Implant-Supported Fixed Dental Prostheses in an Edentulous Patient with Dystrophic Epidermolysis Bullosa

Purpose: This clinical report describes the use of implant-supported fixed dental prostheses (ISFDPs) in a severe case of dystrophic epidermolysis bullosa. Materials and Methods: The patient's appearance was characterized by reduced corporal growth and severe mutilation of the hands and feet. He was first examined at age 20. The severely decayed residual dentition had already been extracted by the time of examination. Conventional dentures were not possible due to severe microstomia and the fragility of the denture-bearing tissues. Even a modest manual touch was very painful and detached the epithelium of the oral mucosa. The first treatment was only possible under general anesthesia. To allow some prospect for oral rehabilitation, four implants were inserted in the maxilla and three in the mandible. Several years of steroid treatment had weakened the bony structures. Therefore, the diameter of the last drill used to prepare the bone for implant insertion was smaller than the diameter of the implants to improve primary stability. Complete FDPs with a shortened dental arch design served as superstructures. Several fractures in the screw-designed titanium abutments in the mandible necessitated insertion of three additional implants and an ISFDP with two occlusal units, which was screwed horizontally to a milled bar mesostructure. Results: Despite multiple fractures of the acrylic resin veneers caused by severe bruxism and the small occlusal surface, this rehabilitation proved successful until the patient died at age 25, as a consequence of his hereditary disease. Conclusion: This treatment greatly improved the patient's oral function, nutrition, and psychosocial well-being.