X-linked hypohidrotic ectodermal dysplasia--an unusual prosthetic problem

Prosthetic rehabilitation of patients with hypohidrotic ectodermal dysplasia: A systematic review

Hypohidrotic ectodermal dysplasia (HED) comprises a large group of inherited disorders of ectodermal structures, characterised by hypo- or anhidrosis, hypotrichosis and hypo- or oligo- or anodontia. We aimed to systematically assess the spectrum of prosthodontic approaches with regard to the patients' age and to provide clinical implications for practicing dentists. An electronic and manual search was conducted in four databases (Medline, LIVIVO, Cochrane Library, Web of Science Core Collection). Publications of multiple study designs written in English or German without data restrictions, reporting on prosthodontic treatment of patients diagnosed with HED and afflicted with oligo- or anodontia, were included. In total, 75 articles on 146 patients were analysed according to the patients' age. In children aged 2-17 years, removable full or partial (over)dentures represented standard treatment. In the mandible, implant-supported removable dentures on two interforaminal implants presented an alternative, already in young childhood. In cases with more than six teeth per jaw, also fixed (resin) bridges were used, frequently after orthodontic treatment. In adults, fixed or removable reconstructions with the help of up to eight implants per jaw, usually placed after bone augmentation procedures, were standard. Ten case reports/series with long-term follow-up illustrated the need for consistent maintenance including denture renewals. Prosthodontic rehabilitation should start in early childhood and needs to be revised in accordance with the patients' growth. Treatment should be carried out by a multidisciplinary team addressing variable demands in different age groups.

Oral rehabilitation of a patient with ectodermal dysplasia: A multidisciplinary approach

Dental abnormalities associated with ectodermal dysplasia (ED) cause severe functional, esthetic and psychological problems. This case report describes treatment of a patient with hypohidrotic (Christ-Siemens -Touraine syndrome) ED. Patient was rehabilitated with the use of endosseous implants in mandible following an orthodontic treatment to bring the impacted maxillary canine in the arch. This procedure aided in the preservation of the surrounding bone and retention of the prosthesis. A tooth supported fixed partial denture (FPD) was fabricated for the maxillary arch and three separate (two all-tooth and one all-implant supported) FPDs were fabricated for the mandibular arch. Fixed prostheses boosted the self-esteem of this patient.

A Preliminary Study to Analyze the Cranio-facial Growth of an Ectodermal Dysplasia Patient After Prosthetic Rehabilitation

An experimental study on craniofacial development and jaw growth pattern of an ectodermal dysplasia patient was performed and was compared with normal individual. An ectodermal dysplasia patient with complete anodontia was prosthetically rehabilitated with complete dentures at age of 6 and 8 years. Two sets of complete dentures were made with age-appropriate denture teeth and a lingualized occlusal scheme. Periodic follow up and adjustment whether needed was done to maintain proper oral function and aesthetics. Serial cephalometric analysis exhibited a marked restriction of forward growth at the ANS point during 6-8 years of age although there was a little change from average in the anteroposterior length of mandibular body and the height of mandibular ramus. So, the maxillary growth was reduced but there was no significant change in the mandibular growth. Cast analysis showed that increase in arch length was greater than in arch width for both maxilla and mandible. There was a little increase in alveolar ridge height in the anterior region but there was a considerable increase in the height of the alveolar ridge in the middle and the posterior region. Our findings concluded that the absence of teeth did not affect the growth of the jaws and probably the denture flange did not arrest the jaw growth, rather it improved the masticatory function by providing good denture stability and retention.

Effect of complete dentures on craniofacial growth of an ectodermal dysplasia patient: a clinical report

The aim of this clinical report was to observe the effect of complete dentures on craniofacial growth and development of an ectodermal dysplasia (ED) patient. A complete anodontia patient diagnosed with ED was successfully rehabilitated with conventional complete dentures at the ages of 5, 8, and 10 years. Three sets of complete dentures were made with age-appropriate denture teeth and a bilaterally balanced lingualized occlusal scheme. Periodic follow-up and adjustment when needed was done to maintain proper oral function and esthetics. Serial cephalometric analysis exhibited a marked restriction of forward growth at the anterior nasal spine (ANS) point between 5 and 10 years of age, although there was little change from average in the anteroposterior length of the mandibular body and the height of the mandibular ramus. So, while maxillary growth was reduced, mandibular growth did not significantly change. Cast analysis showed that the increase in arch length was greater than in arch width for both the maxilla and mandible. There was little increase in alveolar ridge height in the anterior region but a considerable increase in the height of the alveolar ridge in the middle and the posterior region. Our findings concluded that the absence of teeth did not affect the growth of the jaws, and it is probable that the denture flange did not arrest the jaw growth, but rather improved the masticatory function by providing good denture stability and retention.

Camouflaging changes in the appearance of a patient with ectodermal dysplasia

This clinical report describes an innovative method to ease the transition of a patient from old implant-retained prostheses to enhanced prostheses that altered the vertical dimension, esthetics, smile, and overall facial appearance. This procedure was accomplished by a customized labial bow, such as the one commonly used for a removable Hawley-type retainer, adjusted to follow the contour of teeth waxed into a denture. This option was adopted because it is reversible, nondamaging to the denture teeth, yet still camouflages the appearance of the maxillary denture and changes in facial contour during the early transition stage from the old to the new prostheses.

