A Multidisciplinary Approach for Full-Mouth Rehabilitation in Oligodontia: A Clinical Report.

The absence of teeth in children due to congenital agenesis, syndromic or not, could lead to oral dysfunctions with general repercussions and sociopsychological problems. This case was a 17-year-old girl with severe nonsyndromic oligodontia who was missing 18 permanent teeth and had a class III skeletal pattern. It was challenging to provide functional and esthetically pleasing results in terms of temporary rehabilitation during growth and long-term rehabilitation in adulthood. This case report described the originality of the realization steps of oligodontia management, in 2 main parts. The osseous time by the LeFort 1 osteotomy advancement with simultaneous parietal and xenogenic bone grafting to improve a large bimaxillary bone volume, allowing future early implant placement by absence of growth of adjacent alveolar processes. The prosthetic rehabilitation with the conservation of natural teeth for proprioception and the use of a screw-retained polymethyl-methacrylate immediate prostheses to evaluate the needed vertical dimensional changes and make functional and esthetic results more predictable. This article could be retained as a technical note to manage this kind of case with the intellectual workflow and the difficulties encountered.

Recording jaw relation of a pediatric patient with ectodermal dysplasia and complete anodontia using a digital mini arch tracer: A case report.

Children with ectodermal dysplasia and complete anodontia experience difficulties in oral rehabilitation because of the small arch size. A case of a 7-year-old boy, whose arch size (length and width) was 30-40% smaller than that of a male adult and who presented with difficulties in jaw relation recording using commercially available devices is described. A digital workflow involving a mini arch tracer was introduced. Primary impressions were made using three-dimensionally (3D) printed mini trays produced based on the patient's computed tomography images, and digital primary casts were obtained based on the scanned and reversed primary impressions. The final custom impression trays with mini tracing plates were designed based on the primary casts. In addition, the hand shank, retention plate, and retainers were placed on the designed custom trays and 3D-printed to produce an individual arch tracer system. In addition, two height-checking buckles were designed to help adjust the height of a tracing screw. Finally, the jaw relation of the patient was recorded and transferred, and a set of complete dentures were delivered, satisfying both the patient and his family.

Prosthetic rehabilitation of a child with X-linked hypohidrotic ectodermal dysplasia: a case report and 12-month follow-up.

The hereditary condition known as ectodermal dysplasia (ED) is characterized by the absence of or a defect in 2 or more ectodermally derived structures such as skin, nails, hair, sweat glands, or teeth. Patients with this disorder usually present with reduced salivary gland function and absence of some or all teeth, which compromises orofacial function and development. In addition, children with ED usually experience difficulty in social interactions because of their appearance. This article reviews previously published case reports pertaining to ED and describes oral rehabilitation with removable partial dentures (RPDs) in a 5-year-old girl diagnosed with X-linked hypohidrotic ED, which presented as hypodontia. An orthodontic expander screw was inserted in the maxillary prosthesis to correct the patient's crossbite, and periodic recall examinations were scheduled to monitor the effects of the patient's growth on occlusion and fit of the prosthesis. The child was monitored for 12 months, during which she exhibited significant improvement in physiologic function, appearance, and social behavior. Because negative esthetic, functional, and psychological consequences are associated with this condition, dentists must be knowledgeable about its common oral manifestations.

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 Treated With Fresh-Frozen Bone Allografts and Computer-Guided Implant Placement: A Clinical Case Report.

Ectodermal dysplasia (ED) is an inherited disorder characterized by abnormality of ectodermally derived structures. A recurrent oral finding is oligodontia, which in turn leads to a severely hypotrophic alveolar process with typical knife-edge morphology and adverse ridge contours. This unfavorable anatomy can seriously hamper proper implant placement. Fresh-frozen bone (FFB) allografts recently have been proposed to augment the residual bone volume for implant placement purposes; however, scientific evidence concerning the use of FFB to treat ED patients is absent. Similarly, data reporting computer-aided template-guided implant placement in medically compromised patients are limited. Thus the purpose of this report is to illustrate the oral rehabilitation of a female patient affected by ED and treated with appositional FFB block grafts and consecutive computer-guided flapless implant placement in a 2-stage procedure. Fixed implant-supported dental prostheses were finally delivered to the patient, which improved her self-esteem and quality of life. During the follow-up recall 1 year after the prosthetic loading, the clinical examination showed healthy peri-implant soft tissues with no signs of bleeding on probing or pathologic probing depths. The panoramic radiograph confirmed the clinical stability of the result. Peri-implant marginal bone levels were radiographically stable with neither pathologic bone loss at the mesial and distal aspects of each implant nor peri-implant radiolucency. Within the limitations of this report, the use of FFB allografts in association with computer-aided flapless implant surgery might be considered a useful technique in patients affected by ED.

