Tooth Ankylosis Research Articles

Post-trauma complex orthodontic approach: the impact of psychological issues of bullying on treatment decision.

ABSTRACTObjective: This article aims to discuss the multidisciplinary approach required in the treatment of cases of impaction and ankylosis of permanent teeth, associated with a history of trauma, considering the psychological state of the child and family when faced with a traumatic case of bullying, by reporting the complex treatment of a central incisor needing to be orthodontically moved across the midline. Conclusion: This clinical case was a major challenge, which included complex multidisciplinary procedures. Results and stability after 26 months of retention indicated successful orthodontic space closure of two maxillary teeth, without the use of implants or prostheses, in an adolescent patient who had a history of dental trauma, alveolar bone loss, and an uncertain initial prognosis.

TREATMENT OF AN ANKYLOSED MAXILLARY CENTRAL INCISOR BY SINGLE-TOOTH OSSEOUS OSTEOTOMY

Ankylosis is the fusion between the mineralized root surface and the alveolar bone and led to development of infraocclusion. Osteocorticotomy is a surgical procedure in which the intact ankylosed tooth and adjacent bone are either repositioned in 1 step or moved orthodontically. This case report describes the treatment of a boy, aged 14.9 years, whose ankylosed maxillary right central incisor had been infraocclused due to the trauma. We performed a segmental osteotomy with in a single-stage surgery to allow for inferior repositioning of the tooth and bone. This technique permits optimal repositioning of the tooth and allow rapid movement of teeth with the block of bone. The traction of the single-tooth osteotomy block can be repositioned to the desired position immediately by vertical extrusion bends, vertical elastics, a coil spring, a nickel-titanium wire, or a simple distraction device.

Surgical Orthodontic Treatment of Skeletal Mandibular Protrusion with Multiple Impacted Ankylosed Teeth Treated with Alveolar Corticotomy

To present a case of skeletal mandibular protrusion with multiple impacted ankylosed teeth, which were treated with conventional orthognathic surgery and alveolar corticotomy, respectively. Tooth ankylosis is characterized by the fusion of a root surface with the surrounding alveolar bone. Various treatment modalities for tooth ankylosis have been developed and are used commonly in the clinic. Corticotomy is defined as the application of intentional surgical injury to the cortical bone to mobilize a tooth with the adjacent bone and soft tissues. The corticotomy technique has been improved in recent years to avoid possible risks such as periodontal damage, tooth devitalization, and osseous necrosis due to an inadequate blood supply. A female patient aged 16 years and 3 months was diagnosed with anterior crossbite and the impaction and ankylosis of multiple canines. After the confirmation of ankylosis, alveolar corticotomy was performed on the maxillary left and mandibular right canines. After 6 months of traction (patient age, 19 years and 7 months), both canines had extruded successfully. After the completion of preoperative treatment, bilateral intraoral vertical ramus osteotomy was performed to correct the anterior crossbite involving a skeletal mandibular protrusion. The amounts of mandibular setback on the right and left sides were approximately 7 and 5 mm, respectively. The total treatment period was 55 months. Acceptable occlusion with a balanced profile was maintained over a 5-year retention period, indicating the long-term stability and success of the treatment. Our results indicate that alveolar corticotomy should be considered to facilitate the treatment of multiple impacted ankylosed teeth. This report proposes an efficacy of alveolar corticotomy for extrusion of impacted ankylosed teeth.

Mouthguard Use Effect on the Biomechanical Response of an Ankylosed Maxillary Central Incisor during a Traumatic Impact: A 3-Dimensional Finite Element Analysis.

(1) Background: Trauma is a very common experience in contact sports; however, there is an absence of data regarding the effect of athletes wearing mouthguards (MG) associated with ankylosed maxillary central incisor during a traumatic impact. (2) Methods: To evaluate the stress distribution in the bone and teeth in this situation, models of maxillary central incisor were created containing cortical bone, trabecular bone, soft tissue, root dentin, enamel, periodontal ligament, and antagonist teeth were modeled. One model received a MG with 4-mm thickness. Both models were subdivided into finite elements. The frictionless contacts were used and a nonlinear dynamic impact analysis was performed in which a rigid object hit the model at 1 m·s−1. For each model, an ankylosed periodontal ligament was simulated totaling 4 different situations. The results were presented in von-Mises stress maps. (3) Results: A higher stress concentration in teeth and bone was observed for the model without a MG and with ankylosed tooth (19.5 and 37.3 MPa, respectively); the most promising mechanical response was calculated for patients with healthy periodontal ligament and MG in position (1.8 and 7.8 MPa, respectively). (4) Conclusions: The MG’s use is beneficial for healthy and ankylosed teeth, since it acts by dampening the generated stresses in bone, dentin, enamel and periodontal ligament. However, patients with ankylosed tooth are more prone to root fracture even when the MG is in position compared to a healthy tooth.

