The dental variations in FD and the management of dental problems in patients with FD are poorly characterized. Due to the lack of information, the dental community is wary of treating patients with FD or MAS out of concern for potential post-procedure complications and exacerbation of the FD lesions around the teeth [63
Akintoye et al [64
] examined 32 patients with craniofacial FD that were enrolled in the SNHFD Study. Twenty-three patients had PFD/MAS and 9 had monostotic disease; this population reflected the NIH study population with more extensive disease. In this study, 41% of the patients had dental anomalies in general, and 28% of the patients had the dental anomaly within FD bone. The most common anomalies included: tooth rotation, oligodontia, displacement, enamel hypoplasia, enamel hypomineralization, taurodontism, retained deciduous teeth, and attrition (Figure ). There was no correlation between any endocrine dysfunction or renal phosphate wasting and enamel hypoplasia or hypomineralization, attrition, or any of the other tooth anomalies. However, taurodontism, a condition noted on dental radiographs characterized by enlargement of the pulp chamber in multi-rooted teeth, has been described in patients with syndromes including growth hormone excess [65
] but never in FD/MAS. Taurodontism was noted only in the FD patients that had 1 or more endocrinopathies. While taurodontism does not require special dental care, it may be an indicator of an underlying endocrinopathy associated with MAS.
Figure 8 Dental anomalies seen in patients with fibrous dysplasia of the jaw bones. In a study by Akintoye et al , 41% of the patients with FD had dental anomalies in general and 28% of the patients had the dental anomaly within FD bone. Adapted from reference (more ...)
The caries index scores were higher among FD patients (Table ). This may be attributed to the increased enamel hypoplasia and hypomineralization or the limited dental care these patients receive. There were no histological abnormalities in the extracted wisdom teeth that may explain the increased caries index scores. We recommend more frequent dental visits, every 3-4 months. Additionally, no patients reported any complications or exacerbation of their FD lesions after dental restorations, tooth extractions, orthodontic therapy, odontoma removal, maxillary cyst removal, or biopsy of the jaws. Among the 10 patients that received orthodontic therapy, the duration of treatment appeared somewhat longer than conventional cases (2-4 years in duration), the results were less than satisfactory, and there was relapse. We recommend careful monitoring of the post-orthodontic results in patients with FD. Despite the extensive disease in and around the dentition in some of the patients, the arch form was predominantly maintained without significant displacement of the teeth as compared to other benign growths.
While this may describe the natural progression of most FD, there is clearly a subset of patients that have the clinical and histologic diagnosis of FD that have rapid growth of the facial lesions, radiolucent changes on CT, and the displacement of teeth from the natural arch form. While some of these lesions have tested Gsα mutation negative, many patients in this subset have not been genetically characterized to determine if the absence of the Gsα mutation in the presence of a fibro-osseous lesion increases the risk of aggressive behavior and aberrant growth. Further studies are necessary to discern the implications of the mutation or lack of the mutation.
For patients with missing teeth, dental endosseous implants may be considered [67
]. Bone healing and integration of the implants occurs, though it may be slower and the quality of bone is consistent with grade 3 or 4 bone as the cortex is often thin or nonexistent. In a reported case of a 32-year old female with MAS, successful integration and loading of dental implants in the maxilla and mandible occurred. The maxillomandibular lesions had been quiescent for 3 years. The dental implants were at least 15 mm in length and were functional after 5 years. The literature is limited, and it is unclear whether there is an increased risk of implant failure. There is also the concern that osteomyelitis may occur in the setting of a failed implant. If implant treatment is considered, we recommend that the implant be placed once growth of the FD lesion has subsided. Additionally, we would recommend following the principles of implant placement and place the dental implants after a young patient has completed growth to avoid submerged implants and revision of the prosthesis [68