Implant prosthodontics timing, loading and management in Ectodermal Dysplasia patients

Ectodermal Dysplasia is a hereditary disease characterized by a congenital dysplasia of one or more ectodermal structures and their accessory appendages. This genetic birth defect has origin during the fetal life, probably around the third or fourth month, because of a failure of the growth. Ectodermal manifestations of E.D. include reduced or absent sweat glands, fine sparse scalp and body hair, abnormally developed nails, marbled pattern of skin pigmentation, atrophic rhinitis, epistaxis, hearing-loss. Dysmorphic facial features included prominent supraorbital ridges, saddle nose deformity, protuberant lips, depresses midface. The typical intraoral findings show anodontia, hypodontia, misshapen teeth, conical teeth, generalized spacing, taurodontia, super numerary teeth, neonatal teeth, natal teeth, retained primary teeth, enamel hypoplasia, and lack of an alveolar ridge. This work focuses on the importance which has interdisciplinary consultation and collaboration between specialists in various branches of dentistry, in particular between prosthodontist, implantologist and orthodontist, to obtain best results which include the teeth health and their support tissue, the occlusion and aesthetic appearance. This study has utilized 37 patients divided into two experimental groups: the former included 15 E.D. patients, 11 men and 4 women, aged 15 to 45; the latter consisted of 22 patients, 12 men and 10 women, aged 16 to 45, with missing teeth because of agenesis, extractions, or trauma. In all the patients have been inserted osseointegrated titanium implants rehabilitating them from both esthetical and functional points of view. The two groups had poor esthetics, reduced occlusal vertical dimension; decreased alveolar bone malocclusions. The E.D. patients show a lack of alveolar bone both in height and in width, above all the mandibular ridge often presents a knife-edge contour, which make difficult ideal implants placement. The clinical investigation has demonstrated that the osseointegration rates of implant fixtures in the jawbones of E.D. patients approaches that of non-E.D. edentolous patients.