Periodontal plastic surgery for the management of an ankylosed permanent maxillary lateral incisor: A clinical report with 5-year follow-up

Anterior maxillary tooth ankylosis disturbs the development of the alveolar bone process, leading to discrepancies between the cervical gingival margin and incisal edge position of the affected tooth, and therefore, the esthetics is compromised. Proposed treatments in adults and growing patients have been used successfully, but they have disadvantages and are contraindicated in some circumstances. This article proposes an alternative treatment for an ankylosed permanent maxillary anterior tooth with a slow replacement resorption rate in an adult patient, for whom a combination of a periodontal plastic surgery procedure and a fixed dental prosthesis was used to correct the esthetics. This treatment has less risk of complications, preserves the ankylosed tooth as long as possible, creates an optimal gingival contour, and maintains the alveolar bone for further treatment should the tooth be lost.

Modified Orthodontic Bone Stretching for Ankylosed Tooth Repositioning: A Case Report.

Background:Different approaches were proposed in the literature for the treatment of malpositioned ankylosed teeth. The present case report describes a modification of Orthodontic Bone Stretching Technique (OBS) for the repositioning of ankylosed teeth, consisting of dentoalveolar segmental osteotomies performed with piezoelectric instruments followed by orthodontic and orthopedic traction.Case Report:A 22-year-old female in good general health was referred by her orthodontist due to an infraoccluded and ankylosed maxillary upper left canine. Attempts of conventional and corticotomy-assisted orthodontic alignment of the tooth were previously performed with no success. After elevating a full-thickness flap, three osteotomies were performed by using piezoelectric inserts (Piezotome Cube, Acteon, Merignac, France). Mesial and distal cuts were full-thickness osteotomies, parallel to the long axis of the tooth, through the buccal and palatal cortical plates. The apical osseous incision was a horizontal corticotomy, involving only the buccal plate, and connecting the vertical osteotomies two millimetres over the apex of the tooth. Heavy orthodontic forces were immediately applied by using both dental and skeletal anchorage. The initial movement of the dentoalveolar segment was observed three weeks after surgery and case finishing has been completed in two months. At a one-year follow-up, the repositioned canine showed good periodontal conditions, no discoloration and positive pulp response to the electric test.Conclusion:Modified OBS technique was effective in repositioning an infraoccluded and ankylosed maxillary canine, providing satisfactory function and esthetics with short treatment time.

Geomorphologic Study on Root Surface of Human Avulsed Teeth by Scanning Electron Microscopy

Dental avulsion from alveolar socket is the most severe type of traumatic tooth injuries. Immediate replantation after avulsion provides the highest success, whereas delayed replantation in storage of long time dehydration always results in ankylosis, absorption and loss of teeth eventually. Maintaining the vitality of periodontal ligament (PDL) cells on root surface is regarded as a crucial step deciding the long term survival of avulsed teeth. In present study, the geomorphology on the root surface from immediate to delayed replantation of avulsed teeth was inspected by scanning electron microscopy (SEM). Fibrous “vegetation” covering cementum was observed in fresh wound of PDL, that was transformed into “Gobi desert” on root surface because of the extinguishment of the fibers in long time air dry storage. Reutilization of the PDL embedded in the cementum was attempted to simulate the fresh root surface to improve prognosis of delayed replantation. Fibers protected by mineralized stroma were decalcificated and exposed again that reversed the deteriorated geomorphology for the regeneration of PDL on root surface. The direct evidences from SEM give a new sight for the etiology and therapy to delayed replantation of tooth avulsion. Funding Statement: This study was supported by grants from the National Nature Science Foundation of China (Nos. 81100765, 81570990). Declaration of Interests: The authors declare that they have no conflict of interest. Ethics Approval Statement: his study was approved by the Local research ethics committee number CMUSH-IRB-KJ-PJ-2019-17.

