Ectodermal dysplasia in children: clinical study and oral rehabilitation

Aim: The aim of the present study was [1] To describe the dental findings in children with ectodermal dysplasia [ED], [2] To evaluate the restorative and prosthodontic treatment that was provided to these children, [3] To evaluate the related oral health quality of life [QOL] measure

Patients and Methods: Eight children suffering from ED were presented to the outpatient clinic of the Pediatric Dentistry Department for oral rehabilitation. They were subjected to dental clinical and radiographic evaluation. Restorative and prosthodontics treatment was provided to improve speech, masticatory function and facial esthetics of these children. The children were recalled for clinical and radiographic evaluations after 1 week [baseline], 6, 12 and 18 months. The oral health-related QOL measure were evaluated before and 4 weeks after oral rehabilitation

Results: Dental clinical examination and panoramic radiographs revealed a mean of 12.6 missing permanent teeth in the ED group. Maxillary central incisors, maxillary first molars, maxillary first molars, maxillary canines and mandibular first molars showed lowest percentage of absence [were most stable]. Asymmetry in absent teeth was present in almost all tooth types. Clinical follow-up after 6, 12 and 18 months revealed 100% success rate for amalgam fillings, formocresol pulpotomies and stainless steel crowns. Radiographic follow-up of formocresol pulpotomies after 6, 12 and 18 months showed 100% success rate. For composite strip crowns and removable partial overdentures, a clinical success rate of 100 % was found after 6 and 12 months. This dropped to 87.5% after 18 months

Conclusions: From the present study, it can be concluded that: [1] Clinical dental and radiographic examinations are important in diagnosing cases of ED. The number of missing teeth, abnormal crown forms, asymmetry in missing units are characteristics in cases of uncertain diagnosis. [2] A clinical success rate of 87.5% for composite strip crowns and removable partial overdentures in comparison to 100% for amalgam fillings, formocresol pulpotomies and stainless steel crowns was recorded at the end of the study. [3] Early dental intervention improved the patients' appearance, speech and masticatory function. [4] Oral rehabilitation was successful, establishing the function and improving the social living and QOL of these children

Evaluation of restorative procedures in children following dental rehabilitation under general anesthesia

The present study was carried out to assess the success of oral rehabilitation performed under general anesthesia [GA] in the "Special Care Unit", in the Department of Pediatric and Community Dentistry, Faculty of Dentistry, Alexandria University, in terms of restoration survival and absence of new/recurrent caries. The study involved 93 healthy patients who had previously received oral rehabilitation under GA in 2002-2003 and who were recalled for follow up examinations after a time period ranging from 20-42 months. The mean age of the children was 3.79 +/- 1.23 years. Data were collected from the children and their families through clinical examination to assess the success of the restorations previously inserted under GA and the presence of new caries. Background information about the education and occupation of parents as well as dietary and oral hygiene habits and visits to dentists were also collected through a questionnaire. Kaplan Meier survival analysis was performed to determine the mean survival time in months of the different restorations. Cox regression model was used to examine the effect of different variables on the time to restoration failure. Logistic regression was used to study the effect of different variables on presence of new caries in different surfaces. The failure rate for anterior restorations was 49.3% and 12.7% for posterior restorations with a total number of restorations failing = 207 out of 746 initially inserted. The longest and shortest survival times were for strip crowns and anterior glass ionomer for anterior restorations [38 and 32 months respectively] and for posterior restorations stainless steel crowns and amalgam [40 and 36 months respectively]. Not visiting the dentist increased the hazards of failure of both anterior and posterior restorations [hazards ratio = 1.54 and 1.89 respectively]. Out of 42 subjects who had new caries lesions, 29 had proximal lesions with a total number of new caries lesions on any surface = 53. Not eating snacks significantly lowered the risk of new caries on any surface [odds ratio = 0.05, CI= 0.01, 0.19]. Strip crown and stainless steel crown had the longest survival times among anterior and posterior restorations. In spite of the radical treatment delivered to these children, they will need further treatment mostly to replace failed restorations

Comparison of pulpal response following pulpotomy procedure using enamel matrix derivative versus formocresol in primary dentition

The aim of the present study was to compare the clinical, radiographical and histological effect of enamel matrix derivative [Emdogain] versus formocresol on pulpotomized human primary teeth Clinical follow-up of formocresol treated teeth at 2 months revealed [93.3%] clinical success rate. Only one tooth suffered from pain and was sensitive to percussion in formocresol group This dropped to 86.7% at 4 months. At 6 months five teeth showed pain and pain on percussion clinically lowering the clinical success rate to 66.7%. Emdogain® showed an overall clinical success rate of 100% at 2 and 4 months Only one tooth was reported with pain on percussion at 6 months reducing the clinical success rate to 93.3% All teeth [100%] were free from mobility, abscess formation or draining sinus at 2, 4 and 6 months among both.Formocresol and Enamel Matrix Derivative [Emdogain] tested groups. Radiographically in Formocresol group, eleven teeth [73.3%] showed no pathological signs at 2 months recall The radiographic success rate dropped to four teeth [26.7%] at 4 months recall Two teeth only [13. 3%] were still free at 6 months recall. Emdogain group showed radiographic success rate of 86.7% representing thirteen free teeth This succes rate dropped to ten teeth [66.7%] at 4 months follow-up. Nine teeth [60%] were still frees of pathological signs at 6 months.Histological evaluation seemed far more promising for Emdogain than formocresol When the pulp wound was exposed to EMD, a substantial amount of reparative dentin-like tissue was formed in a process much resembling classic wound healing with moderate inflammatory infiltrate beneath the injury with subsequent increase in angiogenesis of normal pulp tissue At later stages, a fine web of odontoblast-like cells was also observed growing from the central parts of the pulp towards the pulp chamber walls forming a dentin bridge The EMD induced hard tissue closely resembled osteodentin early in the process, but later on the hard tissue became more like the secondary dentin. On the contrary, the severe chronic inflammation of pulp tissue acccompained with formocresol eventually produced pulp necrosis with or without fibrosis and incomplete dentin bridging at terminal stages in some cases Based on the present findings, it may be concluded that Emdogain® is a bio-inductive material that is compatible with vital human tissues. It offers a good healing potential and is capable of inducing dentin formation, leaving the remaining pulp tissue heathy and functioning.