Simultaneous functional and fixed appliance therapy for growth modification and dental alignment prior to prosthetic habilitation in hypohidrotic ectodermal dysplasia: A clinical report

This clinical report describes the simultaneous use of functional and fixed appliances to modify the pattern of dentofacial development and align teeth in preparation for prosthodontic habilitation of a growing child with hypohidrotic ectodermal dysplasia. The treatment objective was to create a more favorable starting point for the prosthodontic phase of habilitation by improving the sagittal and vertical skeletal relationships and facial esthetics. This was accomplished through growth modification with functional appliances conducted simultaneously with eruption of maxillary and mandibular molars, dental arch expansion, alignment, and space management using fixed orthodontic appliances. Orthodontic retention was accomplished by means of removable partial dentures. A second phase of orthodontics conducted closer to the age of skeletal maturation will aim at definitive tooth alignment in preparation for dental implant-supported restorations.

Use of an individual traction prosthesis and distraction osteogenesis to reposition osseointegrated implants in a juvenile with ectodermal dysplasia: a clinical report

This article describes the use of distraction osteogenesis to reposition osseointegrated maxillary implants in an adolescent girl with ectodermal dysplasia and oligodontia. The distraction of 2 osteotomized segments was controlled by a prosthesis fabricated specifically for this purpose.

Pure ectodermal dysplasia: retrospective study of 16 cases and literature review

OBJECTIVE

To review the possible craniomaxillofacial deformative consequences associated with ectodermal dysplasias and embryonic malformations, which include dental ageneses.

SETTING

Oral and Maxillofacial Surgery Department, University Hospital, Lille, France.

PATIENTS

Sixteen patients (seven boys and nine girls, aged 4 to 34 years) with pure ectodermal dysplasia (no ectodermal dysplasia syndromes).

INTERVENTIONS

All patients had a clinical examination. Seven (two boys and five girls, aged 4 to 25 years) had undergone plaster casts and radiographic and Delaire's cephalometric studies before being treated.

MAIN OUTCOME MEASURES

All patients had tooth ageneses (from hypodontia to anodontia), associated with cutaneous dyshidrosis and hair and nail dystrophy. Most of them had a short face, with an unusual facial concavity, a maxillary retrusion, and a relative mandibular protrusion. MANAGEMENT RESULTS AND DISCUSSION: Depending on their ages and their orthopedic abnormalities, patients underwent either dental or prosthodontic, orthodontic, orthopedic, orthognathic, or implant treatment. So as not to interfere with the growth pattern, we preferred to reserve implant and orthognathic surgery for full-grown cases.

CONCLUSIONS

Oral and maxillofacial surgeons must undertake a comprehensive approach to these patients to improve their dental, masticatory, growing, and orthognathic conditions.

Placement of endosseous implants in children and adolescents with hereditary ectodermal dysplasia

OBJECTIVE

The purposes of this investigation were to study the feasibility of placing endosseous implants in children and adolescents with ectodermal dysplasia and to assess the position and stability of such implants during growth. This article reports on 6 subjects with long-term follow-up. Study design. A prospective study was commenced in 1991. Patients with hereditary ectodermal dysplasia who were over the age of 5 years and who presented to the University of California San Francisco Ectodermal Dysplasia Clinic for dental treatment were included and maintained in the study. In each case, clinical and radiographic records were obtained before treatment, immediately after implant placement, at delivery of the prosthesis, and subsequently at yearly intervals. Six subjects are reported, 4 as members of the prospective study group and 2 who had been treated before the study began.

RESULTS

A total of 41 implants (19 maxillary, 22 mandibular) were placed. The average follow-up after implant placement was 7.8 years (range, 6-11 years), and the average time since restoration was 6 years (range, 5-10 years). Forty implants successfully integrated and have been restored. There was no evidence that implant placement or prosthetic rehabilitation resulted in restriction of transverse or sagittal growth. One mandibular implant, placed in a partially dentate 5-year-old, became submerged because of adjacent alveolar development and required placement of a longer abutment. Four maxillary implants placed in a partially dentate 7-year-old also became submerged and required prosthetic revision and the placement of longer abutments.

CONCLUSIONS

This preliminary report suggests that endosseous implants can be successfully placed and can provide support for prosthetic restoration in patients with hereditary ectodermal dysplasia. However, vertical dentoalveolar growth results in submergence of the implant relative to the adjacent natural dentition when implants are placed adjacent to erupting permanent teeth.

Prosthodontic management of ectodermal dysplasia: a review of the literature

Ectodermal dysplasia is commonly a difficult condition to manage with prosthodontics because of the typical oral deficiencies and because the afflicted individuals are quite young when they are evaluated for treatment. It is important that these individuals receive dental treatment at an early age for physiologic and psychosocial reasons. This article reviews the literature that pertains to the prosthodontic treatment of the disorder and the review includes considerations in behavior management and timing of treatment.

Longitudinal study of jaw growth and prosthetic management in a patient with ectodermal dysplasia and anodontia

A patient with hypohidrotic ectodermal dysplasia and anodontia was studied clinically and cephalometrically from 6 to 18 years of age. This case is exceptional in that the patient was a young girl. Five sets of complete dentures were fitted during this period. Periodic recall examination and adjustment maintained good oral function and aesthetics. Serial cephalometric analysis of craniofacial development revealed that growth of the maxilla was slightly reduced, but there was no detectable effect in the mandible. Three-dimensional analysis of the alveolar ridge form from serial casts showed that increase of the anteroposterior arch dimension was larger than that of the lateral arch dimension in both jaws. There was a lateral expansion in the anterior and premolar regions and a considerable height increase in the posterior tooth region of the upper alveolar ridge. Our findings support those of Sarnart et al. (1953) in showing that lack of teeth did not affect growth of the jaws.

Prosthetic management of hypohydrotic ectodermal dysplasia with anodontia. Case report

The patient in this report is a young boy with hypohydrotic ectodermal dysplasia. His case is exceptional in that anodontia was complete in both deciduous and permanent dentitions. A brief review of this condition is presented along with the prosthetic management of the case which emphasizes the need for regular modification and replacement of dentures worn by growing child.