Orthodontic treatment recommendation and expected adverse reactions in patients with a history of dental trauma: A survey among general dentists, paediatric dentists, and orthodontic specialists.

Trauma-induced adverse reactions may trigger complications when moving teeth orthodontically. The purpose of this study was to evaluate the knowledge of dental practitioners about this topic. A questionnaire survey was organized among general dentists, paediatric dentists, and orthodontists in Flanders (Belgium). Three clinical cases describing trauma-induced tooth damage (tooth ankylosis, apical root resorption, and pulp/root canal obliteration) were presented, followed by a set of questions. The questionnaire was completed by 121 general dentists (GD), 47 paediatric dentists (PD), and 99 orthodontic specialists (OS). In the case with ankylosis, impossibility to move the tooth orthodontically was reported as most frequent adverse reaction (82.8% of GD, 95.7% of PD, and 100.0% of OS) (P<.001). In the situation of apical root resorption, the most frequently reported adverse event was progressive apical root resorption (78.9%, 85.7%, and 88.8% respectively; P=.265). Most frequently mentioned adverse reaction in the case with pulp and root canal obliteration was tooth discoloration (64.1%, 57.1%, and 78.3%; P=.055), followed by apical root resorption (57.4%, 56.8%, and 68.7%; P=.283). Orthodontic treatment recommendation differed among specific clinical situations but also among groups of dental practitioners. Important knowledge gaps exist regarding the orthodontic managment of traumatized teeth. This topic requires more attention in undergraduate training, specialist training, and continuing education.

Risk of ankylosis of 400 avulsed and replanted human teeth in relation to length of dry storage: A re-evaluation of a long-term clinical study.

Ankylosis and subsequent tooth loss is a serious complication following tooth avulsion and replantation. The aim of the study was to evaluate the risk of ankylosis of human teeth replanted after various periods of dry storage prior to replantation. The material originates from a previously reported clinical study of 400 replanted teeth. Initial treatment, clinical and radiological examination and follow-up were conducted according to a standardized protocol. PDL was not removed. Follow-up periods ranged from 0.2 to 20years (mean 5.1years). The risk of ankylosis was analysed using the Cox regression model including stage of root development, length of dry time and age>20years. The risk of ankylosis significantly increased with increasing length of dry time (hazard ratio: 1.22, P=.002) and was significantly higher for teeth with mature root development than for teeth with immature root development (hazard ratio: 2.1 P<.0001). The estimated risks of ankylosis after 900days for teeth with immature root developmentwere: dry time<20minutes: 33.9% (95% confidence interval (CI): 25.4-42.7), dry time 20-40minutes: 49.6% (95% CI: 37.5-64.8), dry time 40-60minutes: 54.4% (95% CI: 37.1-71.3) and dry time>60minutes: 60.0% (95% CI: 45.0-75.8). The risks for teeth with mature root development were: dry time<20minutes: 59.4% (95% CI: 51.6-66.5), dry time 20-40minutes: 78.3% (95% CI: 69.5-86.2), dry time 40-60minutes: 81.9% (95% CI: 67.2-92.4) and dry time>60minutes: 86.4% (95% CI: 79.7; 92.9). The risk of ankylosis rose with increasing length of dry time. However, some teeth may heal without ankylosis even after 60minutes of dry time. Immature teeth have a lower risk of developing ankylosis. Replantation should therefore always be considered for avulsed teeth.

Biological Communications Between Implants and Periodontal Tissues

At present, attention is directed to increase the bone to implant contact (BIC) and minimize the marginal bone loss by modifying the root part of titanium implant using chemical and texture surface treatments. In the present review, we evaluate to what extent the titanium implant surface treatments are targeted to achieve biological attachment and connectivity similar to ankylosed teeth. We find that the re-implanted tooth that undergoes ankylosis to alveolar bone and re-attachment of marginal gingiva by cellular and fibrous biological connectivity is a desirable model to seek similar implant attachment to the periodontium. In fact, the root part of the implant that is undergoing osseointegration resembles direct deposition of bone onto tooth cementum. It seems that activating cellular attachment of soft connective tissue of marginal gingiva is less predictable and needs the application of nano technologies to enhance attraction of these cells to the trans-gingival connector. Such cellular physiologically strained attachment will develop normal communicative pathways between implant and periodontium. This paper provides a new perspective on the model that should guide the development of future dental implants. Surface modifications of implants should facilitate their attachment both to the alveolar bone and the marginal gingiva, mimicking the physiological process involved in re-implanted teeth.