Prosthodontic Rehabilitation of an Ectodermal Dysplasia Patient with Implant Telescopic Crown Attachments.

Telescopic crown attachments have been successfully used in completely and partially edentulous patients. This type of attachment provides retention, support, and stability with optimal hygiene for the removable dental prosthesis (RDP). With the emergence of CAD/CAM technology, telescopic crown attachments can be virtually designed and milled precisely to ensure a passive fit of the attachment parts and maximal functionality of the RDP. This article reviews both the clinical outcome and prosthodontic rehabilitation of telescopic crown attachments of an edentulous ectodermal dysplasia patient with solitary rigid conical telescopic crown attachments.

Prosthetic treatment outcome in patients with severe hypodontia: a systematic review.

Severe hypodontia (≥6 missing teeth) is associated with aesthetic and functional problems. Its presentation is heterogenic, and a variety of treatment modalities are used resulting in different treatment outcomes. As there is currently no standard treatment approach for patients with severe hypodontia, the literature was systematically reviewed with the focus on treatment outcomes. Medline, Embase and The Cochrane Central Register of Controlled Trials were searched (last search 24 August 2015). This was completed with a manual search of the reference lists of the selected studies. To be included, studies had to describe dental treatment outcome measure(s) in patients with severe hypodontia; there were no language restrictions. The methodological quality was assessed using MINORS criteria. Twenty-one studies were eligible, but the diversity in type and quality did not allow for a meta-analysis; seventeen studies had a retrospective design; sixteen studies described the results of implant treatment. Treatment with (partial) dentures, orthodontics, fixed crowns or bridges was sparsely presented in the eligible studies. Implant survival, the most frequently reported treatment outcome, ranging from 35·7% to 98·7%, was influenced by 'location' and 'bone volume'. The results of implant treatment in severe hypodontia patients are promising, but due to its heterogenic presentation, its low prevalence and the poor quality of the studies, evidence-based decision-making in the treatment of severe hypodontia is not yet feasible, thus prompting further research.

Rethinking the traditional full-mouth rehabilitation by applying minimal prosthetic dentistry for maximum patient benefit.

The field of dentistry is an ever-evolving discipline. A marked rise in the use of endosseous implants, adhesive ceramic bonding, and composite resins, as well as continued patient desire for minimally invasive procedures, has created a new conservative era in the practices of many restorative dentists. These trends, coupled with the significant financial impact associated with the reconstruction of failing, worn, and esthetically compromised dentitions, have facilitated a paradigm shift in the way that individual patient cases are being treatment planned today. Applying restraint to conventional practices involving the unnecessary gross removal of hard tooth structure is both a skill that needs to be cultivated as well as an evident obligation to the patient. A case report demonstrates the utilization of multiple restorative materials to provide a minimally invasive definitive treatment that was biomechanically, esthetically, and financially satisfactory for the patient.

Full Mouth Implant-supported Rehabilitation of a Patient with Ectodermal Dysplasia: Clinical Report and Literature Review.

OBJECTIVE: The purpose of this case report is to present the clinical course of full mouth rehabilitation in an 1 8-year-old female patient with ectodermal dysplasia who was treated with implant-supported fixed partial dentures for the mandible and the maxilla. CASE REPORT: Fourteen dental implants (8 in the maxilla and 6 in the mandible) were placed simultaneously after full mouth extraction and alveoloplasty surgery. After 6 months of healing, prosthetic rehabilitation was started for screw-retained fixed partial dentures. The patient was followed for one year and a peri-implant maintenance regime established for six-month recalls. The patient was satisfied with the prosthesis both esthetically and functionally. Furthermore, the patient reported significant improvements in oral function and psychosocial activities. CONCLUSION: The use of dental implants to support full mouth prosthetic rehabilitation for adolescents with ectodermal dysplasia may provide a considerable improvement in function and esthetic compared to conventional removable prosthetic options. This has the potential to enhance the quality of life for these patients.

