A case of cleidocranial dysostosis: dilemma for a prosthodontist

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.

Morphometric study of the two fused primary ossification centers of the clavicle in the human fetus

Purposes

A satisfactory understanding of the clavicle development may be contributing to both the diagnosis of its congenital defects and prevention of perinatal damage to the shoulder girdle. This study was carried out to examine the transverse and sagittal diameters, cross-sectional area and volume of the two fused primary ossification centers of the clavicle.

Methods

Using the methods of CT, digital-image analysis and statistics, the size for two fused primary ossification centers of the clavicle in 42 spontaneously aborted human fetuses at ages of 18–30 weeks was studied.

Results

Without any male–female and right-left significant differences, the best fit growth models for two fused primary ossification centers of the clavicle were as follows: y = −31.373 + 15.243 × ln(age) ± 1.424 (R² = 0.74) for transverse diameter, y = −7.945 + 3.225 × ln(age) ± 0.262 (R² = 0.78), y = −4.503 + 2.007 × ln(age) ± 0.218 (R² = 0.68), and y = −4.860 + 2.117 × ln(age) ± 0.200 (R² = 0.73) for sagittal diameters of the lateral, middle and medial ends respectively, y = −31.390 + 2.432 × age ± 4.599 (R² = 0.78) for cross-sectional area, and y = 28.161 + 0.00017 × (age)⁴ ± 15.357 (R² = 0.83) for volume.

Conclusions

With no sex and laterality differences, the fused primary ossification centers of the clavicle grow logarithmically in both transverse and sagittal diameters, linearly in cross-sectional area, and fourth-degree polynomially in volume. Our normative quantitative findings may be conducive in monitoring normal fetal growth and screening for inherited faults and anomalies of the clavicle in European human fetuses.

Histological examination and clinical evaluation of the jawbone of an adult patient with cleidocranial dysplasia: a case report

OBJECTIVES

Cleidocranial dysplasia (CCD) is a rare congenital malformation syndrome, inherited autosomal-dominantly. During a course of treatment including surgical, implantological and restorative procedures, an opportunity arose to histologically examine biopsies of the maxilla and mandible of a CCD patient 47 years of age.

CASE REPORT

The aim of this case report is to present the results of the histological evaluation of the alveolar bone and the surgical pretreatment for and placement of six implants each in the maxilla and the mandible. The implants were inserted in a minimally invasive procedure using 3D template guidance. Following uneventful healing of the implants, ceramically veneered bridges were cemented on individual titanium abutments. Since the patient had not received orthodontic treatment in childhood-which would have been the treatment modality of choice-this implantological and prosthodontic approach was necessary. Biopsies were taken from the maxilla and the mandible before placing the implants. Histological evaluation showed bone with strong, coarsely interconnecting trabeculae, especially in the maxilla. Both the bone and the gingiva otherwise exhibited a normal structure without pathological features or anomalies.

CONCLUSION

The clinical parameters and histological evaluation of this one clinical case suggest that the concepts familiar from general oral implantology in terms of surgical and prosthetic procedures can be adopted for older patients with CCD.