Intentional replantation of periodontally involved hopeless teeth: a case series study.

To explore the clinical effect, the healing modes, and the potential influence factors of intentional replantation for periodontally hopeless teeth in combination with regeneration techniques. Intentional replantation was operated on forty-eight periodontally hopeless teeth from forty-eight patients. The clinical indexes and the X-ray films were recorded during the follow-up period of 18months. The Wilcoxon signed-rank test or the paired T test was adopted to carry out the statistical analysis. The overall survival rate at the ninth month was 95.8% and declined to 91.7% at the eighteenth month. The improved rate of the mobility was 89.1% at the ninth month and the ankylosis percentage was 77.3% at the eighteenth month. The survival rate and mobility-improved rate of anterior teeth were both better than that of posterior teeth. Probing depth and bone loss decreased while ginginval recession increased (P < 0.05). Smoking had an adverse effect on both mobility improvement and bone gain (P < 0.05). Intentional replantation for periodontally hopeless teeth could achieve favorable outcomes through a reasonable healing mode of tooth ankylosis. Strict control of infection and smoking could improve the success rate of this procedure. To provide additional treatment for allowance of flexible options when patients and dentists are faced with periodontally hopeless teeth.

Effectiveness of a Piezoelectric-Assisted Distraction Osteogenesis Procedure for the Treatment of Ankylosed Permanent Front Teeth.

A common complication of tooth replantation after traumatic avulsion is tooth ankylosis causing dental malpositioning, partial loss of function, tipping of adjacent teeth and worsening of aesthetics. The aim of this study is to evaluate the effects of a repositioning procedure of such ankylosed permanent front teeth by a distraction osteogenesis procedure. Five patients (mean age 13.4 years), with an ankylosed permanent front tooth in the anterior area, were enrolled in the present study. After the pre-operatory orthodontic preparation, each selected site was treated with single-tooth dento-alveolar block osteotomy surgery performed with a piezoelectric surgery device with ultrasonic cuts on the buccal side. Subsequently, a custom distraction device, made by a resin splint and a sector expansion screw, was set in such a way it delivered a force with direction and sense towards the planned position of the tooth as well as the osteotomy's incision. After a latency period of 14 days, the distraction of the dento-alveolar block was started with a rate of distraction of 0.8 mm per day. The average shift obtained by the ankylosed teeth was 7.8 ± 0.75 mm (±SD), and the ankylosed tooth was regularly positioned into the occlusion in 20.4 ± 1.85 days (±SD), with a slight relapse (±0.5 mm) observed after 1 year. This study indicates that a therapeutic approach combining piezoelectric surgery and orthodontic therapy may be useful for the treatment of ankylosed permanent teeth in the frontal area with a long-term follow-up over 5 years.

Long-term management of an ankylosed young permanent incisor replanted within 2 h of avulsion: A case report with a 10-year follow-up

Tooth avulsion is a severe form of luxation injury that involves damage to both the pulp and the periodontal ligament. Avulsed teeth need to be replanted immediately in order to restore esthetics and function. Delayed replantation often results in ankylosis of the tooth which is a common sequela following avulsion injuries. An ankylosed tooth with a necrotic periodontal membrane does not move along with a growing alveolus leading to an arrest in height and width of the alveolar bone causing the tooth to be infraoccluded in a growing individual. This case report describes the multidisciplinary treatment and long-term management of an avulsed permanent central incisor in an 8-year-old child with delayed replantation.

Long‐term retention of avulsed maxillary permanent incisors replanted after prolonged non‐physiological storage

Ankylosis and external replacement resorption (ERR) are two typical biological responses to delayed replantation of avulsed teeth in cases where adequate root canal treatment is performed. The patient's growth stage affects the progression of root resorption and the long-term outcome of the affected teeth. This case report describes the long-term outcome of an 18.5-year-old patient following an accident in which both of his maxillary central incisors were avulsed and replanted after four hours of non-physiological storage. ERR and ankylosis of teeth 11 and 21 were detected clinically and radiographically during the second year of follow-up. Sixteen years after replantation, replacement resorption was progressing very slowly, enabling functional tooth retention with favorable esthetics. Young adults, with delayed replantation of avulsed teeth, may benefit from tooth retention with slow ERR.

