A Simultaneous Mobilization of Four Impacted Upper Incisors in a Case of an Adolescent Patient with Cleidocranial Dysplasia (CCD)

Abstract

Introduction: Cleidocranial dysplasia (CCD) is often attended by a considerable number of supernumerary teeth combined with impaction of sometimes all permanent teeth. To help these patients obtain an esthetically pleasing and functional dentition, eruption of an appropriate number of permanent teeth should ideally be brought about, while all other teeth should be removed. The simultaneous traction of several neighboring teeth into the same direction is associated with biomechanical challenges. This report illustrates how these difficulties were solved in a specific treatment case. Findings and diagnosis: A 9-year-old boy presented with delayed tooth eruption. Major concern of the patient was the edentulous maxillary anterior segment. Clinical manifestation was confined to all deciduous canines and molars in both jaws and to the permanent mandibular central incisors. Radiographic examination revealed the impaction of all remaining permanent teeth as well as 20 supernumerary teeth and four third-molar buds. Cephalometric analysis revealed a tendency for skeletal class III in conjunction with a horizontal growth pattern. Treatment progress and outcomes: Utilizing a custom-planned appliance, four completely impacted maxillary incisors could be moved to esthetically and functionally acceptable positions within 8 months. The appliance used was supported exclusively by the maxillary deciduous teeth and the palate. Thanks to biomechanical considerations, the position of the anchor teeth could be fully preserved. Conclusions: Simultaneous mobilization of multiple teeth requires a customized approach that does justice to each patient’s individual situation. Meticulous treatment planning can prevent adverse effects even without the use of skeletal anchorage methods.