Dental anomalies in individuals with osteogenesis imperfecta: a systematic review and meta-analysis of prevalence and comparative studies

Bone disease and oromaxillofacial disorders: a cross- sectional study in a Tanzanian pediatric population

BACKGROUND

Certain bone diseases of congenital origin are associated with dental alterations and with oromaxillofacial (OMF) disorders. The objective of this study was to evaluate and compare the OMF alterations presented by patients affected by bone pathology with respect to a healthy population from the same geographical environment.

MATERIAL & METHODS

A cross-sectional study was carried out at Mount Meru Regional Referral Hospital and Kaloleni secondary school in Arusha, Tanzania. The patients with bone pathologies (n = 60) were consecutively recruited from the hospital, while the controls (n = 581) comprised a population of healthy students from the school, which was located in the same neighbourhood as the hospital. In the case group, the different bone pathologies were divided into two subgroups: (i) disorders in cellular metabolism (DCM); and (ii) disorders of bone growth/deformity (DGD). Musculoskeletal and oral clinical examinations were performed in both groups.

RESULTS

The case group presented significantly higher values of moderate and severe inflammation on the Löe & Silness Gingival Index (GI 2: 65%, GI 3: 25%) than the control group (p < 0.001), where mild inflammation predominated (GI 1: 88%). The case group also had higher scores for decayed, missing and filled teeth. Dental fluorosis was reported in 75.2% of controls and in only 26.6% of cases, the differences being clearly significant (p < 0.001). Significant differences for fluorosis were also reported between the two subgroups (p < 0.001), with a higher incidence for the DCM subgroup (43.8%). Twenty-two patients (36.7%) in the case group displayed clinical absence of teeth: the rate was significantly higher in the DGD subgroup (n = 15, 50%) than in the DCM subgroup (n = 8, 25%) (p = 0.045). In relation to the type of dental occlusion, the group with bone pathology presented a significant predominance of Angle class II - III malocclusions (p < 0.001). Craniofacial abnormalities were more frequent in the DGD subgroup, although the difference was not significant. The spine was normal in 41 patients (68.3%) and the differences between subgroups were not significant. Pathological fractures were significantly more frequent in the DGD subgroup (50% vs. 6.3%; p < 0.001). Assessing whether there was a relationship between malocclusion and skeletal deformities (spine and upper limb) in the case group, subjects with upper limb deformity (n = 16) presented significant differences for inverted overjet (p = 0.031).

CONCLUSION

Patients with bone disease had worse oral health and more severe dental malocclusion than controls. The results presented here may help to raise awareness among orthopedic and pediatric professionals of abnormalities related to OMF conditions in childhood.

Regenerative Therapy in Comprehensive Oral Rehabilitation for Pediatric Osteogenesis Imperfecta: A Case Report

Osteogenesis imperfecta (OI) is a rare genetic condition marked by brittle bones and various degrees of skeletal deformity. It is also referred to as brittle bone disease. There are four forms of OI, and its management relies on preventing fractures and increasing bone strength, which becomes more difficult when treating a juvenile patient in a dental setting. A six-year-old child with OI, type 1, with a history of recurrent multiple fractures, complained of pain in his mandibular teeth. The patient was receiving biannual bisphosphonate injections for OI. During the initial dental appointment, the patient was apprehensive and afraid, but cooperative behavior was achieved using non-pharmacological behavior management techniques. Full mouth rehabilitation was done while restoring the vitality of carious permanent teeth using regenerative endodontic therapy. The patient was then followed up on a regular basis to ensure progressive apical root closure. Regenerative endodontics uses the concept of tissue engineering to restore the root canals to a healthy state, allowing for the continued development of the root and surrounding tissue. This case report discusses the issues in managing a pediatric patient with OI as well as the benefits of regenerative endodontic treatment therapy in preserving tooth vitality.

Craniofacial disorders and dysplasias: Molecular, clinical, and management perspectives

There is a wide spectrum of craniofacial bone disorders and dysplasias because embryological development of the craniofacial region is complex. Classification of craniofacial bone disorders and dysplasias is also complex because they exhibit complex clinical, pathological, and molecular heterogeneity. Most craniofacial disorders and dysplasias are rare but they present an array of phenotypes that functionally impact the orofacial complex. Management of craniofacial disorders is a multidisciplinary approach that involves the collaborative efforts of multiple professionals. This review provides an overview of the complexity of craniofacial disorders and dysplasias from molecular, clinical, and management perspectives.