Cleidocranial dysplasia. Case report

Cleidocranial Dysplasia in a 10-year-old Child: A Case Report

Cleidocranial dysplasia is a rare congenital anomaly characterized by multiple skeletal defects of which partial or complete absence of clavicles, delayed closure of fontanels with presence of open sutures and multiple wornian bones forms a striking feature. The oral manifestations are delayed exfoliation, delayed or failing eruption of the permanent dentition with multiple supernumerary teeth, protruding mandible and mid face retrusion. It is also known as Marie and Sainton's disease, mutational dystosis or cleidocranial dysostosis. A 10-year-old female patient reported to the Department of Pedodontics and Preventive Dentistry, Sathyabama University, Dental College and General Hospital, Chennai, Tamil Nadu with the chief complaint of unerupted permanent teeth. Radiological investigations confirmed the diagnosis of cleido cranial dysplasia and various treatment options are discussed in this article.

Cleidocranial dysplasia: A report of two cases with brief review

Cleidocranial dysplasia (CCD) is a genetic disorder primarily causing dysplasia of bones and teeth with autosomal dominant inheritance pattern. Affected individuals presented with several skeletal and dental abnormalities mainly hypoplasia of clavicles, open fontanelles, short stature, retention of primary teeth, supernumerary teeth, delayed eruption of permanent teeth, multiple impacted permanent teeth etc. The present series of two cases illustrates the clinical and radiological features of pediatric patients with cleidocranial dysplasia. The early diagnosis of the condition helps in proper orientation of the treatment thereby offering better quality of life to such patients.

Genetic background of supernumerary teeth

Supernumerary teeth (ST) are odontostomatologic anomaly characterized by as the existence excessive number of teeth in relation to the normal dental formula. This condition is commonly seen with several congenital genetic disorders such as Gardner's syndrome, cleidocranial dysostosis and cleft lip and palate. Less common syndromes that are associated with ST are; Fabry Disease, Ellis-van Creveld syndrome, Nance-Horan syndrome, Rubinstein-Taybi Syndrome and Trico–Rhino–Phalangeal syndrome. ST can be an important component of a distinctive disorder and an important clue for early diagnosis. Certainly early detecting the abnormalities gives us to make correct management of the patient and also it is important for making well-informed decisions about long-term medical care and treatment. In this review, the genetic syndromes that are related with ST were discussed.

Cleidocranial dysplasia: importance of radiographic images in diagnosis of the condition

Cleidocranial dysplasia (CCD) is a rare syndrome usually caused by an autosomal dominant gene, although 40% of cases of CCD appear spontaneously with no apparent genetic cause. This condition is characterized by several cranial malformations and underdevelopment, absence of the clavicles, and multiple supernumerary and impacted permanent teeth. The diagnosis of this condition is usually based on the presence of the main features (supernumerary teeth, partial or total absence of one or both the clavicles, and bony malformations) and on clinical and familial evidence. The bony and dental features of CCD may be visualized on radiographic images of the face and skull. Here, we present a familial case of CCD and discuss the importance of dental radiographs in diagnosis of the condition.

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.

Dentomaxillofacial variability of cleidocranial dysplasia: clinicoradiological presentation and systematic review

OBJECTIVES

The aim of this study was to determine the clinical and radiological presentation of cleidocranial dysplasia (CCD) in our patient group and to compare them with other reported cases by a systematic review (SR) of the literature.

METHODS

The study comprises two elements, a complete series of all diagnosed patients at the Center for Craniofacial Genetics at the University of Regensburg, Germany, and a SR. Relevant literature was identified by electronic databases, review of citation lists and hand searching of key journals. The principal selection criterion was that the study should contain as many pertinent cases as possible. The presented signs and symptoms were assigned to the following categories: "supernumerary teeth", "failure of eruption", "hypoplastic maxilla" and "clavicular sign". Additionally, the family history was taken into account.

RESULTS

From the 410 English, German or French articles, 40 single case presentations and 17 multiple case studies remained that met the selection criteria. This report reviews the data of 283 patients with CCD including our own patient cohort of 24 individuals. Dental signs such as supernumerary teeth and eruption failure were expressed in over 93.5%. Skeletal symptoms such as hypoplastic maxilla and the clavicular sign were exhibited in over 84.3%. The prevalence of spontaneous mutations differs slightly when comparing the single case studies (72.0%) with our patient data (58.3%). The fraction of spontaneous mutations in multiple case studies was 5.0%.

CONCLUSION

The diagnosis of CCD can be difficult when typical features are not clearly expressed. Since the multiple case studies concentrated on specific clinical aspects, an overall ranking including all associated findings was not possible. Owing to their prevalence, we recommend referencing to the described list of clinical signs as major symptoms for the pathognomy in CCD, since they are infrequent in other conditions and in the general population. To categorize the expression of CCD, more interdisciplinary studies are necessary. Nevertheless, a subjective classification is possible according to the related restrictions in the patients' quality of life.