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Oral rehabilitation is often difficult for the young child with ectodermal dysplasia. Most affected children require extensive dental treatment in order to restore their appearance and function. Early intervention also helps children develop a positive self-image. This paper will review the dental management and timing of different treatment modalities for children with ectodermal dysplasia.
There are only few reports on the prosthetical care of patients with dysgnathias. Thus, it seems appropriate first to delimit the field by well-defined terms from maxillo-facial surgery and orthodontics. Reichenbach, Köle, and Brückl introduced the term "principal symptom" ("Leitsymptom") for the most significant dysgnathic finding. With a view to prosthetical aspects, this term is broadened to include primary and secondary dysgnathias, after several proposals of nomenclature were made. It is reported on the number of dysgnathic patients needing treatment. The description of some of the goals aimed at by prosthetical care concludes the paper.
Ultraconservative techniques are providing dentists with new opportunities for the rehabilitation of the debilitated dentition. These techniques involve the use of bonded, reinforced ceramics that restore function and esthetics. The new parameters of ultraconservative treatment include the routine use of supragingival margins, color gradients, and the alteration of the occlusal vertical dimension. The minimally invasive nature of these new techniques makes them more readily acceptable to, and more easily maintainable by, patients.
Dentistry must re-examine its professional obligations towards the patient and consider whether its present basis is too rigidly technical. Oral rehabilitation can be defined in terms of the restoration of function and aesthetics. However, it must include also a philosophy of concern for an oral invalid who may require continued and varied in the management of his disability. The understanding of this concept requires an analysis of the meaning and impact of an oral disorder on an individual, and the responsibilities of those who have to provide him with guidance. Consideration must be given to the reflection of these principles of care on the teaching of dental students.
After the resection of a tumor, many patients need a reconstruction with hard and soft tissue and also with sufficient dentures. Often, only little space is available for the implantation. Implant length and diameter have to be reduced, and the result is a change in the biomechanics with a possible mechanical overloading of the implant. We examined 52 tumor patients undergoing reconstruction with 189 implants. A new concept involving attachment with the help of magnets is presented, offering a satisfactory solution in these difficult cases after tumor resection and reconstruction.
Oral rehabilitation of children with extensive aplasia includes a number of dental considerations as well as attention to psychological and physical development. The well-documented results of the use of implants in adults have raised the question of the use of implants and the timing of this procedure in children and adolescents with multiple aplasia. Eight-years' experience of a multidisciplinary approach to oral rehabilitation of children with extensive aplasia is described. Special emphasis is placed on early diagnosis, careful therapy planning, and co-ordination and timing of different parts of the therapy. The specific considerations from the point of view of paediatric dentists, orthodontists, oral surgeons, and prosthodontists are presented. A system for integrating all these aspects and knowledge will be a guarantee for high professional standards and a successful outcome. To exemplify the multidisciplinary approach, three treated cases are presented.
This clinical report describes the prosthodontic rehabilitation of a 22-year-old female patient diagnosed with partial anodontia. A combined dental therapy approach was used and included endodontic therapy and a post-and-core buildup on the mandibular left canine, fabrication of a mandibular removable denture, and fabrication of maxillary fixed restorations. Canine-protected occlusion was developed in the final restorations to decrease lateral forces on the posterior dentition. Protrusive guidance was evenly distributed across the maxillary and mandibular incisors. Functional and esthetic results were achieved.
The aim of this article is to demonstrate that the presence of orofacial dyskinesia is often owing to underlying facial dysmorphology in persons with Down's syndrome. A series of cases is presented where orofacial dyskinesia was successfully treated by therapy establishing occlusal stability. The diagnosis of dyskinesia owing to dysmorphology should be precluded before any link with the degree of intellectual disability or neurological deficit is presumed. A multidisciplinary approach may be necessary to diagnose and treat these patients.
Prevention should be regarded as more important for the health than the cure. In adult and geriatric patients prevention is directed towards limiting disability rather than preventing the onset of the disease, since treatment is undertaken after pathological changes have taken place and some degree of invalidity is already present. Oral rehabilitation, if successfully performed, will limit the spread and further deterioration of oral conditions at any developmental stage of a functional pathology. The objective of the rehabilitation should not be the integrity of a single dental arch and certainly not the replacement of the lost teeth. Rather, the principle guiding guiding the treatment should be the achievement of a harmonious functional relation between the maxillary and mandibular jaws, so as to enable them to function in well balanced co-operation and force distribution. This objective may be best achieved by sensible planning and faultless execution, when the patient is younger, and most of his teeth and their supporting structures are still preserved.
