Cleidocranial dysplasia: Part 2--Treatment protocol for the orthodontic and surgical modality

A Clinical Odyssey Involving Cleidocranial Dysplasia: Report of a Rare Case

Cleidocranial dysplasia (CCD) is a rare genetic disorder that causes cranial and skeletal abnormalities. This case report presents a comprehensive analysis of a rare instance of CCD, highlighting its clinical manifestations through an orthodontic lens shedding light on the challenges and complexities associated with managing this uncommon condition. The patient, an 18-year-old female, presented with a variety of symptoms, including delayed eruption of permanent teeth, abnormal facial features, and prominent cranial abnormalities. Multiple teeth in both the arches were missing including over-retention of primary teeth. Features of cleidocranial dysplasia were evident in her facial appearance. Treatment of CCD requires a multifaceted approach, often involving orthodontic interventions, dental extractions, and corrective surgeries to address cranial deformities and other skeletal anomalies. The report emphasizes the importance of multidisciplinary collaboration in diagnosing and managing such cases, shedding light on the distinctive features of CCD and their implications for orthodontic treatment on what kind of best treatment can be given to these patients. This case serves as a reminder of the importance of raising awareness about rare genetic disorders like CCD, as early diagnosis and intervention can significantly improve the patient's quality of life. Furthermore, it underscores the significance of a collaborative and holistic healthcare approach in managing such complex conditions. It emphasizes the need for continued research, awareness, and support for individuals affected by such conditions.

Multidisciplinary prosthetic rehabilitation of an adult patient with cleidocranial dysplasia by using a rapid external distraction device: A clinical report

The multidisciplinary treatment of a 41-year-old man with cleidocranial dysplasia is described. A rapid external distraction device was used to reposition the maxilla before the prosthodontic rehabilitation.

Conservative orthodontic and multidisciplinary approaches for patients with cleidocranial dysplasia in late adolescence or young adulthood

This case series describes conservative orthodontic and multidisciplinary approaches for treating two patients diagnosed with cleidocranial dysplasia in late adolescence and young adulthood. Most of the impacted permanent teeth erupted spontaneously within 3 to 4 years after surgical extraction of the deciduous and supernumerary teeth. The remaining unerupted permanent teeth were facilitated with traction or extracted followed by implantation or restoration. Repositioning of the maxilla and mandible via orthognathic surgery was also applied to correct skeletal and occlusal discrepancies and lead to satisfying results.

Molecular Genetics of Cleidocranial Dysplasia

Cleidocranial dysplasia (CCD) is a genetic disorder with an autosomal dominant inheritance pattern. CCD characterized by abnormal clavicles, patent sutures and fontenelles, supernumerary teeth and short stature. Approximately 60-70% of CCD patients have mutations in the RUNX2 gene. The RUNX2 gene is an essential transcription factor for chondrocyte maturation, osteoblast differentiation and bone formation. Runx2 regulates mesenchymal cell proliferation in sutures and suture closure by inducing the signaling pathways of the genes of Fgf, Pthlh, hedgehog and Wnt. Material and Methods: We summarized molecular genetics aspects of CCD. Result: Approximately 94% of CCD patients have dental anomalies, the most common of which are supernumerary tooth. Dental anomalies are not determined solely by gene mutations of RUNX2, but are also affected by modifier genes, environmental factors, epigenetic factors and copy number variations. Conclusion: a definite diagnosis of CCD should include the patient's clinical history, symptoms and signs, as well as genetic analyses.

A Prosthodontic Approach as a Complementary Solution for a Complicated Orthodontic Treatment of a Patient with Cleidocranial Dysplasia

This clinical report describes a prosthodontic rehabilitation of a 29-year-old patient with cleidocranial dysplasia (CCD), who, after completing an orthodontic treatment, was not satisfied with the aesthetic outcome. Besides aesthetics, the patient complained about mastication muscles pain, and clicking while eating but was not aware about her unilateral open bite on the right side. The aim of this treatment was to improve smile appearance and patient's well-being, as well as to restore the proper occlusal vertical dimension (OVD) along with complete intercuspation and to establish masticatory function. The first phase of the treatment concentrated on eliminating the muscle pain and temporomandibular joint (TMJ) clicking with a repositioning splint. During the second phase, the functional and aesthetic rehabilitation was obtained using adhesive prosthesis overlays and veneers.

