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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Comprehensive management of malocclusion in maxillary fibrous dysplasia: A case report
Harneet Kaur, Sujata Mohanty, Gulsheen Kaur Kochhar, Shahid Iqbal, Anjali Verma, Ritasha Bhasin, Anuraj Singh Kochhar
Harneet Kaur, Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dentistry, Jamia Millia Islamia, Delhi 110025, Delhi, India
Sujata Mohanty, Anjali Verma, Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, Delhi 110002, Delhi, India
Gulsheen Kaur Kochhar, Department of Pediatric and Preventive Dentistry, National Dental College and Hospital, Derabassi 140507, Punjab, India
Shahid Iqbal, Faculty of Dentistry, Jamia Millia Islamia, Delhi 110025, Delhi, India
Ritasha Bhasin, Faculty of Dentistry, University of Toronto, Toronto M5G1G6, Ontario, Canada
Anuraj Singh Kochhar, Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dentistry, University of Toronto, Toronto M5G0C1, Ontario, Canada
Author contributions: Kaur H and Mohanty S contributed equally to this work; Kaur H, Kochhar GK and Iqbal S were involved in the writing of the manuscript; Kaur H and Verma A were involved in providing photographs and case followups; Bhasin R and Kochhar AS in proofreading and copyediting; all authors have read and approve the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors deny any conflict of interest related to this study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Anuraj Singh Kochhar, MDS, DSATP Resident, Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dentistry, University of Toronto, 124 Edward st, Toronto M5G0C1, Ontario, Canada. anuraj_kochhar@yahoo.co.in
Received: April 6, 2021
Peer-review started: April 6, 2021
First decision: July 6, 2021
Revised: July 14, 2021
Accepted: October 20, 2021
Article in press: October 20, 2021
Published online: December 6, 2021
BACKGROUND
Fibrous dysplasia (FD) is a developmental hamartomatous bone disease characterized by a blend of fibrous and osseous entities. Though rarely malignant, the tumor can vary from being small and asymptomatic, to a fairly large sized lesion, progressing gradually, compromising occlusion and facial esthetics. Treatment approach depends on the stage of skeletal maturity. It primarily involves surgical management for stabilizing the disease process. Post-surgical comprehensive dental treatment is necessary for restoring form and function of the jaws and teeth. This article describes comprehensive orthodontic management of severe malocclusion in a surgically operated case of FD maxilla.
CASE SUMMARY
A 19-year female presented with a chief complaint of excessive gingival display when smiling. Dental history included swelling of gums around the upper right front teeth, diagnosed at the age of 15 as FD of the right anterior maxillary segment and treated with surgical recontouring of the dysplastic bone. The clinical and radiological examinations showed adequate post-surgical healing. The surgically treated dysplastic area presented with right canting of the maxillary anterior occlusal plane. The maxillary teeth were torqued palatally, with the root of the right maxillary canine exposed clinically. We discuss sequential management of the associated malocclusion with comprehensive fixed orthodontics, along with special precautions taken to prevent reactivation of the quiescent and healed lesion.
CONCLUSION
The adequate healing of fibro-dysplastic bone post-surgery must be allowed before initiating orthodontic tooth movement in the dysplastic bone. Periodic follow-ups are needed to monitor stability of occlusion and any relapse of the lesion.
Core Tip: This article discusses comprehensive management of severe malocclusion in a surgically treated case of maxillary fibrous dysplasia. Adequate healing of the fibro-dysplastic bone post-surgery must be allowed before initiating orthodontic tooth movement. Orthodontic treatment in such patients should mainly focus on improving function and esthetics. Special precautions must be taken to prevent reactivation/relapse of the quiescent/healed lesion, including sequential orthodontic tooth movement, lighter forces, and avoidance of direct orthodontic forces to the latent bone. Periodic follow-ups are necessary to monitor long-term stability of occlusion and any progression of the lesion.
