外胚层发育不全患者牙列缺损修复1例及文献回顾

Restoration of a dental defect in a patient with ectodermal dysplasia: a case report and literature review

摘要

目的 探讨外胚层发育不全患者先天缺牙的治疗方案，为临床提供参考。方法 报道1例面中份凹陷，颏部前突，面下1/3发育不足的外胚层发育不全患者，患者上颌多颗牙先天缺失，余留牙为畸形牙，下颌牙列先天缺失，牙弓较小，上下牙槽骨发育不良。通过上颌可摘局部义齿、下颌在数字化导板辅助下进行前牙区种植，杆卡式种植覆盖义齿对其进行治疗，并对其治疗方案进行文献回顾。结果 患者佩戴义齿后固位及稳定佳，咬合关系良好，患者面部外形恢复较好，上下唇饱满，面下1/3与面中1/3基本相等，恢复了咀嚼功能。文献回顾结果表明，先天缺牙的外胚层发育不全患者的口内情况通常比较复杂，修复困难，对此类患者常见的修复方式包括固定桥、可摘局部义齿、全口义齿、覆盖义齿和种植义齿，需要根据患者口内实际情况选择不同的治疗方案。目前，对于外胚层发育不全患者先天缺牙的治疗尚未达成共识，有学者建议缺牙少的患者优先选择固定修复，缺牙多的患者选择可摘义齿或种植覆盖义齿修复，未成年患者优先选择活动修复，待颌骨发育完成后视情况更换永久固定修复。结论 对于外胚层发育不全先天缺牙的患者，应该充分考虑各方面因素，以修复为导向个性化制定可行的修复方案。

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.

关键词

外胚层发育不全 / 牙列缺损 / 牙列缺失 / 先天缺牙 / 可摘局部义齿 / 数字化导板 / 口腔种植 / 口腔修复 / 种植覆盖义齿

Key words

ectodermal dysplasia / dentition defect / missing tooth / congenital tooth loss removable / partial dentures / digital guides / oral implant / oral restoration / implant covered dentures

Author summay

吕红，硕士研究生，Email：[e-mail]