Flapless boning to increase space by piezosurgery: A novel mini-invasive strategy for teeth extraction. A retrospective study.

This study aimed to investigate the application of piezosurgery-associated flapless surgery for increasing bone space during teeth extraction and evaluate its success rate, postoperative outcomes, and incidence of major complications.From January 2014 to December 2016, patients who experienced teeth extraction via piezosurgery-associated flapless surgery were enrolled in this study. The positions, diagnosis, dental medical history, and radiographic examination of teeth were recorded before the treatment. During the surgery, the fracture or displacement of root, injuries of soft tissue, and fractures of the alveolar process were noted.A total of 140 patients fulfilled the eligibility criteria in the present study. All these teeth were classified into 4 groups based on diagnosis: residual roots that underwent root canal therapy (28 cases), teeth with root fracture (37 cases), teeth extraction because of orthodontics needed (31 cases), and the vertically impacted lower third molar (44 cases). The radiographic presentation revealed about 50% ankylosed teeth. No root fracture and root displacement emerged, and all roots were removed intact. Moreover, fracture of the alveolar process did not occur. Two cases with buccal mucosal injury were noted, which were because of heat injuries caused by the basement of the tip while cool water was used out.This study introduced a novel mini-invasive strategy for increasing space during teeth extraction. The advantage of this piezosurgery-associated flapless surgery included maximal preservation of the alveolar bone, minimal injury to soft tissues, and prevention of root fracture during the surgery. Furthermore, the cool water used during the surgery must be carefully checked before the procedure.

Effects of platelet-rich plasma on tooth replantation in dogs: a histologic and histomorphometric analysis.

PurposeThe purpose of this study was to evaluate the effects of platelet-rich plasma (PRP) on periodontal healing of replanted root surfaces in dogs histologically and histomorphometrically.MethodsA total of 36 roots of mandibular incisors and premolars from 6 mongrel dogs were used. The roots were randomly divided into 3 groups: 1) a positive control group (n=12), in which the periodontal ligament (PDL) and cementum were retained and the roots were soaked in saline; 2) a negative control group (n=12), in which the PDL and cementum were removed and the roots were soaked in saline; and 3) an experimental group (n=12), in which the PDL and cementum were removed and the roots were soaked in PRP. After soaking the root surfaces, the extracted roots were replanted into the extraction sockets. The roots were covered using a coronally repositioned flapResultsHistologically, irregular-thickness PDL-like and cementum-like tissues were observed in the 4-week experimental group and the positive control group. PDL-like tissue and cementum-like tissue with a more uniform thickness were observed at 8 weeks. In the negative control group, PDL-like tissue and cementum-like tissue were rarely found, and root resorption and ankylosis were observed. In the cross-sectional histomorphometric analysis, the experimental group demonstrated a higher rate of formation of cementum-like tissue and a lower tooth ankylosis rate than the positive and negative control groups at 4 and 8 weeks. Although there was a significant difference in the tooth ankylosis rate and the formation of cementum-like tissue across the 3 groups (P<0.05), no statistical significance was observed between any pair of groups (P>0.017).ConclusionsApplying PRP to root surfaces during tooth replantation in dogs can reduce tooth ankylosis and increase PDL-like and cementum-like tissue formation.

Diagnosis of tooth ankylosis using panoramic views, cone beam computed tomography, and histological data: a retrospective observational case series study.

