DR KHALAF KRIDIN (Orcid ID : 0000-0001-9971-9151)

PROFESSOR NESTOR COHENCA (Orcid ID : 0000-0002-0603-5437)

Article type : Original Article

Accepted Article
Immediate post-operative rehabilitation after decoronation. A systematic review.

Shmuel Einy 1,2, Khalaf Kridin3, Arieh Y Kaufman.4, Nestor Cohenca 5

1
Department of Orthodontics and Craniofacial Deformities, School of Graduate
Dentistry, Rambam Health Care Campus, Haifa, Israel

2
Bruce and Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of
Technology, Haifa, Israel.
3
Department of Dermatology, Rambam Health Care Campus, Haifa, Israel

4
Department of Endodontics, School of Graduate Dentistry, Rambam Health Care
Campus, Haifa, Israel

4
Endodontology Department, Goldschleger School of Dental Medicine, Tel Aviv
University, Tel Aviv, Israel

5
Private Practice Limited to Endodontics Kirkland, WA.

Professor. Department of Pediatric Dentistry. University of Washington and Seattle

Children’s Hospital, Seattle, WA

Correspondence to:
Dr. Shmuel Einy
Department of Orthodontics and Craniofacial Deformities
School of Graduate Dentistry
Rambam Health Care Campus,
Haifa, Israel
Fax: 972-39030687
Email: [email protected]

This article has been accepted for publication and undergone full peer review but has
not been through the copyediting, typesetting, pagination and proofreading process,
which may lead to differences between this version and the Version of Record. Please
cite this article as doi: 10.1111/edt.12513
This article is protected by copyright. All rights reserved.
 All authors have no conflict of interests or commercial relationship to disclose
Accepted Article
Abstract

Background/Aims: Decoronation is currently considered the best treatment option

for ankylosed teeth and discrepancies in the alveolar bone, particularly in childhood

and adolescence. The loss of a front tooth creates aesthetic, functional and

psychological distress in patients and their parents. The aim of this study was to

analyze the types of restorations provided after decoronation, their suitability,

durability and follow-up until insertion of the final restoration.

Materials and methods: A literature review was conducted using Ovid-Medline,

Embase and Web of Science to identify eligible articles. English language

publications until August 9, 2018, were searched independently and crosschecked by

two researchers online, in print, and in press.

Results: Of 618 articles screened, 10 included reports on 11 patients with detailed

descriptions of 13 provisional restorations. Patients' ages at the time of decoronation

were 8-15 years. Seven underwent avulsion and four intrusion. Removable partial

denture (9 cases) was the most common restoration. In two cases, the restoration was

provisional with a lingual bar with prosthetic crown and in two other cases with an

adhesive bridge. Follow up ranged from 3 months to 5 years in 9 patients. Two cases

were followed until the permanent restoration was placed.

Conclusions: The importance of long-term provisional restorations was disregarded

by most authors. A multidisciplinary approach should take into consideration

immediate, mid and long-term rehabilitation of the decoronated tooth.

This article is protected by copyright. All rights reserved.

 Introduction

Avulsion is defined as complete separation of a tooth from its alveolus following a

Accepted Article
traumatic injury. This results in extensive damage to the pulp and periodontal tissues.

Avulsed teeth comprise 1-16% of all traumatic injuries of the permanent dentition.

One of the negative sequelae of replanted teeth is ankylosis, where infra-positioning

occurs due to local arrest of the surrounding alveolar bone growth concomitant to

continuous skeletal growth and development.1-3 Such infra-positioning results in an

unaesthetic dento-gingival complex and complicates future prosthetic rehabilitation.4

The only accepted treatment option of ankylosed teeth has been surgical

removal, frequently accompanied by traumatic alveolar bone tear, particularly in the

presence of a thin maxillary buccal plate.5 Often this has led to bony ridge deformities

that interfere with future optimal prosthetic rehabilitation.6

Decoronation was first proposed and discussed by Malmgren et al.6 and is

considered the most conservative alternative treatment in adolescents before the pre-

pubertal growth spurt.7-9 The procedure involves gingival mucoperiosteal flap

elevation, sub-crestal removal of the tooth crown leaving the root in its alveolus to be

replaced by bone. The preservation of decoronated roots in the alveolar process not

only helps maintain existing bone volume10 but also enables vertical bone growth

which can be observed coronally to the decoronated roots. Such vertical growth could

minimize the need for future ridge augmentation before implant placement.11 The

degree of development of the crestal bone is directly correlated to the age and growth

of the patient.1,12,13

This article is protected by copyright. All rights reserved.

