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ABSTRACT
Ectodermal dysplasia is a rare, hereditary, congenital disease that affects the normal development of certain tissues and structures of ectodermal origin. The disease is manifested to different degrees of severity and may involve the nose, eyes, hair, nails, sweat glands, and enamel. This report describes a 14-year-old boy with ectodermal dysplasia, rehabilitated with monolithic, multichromatic maxillary and mandibular computer-aided design and computer-aided manufacturing (CAD-CAM) acrylic resin complete overdentures. (J Prosthet Dent 2017;-:—)
Ectodermal dysplasia (ED) is a rare, hereditary, congenital disease characterized by abnormal development of certain tissues and structures of ectodermal origin. Disturbances in tissues derived from other embryologic layers are not uncommon. The ectodermal germ layer gives rise to different organs and structures, including the nose, eyes, hair, nails, sweat glands, and enamel.1 The prevalence of hypohidrotic ED in the general population has been estimated between 1:10 000 and 1:100 000 male live births.2,3 Individuals with this disease generally exhibit a triad of symptoms: hypodontia, hypotrichosis, and hypohidrosis.4
Dental abnormalities can range from anodontia to hypodontia, which is the more common form.5 Both deciduous and permanent dentitions seem to be affected, and conical or peg-shaped teeth predominate.5 In the absence of teeth, the alveolar process is poorly developed, decreasing the occlusal vertical dimension (OVD) and giving the child’s face an aged appearance, similar to that of a patient with edentulism. The growth and development of the child, however, is normal.6,7
Dental treatment should start early in the life of the patient. Function, psychology, and esthetics are primary reasons behind such an early approach.8,9 Facial appearance can create an inadequate self-image, leading to social withdrawal and difficulty integrating into society9,10; the dental appearance of these young patients, therefore, is of the utmost importance. Treatment timing and sequence should be determined in conjunction with the patient’s parents and may include fixed, removable, or implant-supported fixed partial dentures.9-12
Removable prosthodontics is the most frequently used treatment for ED.13 When teeth are present for support, overdentures have been successful.14 In addition to being straightforward and inexpensive, removable prosthodontics are a reversible and conservative treatment that will leave the teeth of the young patient intact and preserve the alveolar bone.13-15 Mini-implants can be considered as a viable reversible treatment option for a growing child with ED.3 Subsequently, the adult patient can be provided with more definitive treatment, including implant-supported prostheses, without damaging their few remaining teeth. Overdentures help to achieve better function, esthetics, and phonetics, along with improved self-image.13 Limitations of this option with very young patients include the patient’s failure to comply with oral hygiene, which requires several recall visits (3 to 4 months), daily application of stannous fluoride to minimize dental caries, and periodic replacement of the overdenture because of the child’s normal growth.16
Removable complete overdenture prostheses (RCOPs) have been used successfully for patients with ED who present with hypodontia, especially young patients who have not yet stopped growing.17 Monolithic, multichromatic computer-aided design and computeraided manufacturing (CAD-CAM) has been developed to fabricate removal complete dental prostheses (RCDPs).18 Compared with conventionally processed dentures, CAD-CAM RCDPs show several advantages, including a reduction of residual monomer, improved physical properties of the acrylic resin base, reduction in polymerization shrinkage, and reduced adhesion of Candida albicans organisms to the denture base.19 In addition, CAD-CAM RCDPs can be provided over fewer patient visits, the digital files permit easier remakes, and denture base adaptation and retention are improved.20,21 This clinical report describes the treatment of an adolescent patient with ectodermal dysplasia, using monolithic, multichromatic CAD-CAM RCOPs.
Figure 1. Pretreatment intraoral views. A, Right view. B. Frontal view. C, Left view.
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