PMC6305053_01
Clinic pictures of HED subject 1. (a) Panoramic radiograph at age twelve presented only five permanent teeth being developed on the patient. (b) Cephalometric radiography showed midface underdevelopment. (c) Patient presented with spacing teeth in the maxillary dentition before orthodontic treatment. (d) After orthodontic therapy (age fourteen), space between central incisors were closed. (e) Mandibular oligodontia was presented. Only left first molar was erupted. (f) Loss of vertical dimension of occlusion in profile view. (g) Front view of interim prosthesis in position.
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When the patient turned 12, only five permanent teeth had erupted (Figure 2(a)) and retrognathic maxilla can be noted in the cephalometric radiograph (Figure 2(b)). He received orthodontic therapy which reduced midline diastema and provided more space to accommodate the replacement for the missing lateral incisors (Figures 2(c) and 2(d)). At age fourteen, he had only one molar in the mandible (Figure 2(e)) and did not have any occlusion pair of the teeth. Noticeably, the vertical dimension of occlusion (VDO) was lost (Figure 2(f)). Composite reconstruction was completed in both maxillary central incisors and a maxillary interim removable partial denture and a mandibular removable complete overdenture were fabricated in the Prosthodontic clinic (Figure 2(g)).
PMC6305053_02
Clinic pictures of HED subject 2. (a) Panoramic radiograph at age seven showed tooth germ of permanent central incisors. All other permanent teeth were congenitally missing. (b) Frontal view at age twelve before orthodontic therapy. (c) Front view after completion of orthodontic and restorative treatment with composite veneers on maxillary canines and central incisors. (d) Panoramic radiograph at age eighteen. Underdeveloped alveolar ridge was noted in the edentulous area. (e) Loss of vertical dimension of occlusion and sparse hair and eyebrows are presented in the profile view. (f) The design of overlay cobalt-chrome alloy framework of maxillary prosthesis. (g) The tissue surface of the maxillary prosthesis. (h) Occlusal view of maxillary permanent removable partial denture in position. (i) Occlusal view of mandibular complete overdenture in position. (j) Finish of full mouth habilitation.
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As he grew up, the primary maxillary central incisors were the only shed teeth, and the rest of the primary teeth were preserved without succeeding permanent teeth (Figure 3(a)). Reduction of midline diastema was accomplished and composite veneers were done on the maxillary anterior teeth (Figures 3(b) and 3(c)). His latest oral examination revealed only two permanent teeth and six deciduous teeth (Figure 3(d)). The vertical dimension of occlusion was diminished as well (Figure 3(e)). Leveling of the posterior plane of occlusion was achieved with the fabrication of the maxillary RPD with an overlay cobalt-chrome alloy framework (Figures 3(f)-3(h)). For the mandibular overdenture prosthesis, both mandibular canines served as abutment teeth (Figure 3(i)). Patient was able to accommodate to the new prostheses in a short period of time and reportedly gained not only masticatory and esthetic functions (Figure 3(j)) but also confidence in his daily routine social relations.