PMC4086548_01
Frontal appearance of the patient
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F1
Extraoral examinations revealed that his hair and eyebrows were sparse, his supraorbital ridges and chin were prominent, protuberant and everted lips with angular cheilitis and reduced lower facial height (Fig. 1) contributed to a senile facial expression.
Self mutilation (A) Scratch marks over his hands,
(B) Peeling of skin in fingers, (C and D) Burn marks on his
palm and legs
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F2
Scratch marks on his hands, peeling of skin in fingers, burn marks on palm of hand and legs, (Figs 2A to D) and multiple scars over his forehead were seen.
Hyperkeratosis of palm of hand
with deformity of nails
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F3
Nails were deformed with hyperkeratosis of palms of his hands (Fig. 3). 
Intraoral view: (A) Lower arch,
(B) Upper arch
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F4
Following teeth were present (Figs 4A and B): 16, 55, 53, 11, 26, 31, 34, 36, 42 and 46.
Orthopantomograph showing hypodontia
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F5
Radiographic evaluation by an orthopantomograph confirmed hypodontia with missing 21, 45, 41 and presence of tooth buds of remaining teeth with delayed root formation (Fig. 5).
PMC4086548_02
PMC4086548_03
Postoperative view after removable
partial denture insertion
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F6
To improve the child's appearance, mastication, and speech, removable dentures were fabricated and inserted (Fig. 6).
Follow-up after 1 year: (A) Lower arch, and
(B) Upper arch
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F7
Every three month recall visits were planned and one year follow up revealed the following erupted teeth- 12, 14, 22 and 32 (Figs 7A and B).