 One of the critical phases of decoronation is the multidisciplinary treatment

planning, including the immediate post-operative rehabilitation of the decoronated

Accepted Article
tooth space. Although not often discussed, the social and psychological effect of

losing a tooth in the esthetic area should be considered before the surgical procedure

is performed.14-19 Malmgren has described three possible options for restoration with

no preference: a removable partial denture, a lingual bar with a prosthetic crown

during the mixed dentition, and a crown bonded to the adjacent teeth with an acid-

etch technique.12,13 Both removable and fixed provisional restorations in children and

adolescents have serious shortcomings.14 Irrespective of any of the three

recommended options, attention should be called to the lack of interference with the

normal eruption of adjacent teeth or normal inter-arch width development.7 The

current literature on provisional restorations immediately post-decoronation is

inconsistent,1,4,9 and follow-up is lacking.8

The aim of this study was to systematically review the literature concerning

the various options for immediate post-operative rehabilitation after decoronation

over the past 34 years. In addition, the review presents the prevalence of the options,

the follow-up periods and recommendations concerning the preferred restoration in

light of the review.

Materials and Methods

The literature review was conducted using Ovid-Medline (1946-present),

Embase (1947-present) and Web of Science (1900-present) to identify eligible

articles. Publications until August 9, 2018, were searched independently and cross-

checked by two researchers. Any disagreements regarding the suitability of individual

articles were resolved by discussion. The reference lists in the articles included in the

This article is protected by copyright. All rights reserved.

 study were further screened for additional eligible publications. The search strategies

are detailed in Table 1.

Accepted Article
Articles published in English, whether online, in print, or in press within the

34-year period were considered. There were no limitations on the types of articles. All

articles reporting on one or multiple cases of decoronation were included. Articles

were excluded based on the title, abstract, or both if there was no clear indication that

they discussed decoronation. However, editorials and reviews were not excluded.

Two researchers independently performed data extraction from the eligible

articles. Each paper was critically reviewed and the following data extracted: age of

the patient at presentation, gender, age of the patient when the trauma occurred, type

of trauma, characterization of the restoration, description of the orthodontic treatment,

and eventual follow-up duration.

Results

Twenty nine publications were found in relation to decoronation. However, some did

not address the temporary restoration (n=12) and others mentioned temporary

restoration without clinical cases (n=7). The remaining 10 articles that provided a

detailed description of the provisional restoration were included. The Preferred

Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram

is depicted in Figure 1.

Seven males and four females, aged 8-15 years old at the time of decoronation

were included (Table 2). Seven patients presented with a history of avulsion and there

were four cases of intrusion. Four patients were under orthodontic treatment, of which

two were decoronated during treatment. In two patients, the orthodontic treatment was

This article is protected by copyright. All rights reserved.

 performed after decoronation. Thirteen provisional restorations were reported in the

eligible articles (Table 2).

Accepted Article
The most common restoration provided immediately after decoronation was

removable partial denture (nine patients). Lingual bars were used in two patients, and

an adhesive bridge was described in two additional cases. Follow-up ranged from 3

months to 5 years and included 9 of the patients (81%).

Table 3 demonstrates seven additional articles in which a provisional

restoration was mentioned, but with details of the cases. All articles mentioned a

removable denture as a provisional option.7,12,13,20-23 In five articles the adhesive

bridge was chosen,12,13,21-23 and 4 lingual bar as restorative options.7,12,22,23

Discussion

Replacement root resorption and ankylosis are serious sequalae of traumatic

injuries.24-26 Decoronation is an efficient and predictable approach aimed at

preserving the alveolar bone. The procedure is relatively simple and well tolerated by

children and adolescents.1,6,9,11,27 As the time span between the decoronation

procedure until the final restoration continues over several years, the patients should

be provided with a provisional esthetic and functional restoration immediately after

the surgical decoronation.16 Several factors should be taken into consideration prior to

the surgical intervention, such as the patient's age, oral hygiene habits, arch

development, and the need for orthodontic treatment. The arch situation of the

neighboring teeth is also a dominant factor. Therefore, a multidisciplinary team

should be involved in the comprehensive treatment to determine the most suitable

provisional restoration.

This article is protected by copyright. All rights reserved.

 In most studies included in this systematic review, timing of the decoronation

was either before or during the pubertal growth period. Rate of infraposition16 of
Accepted Article
reimplanted ankylosed incisors is age-related. During the pubertal growth spurt, there

is a greater risk for severe infraposition in children and adolescents combined with

arrest of alveolar bone development. Consequently, these children required a long-

term temporary rehabilitation until permanent implant-based restoration.9,16,25,27-33

The long period raises the risk of recurrent failures or breakage over this waiting

period that should be taken into consideration, and not constitute a deterrence from

performing the procedure.16,27,33 As a result, patients who have undergone

decoronation should be monitored continuously by a multidisciplinary team, which

should include a thorough examination of the provisional restoration status.

