Complete Denture Treatment In A Child With Ectodermal Dysplasia: A Clinical Report

INTRODUCTION

Ectodermal dysplasia (ED) associated with dentition abnormalities has been well documented in the dental literature and has an incidence of 7 per 10,000 live births. ED is characterized by deficiency or absence of hair, sweat glands, nails, teeth and other ectodermal structures; however, it does not affect the growth of jaws and face. Reduced occlusal vertical dimension is a noticeable feature. Prosthodontic treatment at an early age with provision for periodic modification or refabrication is indicated in such cases. Prosthodontic intervention comprises of conventional complete dentures, complete overdentures, or partial dentures. It has been recommended to start the prosthodontic treatment at an early age of 2 to 3 years. It is well accepted that at this age, children benefit greatly from dental and psychologic treatment. Complete dentures have been used successfully in numerous patients with ED ¹.

CASE REPORT

A case is reported where complete dentures were fabricated for a patient who has manifested with signs of ED. CASE REPORT A case diagnosed with ED was referred to the Department of Prosthodontics, AECS Maaruti College of Dental Sciences and Research Centre, from the Department of Oral Medicine and Radiology. A4 year old male child presented to the clinic desirous of replacement of his missing teeth to overcome psychological trauma experienced in the school. On general examination, the child had sparsely distributed hair. The skin was found to be smooth, dry and scaly but nails were normal (Fig. 1). Intraoral examination revealed completely edentulous maxillary and mandibular arches (Figs.2 and 3). Radiographic examination revealed complete absence of deciduous as well as permanent tooth buds (Fig. 4). The child's parents were counselled regarding his condition. Treatment plan was explained to them. It was decided to fabricate complete dentures for the child. Multiple denture replacements are often needed as the child grows, and dental implants could be an option once the jaw was fully grown.

Procedure

Primary impressions of the maxillary and mandibular arches were made with condensation silicon putty and light body elasomeric impression material. Plaster casts were obtained and self-cure acrylic custom trays were fabricated. Border molding and final impressions of both the arches were made using addition silicon putty and light body impression materials respectively (Figs. 5 and 6). Master casts were obtained (Figs. 7 and 8). Wax up on the casts were done for permanent denture bases. Heat-processed record bases were made because they provided superior stability and confirmation of the final retention. Occlusal rims were constructed on the permanent denture bases. The maxillary rim was adjusted for the lip support, esthetics and phonetic requirements. Face bow transfer was done using a custom made face bow because of paediatric dimensions (Fig. 9). Maxillary cast was mounted on a fixed path three point articulator (Figs. 10 and 11). The patient's intercondylar distance was well within the range of this articulator. The mandibular rim was next adjusted and the jaw relations were obtained. Teeth were selected and modified to match deciduous dentition. Teeth arrangement and trial was completed. Dentures were processed in heat cure acrylic resin (Figs. 12 and 13). Patient was comfortable at the time of insertion. Recall appointments were scheduled for 24-hour, 1-week, 3-month and 1 year intervals. At 1-year recall, the patient's mother reported his excellent adaptation to the prosthesis and improvements in his mastication, speech and social attitude. The patient and his mother were pleased with the outcome of the prosthesis (Figs. 14 and 15).

DISCUSSION

Oral rehabilitation of the ectodermal dysplasia patient is necessary to improve the skeletal relationship during craniofacial growth and development. It also provides improvement in esthetics, speech, masticatory efficiency and psychological well being.³ Till and Marquez recommend that an initial prosthesis could be made when the child starts going to school, so that he may enjoy a better appearance and will have time to adapt to the prosthesis. Dental prostheses will also improve the tone of the muscles of mastication and may compensate for the reduced vertical dimension .⁴

CONCLUSION

The clinical manifestations of ectodermal dysplasia cause considerable social problems in individuals affected by the condition. Complete dentures are a simple, inexpensive and reversible prosthodontic option. This simple therapeutic option provides esthetic, functional and psychological benefits for children and thus contributes to their overall development and well being. Complete dentures are necessitated in an early age especially in ED. However, careful adaptation of clinical methods will ensure success of complete dentures even in a child.