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Artculo:

Rehabilitacin bucal con coronas de celuloide

y resina en paciente con displasia ectodrmica

hipohidrtica: Reporte de un caso

Derechos reservados, Copyright 2004:

Facultad de Odontologa, UNAM

Revista Odontolgica Mexicana

NmeroNumber 1-2

Enero-JunioJanuary-June 2004

VolumenVolume 8

edigraphic.com
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Facultad de OdontologaCentenario 1904-2004

Vol. 8, Nms. 1-2 Enero-Junio 2004

pp 43-50 MG

Revista Odontolgica Mexicana

REPORTE DE CASO

edigraphic.com* Alumna de la Especialidad de Odontopediatra. Divisin de Es-

tudios de Posgrado e Investigacin, Facultad de OdontologaUNAM, residente en el Instituto Nacional de Pediatra.

Mdico adscrito al Servicio de Estomatologa del Instituto Na-cional de Pediatra.

Rehabilitacin bucal con coronas de celuloide y resina en pacientecon displasia ectodrmica hipohidrtica: Reporte de un caso

Mnica Martnez Snchez,* Antonia Cadena Galds

RESUMEN

La displasia ectodrmica constituye un grupo de enfermedadeshereditarias caracterizada por la ausencia o pobre desarrollo delos tejidos que provienen del ectodermo, por lo que se ven afecta-

das: piel, pelo, uas, dientes, glndulas sebceas, glndulas ma-marias y pituitaria, tambin hay defectos en el sistema nerviosocentral, se afecta el epitelio sensorial del odo, la nariz y los ojos.El objetivo de este artculo fue la descripcin de la rehabilitacinbucal con coronas de celuloide con resina en un paciente mascu-lino de 3 aos de edad con displasia ectodrmica hipohidrtica,quien presentaba caractersticas propias de su sndrome. Dentrode la exploracin bucal se observaron mucosas sanas, saliva nor-mal, periodonto sano, paladar ntegro, todos los rganos denta-rios de la primera denticin presentes, plano terminal mesial ydientes anteriores superiores e inferiores de forma cnica. Se de-cidi la colocacin de coronas de celuloide con resina 3M Z250,para la rehabilitacin oral del paciente. Se colocaron las coronasen tres citas, debido a la facilidad de la colocacin y a la buenacooperacin del paciente, obteniendo muy buena esttica, exce-lente retencin y restableciendo perfectamente la funcin. No se

tuvieron problemas con el ajuste gingival. La rehabilitacin concoronas de celuloide con resina, resulta muy eficiente para la re-habilitacin de este tipo de pacientes, ya que necesitan un trata-miento a muy temprana edad para su mejor adaptacin social ascomo para una mejor funcin y desarrollo del lenguaje, por lo queeste tratamiento por su facilidad de colocacin es muy rpido yeficaz.

ABSTRACT

Ectodermal dysplasia is an inherited group of disorders that presentlack or absence of ectodermic tissue, thus this affects: skin, hair,nails, teeth, sebaceous, sweat, pituitary and mammary glands, as

well as the central nervous system and the sensory epithelium of theears, nose and eyes. The present review focuses on the descriptionof oral rehabilitation using adhesive bonded full-resin compositecrowns as an aesthetic approach to treating hypohidrotic ectodermaldysplasia in a 3-year-old male child. The patient demonstrated theclassical clinic manifestations of ectodermal dysplasia. Oral examina-tion presented healthy oral mucosa and gingiva, normal palate andsaliva. Primary teeth were complete and presented conoid superiorand inferior incisors. The 3M Z250 composite resin crowns were se-lected for this procedure. Due to the cooperative attitude of the pa-tient and the easy handling of material, they were placed during threesessions, succeeding in the aesthetical results, as well as in the goodretention and the excellent rehabilitation of teeth functions. Marginalgingival adjustment did not presented any complications. Bonded full-resin composite crowns demonstrated to be an efficient treatment forthis kind of patient, as they need early attention in order to accom-

plish accurate language development skills and appropriate chewfunctions, as well as a better social adaptation.

