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RODisarelativelyrare,nonhereditary,localizeddevelopmental

anomalyofthedentalhardtissuesofagroupofcontiguousteeth.It
occursinbothdeciduousandpermanentdentitions,buthasamarked
preferenceforthemaxilla.7Theetiologyremainsunknown,although
severalcausativefactorshavebeenproposed.1Bothcasesdescribed
herecannotberelatedtoanyoftheetiologicalfactorspreviously
described.Hence,anidiopathicoriginissuggested.Diagnosiswas
basedontheclinicalandradiographicfindingscharacteristicofROD.
Inbothcases,onlyonequadrantinthemaxillawasaffected.Incase
1,however,aslightdegreeofRODwasfoundinthetoothnexttothe
affectedquad
Figure11.Clinicalviewshowingabsenceofinfectionintheupperleftquadrantinspite
ofthecoronaldestructionofIandJ.

rant,ashasbeenpreviouslyreported.9,10

RODtreatmentremainssomewhatcontroversial.3,10,14Thesecases
requireacontinuousandmultidisciplinaryapproach.16,23Inachildwith
ROD,conservativetreatmentshouldbeappliedtopreservethe
affectedteethforaslongaspossibletoprovidenormaljaw
development.3,7,24Severalreports7,21,24statethatifabscessedteethare
present,theyshouldbeextractedandedentulousareasshouldbe
restoredwithacrylicremovableappliancesto:
1.maintainaestheticandmasticatoryfunctions;
2.avoidovereruptionofopposingteeth;3.achievespacepreservationand
normalverticaldimension;
Figure12.Affectionofthemaxillaryleftpermanentfirstmolarisconfirmed
radiographically.
PediatricDentistry27:1,2005RegionalodontodysplasiaCahuanaetal.37

4.lessenthepsychologicaleffectsofprematuretoothloss.

Theconservativeapproachappliedincase2(oralhygieneinstructions
andantibiotictherapyforaweek),however,allowedthepreservation
oftheaffectedprimaryteethfor4yearswithoutinfectionrecurrence
andpain.
Otherreportshaveemphasizedtheuseoftheremovablepartial
dentureaspartoftheRODtreatment.2,8,11,13,25Astheboneitselfisnot
affectedbyROD,autotransplantationoffersagoodalternativeif
suitabledonorteethareavailable.21Autotransplantationisanaccepted
therapeuticoptionindentistry26,27andhasbeensuccessfullyusedtotreat
ROD.21Despitetheincreasinguseofosseointegratedimplantsin
patientswithmissingteeth,theiruseiscontraindicatedingrowing
patients.28Implantsareprefer
ablyplacedafterpubertalgrowth.10Theautotransplantationwascon
sideredincase1duetothedentoalveolardiscrepancyinthe3

unaffectedquadrants.Theposteriorsitewaspreferredfor
autotransplantationbecause,atthatmoment,thepermanentincisor
hadabetterprognosisforeruption.
Theposteriorsiteallowedtheextractedpremolarstobeplacedina
naturalalveolarbedcorrespondingtotheaffectedteethimmediately
aftertheirextraction,withoutremovingaconsiderableamountofbone.
Moreover,thisprocedurepreservedtheposteriorboneheightand
avoidedthelossofverticaldimension.
Ariskofankylosisinautotransplantedteethhasbeenpreviously
reported26,27andisdiagnosedduringthefirstyearbyradiographic
appearance(lossof
laminadura)andahighmetallicpercussivesound.28Duringthe5
yearfollowupperiodofcase1,therewasnoevidenceofankylosisin
theautotransplantedpremolars(Figures5and6).Nevertheless,
prosthetictreatmentwithimplantswillbeconsideredoncethepatients
craniofacialdevelopmentiscompleted.

Conclusions
ThetreatmentplanforRODshouldbebasedonthedegreeofROD,
characteristicsofunaffectedareas,andtheaestheticandfunctional
needsofeachcase.Individualmanagementisrequireduntilthe
patientreachestheageforprostheticrehabilitation.(Thetherapeutic
considerationsincasesofRODareillustratedinTable1.)