Prosthodontic Management of Ectodermal Dysplasia with Iliac bone graft and endosseou

Illica crest bone graft Ectodermal DysplasiaProsthodontic Management of Ectodermal Dysplasia with Iliac bone graft and endosseous implants : A case report

Dr Neeraj Nagpal , Dr K L Gupta, Dr Ruchi Nagpal, Dr Dhruv Sharma

ABSTRACT : Ectodermal dysplasia is a rare congenital disease that affects several ectodermal structures . Persons suffering from ectodermal dysplasia may have various manifestations of the disease that differ in severity and may or may not involve teeth, skin, nails , seat and sebaceous glands. The most common form of ectodermal dysplasia syndrome is hypohidrotic ectodermal dysplasia and is usually inherited as an X- linked recessive trait .Female carriers have a variable degree of clinical manifestations . This case report discusses prosthodontic management of an 18 year old female suffering from ectodermal dysplasia . Clinical management consisted of iliac crest autogenous bone graft to augment premaxilla . Later 2 endosseous implants placed in premaxilla and 2 endosseous implants placed in parasymphysis region of the mandible. After Osseointegration of the implants a four unit fixed partial denture placed in maxilla and an implant supported over denture fabricated for mandibular arch. Keywords : Ectodermal dysplasia , Christ Siemens syndrome ,Hypohidrosis , Hypotrichosis , Hypodontia . Introduction : Ectodermal dysplasia is a hereditary disorder manifested as dysplasia of tissues of ectodermal origin primarily nail, teeth skin and occasionally dysplasia of mesoderm derived tissues . As defined by Freire – Maia the nosologic group of Ectodermal dysplasia is any syndrome that exhibits at least 2 of the features ,that is ,abnormal hair (trichodysplasia ) , abnormal dentition , abnormal nails (onchodysplasia ) and abnormal or missing seat glands (dyshidrosis ) [1]. More than 150 different variants of Ectodermal dysplasia have been described [2]. Hidrotic and hypohidrotic are the 2 forms of Ectodermal dysplasia . In both types teeth and hair are similarly affected , but manifestations in nails and s eat glands and the hereditary pattern tend to differ [3] . The X- linked hypohidrotic form or Christ Siemens syndrome is characterized by clinical triad of hypohidrosis , hypotrichosis and hypodontia . Hidrotic form is inherited as an autosomal dominant trait and affects teeth , hair , and nails but usually spares the s eat glands .Prosthodontic rehabilitation is of paramount importance in patients suffering from Ectodermal dysplasia for functional , physiologic and psychologic reasons [1]. Case Report : An 18 year old female named Reena reported with multiple missing teeth since birth. Her parents reported in difficulty in getting her married due to poor look resulting from several congenitally missing teeth. After clinical and radiographic examination the case diagnosed as Anhidrotic Ectodermal Dysplasia . Family history of Ectodermal dysplasia as negative . The young lady as moderately built with hypotrichosis , scarce eyebrows and scarce eyelashes , dry anhidrotic skin , depressed nasal bridge , thin lips ,dark pigmented skin around periorbital area and nose , facial height as reduced ( fig . 1 ) She reported absence of eat and that her lips and tongue remain dry in all climates . There was no relevant effect on the nails . Intraoral examination revealed presence of partially erupted four teeth in the region of 13, 16, 23 and 26 ( fig 2, 3 ). The edentulous ridge as atrophic with decreased height . the palate as shallow , oral mucosa as normal and dry due to less saliva , the tongue as relatively large . OPG X ray depicted poorly developed premaxilla and completely edentulous mandible .( fig 4 ) Surgical and Prosthodontic Management Initially the impacted canine in the mandibular arch as surgically removed ( seen in the OPG fig 1 ). The ridge augumentation of the premaxilla was done with the help of an autogenious bone graft taken from the patients iliac crest( fig 2 ). Hence, the residual alveolar ridge made suitable for the implant placement .Three implants were placed in the mandibular arch in C,B and D positions , followed by the fabrication of an implant supported mandibular overdenture .