Palabras clave: Displasia ectodrmica hipohidrtica HED. Es un grupo de enfermedades hereditarias con ausencia o pobre desarrollode los tejidos que provienen del ectodermo.Corona de celuloide con composite. Coronas prefabricadas de celuloide, las cuales se rellenan de resina y se colocan sobre el diente arestaurar.Key words: Hypohidrotic ectodermal dysplasia HED is an inherited group of disorders that present lack or absence of ectodermic tissue.Adhesively bonded Full-Resin composite crown restoration.

INTRODUCCIN

La displasia ectodrmica es un grupo de enferme-dades hereditarias con ausencia o pobre desarrollo,de los tejidos que provienen del ectodermo.1,2

Esta patologa fue descrita por primera vez en 1792por Danz. En 1987 se haban informado ms de 200

tipos diferentes, Freire y col. conocen 117 varieda-des difciles de identificar entre ellas.3,4

En la displasia ectodrmica hipohidrtica predominanlos casos de herencia ligada el sexo (gen localizado en

Xq12q13), propia de varones, pero tambin hay unaforma recesiva autosmica, que aparece en nias.2

Los tejidos que se ven afectados son: piel, pelo,uas, dientes, glndulas sebceas, mamarias y pitui-taria, tambin hay defectos en el sistema nervioso
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central, se afecta el epitelio sensorial del odo, nariz yojos. Dentro de las caractersticas clnicas de estesndrome encontramos:

Hipohidrosis que se manifiesta con fiebre de origen

desconocido, intolerancia al calor, hiperpirexia des-pus de los alimentos, piel lisa delgada y blanda.Hipotricosis que se caracteriza por pelo delgado, es-

caso, ausencia de cejas y pestaas escasas. En oca-siones pueden presentar uas en forma de cucharn.

Puede presentarse alteracin de la funcin de lasglndulas salivales, las glndulas lagrimales y suelenser susceptibles a infecciones causadas por disminu-

cin de las glndulas en las mucosas del tracto respi-ratorio y gastrointestinal. En mujeres las glndulas

mamarias son aplsicas o hipoplsicas.La facies de estos pacientes es peculiar, con cabe-

za en forma de tringulo invertido, base del crneo

pequea, cara pequea debido a que la frente es pro-tuberante, puente nasal deprimido y amplio, rbitas de

los ojos prominentes, labios protuberantes, orejas si-tuadas en forma oblicua sobre la cabeza, aumento de

pigmentacin alrededor de ojos y boca. Se han en-contrado diferencias significativas en el desarrollo cra-

neofacial de estos pacientes, principalmente por fac-tores como la ausencia de dientes, mala nutricin yfalta de desarrollo de los msculos masticatorios por

deficiencia masticatoria3,5,6(Figura 1).Dentro de las caractersticas bucales descritas

ms frecuentemente se encuentran anodoncia o hipo-doncia, dientes hipoplsicos o cnicos, falta de desa-

rrollo del proceso alveolar, diferentes grados de xe-rostoma, labios protuberantes, disminucin de ladimensin vertical, Gruckes encontr hipodoncia de

dientes permanentes y los dientes que ms frecuente-mente estaban presentes eran los primeros molares y

los caninos superiores e inferiores y los incisivos cen-trales superiores.3,5,6

Entre los cuidados que requieren estos pacientes te-nemos: control de la temperatura, esto puede ser conbebidas fras, aire acondicionado, antipirticos, ropa li-

gera no exponindose al sol etc. La susceptibilidad ainfecciones causadas por disminucin de las glndulas

en las mucosas del tracto respiratorio y gastrointestinalrequieren de un tratamiento preventivo como vacunas

para el fortalecimiento del sistema inmunitario, etc. El70% de los pacientes tienen problemas de alimenta-cin, los alimentos calientes y secos pueden causar di-

ficultad a la masticacin y deglucin, lo cual se aliviacon el uso de una prtesis dental adecuada, saliva arti-

ficial y alimentos hmedos. En cuanto al crecimiento ydesarrollo requieren de un control cuidadoso, general-

mente los individuos afectados presentan una estaturabaja. Es importante tambin mantener un monitoreo

del habla y del odo. Estos pacientes pueden presen-tar problemas con la secrecin lagrimal que requieredel uso de gotas lubricantes.

