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Body aspect (A), frontal aspect (B) and lateral aspect (C) of the patient.
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In the physical examination, it was possible to note low height (Figure 1), hooked nose, prominent, exophthalmos and loss of the vertical dimension.
Radiological aspects of patient's hand (A) and humerus and radius (B).
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The phalanges of the altered hands (Figure 2A) characterize the syndrome, the same way as changes in long bones (Figure 2B).
Initial panoramic radiograph.
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The X-rays confirm the characteristics of mandibular hypoplasia with loss of mandible angle (Figure 3), abnormal dentition and craniofacial disproportion (Figure 4).
Initial lateral cephalogram.
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The X-rays confirm the characteristics of mandibular hypoplasia with loss of mandible angle (Figure 3), abnormal dentition and craniofacial disproportion (Figure 4).
Initial intraoral photographs. (A) Right side view; (B) front view; (C) left side view.
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In the intraoral clinical examination, it was detected an absence of occlusal stability (Figure 5), increase of the free functional space, inadequate dental positioning, atypical and arched palate with fibrous tissue development typical of the syndrome.
Full-mouth periapical X-ray.
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In the mandibular dental arch, the remaining teeth were crowded, with inclinations and rotations, but without mobility or probing depth to justify their extractions. (Figure 6).
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Initial impressions with a custom tray (A). Base plaque and wax guide plane performed over the patient teeth (B). Maxillomandibular records (C).
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Initially, an irreversible hydrocolloid impression was made to obtain the study casts (Figure 7A) and, these were duly assembled in semi-adjustable articulator. The analysis of the casts assembled in a vertical occlusion dimension previously restored through phonetic and metric tests allowed the planning of a full removable overdenture with dental cover, from verification of the interocclusal spaces obtained (Figure 7B and C).
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Reanatomization of lower incisors with composite resin. (A) Isolation with a rubber dam; (B) details of the isolation; (C) clinical aspects after the reanatomization.
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After obtaining the superior test base, reanatomizations were performed on the lower teeth, mimicking the aesthetic and conventional standard desired by the patient (Figure 8).
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Final aspect of the first denture place over the teeth. (A) Right side view; (B) front view; (C) left side view.
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In the Figure 9, it is possible to note a clinical perspective after prosthesis installation.
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Panoramic radiograph after the O-rings installation (A). Occlusal view of the tree O-rings installed (B). Inner surface of the denture with the attachments placed on position (C).
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The male components of the O-rings were positioned on the molar crowns (Figure 10), as well as between the crowns of the elements 11 and 12, which were splinted.
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Frontal and lateral aspects of the patient before (A and B) and after (C and D) the rehabilitation procedure.
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After the installation, all controls were made until the patient was fully comfortable with the denture (Figure 11).
Final aspect of the patient with an improvement of esthetic appearance achieved with minimally invasive prosthetic approach.
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The results were quite satisfactory both functionally as aesthetically (Figure 12).
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