Prosthetic rehabilitation of a patient with cleidocranial dysplasia using dental implants-a clinical report

Adult patients with oral manifestations of untreated syndromic malformations usually exhibit a high degree of suffering. In this clinical report, we describe the implant-supported prosthetic treatment of a patient with cleidocranial dysplasia, a rare autosomal-dominant inherited malformation syndrome. Therapy for oral manifestations of cleidocranial dysplasia should be started in early childhood; however, the 26-year-old patient in the present study had not undergone orthodontic therapy in childhood. The treatment measures performed prior to this study were limited to the removal of several permanent teeth. Surgical pretreatment, placement of six implants each in the maxilla and mandible, and prosthetic restoration are described. The implantation was guided using a three-dimensional template. Long-term immediate temporary restoration and immediate loading of the implants were performed. The definitive prosthetic restoration was completed using fixed, acrylic resin-veneered screw-retained fixed dental prostheses. The clinical and radiological parameters observed in this case suggest that surgical and prosthetic procedure concepts from implantology can be adopted for patients with CCD.

Identification of a novel RUNX2 gene mutation and early diagnosis of CCD in a cleidocranial dysplasia suspected Iranian family

This research resulted in the identification and submission of a novel RUNX2 gene mutation in the affected members of the studied pedigree. Mutation screening is an effective method for the early diagnosis of CCD in the affected individuals.

A case report of cleidocranial dysplasia: A noninvasive approach

Cleidocranial dysplasia (CCD) is a rare bone disorder. The main dental features are the presence of multiple retained deciduous teeth and supernumerary teeth, as well as unerupted permanent teeth. To date, CCD is managed by a combination approach, which consists of the extraction of deciduous and supernumerary teeth, followed by orthodontic traction of unerupted permanent teeth. This case highlights the management of a girl with CCD, who refused the recommended protocol. A 15-year-old Malay female presented with a complaint of retained deciduous teeth. Intraoral examination revealed multiple retained deciduous teeth. Radiographs showed numerous impacted supernumerary and unerupted permanent teeth. The patient opted to improve her facial appearance with a less aggressive treatment option. A composite build-up on all anterior maxillary deciduous teeth was carried out until the patient was ready to undergo surgical intervention.

Delayed tooth movement in Runx2+/- mice associated with mTORC2 in stretch-induced bone formation

Runt-related transcription factor 2 (Runx2) is an essential transcription factor for osteoblast differentiation, and is activated by mechanical stress to promote osteoblast function. Cleidocranial dysplasia (CCD) is caused by mutations of RUNX2, and CCD patients exhibit malocclusion and often need orthodontic treatment. However, treatment is difficult because of impaired tooth movement, the reason of which has not been clarified. We examined the amount of experimental tooth movement in Runx2^+/− mice, the animal model of CCD, and investigated bone formation on the tension side of experimental tooth movement in vivo. Continuous stretch was conducted to bone marrow stromal cells (BMSCs) as an in vitro model of the tension side of tooth movement. Compared to wild-type littermates the Runx2^+/− mice exhibited delayed experimental tooth movement, and osteoid formation and osteocalcin (OSC) mRNA expression were impaired in osteoblasts on the tension side of tooth movement. Runx2 heterozygous deficiency delayed stretch-induced increase of DNA content in BMSCs, and also delayed and reduced stretch-induced alkaline phosphatase (ALP) activity, OSC mRNA expression, and calcium content of BMSCs in osteogenic medium. Furthermore Runx2^+/− mice exhibited delayed and suppressed expression of mammalian target of rapamycin (mTOR) and rapamycin-insensitive companion of mTOR (Rictor), essential factors of mTORC2, which is regulated by Runx2 to phosphorylate Akt to regulate cell proliferation and differentiation, in osteoblasts on the tension side of tooth movement in vivo and in vitro. Loss of half Runx2 gene dosage inhibited stretch-induced PI3K dependent mTORC2/Akt activity to promote BMSCs proliferation. Furthermore, Runx2^+/− BMSCs in osteogenic medium exhibited delayed and suppressed stretch-induced expression of mTOR and Rictor. mTORC2 regulated stretch-elevated Runx2 and ALP mRNA expression in BMSCs in osteogenic medium. We conclude that Runx2^+/− mice present a useful model of CCD patients for elucidation of the molecular mechanisms in bone remodeling during tooth movement, and that Runx2 plays a role in stretch-induced proliferation and osteogenesis in BMSCs via mTORC2 activation.

