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Int Poster J Dent Oral Med 13 (2011), No. 1     15. Mar. 2011

Int Poster J Dent Oral Med 2011, Vol 13 No 1, Poster 518

Multidisciplinary approach in the treatment of a patient with Turner syndrome: Case Report

Oral rehabilitation of a patient with Turner syndrome: multidisciplinary approach

Language: English
 

Authors:
Assist. Prof. Anca Jivanescu, Phd student Diana Naiche, Assist. Prof. Luciana Goguta,
University of Medicine and Pharmacy "Victor Babes", Faculty of Dentistry, Department of Prosthodontics, Timișoara, România
Adina Scurtu,
Private Practice, Timișoara, România

Date/Event/Venue:
April 22nd-25th, 2010
15th Congress of the Balkan Stomatological Society (Bass)
I. Vellidis Congress Center, Thessaloniki
 

Introduction

Turner syndrome is a chromosomal disorder in which one of the sex chromosomes is missing or has other abnormalities. Occurring in one out of every 2500 girls, the syndrome manifests itself in a number of ways: short stature, gonadal dysfunction, hypotiroidism, congenital heart disease. Distinct craniofacial features in Turner syndrome include micrognatia, high arch palate and malocclusion.
 

Objectives

In this poster we present a case of a 30 years old female patient with Turner syndrome. (Fig. 1). At the initial presentation she presented a class III malocclusion with periodontal disease at the frontal teeth and multiple carious lesions. (Fig. 2, Fig. 3, Fig. 4) The clinical examination was completed with the orthopantomography (Fig. 5), and study casts (Fig. 6).
The collaboration with the cardiologist was determinant for the treatment sequences. The blood pressure was checked routinely and echocardiogram was performed to evaluate possible cardiac defects.

This study was approved by the Ethical Committee of the University of Medicine and Pharmacy "Victor Babeş" and the patient gave us the written consent for full face photography.

Fig. 1: Full face at the first presentation Fig. 2: The initial smile
Fig. 3: The class III malocclusion: frontal view Fig. 4: Class III malocclusion: lateral view
Fig. 5: Orthopantomography prior to orthodontic treatment
 
Fig. 6: Class III malocclusion: diagnostic cast

Material and Methods

After the initial periodontal therapy and carious lesions treatment, we decide for the orthodontic treatment. The objectives of orthodontic treatment were :space closure, correct overbite and overjet. The orthodontic treatment consisted of upper and lower fixed appliances Roth .022 with bands on the molar (Fig. 7, Fig. 8). The duration of the active treatment was 18 months and it was followed by retention with vacuum formed retainers.
After completing the orthodontic treatment, the patient presented a class III Kennedy partially edentulous maxilla with modification 1 and a class III Kennedy partially edentulous mandible and was referred for the prosthodontic treatment. (Fig. 9)

Fig. 7: The orthodontic treatment consisted of upper and lower fixed appliances Roth .022 with bands on the molar Fig. 8: Lateral view of the occlusion during the orthodontic treatment
 
Fig. 9: Orthopantomography after the orthodontic treatment
 
 

Results

The prosthodontic treatment plan consist in two porcelain fused to metal fixed partial dentures. (Fig. 10, Fig. 11) After the prosthetic rehabilitation was completed, we decide to bleach the two central incisors (external bleaching at 11 and both internal and external bleaching at 21). After two weeks we have restored the incisal edges on central incisors with composite resin, to improve the smile design. (Fig. 12, Fig. 13) The satisfaction of the patient after completing the treatment was an important step in rising her self esteem feeling. (Fig. 14).

Fig. 10: The fixed partial denture on the right mandibular arch Fig. 11: The framework of the lateral maxillary porcelain fused to metal bridge on the cast
Fig. 12: The final smile: frontal view Fig. 13: The final smile : lateral view
 
Fig. 14: Full face at the end of the treatment
 
 

Conclusions

Despite the physical and psychological differences and other problems that can occur in Turner syndrome, with appropriate medical care, interdisciplinary collaboration and ongoing support, a person with Turner syndrome can lead a normal and healthy life. This case revealed a consistent collaboration between the prosthodontist, the orthodontist and the cardiologist, to perform the most appropriate treatment for a 30 years old female patient with Turner syndrome.
 

Literature

  1. Vandewalle KS, Castro GW, Camm JH. Dental treatment of a patient with Turner syndrom.Clin Pediatr Dent. 1993 Fall;18(1):26-30.
  2. Kathy A Russel.Orthodontic treatment for patients with Turner syndrome.American Journal of Orthodontics and Dentofacial Orthopedics, Volume 120, Issue 3, 2001; 314-322
  3. A. Kusiak 1 , J. Sadlak-Nowicka 2 , J. Limon 3 & B. Kochańska . Root morphology of mandibular premolars in 40 patients with Turner syndrome.Int Endodontic Journal., vol 38, No 11, 2005;21-24
     

This Poster was submitted by Assist. Prof. Anca Jivanescu.
 

Correspondence address:
Assist. Prof. Anca Jivanescu
Anghel Saligny street, No 17
Timisoara, 300588
Romania