In the maxillary arch ridge the ridge augumentation was done with the help of a iliac crest graft Henceforth , a tooth supported fixed prosthesis i.r.t 24,25,26 as fabricated . Followed by the placement of 2 implants in the premaxillary segment .After three months of osseointegration , a four unit implant supported fixed prosthesis replacing 11 ,12 ,21 and 22 as fabricated .

An iliac crest bone graft as harvested ( fig 3 ) and stabilized to augment the premaxilla ( fig 5 ) .The iliac crest is preferentially selected because it is an autogenous cancellous bone graft and is easily harvested and has predictable acceptance and biointegration . After 2 months of bone augmentation 2 endosseous implants were placed in the augmented premaxilla( fig 6 ). Osseointegration of the implants as allowed for four months , followed by fabrication of four unit fixed partial denture prosthesis in 11, 12, 21and 22 regions. Impression as made using elastomeric impression material by putty ash technique .Abutment analogues and implant analogues were placed in the impression . The impression as poured in die stone by split cast technique. Later three endosseous double stage implants were placed in the mandibular arch ( fig 7 ). After four months of Osseointegration , the implants were uncovered , the abutments ere attached and a customized impression as made , after border molding , in rubber base impression material. The mandibular arch rehabilitated with implant supported overdenture ( fig 8 ) due to economical constraints and ease of rehabilitation .The denture as fabricated from heat cured P.M.M.A. (Trevalon powder and liquid , Dentsply ) .The intaglio surface of the denture as relieved and the female housings of the implant attached using autopolymerising acrylic resin P.M.M.A. (Dentsply ) There as marked improvement in speech and the facial esthetics . Discussion The treatment for a patient of Ectodermal dysplasia varies and generally depends on the persons age , dental agenesis , degree of malformation of teeth , the growth and development of the stomatognathic system of the patient and patient’s motivation . According to Nowak [1] treating the ectodermal dysplasia patient requires the clinician to be knowledgeable in growth and development , behavioral management , techniques in fabrication of prosthesis , the ability to motivate the patient in the use of the prosthesis and the long term follow -up for the modification and/ or replacement of the prosthesis . Prosthodontic treatment for ectodermal dysplasia includes removable partial denture or complete denture , overdenture and implants .These approaches may be used either individually or in combination to provide optimal results . Early prosthodontic treatment is generally recommended from the age of 5 years . This early restoration of facial appearance is essential for normal psychological development . [1] . Rapid growth in early life dictates the use of removable partial or complete dentures for these patients. When full growth is reached, treatment planning may include dental implants to retain, support, and stabilize prostheses. Osseointegrated implants offer an alternative that will provide major improvement in the long-term prognosis for oral rehabilitation. In treatment planning for implant dentistry in these patients, extra care must be taken to determine whether adequate bone level to receive the implants is present and whether there is adequate vertical dimension of bone to support the implants. Diminished bone volume may limit the success of implants, especially in the maxilla . The problems associated with complete denture placement in an ectodermal dysplasia case are mainly associated with periodic adjustment due to growth changes and difficulties in achieving good retention and stability [5] .Difficulties in achieving adequate resistance to lateral and anteroposterior displacement of the denture in hypohidrotic ectodermal dysplasia patient are due to dryness of oral mucosa and underdevelopment of maxillary tuberosities and alveolar ridges .[6] If few teeth are present in the mouth, overdentures are the most desirable treatment options [1,3].Overdentures help in preservation of the alveolar bone . Due to decreased number of abutments conventional fixed prosthodontic treatment needs to be altered . Dental implants may be placed in specific areas of the alveolar ridge to gain support for the FPD . For adult patients with ectodermal dysplasia , dental implants are the treatment of choice because growth has stabilized and implants may be used to support , retain and stabilize the prosthesis [1]. In this case of an 21 year old female and the premaxilla being poorly developed . Hence, an iliac crest autogenous bone graft used to augment the premaxilla followed by placement of 2 endosseous implants . The implants were later rehabilitated with a four unit porcelain fused to metal fixed partial denture . The treatment not only improved the patient- s functional and esthetic status (fig 7 ) but also improved the psychological wellbeing and the social life. Conclusion The study discusses the management of a young lady with Anhidrotic Ectodermal Dysplasia having multiple missing teeth and atrophic partially edentulous maxilla and edentulous mandibular ridge . A prosthodontic rehabilitation consisted of bone augmentation of premaxilla with iliac crest autogenous bone graft . Subsequently , 2 endosseous implants were placed to support a four unit fixed partial denture . An implant supported overdenture fabricated for completely edentulous mandibular arch . Hence , physical , physiological and psychological status of the patient as optimally restored . References 1.Pigno MA , Blackman RB ,Cronin RJ ,Cavazos E (1996 ) Prosthodontic management of ectodermal dysplasia :a review of literature . J Prosthet Dent 2.Pinheiro M ,Freire-Maia N (1994 ) Ectodermal dysplasias : a clinical classification and a casual review . Am J Med Genet 53 : 153- 162 3.Bonilla ED , Guerra L , Luna O (1997 ) Overdenture prosthesis for oral rehabilitation of hypohidrotic ectodermal dysplasia : a case report . Quintessence Int 28 (10): 657-661 Tarjan I , Gabrir K , Rozsa N (2005 ) Early prosthetic treatment of patient with ectodermal dysplasia : a clinical report J Prosthetic Dent 93 : 419-424 REFRENCES