Pontic restoration bonding to adjacent teeth is possible only when the dental

arch development and teeth eruption are not interrupted.12 In addition, a minimum

clearance space between the gingival edge of the pontic and the surface above the

ankylosed root should be maintained. This is imperative to permit coronal bone

growth without interference. Of all the case reports describing surgical decoronation,

only a few present a follow up until the implant insertion.16 Moreover, the literature

consists of even fewer case reports that describe the provisional restoration. Most

articles describing decoronation case reports were published by authors affiliated with

academic institutes and hospitals. Consequently, one would have expected that such

procedures would be accompanied by a multidisciplinary team or at least consultation

with them. However, the publications had a lack of the appropriate emphasis for the

need of multidisciplinary cooperation or consultation with other specialists such as

orthodontists and endodontists. This lack of multidisciplinary consultation and

This article is protected by copyright. All rights reserved.

 disregard of the provisional restoration may result in future complications and may

also affect orthodontic treatment.

Accepted Article
Although the most crucial interest and psychological considerations of the

patients and their guardians is to provide the patient with an aesthetic restoration, this

systematic review disclosed that none of the case reports mentioned this concern.

Moreover, in some of the cases, there was no detailed description of the provisional

restoration.11,15,34,35 The remaining cases with provisional restorations (Table 2)

demonstrate inconsistency regarding the preferred restoration.14,20 Table 4 summarizes

the overall characteristics of a provisional restoration. The most important

requirement is the protection of the alveolar process and soft tissue to enable proper

vertical bone growth.7 Additionally, it must be hygienic, esthetic and long-term.14 This

systematic review discloses that removable appliances applied (Table 2) or only

recommended (Table 3) are the most popular restorations. Although Malmgren12

initially described this restoration as the most common one, it has multiple

shortcomings14,36 as detailed in Table 4. In addition, a high level of compliance is

required both on the part of the child and the family. Nonetheless, most children

refuse to wear a removable appliance due to both psychological and social

considerations. These disadvantages presumably led Malmgren13 to prefer the use of

the removed natural crown by bonding it to the adjacent teeth as the first choice

restoration. This option was found in the literature review either as a natural tooth

pontic, or with a modified artificial acrylic tooth.7,21,22 In one case, to improve

stability, the fixation to the adjacent tooth was performed by twist-flex wire.23

Although this option is well accepted by patients and is seemingly simple, it involves

several difficulties.31,32 An etched bonded laboratory bridge incorporating the missing

crown attached to the palatal aspect of both adjacent crowns can serve as a more

This article is protected by copyright. All rights reserved.

 retentive restoration. However, this bridge which is made of fiberglass, a metal plate,

or ceramic may result in fractures and loosening of the retentive arms from the
Accepted Article
supported teeth and composite cementation material failure.37-39 Moreover, its use is

contraindicated during orthodontic treatment.12 The third option suggested by

Malmgren12 is a lingual bar with a prosthetic crown. Surprisingly, although this

appliance is considered to be superior over pontic cantilever restoration and a

removable appliance, the literature review indicates it to be the least frequently used

method.14,25,31 The reason for this may be that the frequent provisional solutions such

as the removable denture or a bonded bridge are more familiar and accessible.

The lingual bar with a prosthetic crown is a fixed appliance that can serve the patient

in the long-term, depending on growth and orthodontic needs.7 The integration of

orthodontic laboratory work enables a highly esthetic solution at a reasonable price.

Moreover, it solves the psychological problem of front teeth loss in a child, avoiding

the outcome of becoming a target of ridicule by other children.29,40 A provisional

fixed partial appliance compared to a removable one presents a 3 to 6 fold higher

probability of the elimination of significant social effects.41 A modification such as

the Trans Palatal Arch and Nance appliance12 presented in the literature14 exhibits an

even greater improvement over the recommended lingual arch.12 This solid laboratory

device suits the need of increased stability, avoids pressure on the alveolar ridge and

can serve as a good alternative to occlusal stops previously recommended by

Malmgren.12 These stops are not always possible due to occlusal, esthetic and

orthodontic considerations. Moreover, the review disclosed that during the long

period of having a provisional restoration, orthodontic treatment can be performed.

