Implant Patient with Ectodermal Dysplasia: How Do I Manage the Overdenture?

Treat this patient like your daughter. If you are not familiar with this type of patient I respectfully recommend you REFER to someone else in your area that is.

endosseous implants can be successfully placed and can provide support for prosthetic restoration in patients with hereditary ectodermal dysplasia as per Kearns G, Sharma A, Perrott D, Schmidt B, Kaban L, Vargervik K.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Jul;88(1):5-10. Placement of endosseous implants in children and adolescents with hereditary ectodermal dysplasia. However u need to do a CBCT, get exact buccolingual & vertical height. Short implants will do in this case.Take care during surgical procedire since pt is susceptible to infections, high risk for hyperthermia

A CBCT with the exact dimensions is very essential to choose the size of the implant. Also the prothesis is designed as split in the midline to allow for growth. Periodic evaluation of the posthesis and the growth will be mandatory. The IAN looks to be close to the ridge crest. Guided surgery is a good option. The implant position will change over a period of time and new implants may have to be placed and older ones made sleeping implants. What about the maxilla? Unless there are teeth there too what purpose does it serve.

I have to agree with Dr MArch If you are unfamiliar with this type of case then you should refer to someone who is. It is not fair to the patient. With regards to implants young patients I feel it is inexcusable to place implants in a young child despite what Kearns et al says. the effects on growth of patients especially when you do cross arch anchorage which is what will happen in this case is horrendous and they are already compromised. Mini implants perhaps with an overdenture for now is the maximum I would do in this case and then fixed or removable once the growth has been completed. good luck

I have a patient with similar missing and under developed teeth in the same age range, but with more teeth than your example. She is beginning to want to look like the other kids her age and I've been asked to place implants and over denture. I asked this same question of a long experienced (decades), knowledgeable oral surgeon. His answer was that the bone development should have reached the completion of the long bone end plates prior to implant placement. i.e., have a bone surgeon take the wrist joint or other needed x-rays and determine her bone age. While it is unlikely she is ready at thirteen, he said some children reach the completion stage as early as 14. As to what exactly would ensue if you place implants prior to this, my understanding is the patient could suffer unpredictable development or lack of development around the implant, leaving it to be buried, exposed, or to appear to have drifted.

The potential for growth disruption cannot be overstated. Once growth has been altered, the difficulties mount. Also, remember that implants behave like ankylosed teeth in bone, they will not move as bone grows and eventually end up in a "submerged" position. A general comment- while it is good to see the questions, please remember that REFER is not a dirty word. As they say in hot air ballooning- I'd rather be on the ground wishing I was in the air than in the air wishing I was on the ground!!!

I agree with Abg. Implants in the anterior mandible can be placed for a removable prosthesis. Experience is definitely a must in a case like this. Rather than post opinions, lets stick to the literature in this one, there is plenty of good lit on this subject. I have treated several ED cases successfully in this manner. I would refer and become involved in co-treating this patient so that you can acquire the experience and knowledge necessary.

Dear Dr B, This is a 13 year old girl who has obviously suffered psychological hell while growing up and urgently needs a set of smiles to begin her overall rehabilitation in function, appearance and very likely self-esteem. Use 4 O-ball head minis on the lower anterior ridge to give her a removable over-denture. In this case, an upper over-denture should be made together with close attention to restoring the correct vertical height and anterior fullness to bring normality to the pouty lips that are present in ectodermal dysplasia cases. Once the young lady is used to the dentures, use minis to restore her upper posterior teeth up to the premolars. Use composite to reshape the upper conically shaped anteriors to look like the 4 incisors. Orthodontically align them. The remaining canine spaces can either be restored with cantilevers from the restored incisors or minis can be used with crowns. Minis are recommended because in such cases, the ridges are narrow and placement is flapless and bonegrafts can be avoided. Minis can be used transitionally, i.e. as the child grows, they can be unscrewed and repositioned at will. Finally, they can be used long term until they are adults and have the crowns changed if necessary. The lower can also be restored with a hybrid on minis. I have an ongoing case posted and may post a younger case later. These cases require a multidisciplinary approach and careful treatment planning. All the best and cheers.

I was a resident involved in follow-up on one of those cases from Kearns et al. Saw the patient when he was close to 15 years old. The one implant with a ball attachment was a very serviceable option for him. It allowed for retention, which is what the child needed. The implant became submerged relative to the crestal bone overtime, resulting in the need of changing out the ball attachment to a longer one and remake of the dentures as growth occured. A few years after I left, he was scheduled to have more implants placed and either fixed or removable reconstruction. The main thing was to wait until he was done growing. I concur that referral to a surgeon and prosthodontist is in the best interest of the patient. I would want nothing less for my child.

In ectodermal dysplasia, the need to catch them young to preempt undue damage to their self-esteem, the narrow ridges and absence of alveolar bone, and the need to modify the dentition built on transitional implants as they mature towards 18/19 years old may well mean that minis or narrow diameters used in a transitional and finally long-term manner may well be the TREATMENT OF CHOICE. And the bonus of a low budget solution makes it a no-brainer. I have a 13 year old ectodermal dysplasia posted with a blow by blow account.