1.Hickey A, Vergo JR TJ: Prosthetic treatments for patients with ectodermal dysplasia. J Prosthet Dent 2001;86:364- 368. 2.Guckes AD, Scurria MS, King TS, et al: Prospective clinical trial of dental implants in persons with ectodermal dysplasia. J Prosthet Dent 2002;88:21-25. 3.Dhanrajani PJ, Jiffry AO: Management of ectodermal dysplasia: a literature review. Dent Update 1998;25:73-75 4.NaBadalung DP: Prosthodontic rehabilitation of an anhidrotic ectodermal dysplasia patient: a clinical report. J Prosthet Dent 1999;81:499-502 5.Pigno MA, Blackman RB, Cronin RJ, et al: Prosthodontic management of ectodermal dysplasia: a review of the literature. J Prosthet Dent 1996;76:541-545 6.Blattner RJ: Hereditary ectodermal dysplasia. J Pediatr 1968;73:444-447 7.Davarpanah M, Moon JW, Yang LR, et al: Dental implants in the oral rehabilitation of a teenager with hypohidrotic ectodermal dysplasia: report of a case. Int J Oral Maxillofac Implants 1997;12:252-258 8.Bolender CL, Law DB, Austin LB: Prosthodontic treatment of ectodermal dysplasia. A case report. J Prosthet Dent 1964;14:317-325 9.Snawder KD: Considerations in dental treatment of children with ectodermal dysplasia. J Am Dent Assoc 1976;93:1177-1179 10.Guckes AD, Brahim JS, McCarthy GR, et al: Using endosseous implants for patients with ectodermal dysplasia. J Am Dent Assoc 1991;122:59-62 4. Sha RM (1990 ) Prosthetic management of hypohidrotic ectodermal dysplasia with anadontia : case report . Aust Dent J 35 : 113-166

Innovation And Advanced Technology in Eureka Forbes Products

A company that runs one of the largest networks in India
catering to more than 145 cities and 398 towns, an identity identified
with the phrase ‘friends for life’, a firm that has maintained a
dominant market presence for thirty years now – it is all about Eureka
Forbes Ltd. The very utterance of the name of Eureka Forbes Ltd. will
transport you to a terrain of health care appliances, security
solutions, and a green world. The product portfolio encompasses water
purifiers, vacuum cleaners, and air purification system, designed to
facilitate a healthy living for people at large. Security products from
Eureka Forbes Ltd. are designed to help consumers lead a secured life.
The recently added solar solutions are directed towards saving energy
and saving the earth. Using solar lighting solutions, you can be a part
of the group of people who pledge to contribute towards maintaining and
creating a green earth. Part of the company’s products is available via
direct sales. The 15,000 strong dealer sales network and over 58
distributor industrial sales network ensures that Eureka Forbes Ltd.
products are available in every corner across the country. A team of
7500 direct personnel facilitates delivery and installation of the
ordered products right at the consumers’ doorsteps on time. Then certain
products from Eureka Forbes Ltd. are available at all leading consumer
durable, home appliance and modern organized retail outlets. Both the
types are available under different brands.