The literature indicates that orthodontic archwire that holds a provisional tooth4 may

serve as a provisional restoration, but sometimes must be replaced.9,25 However, the

This article is protected by copyright. All rights reserved.

 modified Trans Palatal Arch and Nance appliance restoration can serve as a sole

appliance until final restoration.14 If needed, minor changes in the provisional tooth's
Accepted Article
position or size can be easily performed during orthodontic treatment.

This review disclosed only 29 publications describing decoronation over the

past 34 years. A meta-analysis of the literature was not possible due to the small

number of cases available in the literature. The only case series found was

Malmgren's publication.13 However, without reference to the restorations, it was not

possible to include it in this systematic literature review. The findings in this

systematic review lead to the conclusion that although decoronation of ankylosed

teeth is considered the gold standard treatment for young growing patients, many

professionals still do not use it.24 The variety of provisional restorations of

decoronation in the case reports indicates the need for further research, which should

indicate the advantages and disadvantages of each option and will provide

recommendations for planning the most appropriate solution for each decoronated

tooth.

Conclusion

Decoronation, a safe and easy procedure performed in children and

adolescents for alveolar bone height and width preservation, is the first choice

treatment for early loss of traumatized teeth. However, special attention should be

paid to its complementary step - a provisional restoration that needs to be used for the

long-term until the insertion of the final restoration. The post-decoronation restoration

is either totally ignored in many articles in the literature or described with

inconsistencies concerning its type. Among the three recommended options, the

modified lingual arch seems to address the most common requirements. It is

This article is protected by copyright. All rights reserved.

 important to promote awareness among health care providers regarding the necessity

of a multidisciplinary approach to plan the ideal restoration. An ideal provisional

Accepted Article
restoration should be durable functional, esthetic and solve psychological problems

regarding front tooth loss.

References:

1. Malmgren B, Malmgren O. Rate of infraposition of reimplanted ankylosed

incisors related to age and growth in children and adolescents. Dent Traumatol.
2002;18:28-36.
2. Campbell KM, Casas MJ, Kenny DJ. Ankylosis of traumatized permanent
incisors: pathogenesis and current approaches to diagnosis and management. J Can
Dent Assoc. 2005;71:763-8.
3. Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, DiAngelis AJ, et
al. Guidelines for the management of traumatic dental injuries: 2. avulsion of
permanent teeth. Pediatr Dent. 2016;38:369-76.
4. Cohenca N, Stabholz A. Decoronation - a conservative method to treat
ankylosed teeth for preservation of alveolar ridge prior to permanent prosthetic
reconstruction: literature review and case presentation. Dent Traumatol. 2007;23:87-
94.
5. Barrett EJ, Kenny DJ. Survival of avulsed permanent maxillary incisors in
children following delayed replantation. Endod Dent Traumatol. 1997;13:269-75.
6. Malmgren B, Cvek M, Lundberg M, Frykholm A. Surgical treatment of
ankylosed and infrapositioned reimplanted incisors in adolescents. Scand J Dent Res.
1984;92:391-9.
7. Mohadeb JV, Somar M, He H. Effectiveness of decoronation technique in the
treatment of ankylosis: A systematic review. Dent Traumatol. 2016;32:255-63.
8. Lin S, Schwarz-Arad D, Ashkenazi M. Alveolar Bone Width Preservation
after Decoronation of Ankylosed Anterior Incisors. J Endod. 2013;39:1542-4.
9. Lima TFR, Vargas Neto J, Casarin RCV, Prado M, Gomes BPFd, Almeida
JFAd, et al. Multidisciplinary approach for replacement root resorption following
severe intrusive luxation: A case report of decoronation. Quintessence Int.
2017;48:555-61.
10. Andersson L, Emami-Kristiansen Z, Hogstrom J. Single-tooth implant
treatment in the anterior region of the maxilla for treatment of tooth loss after trauma:
a retrospective clinical and interview study. Dent Traumatol. 2003 Jun;19:126-31.
11. Filippi A, Pohl Y, von Arx T. Decoronation of an ankylosed tooth for
preservation of alveolar bone prior to implant placement. Dent Traumatol.
2001;17:93-5.
12. Malmgren B. Decoronation: how, why, and when? J Calif Dent Assoc.
2000;28:846-54.
13. Malmgren B. Ridge Preservation/Decoronation. J Endod. 2013;39:S67-S72.
14. Einy S, Kaufman AY, Yoshpe M, Philosoph N, Aizenbud D, Lin S.
Decoronation of an ankylosed tooth: Postoperative restoration by means of an
intermediate fixed orthodontic laboratory device. Quintessence Int. 2018;49:239-44.

This article is protected by copyright. All rights reserved.

