Based on case history, clinical assessment, and radiological findings,
the diagnosis was confirmed as ectodermal dysplasia (ED) of the
hypohydrotic variant.
Outcome and Follow-Up
After careful patient assessment, a detailed, comprehensive treatment
plan for corrective rehabilitation was planned out. The patient and his
father were given two options:
First prosthetic implant-supported prosthesis.
Second, removable dentures for maxillary and mandibular arches.
The Patient and his family discussed the pros and cons of each treatment
option, and it was decided to proceed with removable dentures for the
maxillary and mandibular arches. The patient was informed about the
future implant-supported prosthesis in the upper and lower arches.
Before the commencement of treatment, consent was obtained from the
patient. He was given the option of reshaping 11, which he declined. A
frenectomy was done for the maxillary labial frenum, which was necessary
to provide a better fit for the prosthesis. Irreversible hydrocolloid
impressions (Tropicalgin, Zhermack S.P.A, Italy) were made for maxillary
and mandibular arches, and casts were poured using dental stone
(Kalabhai Kalstone, Kalabhai Karson Pvt Ltd, India). Special trays were
fabricated, and border moulding was done with a thermoplastic material
(DPI® Pinnacle, Dental Products of India, India) for a
better marginal seal and fit. Functional wash impressions were made
using light body polyvinyl siloxane impression material
(Aquail® Ultra+ Dentsply, Milford,
DE, USA), impressions were poured with dental stone, and casts were
obtained. Maxillo mandibular relationships were established, followed by
a recording of the vertical dimension of occlusion and centric relation.
This was followed by mounting the cast on a semi-adjustable articulator
setting of the teeth and clinical trial. The final trial also allows the
clinician to verify centric and vertical facial relations, occlusion,
phonetics, and retention of the plates. Maxillary and mandibular
dentures were fabricated using a cross-linked heat cure acrylic resin
(DPI® Heat Cure, Dental Products of India, India). The
denture was placed inside the patient’s mouth and adjusted (Fig. 3).
There was an immediate improvement in the patient’s vertical facial
profile, thus improving his facial profile (Fig. 4). The Patient was
provided information on how to insert and remove the dentures,
maintenance of hygiene, and usage.
Follow-up was done after one week to check the fit of the maxillary and
mandibular dentures. This was followed by a three-month follow-up for
the next two visits and 6 months after. The Patient is motivated to
maintain good oral and denture hygiene at each follow-up appointment.
Regular follow-up visits and check-ups have been emphasized at each
appointment to ensure the success of the treatment.
The patient was successfully rehabilitated with maxillary and mandibular
removable dentures. He was happy and satisfied with his improved facial
aesthetic and oral functions. This has increased his self-esteem and
confidence.
Discussion
The case under discussion was diagnosed with ED based on distinctive
clinical features and radiological findings. One of the most important
intra-oral findings was multiple clinically missing permanent teeth; the
teeth that were present exhibited abnormal shape, making oral
rehabilitation challenging. Oral rehabilitation of ED patients is
demanding and requires a multidisciplinary approach. The primary goal of
such an approach is the combination of active preventive measures and
prosthodontic interventions. Preventive measures include reinforcement
of oral hygiene instructions and oral health education. To achieve the
patient’s aesthetic, speech and masticatory functionality as far as the
treatment modality is concerned is based on age, skeletal growth,
development of the stomatognathic system, degree of malformation, dental
agenesis, and patient motivation.
Prosthetic implant is the treatment of choice for adult patients with
ED.18 Studies have suggested an increase in the
prevalence of failure of prosthetic implants in the maxillary
anterior.19 In partial or complete anodontia of the
maxillary and/or mandibular arch, the height of the alveolar bone is
compromised, further complicating the rehabilitation. Further, such
approaches are contraindicated in growing patients. Oral rehabilitation
with removable partial and/ or complete prostheses and composite resin
restorations is the treatment of choice in growing or young adult
patients. Removable prostheses fabricated with cross-linked heat-cured
acrylic resin are frequently reported in the literature due to their
ease of fabrication and cost-effectiveness. After considering all the
limiting factors, such as biological and economic factors, a removable
prosthesis for the maxillary and mandibular arches is needed. Patients
are usually advised to be on regular follow-up appointments to adjust
the appliance and its maintenance for optimal function.
Marked improvement in the facial aesthetic was evident following the
insertion of the removable prostheses; apart from this, the patient
noted an improvement in the form and functions, such as speech and
masticatory efficiency.
Conclusions
The comprehensive and holistic oral rehabilitation of ED patients is
challenging and requires a multidisciplinary approach. Conventional
maxillary and mandibular removable dentures effectively rehabilitate the
patient by improving the patient’s stomatognathic function, aesthetics,
and self-confidence.