Cleidocranial dysplasia - treatment of dentofacial abnormalities

Resident’s Name: Joanne Lewis Date: February 12, 2010

Article title: Cleidocranial dysplasia: comprehensive treatment of the dentofacial abnormalities

Author(s): Trimble, Douglas DMD MD, et al

Journal: JADA

Volume (number): 105

Date: October 1982

Major topic: Cleidocranial dysplasia

Type of Article: review article

Main Purpose: to describe a 5 phase surgical and orthodontic approach to correcting the dentoalveolar abnormalities seen in patients with cleidocranial dysplasia.

Key points/Summary: Abnormalities of the dentoalveolar complex in patients with CD include – multiple supernumerary teeth, root form abnormalities, failure of primary teeth to exfoliate, failure of permanent teeth to erupt, poorly developed alveolar processes, hypoplastic maxilla, frontal bossing. Possible treatment options include:

Extraction of all primary and permanent teeth with removable prosthesis – problem: retention of denture is compromised due to the amount of alveolar bone removed during extractions and preexisting alveolar insufficiency.

Extraction of all erupted teeth with placement of removable prosthesis – problem: continued tooth eruption results in ulceration, cysts formation, or osteomyelitis. Retention of the erupted permanent teeth with fabricated of an overlay denture has the same problems.

Restoration with a fixed prothesis – problem: poor abutment availability.

The authors advocate a 5 phase surgical and orthodontic treatment plan aimed at restoring function and esthetics.

Phase 1: extraction of primary and supernumerary teeth with exposure and orthodontic banding of the permanent dentition. Considerations: this phase is ideally begun with the crown and approximately 50% of the roots of the canines and premolars have calcified. Extraction decisions made presurgically may have to be altered during surgery due to ankylosis or fusion of the permanent teeth to supernumerary teeth. Made need to retain the primary second molars until the permanent first molars erupt to preserve an occlusal stop and prevent mandibular overclosure. Flap replacement may be complicated by the bulk of orthodontic appliances. Meticulous OH, irrigation, and antibiotic coverage are needed postsurgically. Placement of ortho bands may require extensive removal of alveolar bone.

Phase 2: orthodontic coordination of the maxillary and mandibular dentitions. Considerations: Arch wire is placed at the time of surgery. Teeth are initially highly mobile; may be 6-9 months after surgery before teeth become stable. Once teeth emerge, subsequent orthodontic treatment is conventional.

Phase 3: surgical correction of the facial-skeletal deformities – Le Forte I, etc. Considerations: conventional osteotomy sites may be altered due to abnormal root formation. Final evaluation regarding facial esthetics cannot be made for at least 12 months.

Phase 4: finishing orthodontics.

Phase 5: supplemental treatment procedures – perio, restorative.

Assessment of article: Concise article that gives a good review of the problems associated with CD as well as some relevant clinical information. A good read.