 15. Sapir S, Kalter A, Sapir MR. Decoronation of an ankylosed permanent incisor:
alveolar ridge preservation and rehabilitation by an implant supported porcelain
crown. Dent Traumatol. 2009;25:346-9.
16. Sigurdsson A. Decoronation as an approach to treat ankylosis in growing
Accepted Article
children. Pediatr Dent. 2009;31:123-8.
17. Bomfim RA, Herrera DR, De-Carli AD. Oral health-related quality of life and
risk factors associated with traumatic dental injuries in Brazilian children: A
multilevel approach. Dent Traumatol. 2017 Oct;33:358-68.
18. Giannetti L, Murri A, Vecci F, Gatto R. Dental avulsion: therapeutic protocols
and oral health-related quality of life. Eur J Paediatr Dent. 2007 Jun;8:69-75.
19. Holan G, Needleman HL. Premature loss of primary anterior teeth due to
trauma--potential short- and long-term sequelae. Dent Traumatol. 2014 Apr;30:100-6.
20. Lin S, Ashkenazi M, Karawan M, Teich ST, Gutmacher Z. Management of
ankylotic root resorption following dental trauma: a short review and proposal of a
treatment protocol. Oral Hlth Prev Dent. 2017;15:467-74.
21. Day PF, Kindelan SA, Spencer JR, Kindelan JD, Duggal MS. Dental trauma:
part 2. Managing poor prognosis anterior teeth--treatment options for the subsequent
space in a growing patient. J Orthod. 2008;35:143-55.
22. Sapir S. [Decoronation: indications and treatment timing]. Refu'at ha-peh
veha-shinayim . 2006;23:19-26,68.
23. Buczek O, Zadurska M, Osmólska-Bogucka A. Ankylosis in adolescence –
treatment options with special focus on decoronation – Review of literature. J
Stomatol. 2014;67:346-59.
24. Calasans-Maia JA, Neto AS, Batista MMD, Alves ATNN, Granjeiro JM,
Calasans-Maia MD. Management of ankylosed young permanent incisors after trauma
and prior to implant rehabilitation. Oral Surgery.7:45-51.
25. Sapir S, Shapira J. Decoronation for the management of an ankylosed young
permanent tooth. Dent Traumatol. 2008;24:131-5.
26. Kim Y-I, Kim S-S, Son W-S, Park S-B. Orthodontic treatment of an ankylosed
tooth; application of single tooth osteotomy and alveolar bone distraction
osteogenesis. Korean J Orthod. 2009;39:185-98.
27. Mahakunakorn N, Chailertvanitkul P, Kongsomboon S, Tungkulboriboon J.
Decoronation as a treatment option for replacement root resorption following severe
intrusive trauma: a case report. Oral Health Dent Manag. 2014;13:266-70.
28. Sala M, Mendoza-Mendoza A, Yanez-Vico R-M. Decoronation: an alternative
treatment for replacement root resorption. Case Rep Dent. 2017;2017:7-.
29. Ashkenazi M, Kaufman A, Einy S. The diagnostic and treatment challenges
associated with traumatized intruded permanent incisors: a case report. Quintessence
Int. 2015;46:309-15.
30. Lin S, Fuss Z, Wigler R, Karawani M, Ashkenazi M. [Decoronation: treatment
protocol for ankylotic root resorption as a consequence of dental trauma]. Refu'at ha-
peh veha-shinayim . 2013;30:32-40,75.
31. Peretz B, Nuni E. Resin-bonded cantilever and twist-flex wire for maxillary
incisor lost due to trauma. J Can Dent Assoc. 2012;77:C28-C.
32. Diaz JA, Sandoval HP, Pineda PI, Junod PA. Conservative treatment of an
ankylosed tooth after delayed replantation: a case report. Dent Traumatol.
2007;23:313-7.
33. Schwartz-Arad D, Levin L, Ashkenazi M. Treatment options of untreatable
traumatized anterior maxillary teeth for future use of dental implantation. Implant
Dent. 2004;13:120-8.

This article is protected by copyright. All rights reserved.

