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

Abstract

ObjectivesTo 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.MethodsA 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.ResultsEight 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.ConclusionSurgical 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.

Orthodontic treatment of patients with cleidocranial dysplasia Systematic review of the literature

“…Zespół obojczykowo-czaszkowy (CCD, Cleidocranial Dysplasia) jest rzadką chorobą genetyczną, dziedziczoną autosomalnie dominująco, niewykazującą predylekcji do płci. Występuje jako spontaniczna mutacja z częstotliwością 1:1 000 000 u około 20-40% chorych na CCD (1). Schorzenie jest uwarunkowane mutacją genu RUNX2, który zlokalizowany jest na krótkim ramieniu chromosomu 6 (6p21).…”

“…The disease-causing gene mutation clearly affects membranous bones, which can be manifested by delayed pubic symphyses, spine curvatures (scoliosis, kyphosis), knee valgus, flat feet, hand malformations or trumpet dysfunctions, and consequently frequent middle ear infections or even hearing loss. These disorders do not affect the mental development (1,2,5,6). Cimen suggests an increased risk of temporomandibular joint disorders in patients with CCD due to morphological skeletal abnormalities (12).…”

“…Opisywana jest dysfunkcja trąbki słuchowej w konsekwencji częstych zakażeń ucha środkowego lub nawet utrata słuchu. Zaburzenia te nie mają wpływu na rozwój umysłowy (1,2,5,6). Cimen sugeruje zwiększone ryzyko występowania zaburzeń stawów skroniowo-żuchwowych u pacjentów z CCD na tle nieprawidłowości morfologicznych szkieletu (12).…”

“…Pionowy wzrost twarzy -zmniejszony z powodu hipoplazji kości wyrostka zębodołowego -jest także zaburzony (13). Według niektórych autorów III klasa szkieletowa to wynik hipoplazji szczęki i hiperplazji żuchwy (1). U pacjentów z CCD zwiększone jest również ryzyko rozwoju rozszczepu podniebienia (1), a także podniebienia gotyckiego (9).…”

A case report of cleidocranial dysplasia: A noninvasive approach

“…Spontaneous eruption of impacted teeth may be achieved by extracting the deciduous and supernumerary teeth, while removing the bone that covers the impacted teeth in early age 6,7 . Combined surgical‐orthodontic treatment has also been reported to be successful in accomplishing almost complete dentition and establishing occlusal contact 8 . The purpose of this report is to highlight the case of a 15‐year‐old female diagnosed with CCD, but who requested a less aggressive approach to manage her oral health conditions.…”