Genetic Pattern, Orthodontic and Surgical Management of Multiple Supplementary Impacted Teeth in a Rare, Cleidocranial Dysplasia Patient: A Case Report

Abstract

Background: Cleidocranial dysplasia (CCD) is a rare, autosomal dominant skeletal dysplasia with a prevalence of one per million births. The main causes of CCD are mutations in the core-binding factor alpha-1 (CBFA1) or runt-related transcription factor-2 (RUNX2), located at the 6p21 chromosomal region. RUNX2 plays important roles in osteoblast differentiation, chondrocyte proliferation and differentiation, and tooth formation. The disease is characterized by clavicular aplasia or hypoplasia, Wormian bones, delayed closure of cranial suture, brachycephalic head, maxillary deficiency, retention of primary teeth, inclusion of permanent teeth, and multiple supernumerary teeth. Materials and Methods: A 22-year-old girl suffering from cleidocranial dysplasia with short stature, narrow shoulders, craniofacial manifestations (short face, broad forehead, etc.) and dental anomalies (different lower dental elements under eruption, supernumerary and impacted multiple teeth, etc.) was examined at our service (Complex Operative Unit of Odontostomatology of Policlinico of Bari). RX Orthopantomography (OPG) and cone beam computed tomography (CBCT) were requested to better assess the position of the supernumerary teeth and their relationships with others and to evaluate the bone tissue. Results: Under eruption was probably caused by dental interferences with supernumerary teeth; hence, extractions of supernumerary upper canines and lower premolars were performed under general anaesthesia. Surgery outcome was excellent with good tissue healing and improvements in the therapeutic possibilities with future orthodontics. Conclusions: The objective of this article is to give an update about radiological, clinical, and molecular features of CCD and to alert the health team about the importance of establishing an early diagnosis and an appropriate treatment in these patients to prevent impacted teeth complications and to offer them a better quality of life.

The Efficacy of a New AMCOP® Elastodontic Protocol for Orthodontic Interceptive Treatment: A Case Series and Literature Overview

“…The purpose of the elastodontic devices as well as all the functional devices is to work and stimulate groups of muscles that influence the positions of the mandible, tongue and dental arches as a consequence, with light and biological forces [ 41 ]. The scientific literature evidences the resolution or improvement of the basal second class with augmented overjet and deep bite malocclusion since they stimulate mandibular growth and protrusion, retrusion of the upper incisors, protrusion of the lower incisors, improvement of molar relationship [ 12 , 29 , 42 , 43 ]. Such devices can be used in association with fixed orthodontic appliances in every age since it shows a reduction of treatment times and contributes to creating an ideal arch form [ 44 ].…”

“…Many studies have demonstrated the importance of the use of functional devices in growth subjects, demonstrating the importance of the interceptive phase [ 12 , 57 , 58 , 59 ]. Interceptive therapy acts on abnormal behavior of the musculature, resolving issues related to the presence of non-physiological functional spaces through the use of removable appliances [ 60 ].…”

“…Elastodontic appliances are useful for the retention phase after an active elastodontic therapy [ 12 ]. In this study patients in mixed dentition were examined, with skeletal Class II malocclusion and the active phase was estimated at twelve months.…”

“…The term elastodontics refers to a specific type of interceptive orthodontic treatment based on the use of removable elastomeric devices. These devices are characterized by an extreme simplicity in terms of use by the patient, by safety and by construction [ 12 , 13 ]. A new elastodontic approach is represented by AMCOP ® (Cranium-Occluded-Postural Multifunctional Harmonizers) Bio-activators (Micerium spa patent).…”

Impacted Central Incisors in the Upper Jaw in an Adolescent Patient: Orthodontic-Surgical Treatment—A Case Report

“…Necrosis or ankylosis of a deciduous tooth and the simultaneous presence of systemic pathologies (endocrine diseases, cleidocranial dysostosis) can also determine dental inclusions [10,11].…”