 34. Levin I, Ashkenazi M, Schwartz-Arad D. [Preservation of alveolar bone of un-
restorable traumatized maxillary incisors for future]. Refu'at ha-peh veha-shinayim.
2004;21:54-9,101-2.
35. Tsukiboshi M, Tsukiboshi T. Bone morphology after delayed tooth
Accepted Article
replantation - case series. Dent Traumatol. 2014;30:477-83.
36. Wong P, Freer TJ. Patients' attitudes towards compliance with retainer wear.
Aust Orthod J. 2005;21:45-53.
37. Gupta A, Yelluri RK, Munshi AK. Fiber-reinforced composite resin bridge: a
treatment option in children. Int J Clin Pediatr Dent. 2015;8:62-5.
38. Van Rensburg JJ. Fibre-reinforced composite (FRC) bridge--a minimally
destructive approach. Dent Update. 2015;42:360-2.
39. Berekally TL, Smales RJ. A retrospective clinical evaluation of resin-bonded
bridges inserted at the Adelaide Dental Hospital. Aust Dent J. 1993;38:85-96.
40. Tzemach M, Aizenbud D, Einy S. [Early orthodontic treatment for growth
modification by functional appliances--pros and cons]. Refuat Hapeh Vehashinayim.
1993;31:25-31.
41. Bouchardet F, de Souza Gruppioni Cortes MI, Vilela Bastos J, Costa de
Morais Caldas IA, Caldas M, Franco A, et al. The impact of tooth avulsion on daily
life performance using the Brazilian OIDP index in children and young adults. J
Forensic Odontostomatol. 2014;32:9-14.

This article is protected by copyright. All rights reserved.

 Table 1. Literature search strategy for each of the databases examined
Literature search scheme for OVID Medline (276 results)
Accepted Article
Search String:

1 exp INCISOR/

2 Incisor*.tw.

3 (esthetic-zone or aesthetic-zone).tw.

4 ((anterior or front*) and (tooth or teeth or dental or incisor*)).tw.

5 1 or 2 or 3 or 4

6 exp "ROOT RESORPTION"/

7 ((Tooth or teeth or dental or incisor or dentoalveolar) adj3 Ankylos*).tw.

8 infraocclusion.tw.

9 infraposition.tw.

10 ((Root or tooth or teeth or dental) adj3 Resorption*).tw.

11 tooth diseases/ or exp dental pulp diseases/ or exp mouth, edentulous/ or exp tooth ankylosis/
or exp tooth discoloration/ or exp tooth injuries/ or exp toothache/

12 ((teeth or tooth) adj3 injur*).tw.

13 exp Periodontal Diseases/

14 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13

15 exp Dental Restoration, Permanent/

16 exp Dental Restoration, Temporary/

17 exp Mouth Rehabilitation/

18 exp Tooth, Artificial/ or exp Dental Implantation, Endosseous/ or exp Dental Implants, Single-
Tooth/ or exp Esthetics, Dental/ or exp Dental Prosthesis, Implant-Supported/

19 exp TOOTH/su, tr [Surgery, Transplantation]

20 exp Space Maintenance, Orthodontic/

21 exp Tooth Loss/rh [Rehabilitation]

22 exp Orthodontic Space Closure/

23 exp rehabilitation/ or rehabilitation.tw.

24 (artificial or false).tw.

25 retention.tw.

26 ((mariland or dental or partial or bonded) adj3 bridge).tw.

27 flipper.tw.

28 (rehabilit* or reparat* or restorat*).tw.

29 (cosmetic or aesthetic or esthetic).tw.

This article is protected by copyright. All rights reserved.

 30 (implant* or prosthes*).tw.

31 (space adj3 (maintenance or closure)).tw.

32 (replantation* or reimplantation* or transplantation*).tw.

Accepted Article
33 (orthodontic adj5 (appliance* or spacer)).tw.

34 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or
31 or 32 or 33

35 (decoronation or decorona* or de-coronation).tw.

36 ((clinical-crown* or corona-clinica or corona-dentis or crown* or tooth-crown*) adj5 (surg*

or treat* or therap* or manag*)).tw.

37 ridge-preservation.tw.

38 (process* adj3 alveolar).tw.

39 35 or 36 or 37 or 38

40 5 and 14 and 34 and 39

Literature search scheme for Embase (286 results)

Search String:

#38 #5 AND #16 AND #32 AND #37

#37 #33 OR #34 OR #35 OR #36

#36 (process* NEAR/3 alveolar):ab,ti,kw

#35 'ridge preservation':ab,ti,kw

#34 (('clinical crown*' OR 'corona clinica' OR 'corona dentis' OR crown* OR 'tooth crown*')
NEAR/5 (surg* OR treat* OR therap* OR manag*)):ab,ti,kw

#33 decoronation:ab,ti,kw OR decorona*:ab,ti,kw OR 'de coronation':ab,ti,kw OR 'de-

coronation':ab,ti,kw

#32 #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR
#28 OR #29 OR #30 OR #31

#31 (orthodontic NEAR/5 (appliance* OR spacer)):ab,ti,kw

#30 replantation*:ab,ti,kw OR reimplantation*:ab,ti,kw OR transplantation*:ab,ti,kw

