Clauss Francois, Waltmann Etienne, Barriere Philippe, Hadj-Rabia Smaïl, Manière Marie-Cecile, Schmittbuhl Matthieu
Department of Pediatric Dentistry, Faculty of Dentistry, University Hospital, Strasbourg, France; Reference Center for Dental Manifestations of Rare Diseases, Faculty of Dentistry, University Hospital, Strasbourg, France.
Reference Center for Dental Manifestations of Rare Diseases, Faculty of Dentistry, University Hospital, Strasbourg, France.
J Craniomaxillofac Surg. 2014 Sep;42(6):e346-51. doi: 10.1016/j.jcms.2014.01.037. Epub 2014 Jan 15.
PURPOSE: To report the dento-craniofacial phenotype of a family affected by a WNT10A HED and to describe the implant-based oral rehabilitation of a patient presenting a severe oligodontia linked to this mutation. A molecular hypothesis concerning the involvement of Wnt-β-catenin pathway in implant osteointegration will be proposed. MATERIAL AND METHODS: Patients affected by a WNT10A mutation were included from a large group of HED patients. WNT10A gene was sequenced in second intention for patients negative for EDA-EDAR-EDARADD mutations. Dento-craniofacial phenotype was described based on clinical and radiological data. RESULTS: Severe oligodontia was observed in the patient affected by a compound heterozygous mutation of WNT10A gene. CT exams showed marked maxillary bone hypoplasia in the posterior areas with a sub-normal mandible treatment consisted in the placement of 4 mandibular implants and in 2 implant-supported bridges. In the maxilla, an autogenous bone graft was indicated. The post-operative radiological follow-up showed partial bone resorption of the grafts, treated with ramus bone shaving and a membrane, followed by the placement of 4 maxillary implants. CONCLUSION: Patients affected by WNT10A HED require multi-disciplinary dental diagnosis and treatment. A close post-operative radiological follow-up appears necessary given the biological functions of Wnt-β-catenin in bone repair.
目的:报告一个受WNT10A遗传性外胚层发育不良(HED)影响的家族的牙颌面表型,并描述一名与该突变相关的严重少牙症患者的种植体支持式口腔修复情况。将提出一个关于Wnt-β-连环蛋白通路参与种植体骨整合的分子假说。 材料与方法:从一大组HED患者中纳入受WNT10A突变影响的患者。对EDA-EDAR-EDARADD突变阴性的患者进行WNT10A基因的二次测序。根据临床和放射学数据描述牙颌面表型。 结果:在一名受WNT10A基因复合杂合突变影响的患者中观察到严重少牙症。CT检查显示上颌后部区域明显的上颌骨发育不全,下颌骨发育欠佳。治疗包括植入4颗下颌种植体和2个种植体支持式桥体。在上颌,建议进行自体骨移植。术后放射学随访显示移植骨部分吸收,通过下颌升支骨修整和使用膜进行治疗,随后植入4颗上颌种植体。 结论:受WNT10A HED影响的患者需要多学科牙科诊断和治疗。鉴于Wnt-β-连环蛋白在骨修复中的生物学功能,术后密切的放射学随访似乎是必要的。
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