La rehabilitacin bucal es importante ya que se

debe devolver la anatoma adecuada a los dientescon malformacin, colocar una dentadura adecuadapara reemplazar los rganos dentarios faltantes,

para as mejorar su esttica, funcin y desarrollo dellenguaje, desarrollo psicolgico, social y emocional.

Implementar medidas preventivas para el cuidado desus dientes y mucosas, es prioritario.5,6

Este tipo de pacientes requieren frecuentemente de

una prtesis removible. La elaboracin de una prtesises un proceso dinmico, que se modifica conforme

avanza el desarrollo de nuestro paciente y as adecuar-la a sus necesidades, se debe motivar a la familia y al

paciente para un uso adecuado de la prtesis. La pr-

tesis removible debe realizarse lo ms tempranamenteposible para evitar un desarrollo inadecuado de la man-

dbula, una posicin inadecuada del cndilo, la prdidade la dimensin vertical, asimismo el nio se acostum-

brar y la har parte de l, adems ayudar a un mejordesarrollo del lenguaje, una mejor alimentacin y un

mejor desarrollo emocional.7,8

Algunos pacientes pueden presentar un colapsomaxilar, desarrollo inadecuado de la mandbula, por lo

que se recomienda tratamiento de ortodoncia.5,8

El uso de implantes en nios es controvertido, ya

que pueden no ser estables por el crecimiento maxi-lar y mandibular, sin embargo se ha cuestionado,

Figura 1. Foto-grafa de frente

de paciente de3 aos con

diagnstico de

displasia ecto-drmica.
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qu tanto pueden funcionar como matriz funcional oqu tanto pueden mantener hueso en el proceso al-veolar. Por el momento los implantes no se reco-

miendan en nios, hasta que no hayan completado

su crecimiento.9-11

La esttica dental es muy importante para estospacientes, ya que por las caractersticas de su sndro-

me su facies es muy peculiar, con apariencia senil,por lo que estos nios comnmente son rechazados

por los dems nios y suelen ser vctimas de crticasy burlas, Hummel en sus estudios encuentra que suspacientes estn sometidos a un estrs por arriba de lo

normal, debido a varios factores, entre los que desta-can su retardo en el desarrollo del lenguaje y aparien-

cia fsica, en la que incluye las anomalas dentarias.12

La odontopediatra restauradora contempornea

ofrece mltiples materiales estticos, sin embargo la

restauracin de los dientes anteriores sigue siendoun problema.13 Los dientes temporales son muy pe-

queos, sin embargo las restauraciones que colo-quemos requieren de mucha retencin y resistencia

a la fractura, as como facilidad para la colocacin dela misma.14 Tradicionalmente han existido 4 opcio-

nes de tratamiento. 1) Las coronas de acero-cromo,que son fciles de colocar, durables, sin embargo noson estticas. 2) Las coronas con frente esttico con

ventana de resina, que son difciles de colocar y tie-nen pobre retencin. 3) Las coronas con frente est-

tico prefabricadas o de resina o acrlico termocura-ble, son estticas, tienen buena retencin sin

embargo es difcil contornearlas, no se pueden este-rilizar y comnmente sufren fracturas o desalojo delfrente esttico.14 4) Las coronas de resina colocadas

con coronas de celuloide ofrecen muy buena estti-ca, resistencia y excelente retencin, sin embargo la

colocacin debe ser muy cuidadosa y es difcil el evi-tar que sangre la enca al adaptar el borde gingival

de la corona de celuloide.14

Para obtener xito al colocar las coronas de resi-na, se recomiendan las siguientes medidas:

Al momento de la examinacin se deber tomaruna impresin con alginato, en la que se ajustan las

coronas de celuloide. Se debe colocar el dique de talmanera que deje ver la enca y la unin del esmalte

con la dentina. Se graba el esmalte con cido fosfri-co al 37% durante 30 segundos, se lava abundante-mente, se retira el exceso de agua con algodn y aire.