#29 (space NEAR/3 (maintenance OR closure)):ab,ti,kw

#28 implant*:ab,ti,kw OR prosthes*:ab,ti,kw

#27 cosmetic:ab,ti,kw OR aesthetic:ab,ti,kw OR esthetic:ab,ti,kw

#26 rehabilit*:ab,ti,kw OR reparat*:ab,ti,kw OR restorat*:ab,ti,kw

#25 flipper:ab,ti,kw

#24 ((mariland OR dental OR partial OR bonded) NEAR/3 bridge):ab,ti,kw

#23 retention:ab,ti,kw

#22 artificial:ab,ti,kw OR false:ab,ti,kw

This article is protected by copyright. All rights reserved.

 #21 'dental bridge'/exp

#20 'rehabilitation'/exp

#19 'orthodontic device'/exp

Accepted Article
#18 'tooth implant'/exp

#17 'dental restoration'/exp

#16 #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15

#15 ((root OR tooth OR teeth) NEAR/3 resorption*):ti,ab,kw

#14 infraposition:ab,ti,kw

#13 ((tooth NEAR/3 ankylos*):ab,ti,kw) OR ((ankylos* NEAR/3 dentoalveolar):ab,ti,kw) OR

((dental NEAR/3 ankylos*):ab,ti,kw) OR ((teeth NEAR/3 ankylos*):ab,ti,kw) OR ((incisor* NEAR/3
ankylos*):ab,ti,kw)

#12 'tooth discoloration'/exp

#11 'tooth infection'/exp

#10 'tooth injury'/exp

#9 'tooth pain'/exp

#8 'tooth pulp disease'/exp

#7 'periodontal disease'/exp

#6 'edentulousness'/exp

#5 #1 OR #2 OR #3 OR #4

#4 (anterior:ab,ti,kw OR front*:ab,ti,kw) AND (tooth:ab,ti,kw OR teeth:ab,ti,kw OR

dental:ab,ti,kw OR incisor*:ab,ti,kw)

#3 'esthetic zone':ab,ti,kw OR 'aesthetic zone':ab,ti,kw

#2 incisor*:ab,ti,kw

#1 'incisor'/exp

Literature search scheme for Web of Science (56 results)

Search String:

#9 #8 AND #5 AND #4 AND #1

#8 #7 OR #6

#7 TS=(artificial OR false) OR TI=(artificial OR false) OR TS=((mariland OR dental OR partial

OR bonded) NEAR/3 bridge*) OR TI=((mariland OR dental OR partial OR bonded) NEAR/3
bridge*) OR TS=(rehabilit* OR restorat* OR reparat*) OR TI=(rehabilit* OR restorat* OR
reparat*) OR TS="orthodontic device" OR TI="orthodontic device" OR TS=(implant* OR
prosthes*) OR TI=(implant* OR prosthes* OR flipper)

#6 TS=(orthodontic NEAR/5 (appliance* OR spacer)) OR TI=(orthodontic NEAR/5 (appliance*

OR spacer)) OR TS=(replant* OR reimplant* OR transplant*) OR TI=(replant* OR
reimplant* OR transplant*) OR TS=(space NEAR/3 (maintenance OR closure)) OR TI=(space
NEAR/3 (maintenance OR closure)) OR TS=(cosmetic* OR esthetic* OR aesthetic*) OR
TI=(cosmetic* OR esthetic* OR aesthetic*)

This article is protected by copyright. All rights reserved.

 #5 TS=(process* NEAR/3 alveolar) OR TI=(process* NEAR/3 alveolar) OR TS=("ridge
preservation") OR TI=("ridge preservation") OR TS=((("clinical crown*" OR "corona clinica"
OR "corona dentis" OR crown* OR "tooth crown*") NEAR/5 (treat* OR manag* OR therap*
OR surger*))) OR TI=((("clinical crown*" OR "corona clinica" OR "corona dentis" OR
Accepted Article
crown* OR "tooth crown*") NEAR/5 (treat* OR manag* OR therap* OR surger*))) OR
TS=(decoronation OR decorona* OR "de coronation" OR "de-coronation") OR
TI=(decoronation OR decorona* OR "de coronation" OR "de-coronation")

#4 #3 OR #2

#3 TS=((root OR tooth OR teeth) NEAR/3 resorption*) OR TI=((root OR tooth OR teeth)

