition via the dental-periosteal fiber complex. The erupting teeth are linked with the periosteum covering the top of the alveolar socket and indirectly via the alveolar gingival fibers, which are inserted in the alveolar crest and in the lamina propria of the interdental papilla. Both structures can generate a traction force resulting in bone apposition on top of the alveolar crest. This theoretical biological explanation is based on known anatomical features, known eruption processes and clinical observations.