Se coloca el adhesivo en todas las superficies y sepolimeriza durante 10 segundos cada superficie. Se

coloca la resina en la corona de acetato, teniendocuidado de no dejar burbujas internas. Se introduce en

el diente con la inclinacin adecuada y se remueven to-dos los excesos en los mrgenes gingivales. Se polime-

riza por 40 seg. Por cada superficie. Se retiran exce-

dentes con una fresa de punta fina de diamante finoy/o liga para resina y se pulen.15

El objetivode este artculo es presentar la rehabi-

litacin bucal de un paciente con displasia ectodrmi-ca hipohidrtica, con coronas de celuloide con resina.

Justificacin. Es de vital importancia para los pa-cientes con displasia ectodrmica una rehabilitacin

temprana de los dientes, ya que si no se hace as, por

la forma anmala de los dientes no tienen un topeadecuado los dientes incisivos inferiores con los supe-

riores as que tienden a desarrollar una clase III deangle, (como se muestra en la figura 2). Presentar la

facilidad y xito de este tratamiento temprano a unpaciente tan pequeo es un precedente que es impor-

tante presentar para as, establecer protocolos de pre-vencin, diagnstico temprano, tratamiento integral,control y seguimiento de pacientes con displasia ecto-

drmica, a la vez permite elaborar estudios a futurosobre el crecimiento y desarrollo del aparato estoma-

togntico en estos nios. La literatura que al respectoen su mayora son casos que no corresponden a ni-

os mexicanos con esta patologa.

PRESENTACIN DEL CASO

Paciente masculino de 3 aos, con diagnstico de

displasia ectodrmica hipohidrtica (DEH). Productode la segunda gestacin, de parto normoevolutivo,

con gestacin de 38 semanas y media, con controlprenatal e ingesta de vitaminas, hierro y calcio duran-

te el mismo. Peso al nacer 2,800 g y midi 50 cm, llo-

Figura 2. Fo-

tografa de pa-

ciente de 10aos con dis-

plasia ectodr-mica quien no

fue rehabilita-

do temprana-mente y desa-

rroll clase IIIde angle.
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sustradode-m.e.d.i.g.r.a.p.h.i.c

cihpargidemedodabor

:rop odarobale FDP

VC ed AS, cidemihparG

arap

acidmoiB arutaretiL :cihpargideM

sustradode-m.e.d.i.g.r.a.p.h.i.c

r y respir al nacer. A los dos das de vida extrauterinainici con fiebre de 39 grados centgrados sin evidenciade proceso infeccioso, tratada con medios fsicos, por

lo que se remiti del Instituto Nacional de Perinatologa

al Instituto Nacional de Pediatra (INP), donde el servi-cio de gentica le diagnostic, displasia ectodrmica hi-pohidrtica. Actualmente es controlado por los servi-

cios de: Gentica, Dermatologa, Otorrinolaringologa yEstomatologa.

Despus de su valoracin al ingresar al INP, acudipor primera vez al Servicio de Estomatologa a los 5meses de edad, para valorar la cronologa y secuen-

cia de la erupcin dental. Se tomaron radiografas an-teroposterior y lateral de crneo, las cuales mostraron

la existencia de criptas seas a nivel de maxilares su-periores e inferiores, sin embargo, no se pudo obser-

var a qu dientes pertenecan. Clnicamente, se ob-

servaron los centrales inferiores de forma cnica yaumento de volumen al nivel de los centrales superio-

res por vestibular, no prximos a erupcionar, por loque slo se les dio a los padres indicaciones de higie-

ne y que deberan esperar para la erupcin de losdientes centrales de 2 a 3 meses.

El paciente regres al Servicio de Estomatologa alos 3 aos de edad, mostrando caractersticas clni-cas clsicas de displasia ectodrmica, incluyendo hi-

pohidrosis, hiperpirexia, piel lisa delgada y blanda,pelo, cejas y pestaas delgadas y escasas. Facies

caracterstica, como forma de la cara en tringulo in-vertido, base del crneo pequea, frente protuberan-

te, puente nasal deprimido y amplio, rbitas de losojos prominentes, labios protuberantes y ligero au-mento de pigmentacin alrededor de los ojos (Figura

1). Dentro de la exploracin bucal se observaron mu-

cosas de revestimiento y masticatorias sanas, salivanormal, periodonto sano, paladar ntegro con muco-sa, sin alteraciones; todos los rganos dentarios de

la primera denticin presentes, plano terminal me-sial, dientes anteriores superiores e inferiores cni-

cos (Figuras 3 a 9), no se observ xerostoma, tam-bin presentaba frecuentes periodos de respiracinoral por propensin a enfermedades respiratorias.

