Orthodontic rehabilitation of a patient with chronic kidney disease after transplantation

Patients with end-stage chronic kidney disease (CKD), who have undergone transplantation for various diseases associated with impaired homeostatic kidney function, represent a complex cohort of patients to treat and require interdisciplinary management during recovery. Orthodontic rehabilitation of this group of patients has a number of features that are based on changes in calcium/phosphorus and bone metabolisms due to kidney transplantation and lifelong immunosuppressive therapy. Changes in the maxillofacial region (MFR) may be one of the first manifestations of impaired bone mineral metabolism. These MFR lesions include the following structural and morphological changes: micrognathia; malocclusion; changes in the temporomandibular joint structures; premature bone loss that can lead to gomphosis, abnormal trabeculation, and bone demineralization as a consequence, to periapical tissue resorption. These patients are observed to have a predominance of bone-destroying osteoclasts over bone-forming osteoblasts, which increases the period of bone remodeling. When treating patients with end-stage CKD, dentists should take into account these features. The paper describes a clinical case that demonstrates the importance of early diagnosis of CKD and associated complications occurring in MFR. Early diagnosis can improve the chances of a successful dental rehabilitation.