ABSTRACT
Objective@#To explore the treatment options for congenitally missing teeth in patients with ectodermal dysplasia and provide a clinical reference.@*Methods@#A patient with ectodermal dysplasia with a concave midface, anterior protrusion of the chin, and underdevelopment of the lower third of the face presented with congenital loss of multiple maxillary teeth, malocclusion of the remaining teeth, congenital loss of mandibular dentition, small dental arches, and upper and lower alveolar bone hypoplasia. The patient was treated by means of a removable partial maxillary prosthesis, implants in the anterior region of the lower mandible designed with the assistance of digital guides, and bar-clamped implant-overlay prostheses. A literature review of the protocol for the treatment of this condition was also conducted.@*Results@#In addition to good retention and stability after denture wear, an excellent occlusal relationship, improvement of the patient's facial appearance, including upper and lower lip fullness, more equal balancing of the lower and middle 1/3 of the face, and improved masticatory function were achieved. The results of the literature review showed that patients with ectodermal dysplasia who are congenitally edentulous usually have a complex intraoral situation that makes restoration difficult, and common restorative modalities for these patients include fixed bridges, removable partial dentures, complete dentures, overdentures, and implant prostheses, which need to be selected according to the actual intraoral situation of each patient. Currently, there is no consensus on the treatment of congenitally missing teeth in patients with ectodermal dysplasia, and some scholars have suggested that fixed restorations be recommended for patients with fewer missing teeth, while the option of removable or implant-covered denture restorations should be given to patients with more missing teeth, with removeable prostheses for underage patients that are replaced with permanent fixed prostheses when the jaws have stabilized.@*Conclusion@#In patients with ectodermal dysplasia with congenital tooth loss, all factors should be taken into account, and an individualized restorative plan should be developed.
ABSTRACT
Objective @#To evaluate the effect of anatomical healing abutments for mandibular first molars on the morphological changes of gingival soft tissue after implant restoration, as well as on peri-implant gingival molding, food ingrowth and patient satisfaction, to provide a basis for clinical selection. @*Methods @# Twenty-six patients who received implant restoration for a single missing mandibular first molar between September 2020 and September 2021 at the Oral Implant Center of Changsha Stomatological Hospital were randomly divided into a control group (13 cases with 14 implants) and a trial group (13 cases with 14 implants), of which 12 were male and 14 were female; the trial group had anatomical healing abutments applied for 4 weeks and then underwent crown restoration, while the control group finished five time points (before the second stage surgery, 4 weeks after the second stage surgery, immediately after the crown restoration, 4 weeks after the crown restoration, and 12 weeks after the crown restoration). A 3Shape intraoral scanner was used to scan the jaw before and 4 weeks after the second stage surgery to quantify the soft tissue changes and compare the effect of the healing abutment on gingival molding between the two groups. The incidence of food impaction was recorded and compared between the two groups at 4 weeks and 12 weeks after crown restoration. Patient satisfaction was recorded and compared between the two groups immediately after crown restoration, 4 weeks after crown restoration and 12 weeks after crown restoration@*Results @# Four weeks after implant surgery, it was observed that the gingival proximal and distal gingival papillae increased on the coronal side in the test group compared to the control group, 0.50 (0.26, 0.72) mm in the near-medium test group and 0.27 (0.24, 0.38) mm in the control group, with a statistically significant difference (P = 0.029), and 0.48 (0.26, 0.62) mm in the far-medium test group and 0.23 (0.13, 0.39) mm in the control group, with a statistically significant difference (P = 0.004). There was no statistically significant difference (P>0.05) in the buccolingual to gingival margin apex to coronal molding or in the buccolingual to lingual soft tissue at 0, 1, or 2 mm of the root of the middle 1/3 apex of the buccal and lingual gingival margins between the two groups. Compared to the control group, there was no statistically significant difference in the incidence of food impaction observed 4 weeks and 12 weeks after crown restoration in the test group (P>0.05). The satisfaction scores were higher in the trial group than in the control group immediately, 4 weeks, and 12 weeks after crown restoration, and the difference between the groups was statistically significant (P < 0.05). @*Conclusion @# The anatomical healing abutment for the implant mandibular first molar was superior to the finished healing abutment in terms of soft tissue contouring with an increase in the coronal aspect of the proximal and distal gingival papillae, resulting in high patient satisfaction.