En la radiografa panormica (Figura 10), se ob-servaron todos los rganos dentarios presentes, tan-

to temporales como permanentes, sin embargo, pre-sentaban forma cnica y taurodontismo.

El paciente present una conducta muy coopera-

dora hacia el tratamiento odontolgico por lo que sedecidi la colocacin de coronas de celuloide (Figura

11) con resina 3M Z250 de color A2, para su rehabili-tacin oral.

Se hizo el tratamiento de los dientes incisivos y ca-ninos superiores e inferiores, tomando impresin con

alginato, para obtener modelos de estudio en los quese ajustaron las coronas de celuloide. Este ajusteconsiste en seleccionar una corona preformada de

celuloide que se adapte al tamao del los dientes delpaciente y posteriormente recortar la corona prefor-

mada con unas tijeras delgadas por el borde gingivalhasta que sta se adapte al cuello del diente, es im-

portante que el borde gingival de la corona est liso ysin rebabas del acetato (Figura 12). A la siguiente cita,se le coloc el dique de hule, de tal manera que deja-

ra libre la enca y la unin esmalte dentina. Se grabel esmalte con cido fosfrico al 37% durante 30 se-

gundos. Se lav abundantemente, se retir el excesode agua con algodn. Se coloc el adhesivo en toda la

superficie dental y se polimeriz durante 10 segundoscada superficie. Se coloc la resina 3M Z250 durante30 segundos en la corona de celuloide, teniendo cui-

dado de no dejar burbujas internas (Figura 13). Se in-trodujo en cada diente la corona respectiva con la in-

clinacin adecuada y se removieron todos losexcesos de resina en los mrgenes gingivales. Se po-

limeriz por 40 seg, cada una de las superficies den-tales. Se retiraron las rebabas con una fresa de pun-ta fina de diamante fino o con una lija para resina. Se

realiz el ajuste oclusal y por ltimo se pulieron condiscos una piedra de Arcansas.15

Las coronas de resina colocadas con coronas deceluloide ofrecen muy buena esttica, resistencia,

excelente retencin y restablecen perfectamente lafuncin (Figuras 14 a 16). El mtodo de colocacin

Figura 3. Foto-grafa de sonri-

sa de pacientede 3 aos con

diagnstico dedisplasia ecto-

drmica.
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Figura 4. Fotografa de dientes anteriores superiores e in-

feriores cnicos en paciente de 3 aos con displasia ecto-

drmica hipohidrtica.

Figura 5. Fotografa de dientes anteriores inferiores cni-cos en paciente de 3 aos con displasia ectodrmica hipo-

hidrtica.

Figura 6. Fotografa oclusal superior en paciente de 3

aos con displasia ectodrmica hipohidrtica.

Figura 7. Fotografa oclusal inferior en paciente de 3 aoscon displasia ectodrmica hipohidrtica.

Figura 8. Fotografa lateral derecha de modelos de estu-

dio de paciente de 3 aos con displasia ectodrmica hi-

pohidrtica.

Figura 9. Fotografa lateral izquierda de modelos de estu-dio de paciente de 3 aos con displasia ectodrmica hipo-

hidrtica.
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Figura 10. Fotografa panormica de paciente de 3 aos

con displasia ectodrmica hipohidrtica.

Figura 11. Fotografa de vista de coronas de celuloide in-

fantiles de 3M en varios tamaos.

Figura 12. Fotografa de ajuste de coronas de celuloide enmodelo de estudio.

Figura 13. Fotografa de colocacin de resina en corona

de celuloide.

