Effect of Long-term Antiepileptic Medication on Craniofacial Growth Patterns and Orthodontic Treatment Outcomes

Epilepsy is a prevalent neurological disorder often requiring long-term pharmacological management. Antiepileptic drugs (AEDs), such as valproic acid and phenytoin, are known to influence bone metabolism and calcium homeostasis. However, the impact of these systemic medications on craniofacial skeletal development and the efficiency of orthodontic tooth movement remains underexplored.

A retrospective cohort study was conducted involving 50 adolescent patients (mean age 14.2 ± 1.5 years) treated with fixed orthodontic appliances. The sample was divided into the Study Group (n = 25), comprising patients with a history of AED use for > 3 years, and the Control Group (n = 25), consisting of matched healthy individuals. Pre-treatment lateral cephalograms were analyzed for skeletal dimensions. Treatment duration and periodontal health (Gingival Index) were recorded.

The Study Group exhibited a significantly steeper mandibular plane angle (SN-GoGn) of 36.4° ±4.2° compared to 31.2° ±3.5° in controls (P < 0.01) and reduced effective mandibular length (Co-Gn: 108.5 ± 5.1 mm vs. 114.2 ± 4.8 mm; P < 0.05). Orthodontic treatment duration was significantly prolonged in the AED group (26.4 ± 3.8 months) compared to controls (21.1 ± 2.4 months; P < 0.001).

Long-term administration of antiepileptic medication is associated with a hyperdivergent growth pattern and reduced mandibular dimensions. Furthermore, these patients require significantly longer orthodontic treatment time, potentially due to altered bone remodeling dynamics and periodontal complications.