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Experimental tooth movement is delayed in Runx2^+/− mice compared with wild-type mice.

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Runx2 plays a role in stretch-induced proliferation and differentiation of BMSCs via mTORC2 activation.

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Runx2^+/− mice are useful model to clarify the mechanical stress-induced bone remodeling in CCD patients.

Surgical strategy for patients with late-diagnosed minor form of cleidocranial dysplasia: three cases

Introduction: Cleidocranial dysplasia is a genetic disease affecting bone growth. Observations: 3 patients, aged 12, 14, and 15 followed an orthodontic and surgical treatment to solve an eruption issue of the permanent teeth. Temporary teeth were extracted and impacted teeth were progressively exposed by multiple surgeries under local anesthesia. Anchorages were placed on the teeth and a traction started, on incisors and molars first, then on premolars, and finally on canines. The treatments lasted for 6 to 8 years. Comments: These patients presented minor form of cleidocranial dysplasia which only affected the teeth. The difficulty of these cases lied in the lateness of their diagnosis and treatment. Adaptations had to be made to simplify treatment plans (shortened dental arch, premolar extractions, etc.).

[Cleidocranial dysplasia: a case report and gene mutation analysis]

Cleidocranial dysplasia is a rare autosomal dominant hereditary disease characterized by abnormal skeletal and dental development. In this work, a case of cleidocranial dysplasia is reported, and a new frameshift mutation is confirmed by gene detection.

The Treatment Strategy of Cleidocranial Dysplasia: Combined Orthodontic and Orthognathic Treatment

Cleidocranial dysplasia is a rare autosomal-dominant condition that affects ossification. The main symptoms of this cleidocranial dysplasia patient include craniofacial abnormalities, hypoplasia of clavicles, narrow thorax, retarded exfoliation of deciduous teeth, retarded eruption of permanent teeth, and multiple impacted supernumerary teeth. The aim of this treatment was to correct the craniofacial abnormalities and provide an adequate functional reconstruction of the occlusion. The patient was treated with a multidisciplinary therapeutic protocol including removal of supernumerary teeth, surgical exposure of impacted teeth, orthodontic, and orthognathic surgery. After 6 years' follow-up, the treatment objectives of acceptable occlusion, normal function, and acceptable profile were achieved.

Multidisciplinary Implant Rehabilitation of a Patient with Cleidocranial Dysostosis: A Journey from Age 13 to 21

This clinical report describes the multidisciplinary oral rehabilitation of a teenage female patient with cleidocranial dysostosis, whose treatment was started in her teenage years. The unique challenges of delayed intervention are described in this report, highlighting the surgical, orthodontic, and prosthodontic care the patient received from age 13 to 21. Maintaining as many natural teeth as possible, orthodontically erupting impacted teeth using a mandibular provisional fixed implant prosthesis as anchor, crowning several natural teeth, and rehabilitating edentulous areas with fixed implant restorations provided the patient with esthetic and functional outcomes.

Combined surgical-orthodontic treatment of patients with cleidocranial dysplasia: case report and review of the literature

Objectives

To study the present treatment situation and investigate a better orthodontic approach for patients with cleidocranial dysplasia (CCD) through systematically reviewing the published cases and to conclude the surgical-orthodontic treatment experience of cleidocranial dysplasia.

Methods

A comprehensive search for studies published through to April 10, 2018 was conducted using the Pubmed, Web of Science, and Embase databases. The CCD cases treated with the approach combining surgical exposure and orthodontic treatment were concluded.

Results

Eight papers and 9 finished cases were included to be compared with the present case. The age of cases ranged from 9 to 28 years. Clearing the way of eruption path in early age can facilitate the spontaneous eruption of impacted teeth. For adults, combined surgical-orthodontic treatment can achieve a nearly complete dentition and stable occlusal contact, but it is time consuming and needs surgical assistance. The combination of orthognathic surgery can reduce the difficulty of orthodontic treatment and treatment duration, as well as achieve a better facial profile.