Complete oral rehabilitation of a patient with hereditary gingival fibromatosis: a clinical report.

Hereditary gingival fibromatosis is a rare disease that has several debilitating oral and psychological manifestations, especially with young children and adolescents. The complexity of the treatment as well as the timing relative to the growth and maturation of the patient present a challenge. Few treatment options have been reported in the literature. This clinical report presents a multidisciplinary approach to treating a young patient with hereditary gingival fibromatosis by using implant-supported prostheses. The treatment steps and its outcome are discussed.

Intermediate rehabilitation with (non)-prep all-ceramic onlays in an adolescent patient with oligodontia--4-year follow-up.

BACKGROUND: Initial rehabilitation in juvenile patients with oligodontia is a major challenge for the dentist. Conventional permanent prosthetic and/or implantological treatment options alongside permanent natural teeth are contraindicated in growing patients, because their skeletal development is still in progress. CASE REPORT: A non-invasive temporary-fixed treatment option for an adolescent patient is presented by the use of adhesively cemented (non-prep) all-ceramic onlays of primary teeth. The outcome of treatment was monitored over a period of 4 years. CONCLUSION: Long-term preservation of persistent primary teeth may be a meaningful alternative to removable dentures in growing patients with oligodontia. Intermediate rehabilitation should cause no more than mild psychological stress for the patient and improve quality of life, especially when extensive orthodontic and/or implantological treatment is planned at the end of the patient's skeletal growth.

Determination of vertical dimension in prosthodontic rehabilitation of a growing patient with severe oligodontia.

CASE REPORT: This report describes the oral rehabilitation of a young boy with severe oligodontia of primary dentition and complete anodontia of permanent dentition, treated by complete maxillary and partial mandibular removable dentures. Since the determination of a proper occlusal vertical dimension in paediatric patients is often difficult, treatment was achieved by means of a multidisciplinary approach involving conventional prosthodontic principles combined with cephalometric analysis and growth prediction. After a follow-up of two years a second lateral cephalogram was taken to evaluate the developmental changes in craniofacial morphology and the superimpositions method was performed, showing an improvement of both sagittal and vertical relationship between basal bones. In this case, the early prosthetic treatment resulted in enhanced aesthetics and masticatory function as well as skeletal growth changes.

A multidisciplinary treatment of patients with craniofacial disorders. Own experience.

Oral rehabilitation of patients with craniofacial disorders is a great challenge and needs a multidisciplinary approach. This is due to the diverse etiology of the disease and severity of changes in tissues and organs. Congenital absence of tooth germs manifested in the form of oligodontia or anodontia, the presence of persistent deciduous teeth in ectodermal dysplasia (ED), cleft lip and hard palate or cancer-induced changes in the tissues of the stomatognathic system are the most common causes of these disorders. The observed abnormalities are responsible for functional disorders of musculo-articular system, speech and chewing. In addition, noticeable adverse changes in the appearance have a huge psychological impact on patients and their well-being. Therefore, the treatment of these medical conditions should begin in childhood and comprise interdisciplinary rehabilitation, involving prosthetics and orthodontics supported by surgery, as well as speech or laryngological therapy. In this paper the interdisciplinary treatment of patients with oral hard and soft tissues disorders during ectodermal dysplasia is discussed. Early oral rehabilitation can restore lost or abnormally shaped tissues and proper functions of the masticatory system. It can also have a positive impact on further physical and psychological development of patients.

[Ectodermal Capdepont syndrome and oral prosthetic rehabilitation. About a clinical case]. / Syndrome ectodermique de Capdepont et réhabilitation orale prothétique. A propos d'un cas Clinique.

The authors describe the ectodermal Capdepont syndrome as an anomaly characterized by anhidrosis, hypotrichosis and anodontia diagnosed in a 22 year-old adult. In front of this anodontia, oral prosthetic rehabilitation remains the only solution.

Implant-retained overdentures for young children with severe oligodontia: a series of four cases.

