Evaluating dental developmental abnormalities in osteogenesis imperfecta: associations with timing and cumulative...

Bisphosphonates are widely used in pediatric Osteogenesis Imperfecta (OI), but their potential impact on odontogenesis is not well characterized. We examined whether intravenous pamidronate exposure is associated with specific developmental dental abnormalities in OI, with particular attention to treatment timing, duration, cumulative exposure, and gender.

Fifty-eight individuals with OI (38 treated and 20 untreated) underwent standardized clinical examination and panoramic radiography. Outcomes included enamel hypoplasia, dentinogenesis imperfecta (DI), dens evaginatus (DE), microdontia, hypodontia, taurodontism, bulbous crowns, pulpal obliteration, short roots, root dilaceration, and tooth fractures. Treated individuals were further stratified by whether treatment began before or after age two years. Associations with treatment duration and cycle count were also evaluated.

Enamel hypoplasia occurred only in treated participants (p = 0.005). Initiation of therapy before age two years was associated with a higher prevalence of enamel hypoplasia (p = 0.036). Enamel hypoplasia showed a significant association with treatment in females (p = 0.034). Root dilaceration was the only abnormality associated with cycle count (p = 0.008). Longer treatment duration was associated with DE (p = 0.021), microdontia (p = 0.026), and pulpal obliteration (p = 0.002).

In this exploratory pilot cohort, enamel hypoplasia showed the clearest association with pamidronate exposure, particularly when treatment began before age two years. Root dilaceration demonstrated a cumulative-exposure pattern. Other abnormalities appeared more strongly related to underlying disease severity than treatment variables.

These findings underscore the importance of structured dental surveillance in children receiving pamidronates during early developmental windows.