Modified hyrax screw for treatment of ankylosed incisor by applying alveolar distraction and floating bone concept

Ankylosis is a known complication of replanted or severely intruded permanent incisors and can be diagnosed by lack of physiologic mobility, radiographic evidence of replacement resorption, and the characteristic dull sound on percussion. Treatment of such cases is challenging with regard to gingival aesthetics and conservation of bone health. In such cases, application of alveolar distraction and the floating bone concept can provide the best possible solution. The purpose of this clinical report is to show the treatment of a growing patient with ankylosed maxillary central and lateral incisors. The hyrax screw was modified, and an assembly was made for alveolar distraction of lateral incisor. Final fine adjustments were carried out by applying the floating bone concept using elastic traction. The importance of a less traumatic piezoelectric surgical unit for osteotomies is also highlighted. Application of this concept will give the best results in patients with ankylosed incisors having favorable root length and severe vertical discrepancy in alveolar bone.