METHODS: After emergency neurological treatments, patient was refered to us 3 months after accident with a severe Cl II div I, increased overjet and complex open bite, due to a bilateral condylar fracture with medial rotation, and severe crowding and dental malpositions and intrusions due to heavy trauma. One upper lateral incisor and two premolars were lost during accident and 12 teeth needed RCT because of pulp exposures and fractures resulted from trauma. Possible endodontic and restorative treatments were done before orthodontic intervention. Pre-surgical orthodontic treatment resulted in acceptable alignment but 5 teeth had ankylosis due to intra-PDL bleeding and severe intrusion resulted from trauma. Treatment of these teeth was accomplished by periodontal intervention (Periotomy, Drilling Osteotomy and Re-implantation), and compared with a control group of 10 ankylosed teeth treated only by Re-implantation in a period of 3 years follow up. Post surgical fixation is done by orthodontic wires. Orthognathic surgery was the next stage, in which a 8mm advancement of mandible and 7mm of genioplasty were done. Prosthetic and cosmetic procedures were the last step.
RESULTS: Significantly important improvements in patient's appearance were occured after a short period of wound healing. The index of resorption ( Root and Alveolar crest) was significantly decreased in the ankylosed teeth treated with Drilling Osteotomy plus Re-implantation in comparison to Re-implantation alone ( p-value < 0.001 ).
CONCLUSION: In heavy head and face trauma a closed co-operation between orthodontist, periodontist and maxillofacial plastic surgeon is of great importance in giving an acceptable appearance to the patient. Treatment of Ankylosed teeth in these patients may be preferably done by a Drilling Osteotomy procedure plus Re-implantation, rather than Re-implantation alone.