Decoronation as a Surgical Technique for Managing Ankylosed Permanent Anterior Teeth in Growing Patients: A...

Background: Dental ankylosis (DA) in growing patients leads to progressive infraocclusion and alveolar ridge deformities, compromising future implant rehabilitation. Decoronation has been proposed as a biologically driven alternative to extraction for preserving alveolar bone during growth. Objective: We aimed to evaluate the clinical outcomes of decoronation-alveolar ridge preservation, infraocclusion progression, implant site development, and the influence of treatment timing-in growing patients with ankylosed permanent anterior teeth. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of MEDLINE (EBSCO), EMBASE, Scopus, and Web of Science was performed (January 2006-May 2026), supplemented by grey literature screening. Eligible studies included clinical investigations reporting outcomes of decoronation in patients ≤18 years. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) checklist. Certainty of evidence was evaluated using the GRADE framework. Lastly, an inter-rater agreement was quantified using Cohen's kappa coefficient. Results: Five studies (two retrospective cohorts and three case series) comprising 140 decoronated teeth with follow-up periods ranging from 1 to 30 years were included. A total of 78 records were identified across four databases; five studies met the eligibility criteria after duplicate removal and screening. Inter-rater agreement at the full-text eligibility stage was good (κ = 0.70). The overall risk of bias was low to moderate, and the certainty of evidence was rated as low using the GRADE framework. Vertical alveolar bone preservation or gain was consistently observed, particularly when decoronation was performed during the prepubertal or pubertal growth phases. The largest cohort (n = 103) reported substantial vertical bone gain when intervention occurred at a mean age of 13.0 years in girls and 14.6 years in boys. Infraocclusion stabilisation or improvement was reported across all studies. In contrast, horizontal ridge reduction persisted, with the only quantitative study reporting a mean bucco-palatal loss of 1.67 ± 1.12 mm (p = 0.004). No included study directly assessed implant placement outcomes. Overall, the certainty of evidence was low due to observational study designs, heterogeneity in outcome assessment, and absence of controlled comparators. Conclusions: Decoronation appears to be a promising strategy for preserving vertical alveolar bone and stabilising infraocclusion in growing patients with ankylosed teeth, particularly when performed before or during the pubertal growth phase. Evidence showed considerable bone height preservation, though horizontal ridge reduction persisted across cases. However, the certainty of evidence remains low because available studies are observational, heterogeneous, and lack direct extraction comparators. Therefore, high-quality prospective studies with standardised outcome measures and controlled comparisons are required to establish definitive clinical protocols. Participants underwent decoronation during childhood or adolescence (≤18 years); reported follow-up periods of up to 30 years reflect monitoring that extended into adulthood. Clinical significance: For clinical decision-making, decoronation should be considered once ankylosis with progressive infraocclusion is confirmed during active growth, ideally before the pubertal spurt; the decision should be guided by growth stage rather than chronological age, and clinicians should anticipate likely horizontal ridge reduction by planning for possible augmentation at implant placement and coordinating multidisciplinary follow-up until skeletal maturity.