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of DI based on color, 70% of them had color as well as
radiographic signs of DI (early obliteration of pulp
chambers and/or canals, short roots, pulp stones and/
or taurodontism). They also had twice as many miss-
ing teeth and a higher number of endodontically (root
canal therapy) treated teeth. The relatively low percent-
age reported as having DI based upon color may be
related to 78% of the cohort having OI type I, although
the much more common radiographic findings rein-
force the variable effect of type I collagen quantitative
or qualitative abnormalities on dental development.
About 20% of the participants felt pain on palpation of
their temporomandibular joints, and masseter and tem-
poral muscles. Although their daily oral health habits
and professional care visits were good, their oral health
was not as good as comparable non-OI patients.
36
FIGURE 33.6
Retained primary teeth and underlying succedane-
ous teeth in an OI patient who received IV bisphosphonates.
Fixed Restorations (Crowns and Bridges,
or “Caps”) and Endodontic (Root Canal)
Treatment
Caps, also called crowns, are made of metal or
ceramic and cover the entire tooth after the enamel is
removed. If teeth are wearing excessively, crowns usu-
ally provide the best treatment. As previously men-
tioned, preformed stainless steel crowns are typically
used for baby teeth, while cast metal or ceramic crowns
are used for adult teeth. If there is not enough tooth left
above the gum to place a crown, the individual may
need gum surgery to make the part of the tooth show-
ing above the gum larger. The surgeon may place a post
down into the root of the tooth to act as a reinforcing
rod, and then rebuild part of the tooth above the gum
for the crown to sit on. In teeth not affected with DI, root
canal treatment may be needed if the nerves and blood
vessels inside the tooth are infected from a cavity or if
the post needs to go down the center of the root(s).
13
In teeth with DI, the inside where the nerves and blood
vessels are normally located may already be filled with
more of the inside of the tooth called dentin. This makes
root canal therapy and placing a post in the center of the
root and/or root canal treatment difficult if not impos-
sible. In cases of OI with DI, it is recommended that a
specialist in root canal treatments (an endodontist) be con-
sulted if possible. Small reinforcing pins may be placed
in the dentin away from the center of the root to help
make the new crown of the tooth stronger. A bridge is at
least one artificial tooth attached to one or more crowns.
A bridge is sometimes called a fixed partial denture.
13
FIGURE 33.7
Lateral cephalometric radiograph and tracing of an
OI type III patient presenting with severe lateral open-bite and retru-
sive maxilla.
another report of no osteonecrosis being reported in 64
OI patients (22 of whom had dental surgery) who had
or were on intravenous bisphosphonates
34
and a case
report.
35
The experience of the doctors at the Montreal
Children's Hospital continues to support their conclu-
sions that a person receiving bisphosphonate treatment
who needs dental/oral surgery, orthodontic interven-
tion or other dental treatment cannot be deprived
of such treatment solely on the grounds of potential
complications.
While it cannot be concluded from this report or
their subsequent experience that dental extractions
done on patients with OI are risk free, and that further
studies are necessary to analyze the dosage and other
factors required to recommend appropriate treatment,
the risk in this population seems to be very low.
CONCERNS ABOUT DENTAL CARE IN
ADULTS
Complete and Removable Partial Dentures
Complete dentures are used when there are no teeth
remaining in one or both jaws. How well the den-
ture its depends on how much bone remains after the
A report on the oral findings in a group of 94 adults
with OI found in addition to 19% having clinical signs
