HAC (Russian)
RSCI (Russian)
Ulrichsweb (Ulrich’s Periodicals Directory)
Scientific Indexing Services

Orthodontic rehabilitation of a patient with chronic kidney disease after transplantation

DOI: https://doi.org/10.29296/25877305-2021-10-09

N. Morozova, Candidate of Medical Sciences; A. Elovskaya; T. Timoshchenko, Candidate of Medical
Sciences; A. Potryasova; Professor A. Mamedov, MD I.M. Sechenov First Moscow State Medical University
(Sechenov University), Ministry of Health of Russia

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.

chronic kidney disease
renal transplantation
dental rehabilitation
bone demineralization
temporomandibular joint dysfunction
distal occlusion

  1. 1. Tamimi D., Hatcher D. Specialty imaging. Temporomandibular joint. Elsevier, 2016; p. 800.
  2. 2. Hernandez C. Oral disorders in patients with chronic renal failure. Narrative review. J Oral Res. 2016; 5 (1): 27–34. DOI:10.17126/joralres.2016.006
  3. 3. Ketteler M., Elder G., Evenepoel P. et al. Revisiting KDIGO clinical practice guideline on chronic kidney disease-mineral and bone disorder: a commentary from a Kidney Disease: Improving Global Outcomes controversies conference. Kidney Int. 2015; 87 (3): 502–28. DOI: 10.1038/ki.2014.425
  4. 4. Gupta M., Gupta M., Abhishek. Oral conditions in renal disorders and treatment considerations – A review for pediatric dentist. Saudi Dent J. 2015; 27 (30): 113–9. DOI: 10.1016/j.sdentj.2014.11.014
  5. 5. Cazzolla A., Zhurakivska K., Ciavarella D. et al. Primary hyperoxaluria: Orthodontic management in a pediatric patient: A case report. Spec Care Dentist. 2018; 38 (4): 259–65. DOI: 10.1111/scd.12302
  6. 6. Dick R., Jones N. Temporo-mandibular joint changes in patients undergoing chronic haemodialysis. Clin Radiol. 1973; 24 (1): 72–6. DOI: 10.1016/s0009-9260(73)80120-5