Conclusion

Surgical exposure combined with orthodontic traction is an effective treatment for patient with CCD. Patient’s age, demand, economic circumstances, and status of permanent dentition should be considered when making treatment plan.

Failure of Eruption of Permanent Tooth

Primary failure of eruption (PFE) is a rare condition that can lead to posterior open bites. It is difficult to diagnose and difficult to treat. PFE appears to be a condition that predominantly affects the molar dentition. The increased frequency of hypodontia in affected individuals and common findings of a family history regarding tooth eruption problems suggests a significant genetic component to the etiology of this rare condition.

Therapeutic Protocol for Orthosurgical Management of Class III Malocclusion in Patients With Cleidocranial Dysostosis

Cleidocranial dysostosis (CCD) is a congenital skeletal disorder with significant manifestations in facial and dental development. Patients are affected with CCD present maxillary deficiency, late dental eruption, and supernumerary teeth. Early and multidisciplinary approach is necessary to treat CCD patients, especially to manage dental eruption and Class III malocclusion with maxillary deficiency. Several orthodontic and surgical interventions are performed to enable traction and extraction of teeth. Yet the maxillary deficiency may be protracted followed by orthodontic dental compensation. On the other hand, it is important to note that CCD patients' treatment is closely related to the severity of transversal and sagittal deformities, as well as the discrepancies in the lower third of the face. In this context, patients with facial impairment highly affected by CCD may need ortho-surgical decompensation to reach more aesthetic outcomes. The present study reports a case of a 14-year-old young patient affected by CCD. Clinically, the patient presented Class III malocclusion, maxillary deficiency, short lower facial third, posterior crossbite, and anterior open bite leading to facial disharmony. The patient underwent treatment in 2 stages: the interceptive approach aimed to transversally expand the maxilla and promote its protraction; and the corrective phase combined with the orthognathic surgery treated the patients' main complains; the anterior open bite, unerupted teeth, and chin prominence. The treatment approach applied in the clinical report allowed the correction of the malocclusion and facial profile satisfying completely the patient's expectations.

Craniofacial features of cleidocranial dysplasia

Cleidocranial dysplasia (CCD) is an autosomal-dominant malformation syndrome affecting bones and teeth. The most common skeletal and dental abnormalities in affected individuals are hypoplastic/aplastic clavicles, open fontanelles, short stature, retention of primary teeth, delayed eruption of permanent teeth, supernumerary teeth, and multiple impacted teeth. Treatment of CCD requires a multidisciplinary approach that may include dental corrections, orthognathic surgery and cranioplasty along with management of any complications of CCD. Early diagnosis of this condition enables application of the treatment strategy that provides the best quality of life to such patients. Notably, Runx2 gene mutations have been identified in CCD patients. Therefore, further elucidation of the molecular mechanism of supernumerary teeth formation related to Runx2 mutations may improve understanding of dental development in CCD. The insights into CCD pathogenesis may assist in the development of new treatments for CCD.

Multidisciplinary team approach in the oral rehabilitation of patients with cleidocranial dysplasia to achieve a functional aesthetic outcome

Cleidocranial dysplasia is a hereditary congenital disorder that results in delayed ossification of midline structures, and is caused by mutations in the RunX2 (runt-related transcription factor 2) gene located on the short arm of chromosome 6. Successful treatment depends on multidisciplinary assessment and a comprehensive staged treatment plan. We present a case series of 12 patients who were managed with a specifically tailored combination of surgery, orthodontics, and prosthodontics to provide a functional dentition and restore their smile and facial contour. Successful dental rehabilitation can be challenging in this group because patients often have multiple dental anomalies and a reduced quantity and density of alveolar bone. Rehabilitation with early intervention and a carefully planned multidisciplinary approach has been successful in the long term.

Orthodontic treatment of a patient with cleidocranial dysplasia: A case report

Cleidocranial dysplasia (CCD) is a rare autosomal dominant condition that affects ossification. The dental abnormalities associated with CCD present an obstacle to orthodontic treatment planning. Early diagnosis is crucial to provide the patient with different treatment modalities that will suit the particular patient. In the present case, combined surgical and orthodontic treatment were performed to guide multiple impacted teeth. A single nucleotide missense variation was identified in exon 3 of runt-related transcription factor 2 (RUNX2) in this patient. The current results suggest a correlation between dental alterations and mutations in the runt domain of RUNX2 in CCD patients. Further clinical and genetic studies may required to confirm the association between phenotypes and genotypes in CCD and to identify other factors that may influence the clinical features of this disease. Patients with cleidocranial dysplasia require a team approach which demands good communication and cooperation from the patient. Timing of the intervention is critical, and numerous surgeries may be required. The patient in the present case report was treated by a team of practitioners, which involved several dental specialties to achieve an optimal result.

