Tooth Morphology in Cleidocranial Dysplasia
In cleidocranial dysplasia, expect multiple supernumerary teeth that are impacted, smaller than adjacent permanent teeth, positioned lingually and distally to normal teeth, and morphologically resemble their adjacent permanent teeth in cusp number but with reduced size. 1
Key Morphological Features
Supernumerary Teeth Characteristics
- Supernumerary teeth are universally present and impacted in CCD patients, averaging 7.8 per patient (range 1-15 teeth), with all existing as pairs adjacent to permanent teeth 1
- Size reduction is consistent: supernumerary teeth are smaller than their adjacent permanent teeth in both crown and root dimensions, though they maintain similar cusp numbers 1
- Positional pattern: at non-molar sites, supernumerary teeth consistently position on the lingual and distal sides of adjacent permanent teeth 1
- Molar region exception: supernumerary teeth in the molar region present as microdontia with obscure, poorly defined morphology 1
Eruption Abnormalities
- Retention of multiple deciduous teeth is a hallmark feature, occurring alongside impaction or delayed eruption of permanent teeth 2, 3, 4
- Failed eruption of permanent teeth represents one of the most prevalent dental features, particularly affecting anterior permanent teeth 4, 5
- Approximately 20% of supernumerary teeth may exhibit inverse (upside-down) direction compared to normal permanent teeth, which all maintain proper orientation 1
Maxillofacial Skeletal Impact
Jaw Morphology
- Hypoplastic maxilla is a consistent finding that contributes to the overall dental presentation and requires consideration for treatment planning 4, 5
- Morphological abnormalities of both maxilla and mandible affect dental arch form and tooth positioning 4
Clinical Implications
Diagnostic Approach
- Orthopantomography after age 6 is the indicated level I radiological investigation for identifying these numerical and morphological anomalies 6
- CBCT imaging provides superior detail for evaluating the three-dimensional position, morphology, and relationships of impacted supernumerary teeth when 2D imaging is insufficient 1
Common Pitfall
The primary clinical pitfall is underestimating the extent of supernumerary teeth present, as they may be numerous and positioned in unexpected locations. Always obtain comprehensive imaging to map all impacted teeth before initiating treatment 1, 4.