Figura 14. Fotografa de dientes anteriores, posterior a co-

locacin de coronas en mismo paciente de 3 aos con dis-

plasia ectodrmica hipohidrtica.

Figura 15. Vista oclusal de dientes inferiores, posterior a

colocacin de coronas en mismo paciente de 3 aos condisplasia ectodrmica hipohidrtica.

fue muy rpido y accesible, no se tuvieron problemas

con el ajuste gingival, ya que el diente estaba nte-gro, sin caries y la corona se adapt al borde supra-

gingival del diente. En este caso, la esttica fue muyimportante por razones de adaptacin social, ya que

el paciente, prximamente, iniciara sus actividadesescolares (Figura 17).

DISCUSIN

Randy K Ellis y cols. presentaron un caso de un pa-ciente de 3 aos de edad, con diagnstico de displasia
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tipo de restauraciones.13 Kupietzky y Houpt reportan elcaso de la rehabilitacin de un paciente con DEH, el cualpresentaba dientes cnicos, sin embargo, a diferencia

de este trabajo, ellos decidieron colocar una sobredenta-

dura, ya que el paciente no tena presentes los lateralessuperiores y los incisivos inferiores.5

Itthagarum y King reportan la rehabilitacin de un

paciente femenino con DEH de 6 aos, quien tam-bin presentaba sus dientes anteriores superiores

cnicos. Decidieron devolver la funcin y esttica delos dientes con coronas estticas de resina, sin em-bargo, a diferencia de este caso, ellos decidieron

realizar las coronas de resina indirectamente en unmodelo y posteriormente fueron adheridas a los

dientes. Despus realizaron los ajustes oclusales ne-cesarios.16 Crawford y cols. realizan un estudio en ni-

os con DEH, en donde encontraron frecuentemente

taurodontismo en todos los dientes, en el caso quese presenta, coincide con sus resultado, ya que tam-

bin present taurodontismo en todos los dientes.17

Silvia Vierucci y cols. realizaron un estudio en don-

de encontraron que los pacientes con DEH frecuente-mente presentaban hipoplasia maxilar, dimensin ver-tical disminuida y los msculos de la masticacin

hipotnicos, sin embargo, en el paciente de este casono los presentaba. La hipoplasia maxilar no se pre-

senta, ya que el paciente presentaba todos sus gr-menes dentarios permanentes, no se observ la di-

mensin vertical disminuida debido a la presencia detodos sus rganos dentarios y los msculos de masti-

cacin no se observaron hipotnicos, por no habersido afectada la funcin masticatoria.18

Las coronas de acero-cromo con frente esttico no

se eligieron en este caso, debido a que no ofrecantan buena esttica, requeran de desgaste para su co-

locacin por no haber suficiente espacio interoclusal ovestibulolingual. Por lo que las coronas de acero-cro-

mo con ventana, en este caso, no cumplan con la es-ttica deseada y su colocacin resultaba mucho mslaboriosa, adems de no contar con suficiente espacio

interoclusal para su colocacin, adems de que re-queran de desgaste. El paciente slo tena 3 aos por

lo que se indico un tratamiento que fuera rpido, efi-ciente y no traumtico m2d3gr1 p(h)3c

CONCLUSIONES

La rehabilitacin con coronas de celuloide con resi-na, es muy eficiente para el tratamiento temprano de

pacientes con displasia ectodrmica hipohidrtica. Las resinas actuales garantizan una adecuada ad-

hesin, debido a la apropiada adhesin de los ad-hesivos de 5ta generacin.

Figura 16. Vista oclusal de dientes superiores, posterior acolocacin de coronas en mismo paciente de 3 aos con

displasia ectodrmica hipohidrtica.

