Introduction

• Amanda addresses the challenge of identifying ankylosed or impacted canines before orthodontic treatment.
• Clarifies that Straight Smile Solutions doesn’t handle surgical cases but provides educational support.
• Emphasizes that recognizing ankylosis early prevents financial, ethical, and clinical issues for providers.

Ankylosis Definition & Causes

• Ankylosis = the root surface fuses to bone, losing periodontal ligament (PDL) flexibility.
• The tooth becomes “glued” in place, behaving like an implant.
• Often caused by trauma, abnormal root structure, or developmental issues.

Commonly Affected Teeth

• Most often: canines, premolars, and sometimes upper incisors.
• Rare in growing children but more likely in adults (20s–30s).

Diagnosis Tools & Methods

• CBCT (3D imaging): Best for full root visualization in 360°.
• 2D PA X-rays: Limited view; consider taking angled shifts for more perspective.
• True confirmation often comes only when traction is applied and the tooth fails to move.

Clinical Red Flags & Risk Factors

• Stalled tooth movement despite traction.
• Root resorption (external or internal).
• History of trauma, palatal crown position, tapered or oddly angled root.
• Mature, non-growing root apex (no apexogenesis).

Patient Communication & Documentation

• Always disclose ankylosis risk in informed consent forms.
• Get written acknowledgment if risk factors exist.
• Be realistic—prepare patients for the possibility that a tooth might not move.

Conclusion

• Ankylosis can’t always be predicted, but CBCT improves detection chances.
• Be cautious, particularly with adult or complex cases—if ankylosis occurs, the provider may bear financial responsibility.
• Amanda advises erring on the side of caution, managing expectations, and avoiding risky adult ankylosed cases when possible.