The aim of this study was to determine whether cone beam computed tomography is a reliable radiological method to diagnose tooth ankylosis. A series of teeth clinically diagnosed as ankylosed were collected after extraction in a private practice from 2009 to 2015 and analyzed retrospectively. Inclusion criteria comprised permanent molars extracted due to failed tooth eruption in the absence of any visible mechanical obstruction, existing panoramic view (PV), and cone beam computed tomography (CBCT) and histological sections of sufficient quality. The CBCT scans and PVs were evaluated twice for signs of ankylosis by two independent observers using the following score: clear signs, possible signs, and no signs. The histological sections were evaluated and graded similarly to the radiographs by a specialist blinded to the radiographs and treatment. Out of an initial group of 22 patients, 9 subjects with 10 affected teeth were included for final evaluation. The age ranged from 8.3 to 17 years. No agreement was seen in comparing the PV scores to the histological sections. Fair to moderate agreement was seen in comparing the CBCT scores to the histological sections. All histologically confirmed ankylosis were detected in CBCT by both observers but some false positive results were found. Only a small sample size was available as the disorder is rare. It is difficult to distinguish ankylosis from primary failure of eruption. CBCT images can be a useful adjunctive diagnostic tool to diagnose ankylosed teeth, but cannot be recommended as a single diagnostic modality as false positive results were found.

Open versus closed surgical exposure for permanent impacted canines: a systematic review and meta-analyses

Permanent canines are amongst the teeth most affected by impaction and ectopic eruption. Although impacted canines are often subjected to surgical exposure and alignment with either the open or the closed technique for many decades, their treatment effects have not yet been systematically asssessed. The aim of this systematic review was to critically assess whether significant differences exist in the outcomes of the open or closed surgical exposure of impacted canines. An unrestricted electronic search of nine databases from inception to December 2016 was performed. Included were randomized or prospective non-randomized studies comparing open versus closed exposure of impacted canines in human patients. After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs) and odds ratios (ORs), including their 95 per cent confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. A total of eight unique studies and a total of 433 (30.1% male/59.9% female) patients were included, with an average age of 15.2 years and a total of 453 impacted canines (48.6% and 51.4% in the open and closed exposure, respectively). Open exposure of impacted canines was associated with reduced duration of canine alignment (two studies; MD = -2.14 months; 95% CI = -4.23 to -0.05 months; P < 0.05; moderate heterogeneity and moderate quality) and lower odds of tooth ankylosis (one study; OR = 0.15; 95% CI = 0.03-0.83; P < 0.05; low quality) compared to closed exposure; both findings being independent of canine localization. However, initial alignment of palatally impacted canines took overall significantly longer than labially impacted canines (8.87 versus 4.17 months). Based on existing evidence, open surgical exposure seems to be superior in treatment duration and ankylosis risk over the closed technique. Due to the limited number of small included trials, further research is needed for robust clinical recommendations. PROSPERO (CRD42016051916).

Dental anomalies: prevalence and associations between them in a large sample of non-orthodontic subjects, a cross-sectional study

BackgroundTo analyze the prevalence and associations between dental anomalies detectable on panoramic radiographs in a sample of non-orthodontic growing subjects.MethodsFor this cross-sectional study, digital panoramic radiographs of 5005 subjects were initially screened from a single radiographic center in Rome. Inclusion criteria were: subjects who were aged 8–12 years, Caucasian, and had good diagnostic quality radiographs. Syndromic subjects, those with craniofacial malformation, or orthodontic patients were excluded and this led to a sample of 4706 subjects [mean (SD) age = 9.6 (1.2) years, 2366 males and 2340 females]. Sample was subsequently divided into four subgroups (8, 9, 10, and 11–12 year-old groups). Two operators examined panoramic radiographs to observe the presence of common dental anomalies. The prevalence and associations between dental anomalies were also investigated.ResultsThe overall prevalence of dental anomalies was 20.9%. Approximately, 17.9% showed only one anomaly, 2.7% two anomalies, while only 0.3% had more than two anomalies. The most frequent anomalies were the displacement of maxillary canine (7.5%), hypodontia (7.1%), impacted teeth (3.9%), tooth ankylosis (2.8%), and tooth transposition (1.4%). The lower right second premolar was the most frequent missing teeth; 3.7% had only one tooth agenesis, and 0.08% had six or more missing tooth (Oligodontia). Mesiodens was the most common type of supernumerary tooth (0.66%). Two subjects had taurodontic tooth (0.04%). Tooth transpositions and displacement of maxillary canine were seen in 1.4 and 7.5%, retrospectively (approximately 69 and 58% were in the 8 and 9 year-old groups, retrospectively). Significant associations were detected between the different dental anomalies (P < .05).ConclusionsThe results of our study revealed significant associations among different dental anomalies and provide further evidences to support common etiological factors.

Tooth Ankylosis And its Orthodontic Implication

Tooth Ankylosis And its Orthodontic Implication