Figura 17.Fotografa de

la sonrisa delmismo

paciente con

displasiaectodrmica

hipohidrticaposterior al

tratamiento.

ectodrmica hipohidrtica (DEH), el cual, al igual que el

paciente del caso que se presenta, tenan todos sus r-ganos dentarios temporales superiores e inferiores en

forma cnica. Tambin decidieron rehabilitarlo con coro-nas de resina. La diferencia con este caso es que ellosutilizaron coronas indirectas de resina, argumentando

una mejor polimerizacin, mejor resistencia y menostiempo de trabajo, ya que su paciente no cooperaba y

los padres no aceptaron la anestesia general, por lo querecurrieron a la sedacin, a diferencia de este caso, el

paciente era totalmente cooperador y la resina Z250 de3M garantizaba una adecuada polimerizacin para este
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edigraphic.com

Las restauraciones con coronas de resina coloca-

das con coronas de celuloide son ms eficientesque las sobredentaduras en pacientes con displa-

sia ectodrmica hipohidrtica.

REFERENCIAS

1. Nakata M, Koshiba H, Ero K, Nance W. A genetic study ofanodontia in X-linked hypohidrotic ectodermal dysplasia. Am JHuman Gen1980; 32: 908-19.

2. Cruz M, Bosch J. Atlas de sndromes peditricos. 1a ed. Espa-a: Publicaciones Mdicas Espaxs; 1998: 40-1.

3. Bonilla E, Guerra L. Overdenture prosthesis for oral rehabilita-tion of hypohidrotic ectodermal dysplasia: A case report. Quin-tessence Int1997; 28: 657-64.

4. Santos M, Gmez M. Displasia ectodrmica hipohidrtica: In-forme de tres casos. Rev Asoc Dent Mex1991; 48: 167-70.

5. Kupietzky A, Houpt M. Hypohidrotic ectodermal dysplasia: Cha-racteristics and treatment. Quintessence Int1995; 26: 285-90.

6. Hummel P, Guddack S. Psychosocial stress and adaptivefunctioning in children and adolescents suffering from hypohi-drotic ectodermal dysplasia. Pediatr Derm1997; 14: 180-5.

7. Bakri H, Rapp R, Hadeed G. Clinical management of ectoder-mal dysplasia. J Clin Pediatr Dent1995; 19: 167-72.

8. Franchi L, Branchi R, Tollaro I. Craniofacial changes followingearly prosthetic treatment in a case of hypohidrotic ectodermaldysplasia with complete anodontia. J Dent Chil1998: 116-21.

9. Guckes A, Roberts M. Pattern of permanent teeth present inindividuals with ectodermal dysplasia and severe hypodontiasuggest treatment with dental implants. Pediatr Dent1998; 20:278-80.

10.Guckes A, Carthy G. Brahim J. Use of endosseous implantsin a 3 year-old child with ectodermal dysplasia: case reportand 5-year follow-up. Pediatr Dent1997; 19: 282-5.

11.Smith R, Vargervik K. Placement of an endosseous implant ina growing child with ectodermal dysplasia. Oral Surg, OralMed, Oral Pathol1993: 669-73.

12.Hummel P, Guddack S. Psychosocial stress and adaptive func-tioning in children and adolescents suffering from hypohidroticectodermal dysplasia. Pediatr Dermatology1997; 14: 180-5.

13.Randy E, Donly K, Wild T. Indirect composite resin crowns asan esthetic approach to treating ectodermal dysplasia: a casereport. Quintessence Int1992; 23: 727-9.

14.Charles R, Lee J, Wright T. Clinical evaluation of and parentalsatisfaction with resin-faced stainless steel crowns. PediatrDent2001; 23: 28-31.

15.Croll T, Helpin M. Restorative dentistry for preschool children.Dent Clin North Am1995; 39: 737-69.

16.Itthagarun A, King N. Ectodermal dysplasia: A review and casereport. Quintessence Int1997; 28: 595-602.

17.Crawford P, Aldred M, Clarke A. Clinical and radiographic den-tal findings in X linked hypohidrotic ectodermal dysplasia. JMed Genet1991; 28: 181-185.

18.Vierucci S, Baccetti T, Tollaro I. Dental and craniofacial fin-dings in hypohidrotic ectodermal dysplasia during the primarydentition phase. J Clin Pediatr Dentistry1994; 18: 291-97.

Direccin para correspondencia:Dra. Antonia Cadena GaldsFacultad de Odontologa,Divisin de Estudios de Posgrado eInvestigacin Especialidad deOdontopediatraTel. 56225545
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Rehabilitación bucal con coronas de celuloide

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