When we speak about the Eureka Forbes water purifier
series available at retail outlets, we mean the AquaSure series. You
will come across numerous categories with each category having different
models to suit varied preferences and budget. If you want an RO Eureka
Forbes water purifier, there are at least three models to choose from,
viz. Spring fresh DX, Elegant RO, and Nano RO. Under the UV category,
you may opt any of Crystal, Elite UV, Smart UV, and Aquaflow Dx. Then
there are two low cost advanced storage Eureka Forbes water purifier
systems, viz. AquaSure Amrit with Kitanu Magnet and AquaSure Xtra. Blend
system includes the AquaSure RO+UV.

is not only innovation, superlative quality, purification
effectiveness, and advanced technology that every Eureka Forbes water
purifier is known for. Effective customer care and excellent after sales
service support hold equal importance! Users of the Eureka Forbes water
purifier never complain about service support. The company never leaves
any scope for grievance in this aspect.

What Is Sales Recruitment And Who Conducts It

Recruitment activities are sometimes conducted by the organization itself, or it can be outsourced to an external agency that specializes in sourcing and screening candidates.

The recruitment industry operates through four main types of media: (i) employment agencies, (ii) “head hunters”, usually for executive level sales recruitment roles, (iii) in-house recruitment, usually via an internal Human Resources department, and (iv) passive candidate research firms.

The stages involved in sales recruitment can vary depending on the needs of the organization and the type of sales role in question. Generally, recruitment for most types of jobs involves several steps and includes sourcing candidates by advertising or “head hunting”, followed by screening and selecting candidates using tests and interviews.

Agency Types

There are four main types of agencies who conduct recruitment, with some agencies specializing in certain job markets, for example sales recruitment or hospitality recruitment or secretarial recruitment.

The recruitment agencies are usually paid by the companies wanting to fill a position, and not the candidates.

Traditional Agency

Traditional agencies are also known as employment agencies. Candidates can and do approach them directly, either by responding to an advertised vacancy, or to register onto the agency’s books. Recruitment consultants then work to match their pool of candidates to their clients’ vacant positions.

Those candidates who best meet the selection criteria of the vacancy are short-listed and put forward for an interview with their clients.

Recruitment agencies are usually paid a contingency fee by the client once a recommended candidate accepts a job with the client company.

Typically, the fee is 20% to 30% based on the appointee’s first year base salary and usually comes with some form of guarantee (30 to 90 days is standard). Should the appointee fail to perform or leaves the company during the guarantee period, the agency would normally offer a replacement candidate at no further cost to the client company.


A ‘headhunter’ is a term used to describe a recruiter who seeks out candidates, often when the usual recruitment processes (e.g. advertising through an agency) fails. Headhunters usually have extensive industry experience and source their candidates through their contacts. There are headhunters who specialize in the sales recruitment industry.

However, because headhunters typically charge more than agencies (often more than 30% of the candidate’s annual compensation), they are usually employed to fill more senior sales management and executive level sales roles.

In-house Recruitment

Larger employers often will undertake their own in-house sales recruitment, usually through their human resources (HR) department. In-house HR staff either (i) co-ordinate external recruitment agencies who have been commissioned to find staff for the company, or (ii) conduct the end-to-end recruitment processes themselves, from advertising through to interviewing and hiring.

Passive Candidate Research Firms / Sourcing Firms

These firms conduct research to identify potential candidates and generate information about them. Often these research firms uncover candidates that cannot be found using other, more traditional methods. These firms usually charge a per hour fee or by candidate lead.

What is a High Yield Investment Program ( HYIP )

A high yield investment program (or HYIP) is one of the most interesting investments out there. However, like a number of investment opportunities, it has been the target of a number of scams.

