Periodontal Architecture in Ectodermal Dysplasia: An Observational Clinical and Histological Study

OBJECTIVE: To investigate gingival and periodontal characteristics in Ectodermal dysplasia (ED), focusing on soft-tissue phenotype, anatomical variations, and periodontal architecture. MATERIALS AND METHODS: Observational clinical study of 11 individuals (16-30 years) with confirmed clinical or genetic ED diagnosis. Only periodontally healthy patients were included. Assessments comprised Plaque Index and modified Gingival Index, Probing Depth (PD), Bleeding on Probing (BoP), Gingival Phenotype, Widths of Attached Gingiva (AGW) and Keratinized Mucosa (KMW). A histological sample of keratinized gingiva was obtained from a single patient to complement the clinical evaluation. RESULTS: A consistently thin gingival phenotype was found, with medium/thick tissues confined to isolated molars. AGW and KMW were within ranges but unevenly distributed; several mandibular areas showed reduced or absent attached gingiva. Some sites with minimal AGW lacked recession, suggesting a congenital condition. Gingival fragility and translucency complicated standard indices, potentially overestimating PD and BoP. Histology showed epithelial projections into the submucosa and poorly organized connective tissue with loosely arranged collagen and loss of normal supracrestal orientation. Scattered epithelial nests and ectopic enamel matrix deposits are visible within the submucosa. CONCLUSIONS: Individuals with ED may exhibit soft-tissue features and periodontal architecture distinct from typical patterns, supporting the need for tailored clinical assessment and potentially modified diagnostic criteria.