A CASE OF OSTEOPETROSIS: UNUSUAL MAXILLOFACIAL PRESENTATION AND SUCCESSFUL DENTAL IMPLANT RESTORATIONS

Abstract

<h3>Clinical Presentation</h3> A patient presented with malaligned and rotated, missing, unerupted, and partially erupted/maldeveloped teeth seeking care to improve her masticatory function. She had impaired hearing and vision, but no neurologic symptoms. A panoramic radiograph, a lateral cephalometric radiograph, and a medical CT scan were reviewed. The radiographic examination revealed a skeletal Class III relationship. Sclerosis related to osteopetrosis was seen throughout the maxilla, cranial base, and cervical spine. A train track–like radiopaque formation was noted bilaterally within the mandibular inferior alveolar canals. No symptoms related to inferior alveolar nerve impairment were noted. <h3>Differential Diagnosis</h3> Multiple impacted and malformed teeth were unusual presentations, leading to the diagnosis of osteopetrosis. Other syndromes, such as cleidocranial dysostosis and Gardner syndrome, can also have similar features. <h3>Diagnosis and Management</h3> The treatment comprised a maxillary overdenture and an implant-supported mandibular prosthesis. Despite the increased risk of failed osseointegration, the implants placed in the mandible have been successful for greater than 8 years. <h3>Discussion</h3> Osteopetrosis is a disorder characterized by impaired osteoclast function, leading to hyperdense, hypovascular, brittle bone. When considering dental implant placement in a patient with osteopetrosis, one must be wary of the increased possibility of bone fracture or osteomyelitis and the decreased likelihood of successful osseointegration because of hypovascularity. This case report describes successful osseointegration of multiple dental implants supporting a fixed mandibular prosthesis with long-term survival. Therefore, implant placement should not be excluded on the basis of an osteopetrosis diagnosis alone. Rather, one should evaluate the sclerosis radiographically in relation to intended implant sites.