This case report describes the prosthetic rehabilitation of a young patient with total anodontia, which is a rare event in contrast to partial anodontia. A unique approach was devised to improve the retention and stability of compromised ridges.
- Ectodermal Dysplasia (ED) is a large, complex group of clinical and genetic disorders defined by the abnormal development of two or more ectodermal structures.
- The condition is marked by a developmental deficiency of hair, sweat glands, nails, teeth, and other ectodermal structures.
- Even though by some accounts more than 170 different subtypes of ED can be defined, the two most commonly encountered types in this group are Hypohidrotic and Hidrotic ED.
- A 13-year old boy presented with missing teeth since childhood, causing difficulty in eating and speech.
- The parents reported that the child never had teeth in his mouth.
- Diagnosis: Ectodermal dysplasia
- Medical history and family history : non-contributory.
- On examination ,
- the child was moderately built
- exhibited classical features of hypohidrotic ED: anodontia, hypohidrosis, sparse lusterless hair on the scalp, scarce eyebrows and eyelashes, dark pigmentation around periorbital area, frontal bossing, dry and scaly skin, reduced vertical facial height and protuberant lips
- Intraoral examination:
- showed edentulous upper and lower arches
- Mandibular arch was more compromised in terms of resorption therefore vinyl polysiloxane was used to make the mandibular impression.
- Conventional dentures were delivered to the patient with like-pole magnets incorporated in the occlusal surface of posterior denture teeth of upper and lower denture facing correspondingly which resulted in repulsive force. This enhanced retention and stability of the dentures.
- Denture insertion was done and post insertion instructions were given regarding the diet and maintenance of denture.
- Follow-up instructed after 2 days, 1 week, 2 weeks and 3 months for adjustments and trimming of the denture.
- The dentures were well accepted by the patient with improved mastication.
- The child showed increase in weight and improved social interactions in school with increased participation in extracurricular activities.
- Management of patient with ED is challenging and needs a multidisciplinary approach.
- The clinician needs to be astute, knowledgeable in growth and development, behavioral management, techniques in the fabrication of prosthesis, the ability to motivate the patient and parent in the use of the prosthesis, and the long-term follow-up for the modification and/ or replacement of the prosthesis.
- Hypodontia or anodontia is associated with lack of development of the alveolar ridges and results in less volume of bone for support of a conventional prosthesis.
- The prosthetic rehabilitation of a patient with ED involves conventional complete dentures (age appropriate) and implant supported complete dentures.
- Because of early age intervention and the need to frequently modify the intraoral prosthesis during rapid growth periods, a removable partial denture or complete denture prosthesis is indicated initially.
- However, removable partial denture has certain complications like increased caries rate, periodontal complications, and increased residual alveolar resorption.
Young patients with ectodermal dysplasia need early identification and evaluation by a dental professional to determine the oral ramifications of the condition. Appropriate care and multidisciplinary approach needs to be rendered throughout the child’s growth cycle to maintain oral function, address the aesthetic needs of the patient and fulfill social and psychological needs.