NEAR/3 resorption*) OR TS=infraposition OR TI=infraposition OR TS=((tooth NEAR/3
ankylos*) OR (ankylos* NEAR/3 dentoalveolar) OR (dental NEAR/3 ankylos*) OR (teeth
NEAR/3 ankylos*)) OR TI=((tooth NEAR/3 ankylos*) OR (ankylos* NEAR/3 dentoalveolar)
OR (dental NEAR/3 ankylos*) OR (teeth NEAR/3 ankylos*)) OR TS=infraocclusion OR
TI=infraocclusion

#2 TS=((tooth OR teeth OR dental OR incisor*) AND (ankylos*)) OR TI=((tooth OR teeth OR

dental OR incisor*) AND (ankylos*)) OR TS="tooth discoloration" OR TI="tooth
discoloration" OR TS="tooth infection" OR TI="tooth infection" OR TS="tooth injury" OR
TI="tooth injury" OR TS="tooth pain" OR TI="tooth pain" OR TS="tooth pulp disease" OR
TI="tooth pulp disease" OR TS="periodontal disease" OR TI="periodontal disease" OR
TS=edentulousness OR TI=edentulousness

TS=((anterior OR front*) AND (tooth OR teeth OR dental OR incisor*)) OR TI=((anterior OR

#1 front*) AND (tooth OR teeth OR dental OR incisor*)) OR TS=("esthetic zone" OR "aesthetic
zone") OR TI=("esthetic zone" OR "aesthetic zone") OR TS=incisor* OR TI=incisor*

This article is protected by copyright. All rights reserved.

 Table 2: Documented decoronated cases with provisional restorations
Accepted Article
Author No. Of Age Gend Accident Trauma No Orthodontic Treatment During Orthodontic Treatment
patients er Age Type Removed Lingual Bar Partial Removed Partial Follow Up
Lingual Bar With
Crown With A Denture Crown Shaped Denture
A Prosthetic
Shaped Prosthetic As Pontic
Crown
As Pontic Crown

1 Lima 1 M 6 11 * ++ 5 yrs
10
(2017) intrusion
2 Sala 15 F 8 22 ++ No Unkown

(2017) 2 8 intrusion
11 ++
10 M
Einy 1 9 avulsion
11 No * 1.5 yrs
3 12 F
(2018) avulsion
11
4 Sigurdsson 1 10.08 F + No 2.5 yrs

(2009 (
Cohenca 1 9 avulsion
11avulsion No + 2.5 years *
5 15 M
(2007)
Dıaz 1 8 11 + No 44 months
6 10 M
(2007)
Peretz 1 7 avulsion
11 avulsion ++ 11
No 1yr
7 8 M
(2012) 1 avulsion
8 Sapir 1 12 M 10 11 avulsion * +++ 4 years

(2008)
Mahakunakorn 1 11,21- * No 4 years*
9 12 F 8
(2014)
Lin 1 M 12 Intrusion
21 No Unkown
10 12 +

TOTAL ( 2012) intrusion

7 avulsion
7M,
11 8-15 4F 6-13
4 intrusion
6 1 2 3 1 0 3-60 months

Natural tooth +, Natural tooth with a wire ++, orthodontic archwire holds the provisional tooth with elastics +++, Follow up until implant*

This article is protected by copyright. All rights reserved.

ccepted Articl
Table 3: Provisional Restorations Descriptions without Case Presentations
No Removed crown shaped A lingual bar with a Sampl
Author A partial denture Alternatives
as pontic prosthetic crown e size

1 Malmgren + + The most common option +

(2000)

2 Malmgren The most common option + + +

103
(2013)

3 Acrylic or natural tooth + Acrylic or natural tooth+ Acrylic or natural tooth +

Sapir (2006)
fixed by twist-flex wire

4 Buczek +fixed by twist-flex wire The most common option + Laser to weld the artificial tooth to
an orthodontic mini-implant
(2015)

5 Mohadeb Acrylic or natural tooth + Removable appliances

(2016)

6 Resin bonded bridge (RBB) +

Day (2018)

7 Lin +

(2017)

Total 5 4 7

+ options with no preferences

This article is protected by copyright. All rights reserved.

ccepted Articl
Table 4: Overall Characteristics of a Provisional Restoration

OPTION Ridge No Unbreakable Fitting & Esthetic Less Psychologic Hygienic Less Needs for Fair Multidisciplinary
Retention
Pressure Compliance Advantage Replacements Price Approach

involvement

Removable - - +- +- - - + + + -
partial
denture

Bonded - - +- +- + -+ + + - -
bridge

Lingual arch + + + + + + +- + ++ +

This article is protected by copyright. All rights reserved.

Accepted Article

This article is protected by copyright. All rights reserved.