Endodontic management in a patient with vitamin D-resistant Rickets

Hypophosphatemic vitamin D-resistant rickets (VDRRs) is a metabolic bone disease caused by abnormalities in the vitamin D receptive system or in phosphate and calcium metabolism. This condition occurs in growing skeleton affecting bone and dentin mineralization, resulting in systemic and oral manifestations.

A 15-year-old boy was referred to the private clinic for endodontic treatment in #9. His medical history revealed VDRR disease. The dental findings were multiple periapical lesions in several teeth without obvious reason such as caries or trauma. The radiographic examination showed short roots, enlarged pulp chambers with longer pulp horns, thin dentin and enamel, missing or poorly defined lamina dura, and abnormalities in the cementoenamel junction, all pathognomonic features of the disorder. Conservative endodontic treatment was completed in all teeth with pulp necrosis and rarefactions.

A 6-month, 1-year, and 2-year follow-up radiographic examination revealed progressive improvement with bone reconstruction without any clinical symptoms.

Early diagnosis, conventional treatment, and continuous radiographic examination are important factors in improving dental alterations in patients with VDRRs.