PURPOSE: The treatment need is high in children with severe oligodontia and anodontia, because they often have functional and esthetic problems owing to missing teeth. Because the intraforaminal region barely grows after eruption of the permanent mandibular incisors, dental implant treatment should be considered a treatment option for these children. The purpose of our study was to assess the treatment outcomes regarding satisfaction and the care and aftercare of implant-retained mandibular overdentures in a series of 4 young children without erupted mandibular teeth from either severe oligodontia (n = 3) or anodontia (n = 1). PATIENTS AND METHODS: Four children without erupted mandibular teeth, aged 6 to 13 years, were provided with an implant-retained overdenture on 2 implants. The surgical and prosthetic care and aftercare were scored by the clinicians. Also, the patients and their parents were queried about how satisfied they were with the overdenture. RESULTS: The median follow-up of the patients was 5.2 years (range 3.2 to 8.4). No implants were lost, no cases of peri-implantitis occurred, and the need for treatment and aftercare was low. Patient and parent satisfaction with this treatment was high. CONCLUSIONS: A 2-implant, retained overdenture in children with no erupted mandibular teeth is a safe treatment modality when appropriate treatment and aftercare can be provided.

Full mouth rehabilitation of a young patient with partial expressions of ectodermal dysplasia: a clinical report.

Ectodermal dysplasia (ED) is a hereditary disorder characterized by the abnormal development of specific tissues and structures of ectodermal origin. This clinical report describes the multidisciplinary approach to the diagnosis and treatment of a 24-year-old patient with partial expression of ED. The treatment plan used dental implants to support fixed prostheses and ceramic restorations to establish acceptable esthetics and provide function.

From childhood to adulthood: oral rehabilitation of a patient with ectodermal dysplasia.

Ectodermal dysplasia, in all its varieties, occurs in approximately 1 in every 100,000 live births. Depending on the variety, hypohidrosis, hypotrichosis, hypodontia, oligodontia, and/or anodontia may be exhibited. Few long-term clinical reports exist. This report follows the development, growth, and initial treatment of a 10-year-old patient with ectodermal dysplasia and his subsequent oral rehabilitation 20 years later.

Prosthetic rehabilitation of a patient with a unilateral cleft palate: a clinical report.

Cleft palate is a congenital disorder characterized by maxillary growth defect and dental anomalies. Its correction requires an interdisciplinary approach, which includes surgical, orthodontic, and prosthetic treatments. This clinical report describes the prosthetic management of a 19-year-old woman with a unilateral cleft palate defect that had not been closed completely with surgical repair. The deficient maxillary residual anterior ridge was restored with a tooth-supported overdenture that improved her facial appearance, speech, and masticatory functions.

A retrospective 3- to 5-year study of the reconstruction of oral function using implant-supported prostheses in patients with hypohidrotic ectodermal dysplasia.

The aim of this study was to evaluate oral function rehabilitation in patients with hypohidrotic ectodermal dysplasia (HED) using implant-supported prostheses based on bone augmentation. From September 2005 and March 2009, 25 HED patients were chosen for clinical data analysis in this study. The criteria for patient selection included the following: the display of clinical features of HED, the number of congenitally missing teeth (>5), the patient age (>16 years), the patient's willingness, and the patient's tolerance for bone graft surgery and implant placement. Follow-up evaluations were initiated from the time of implant prosthetic placement and scheduled annually for 3-5 years. The effects of oral function reconstruction were assessed based on the cumulative survival and success rates of implants, the health of the peri-implant area, and the degree of patient satisfaction. Twenty-five HED patients received 169 conventional implants and 10 zygomatic implants (179 total implants). During 3-5 years of post-loading evaluations, 5 of the 179 implants failed and 3 implants were removed. The 3-year success and cumulative survival rates were 97.2% and 98.3%, respectively. Furthermore, periodontal probing and radiographic assessments showed that the 3-year incidence of peri-implantitis was 4.5%. Finally, HED patients expressed high degrees of satisfaction with their facial contours, masticatory function, pronunciation ability, and comfort with the implant-supported prostheses. The results of this 3- to 5-year retrospective study indicate that the oral function of HED patients can be effectively reconstructed using bone augmentation and implant-supported prostheses; however, longer term results are warranted in the future.

Temporary replacement of missing maxillary lateral incisors with orthodontic miniscrew implants in growing patients: rationale, clinical technique, and long-term results.

The missing maxillary lateral incisor in adolescent patients presents an orthodontic challenge. Historically, there have been three treatment options to address this clinical problem: (1) canine substitution, (2) tooth auto-transplantation, and (3) dental restoration. Unfortunately, these methods are not without limitation. A novel treatment concept, originating in 2003 and utilizing orthodontic miniscrew implants, is presented along with the rationale, clinical technique and 8 years of follow-up.