Combined surgical-orthodontic rehabilitation of cleidocranial dysplasia: 5 years follow-up

Cleidocranial dysplasia (CD) is an autosomal dominant syndrome which is characterized by several skeletal malformations such as non-closed fontanelles, skeletal abnormalities of the maxilla and mandible and absence of clavicles. Mid-facial hypoplasia and mandibular prognathism are mostly seen jaw abnormalities in CD. In this study, the combined orthodontic-surgical treatment of a patient with CD with class III malocclusion and multiple unerupted primary and deciduous teeth is presented.

Restorative treatment strategies for patients with cleidocranial dysplasia

OBJECTIVE

To develop a suitable treatment strategy for patients with cleidocranial dysplasia (CCD) who miss the optimal early treatment stage.

MATERIALS AND METHODS

This study enrolled 15 patients with CCD who had all missed the optimal treatment stage and were diagnosed with CCD through clinical examinations and genetic tests. Based on the chief complaints and requirements of the patients, three different therapeutic schedules were devised for these patients. Schedules I (periodontal and endodontic treatments) and II (periodontal, endodontic and prosthodontic treatments) were used for patients with low requirements, whereas Schedule III (multidisciplinary strategy, including periodontal, endodontic, surgical, orthodontic and prosthodontic treatments) was used for patients with high requirements.

RESULTS

Schedules I, II and III were used in five, seven and three patients, respectively. Schedule III treatments produced the best outcomes in terms of occlusion and esthetics.

CONCLUSIONS

Schedule III based on a comprehensive multidisciplinary therapy is an ideal restorative therapeutic strategy and can achieve good outcomes for patients with CCD who missed the optimal treatment stage.

Orthodontic traction in a patient with cleidocranial dysplasia: 3 years of follow-up

This case report describes the treatment and long-term follow-up care of a patient diagnosed with cleidocranial dysplasia who had multiple impacted permanent and supernumerary teeth. The aim of the treatment was to provide an adequate esthetic and functional reconstruction of the occlusion with good periodontal care. The patient was treated with a multidisciplinary therapeutic protocol including orthodontic and surgical procedures, and traction of 11 permanent teeth. The proposed objectives of good occlusion, normal function, healthy periodontium, and balanced profile were achieved, and the 3-year follow-up records showed stable results.

A case of cleidocranial dysostosis: dilemma for a prosthodontist

Cleidocranial dysostosis (CCD) is an uncommon, generalized skeletal disorder characterized by delayed ossification of the skull, aplastic or hypoplastic clavicles, and complex dental abnormalities such as retention of multiple deciduous teeth, impaction or delayed eruption of permanent teeth and presence of supernumerary teeth. This case report describes a 30-year old male patient of CCD with classical findings and the challenges faced in his prosthodontic rehabilitation. Conventional complete dentures following interim complete dentures therapy had to be given as all other treatment modalities were ruled out because of anatomic limitations. Despite the disadvantages of removable dentures the patient adapted admirably to them with significant improvement in self-esteem. Though orthodontic and surgical correction may be the treatment of choice, the need to preserve the alveolar ridge could make fabrication of removable dentures in such patients, a viable option.

Interim prosthetic phase of multidisciplinary management of cleidocranial dysplasia: "the Bronx Approach"

This case report presents treatment of two patients with the usual characteristics of Cleidocranial Dysostosis. A multidisciplinary approach using the disciplines of prosthodontics, orthodontics, and oral surgery was effected. Exfoliation of the patient's deciduous teeth and failure of permanent anterior tooth eruption led to emotional, social, and self-esteem issues in both patients. Due to the psychosocial issues confronting these two patients, esthetics was addressed prior to active intervention with orthodontics and after some surgical intervention. The use of two interim overdenture prostheses with magnetic retention is described.