BACKGROUND: Since the first version of the Liverpool Oral Rehabilitation Questionnaire (LORQ) was first published in 2004, the questionnaire has been modified to include more detail on chewing and appearance, and also details of denture, dental and implant status. AIM: The aim of this study is to report the ongoing development and validation of the LORQ version3. METHODS: A postal survey of the LORQv3 and OHIP-14 questionnaires was performed in April 2004 of 164 patients who had attended the oral rehabilitation clinic from February 2000. In addition The LORQv3 was administered to 349 patients attending six General Dental Practices, based in Liverpool, attending for routine care. RESULTS: Patients attending GDP scored appreciably better on most items in the LORQv3. The questionnaire discriminated between cancer and non-cancer oral rehabilitation patients in items such as swallowing, chewing, trismus, drooling and food clearance. There was no significant difference between rehabilitation groups for any of the seven OHIP-14 domains. The LORQv3 demonstrated good criterion validity when compared to the OHIP-14 with social items in the LORQv3 correlating well with items of the OHIP-14. Conversely various LORQv3 items did not have strong correlates within the OHIP-14 thus endorsing the additional items in the LORQv3.
Ninety-nine individuals, all of whom had long avoided dental treatment due to severe dental fear, received therapy according to one of two treatment modalities--behavioral therapy from a psychologist (BT) and treatment under general anesthesia (GA)--both of which were followed by clinical training and dental test treatments. These treatment programs were followed by referring the individuals to community dental clinics for complete oral rehabilitation. Among BT patients, significantly more (92%) completed the treatment program, compared with the GA patients (69%). Complete oral rehabilitation in community dental clinics was achieved by 78 and 53%, respectively. BT patients also had a significantly lower frequency of cancellations. The reduction in dental anxiety according to the Corah Dental Anxiety Scale was substantial in both groups, but the anxiety was significantly more reduced for BT patients, who reached a level equivalent to that of average dental patients. Patients' self-reported tension and the dentists' ratings of patient behavior during treatment were also significantly more positive for the BT groups.
The aims of this study were to determine the characteristics of patients and type of dental treatment carried out using dental general anesthesia (DGA) during two years in a following three year period. A total of 182 patients received treatment between 1999 and 2001. The mean age was 4.9 years. The main indication for DGA was behavior management problems. Complete oral rehabilitation including complex restorative treatment and extractions was provided under DGA at a single visit. Failure to return for recalls was common; 83% of patients returned for the post-operative recall but only 26% after a three year period. Most of the patients requiring further treatment accepted it in the dental chair. Only one patient received a second DGA during the three years following treatment.
A rehabilitation device was designed and used before a reconstructive orthognathic procedure in an adult patient with a severe facial asymmetry. The asymmetry developed as a result of a left hemimandibulectomy in childhood. With this prototype device, the remaining hemimandible was gradually brought into its natural position and dynamics in order to accommodate a graft. The goals were to improve esthetics and function, reduce the chance of the remaining hemimandible not adapting to the graft, and reduce the risk of secondary TMJ pathosis after the mandibular reconstruction.
To rehabilitate means to give back to the patient the former and initial function of his teeth. Various clinical cases are shown, different in age, sex, health and financial status of the patient. They illustrate the method to apply to each case definite constructive principles dictated by biomechanics. The solutions are diversified, but the principles underlying the decision are identical. Before starting work, 3 questions must be asked: What do to? How to do it? At what fee? Thus we can fulfil the patient's wish to eat with pleasure, to talk agreeably and to smile without inhibitions.
To initiate a study on the usefulness of dental treatment with general anesthesia, we investigated clinical characteristics of 933 patients who received total oral rehabilitation using general anesthesia at the Department of Restorative and Pediatric Dentistry of the University Hospital Leuven, Belgium. The median age of the patients was 10 years. The overall male-to-female ratio was 53 to 47. The principal indications for treatment using general anesthesia were rampant caries, fear, and a mental or physical handicap. The mean number of decayed teeth was 10.9 (sd 4.9). Nearly 50 percent of the patients were referred by a dentist.
This case report describes the oral rehabilitation of a female child with hypohidrotic ectodermal dysplasia over a 6-year time period. It demonstrates the need for periodic modification and replacement of a prosthesis, an orthodontic appliance, and a gingivoplasty. Although the initial treatment plan was considered to be a compromise due to limited cooperation, an improvement was observed in the patient's social behavior as a consequence of her dental treatment. The effects of unavoidable changes in the dental team over 6 years are also discussed.
Five practical cases are shown where orthodontic pretreatment preceded the rehabilitation. Most important for the success of such a mixed treatment is the teamwork between the 2 dentists and their understanding of the other's problems and limitations. A clear priority list is indispensable. As a general rule, the role of the orthodontist is subordinate to the prosthetic problems. The 5 cases are: a light and a severe anodontia, a distal bite with spaced protrusion of the upper anteriors, and a distal bite with circular and total nonocclusion, finally a lip, jaw and palatal cleft case. All patients are adult. In 3 cases an instrumental functional analysis was made.
So far, preprosthetic surgery for oral defects improved prosthetic retention problems for only a limited amount of time and led to many side-effects. The alternative offered by the osseointegration technique developed by P.-I. Brånemark changed the concept of preprosthetic surgery dramatically. By means of a few permucosal titanium screws, bridges or overdentures can be retained even in cases of advanced jaw bone resorption. When the latter is extreme, an autologous free bone graft fixed by means of self-tapping titanium implants can offer the necessary support for sometimes elaborate prosthetic reconstructions. The marginal bone loss around Brånemark implants is very limited after a 1st year of bone remodelling, even when an autologous transplant has been used.