18 - Pierre Robin Sequence and Onset of Dental Treatment Needs

Abstract:

Purpose: Pierre Robin sequence (PRS) is identified by the triad of glossoptosis, micrognathia, and airway obstruction; cleft palate is often a concomitant finding. Mandibular distraction osteogenesis (MDO), a surgical treatment option that can relieve upper airway obstruction and improve breathing, can impact the developing tooth buds of permanent teeth due to hardware placement. As permanent first molars (PFMs) are commonly affected, there is insight to be gained from evaluating the outcomes of these teeth after MDO. The primary aims of this retrospective chart review are to evaluate the relationship between PRS and its impact on dental treatment including: 1) age at which operative dental treatment is first indicated for PFMs, 2) type of operative treatment performed (composite restoration, pulp therapy, stainless steel crown, extraction), 3) location of treatment rendered (outpatient clinic setting, operating room (OR) under general anesthesia).

Methods: Retrospective chart review of all patients of record at Children’s Healthcare of Atlanta (Children’s) diagnosed with PRS and treated with MDO from 2014 - 2024. Only patients of the Children's Center for Cleft and Craniofacial Disorders and Children’s Department of Pediatric Dentistry and Orthodontics were included in the study. Information obtained from Epic and Dentrix and included age, type of treatment completed, location of treatment.

Results: Of 142 patients with PRS who were treated with MDO, 37% required operative treatment on mandibular PFMs. 63% of patients required only preventive or no treatment at all for mandibular PFMs. Age of first treatment varied greatly from 3.4 to 16.9 years, with a mean age of 8.7 years. There was no significant difference between male and female patients. Treatment in the OR rather than outpatient clinic setting was required 87% of the time.

Conclusion: MDO surgery impacts mandibular PFM development to the point that operative rather than preventive treatment is often necessary. Over 60% of mandibular PFMs impacted by MDO require extraction rather than restorative treatment. Operative treatment is overwhelmingly completed in the OR rather than outpatient clinic setting. The age of first operative treatment varies greatly.