Pediatric dentoalveolar surgery

Dentoalveolar surgery in children presents general dentists with unique challenges not encountered in adults. The long-term effects that treatments have on these children must always be taken into consideration. A clear understanding of the growth and development of pediatric patients is necessary to correctly identify dental abnormalities.

Molecular genetics of supernumerary tooth formation

Despite advances in the knowledge of tooth morphogenesis and differentiation, relatively little is known about the aetiology and molecular mechanisms underlying supernumerary tooth formation. A small number of supernumerary teeth may be a common developmental dental anomaly, while multiple supernumerary teeth usually have a genetic component and they are sometimes thought to represent a partial third dentition in humans. Mice, which are commonly used for studying tooth development, only exhibit one dentition, with very few mouse models exhibiting supernumerary teeth similar to those in humans. Inactivation of Apc or forced activation of Wnt/β(catenin signalling results in multiple supernumerary tooth formation in both humans and in mice, but the key genes in these pathways are not very clear. Analysis of other model systems with continuous tooth replacement or secondary tooth formation, such as fish, snake, lizard, and ferret, is providing insights into the molecular and cellular mechanisms underlying succesional tooth development, and will assist in the studies on supernumerary tooth formation in humans. This information, together with the advances in stem cell biology and tissue engineering, will pave ways for the tooth regeneration and tooth bioengineering.

Titanium screw anchorage for traction of many impacted teeth in a patient with cleidocranial dysplasia

INTRODUCTION

Cleidocranial dysplasia (CCD) is a rare inherited skeletal dysplasia, often with prolonged retention of deciduous teeth and several impacted permanent successors and supernumerary elements.

METHODS

This article demonstrates the usefulness of titanium screws for orthodontic anchorage to induce eruption of the impacted teeth in a patient with CCD. A boy, aged 10 years 11 months, had a number of impacted permanent teeth. After the supernumerary teeth were extracted and the incisors were surgically exposed, 2 titanium screws were placed in the palate without incisions or flap surgery. After implantation, a lingual arch appliance was placed, and orthodontic load began 4 weeks after surgery with an elastic chain.

RESULTS

After 4 months of traction, 3 impacted incisors had erupted into the mouth.

CONCLUSIONS

This new method for retraction of impacted teeth can reduce the patient's treatment time and psychological stress. Treatment with titanium screws for traction of impacted teeth might be a new treatment strategy for managing CCD patients.

Cleidocranial dysplasia - review with an emphasis on otological and audiological manifestations

Cleidocranial dysplasia is a rare developmental abnormality of bone that affects both the skeleton and the temporal bone. It is genetically characterized and the clinical signs and symptoms can be diverse. Aural pathologies may be the presenting symptoms of the disease. We reviewed the up to date literature on the syndrome with an emphasis on the otological and audiological manifestation.

Dental team management for a patient with cleidocranial dysostosis

Cleidocranial dysostosis is a rare autosomal condition that affects ossification. The dental abnormalities associated with it present a remarkable challenge in orthodontic treatment planning. Early diagnosis is extremely important to give the patient the best treatment options. Patients with cleidocranial dysostosis require a team approach with good communication and cooperation from the patient. Timing of the intervention is critical, and many surgeries might be required. The patient in this report was treated with a team effort that involved several dental specialties to achieve an optimal result.

Early craniofacial signs of cleidocranial dysplasia

OBJECTIVES

Early diagnosis of CCD is essential for a timely introduction of the appropriate treatment approach. Since certain symptoms first fully manifest only during the pubertal growth spurt, their indicatory signs are often overlooked. The aim of this study is to describe the initial craniofacial findings in patients with CCD in order to categorise their reliability for early detection.

METHOD

14 patients with CCD between the ages of 6 and 11 years who were referred to the University of Regensburg over a 4-year period were included in this study. The patients were examined clinically and radiologically and their dental status was determined. Typical signs of CCD were analysed according to such classic criteria as the 'quatermoon'-physiognomy described in the literature. The clinical findings were compared to medical data and case history.

RESULTS

Early signs were registered for each patient. While some signs could be found in all patients, others were variably expressed. The typical extraoral symptoms were only rarely exhibited in our patient population.