The simple version is that it is an investment method that offers a high rate of returns with some risk. The investor can invest small amounts into a HYIP, which can, if it does well, yields a higher-than-normal rate of return, which you can then cash out or re-invest. While investing, you can discuss how the investments are doing and find out about scams on websites called monitors, which keep an eye on how HYIPs do.

The slightly more interesting version is that an investor sets up an account with an HYIP, and then invests a certain amount of money into the HYIP, which can be for either very small amounts or for large amounts, depending on how much you want to invest. You decide when to pull out, and then what to do with the funds.

However, be advised that it is an investment and carries with it all the risks of an investment. As such, there is the real possibility of losing the money that you invest, for all the usual reasons. Dont invest more than you can lose, and thoroughly check out the investment before giving the HYIP a single cent, just as you would any other potential investment. And be aware that, just like other investment, there are some HYIPs that are scams.

Using an HYIP as a scam is abetted by a number of factors. The first is the mystique of investing; too many people jump into investing without really bothering how it works, and hoping to get something big for something little. There is also that it relies on e-gold, which, although it has a number of advantages, but transfers cant be reversed; unlike a credit card, if a transaction goes wrong, you cant get the money back. The last is that it looks like just another HYIP, and can therefore fool most people into putting money into it, which then disappears.

Another part of the problem is that they can be easily be used for ponzi schemes, either fueling one or being the bottom layer of one. Just be watch out for very-well performing HYIP, including those with an outrageously high rate of returns, and trust the monitor sites.

Although it can be a great opportunity, you need to go into it with your eyes open. If you find a scam, then report it to the nearest Treasury office or monitor website. If you dont, then you may have just found the way to an early retirement.

Packaging Your Product For Major Retail Success

It is absolutely vital that you spend the time and effort developing effective packaging. Packaging can be the difference between a sale and a buyer walking away. There are so many amazing product concepts that just don’t get realized by Major Retailers because of packaging that isn’t working for the product inside.

If you put yourself in Buyers shoes an think about your own shopping habits, packaging is the first thing a customer sees when entering into a store or looking online. If the packaging isnt attractive or clear, customers wont be interested and therefore won’t buy – its as simple as that. Understandably, this makes spending time on packaging essential to Major Retail success.

But how do you know if you are on the right track with packaging your product?

Here’s three great questions to ask yourself and really think about when preparing your product for Major Retail success:

1. Does my packaging convey a clear message of what the product is or does?

If someone picked up your product in its current packaging would they know immediately what it was and what it does? If not, then you know you have a problem. You’ve got to make sure that your message is clearly conveyed on your packaging. Many people decide within a few seconds as to whether they want to buy your product or not, so it is vital that you display a clear visual experience for the customer as to what the product is and how it can help them.

2. Does the packaging look good? Is it appealing?

You might think that you’ve created the most awesome packaging ever, but if no one else agrees, then bam, you have another problem. Your packaging must be attractive, concise and enticing. How do you know that you are on the right track? Ask people! Ask your friends, family, colleagues, people on the street ask anyone who can give you an honest answer. Tell them you need the truth, not a compliment. Youd be amazed at how brutally honest people can be!

3. Is the package size comparable with its competition?

If you go to a store and see that your competitors’ packaging is 3 times smaller than yours, then you know you have a problem. Make sure your product aligns with how much space a buyer has to work with. There is a reason why buyers chose to layout their space in a store in a particular way – they are allotted limited space for their category or categories. So pay attention and be respectful for how much room a buyer has to work with. If they love your product but can’t fit it in, you’re just hurting your own sales.

If you know you have a problem, or even if you are not 100% convinced that you are on the right track with packaging, then don’t be shy and get some help! Look for a company or packaging expert that specializes in product packaging for your product type. Working with an experienced packaging expert can save a tremendous amount of time, money and headache!

At the end of the day, the more energy and time you put into having the best packaging the better. So take the time to prepare your packaging and you will be on your way to Major Retail success!

Visit Design your own for more free advice and information.