CONCLUSION

As various indicators of CCD are age related, their expression should be taken into account for early diagnosis. Apparent signs only manifest during the growth spurt when the ideal timeframe for beginning treatment has already past. The symptoms described should serve as early markers to aid the general and paediatric dentist in planning appropriate treatment or referring patients to specialised centres.

A natural history of cleidocranial dysplasia

Cleidocranial dysplasia (CCD) is an autosomal dominant skeletal dysplasia associated with clavicle hypoplasia and dental abnormalities. The condition is caused by mutations in the CBFA1 gene, a transcription factor that activates osteoblast differentiation. Clinical characteristics associated with CCD have previously been described in case reports and small case series. This study was undertaken to gain a more complete delineation of clinical complications associated with CCD. The study population was composed of 90 CCD individuals and 56 relative controls ascertained from genetic and dental practices in the United States, Canada, Europe, and Australia. A number of previously unrecognized complications were significantly increased including: genua valga, scoliosis, pes planus, sinus infections, upper respiratory complications, recurrent otitis media, and hearing loss. Primary Cesarean section rate was significantly increased compared to relative controls and the general population rate. Finally, dental abnormalities, including supernumerary teeth, failure of exfoliation of the primary dentition, and malocclusion, are serious and complex problems that require intervention. Clinical recommendations based on the results of this study are included.

Delayed eruption of permanent teeth in hyperimmunoglobulinemia E recurrent infection syndrome

OBJECTIVE

To determine the incidence of abnormal tooth eruption in patients with hyperimmunoglobulinemia E (hyper-IgE) syndrome.

STUDY DESIGN

This study evaluated 34 individuals with hyper-IgE syndrome (age range, 2-40 years). A comprehensive dental history and a head and neck evaluation were performed on all patients. Dental age was assessed in patients younger than 17 years by 2 methods: (1) clinical assessment of tooth eruption and (2) a radiographic method. Relationships between the chronologic age, dental developmental age, and age at tooth eruption were determined. Other oral or dental anomalies were recorded.

RESULTS

Of patients older than 7 years, 75% reported problems with permanent tooth eruption, as evidenced by retained primary teeth or the need for elective extractions of primary teeth to allow eruption of permanent teeth. None of the patients experienced problems with eruption of primary teeth. Eruption of the first and second permanent molars also occurred on time. Dental maturity scores were established for 14 patients 17 years of age or younger. In each case, the difference between chronologic age and the estimated dental developmental age was less than 12 months; however, we found a significant discrepancy between the chronologic age and the mean age of tooth eruption in 80% of these patients when using a particular set of standardized values. Persistence of Hertwig's epithelial root sheath was observed on histologic examination. Chronic multifocal oral candidiasis was a consistent feature in patients with hyper-IgE recurrent infection syndrome. Other oral anomalies were also noted.

CONCLUSION

We confirmed that a disorder of tooth eruption is part of the hyper-IgE syndrome. This problem occurs because of delayed primary tooth exfoliation rather than a developmental delay in the formation of the permanent dentition. The persistence of Hertwig's epithelial root sheath is unusual and may be associated with the lack of resorption of the primary teeth. Dentists should be aware of this feature of hyper-IgE syndrome because timely intervention will allow normal eruption to occur.

Primary failure of tooth eruption: a unique case

Primary failure of tooth eruption rarely occurs. This case represents a rare clinical situation and appears to reflect a generalized disturbance in the eruptive process, inasmuch as (1) deciduous and permanent dentition are affected, (2) incisors, molars, and premolars are involved in all quadrants, (3) skeletal and craniofacial growth are within normal limits, and (4) no systemic/genetic anomalies were detected. This is the first such case reported in the literature; diagnosis and management are discussed.

Cleidocranial dysplasia: Part 1--General principles of the orthodontic and surgical treatment modality

Over several decades, occasional reports of dental treatment provided by an individual practitioner to patients suffering with cleidocranial dysplasia have appeared in the literature. In the past, the main treatment was prosthetic replacement. Orthodontic treatment has only recently been considered as a serious treatment option, with success being described in several aspects of this treatment modality, in published individual case reports. Given the rarity of the condition, guidelines for the treatment of cleidocranial dysplasia are difficult to find in the literature, because few practitioners have treated enough cases to be in a position to make such recommendations. Two different approaches have been proposed in the past and are discussed here. The relative advantages of a third approach are expounded in detail.