Functional and esthetic rehabilitation of mutilated dentition associated with amelogenesis imperfecta

Impact of complete mouth rehabilitation following Pankey Mann Schuyler versus HOBO Philosophy on Oral Health-Related Quality of Life using Oral Health Impact Profile-14: A randomized clinical trial

Aim

Aim of this in vivo study was to assess the impact of two rehabilitation philosophies namely; Pankey Mann Schuyler (PMS) & Hobo Twin Stage (HOBO) on Oral Health-related Quality of life (OHRQoL) using Oral Health Impact Profile (OHIP 14).

Settings and Design

This was a randomized clinical trial.

Material and Methods

This study was designed based on the PICOT model. 40 patients were selected who need to undergo complete mouth rehabilitation. The intervention performed was complete mouth rehabilitation therapy and the results were compared with that of no intervention. The outcome was assessed in terms of improvement in mastication, phonetics, esthetics and overall OHRQoL (OHIP-14) over a period of 01 year at intervals of 48 hrs, 01 mon, 6 mon and 12 months. Patients were unaware of the treatment philosophy being used and were given a questionnaire (OHIP-14); at baseline (pre-treatment) and 48 hrs, 1, 6 and 12 months after completion of treatment (post-treatment) to evaluate OHRQoL. The data was collected by independent reviewers blinded to the regimen followed making the participants and the outcome assessors blinded to the procedure.

Statistical Analysis

Independent Student's t-test and Chi-Square test were used for analysis.

Result

Analysis illustrated significant differences in scores obtained pre-treatment and post-treatment in both groups at 12 months (P < 0.05). At 12 months, OHIP-14 scores showed a mean percentage change of 51% in Group A (PMS); (P = 0.001) and a mean percentage change of 49% in group B (Hobo).

Conclusion

Complete mouth rehabilitation therapy for management of generalized attrition or mutilated dentition is a viable and effective treatment option and brings about definitive improvement in Oral Health Related Quality of Life (OHRQoL) and overall health status of an individual.

Clear Aligners in Patients with Amelogenesis and Dentinogenesis Imperfecta

Dentinogenesis imperfecta (DI) and amelogenesis imperfecta (AI) are hereditary abnormalities of dental hard tissues. Dental abnormalities may also be accompanied by symptoms of disorders such as osteogenesis imperfecta. AI and DI have a significant burden on socializing, function, and comfort; therefore, frequent screening and accurate diagnosis is the cornerstone of managing such conditions. Both AI and DI could be treated with many strategies, including restorative, prosthetic, periodontal, surgical, and orthodontics treatment. The interdisciplinary combination of orthodontic, prosthodontic, and periodontic treatment has been proven to improve the prognosis of AI and DI. Regarding orthodontic treatment, the most difficult element of orthodontic therapy may be maintaining a high level of motivation for what might be a prolonged form of treatment spanning several years. There are many forms of orthodontic management for AI and DI, including removable appliances, functional appliances, and fixed appliances. Clear aligner therapy (CAT) contains a broad range of equipment that works in different ways, has different construction processes, and is compatible with different malocclusion procedures. The application of CAT in patients with AI and DI is favorable over the fixed applicants. However, the available evidence regarding the application of CAT in AI is weak and heterogeneous. In this review, we discussed the current evidence regarding the application of clear CAT in patients with AI and DI.

Philosophies of full mouth rehabilitation: A systematic review of clinical studies

Aim:

To systematically review the available literature on full mouth rehabilitation of the worn out dentition to help the clinician to choose a suitable philosophy to treat an individual Turner and Missirlian classification.

Settings and Design:

Systematic review following PRISMA guidelines.

Materials and Methods:

The electronic search engine explored for relevant published studies from the earliest available date, from January 1960 till October 2018. Search terms included were “full mouth rehabilitation OR occlusion OR philosophies of full mouth rehabilitation OR oral rehabilitation OR Pankey Mann Schuyler philosophy OR Hobo Twin stage OR Hobo Twin Table OR worn out dentition OR Turner and Missirlian classification”. All collected studies were analyzed and a total of 54 articles and 2 hand searches were extracted, among which 32 articles were selected for the systematic review. Of these 32 articles, 8 were original research studies, 23 case reports and 1 study which comprised 3 case reports were incorporated. Hence, a total of 26 case reports were considered for this systematic review based on CAse REport guidelines.

Statistical Analysis Used:

Qualitative analyisis.

Results:

Among 26 case reports, 15 cases (57.69%) were treated by Pankey Mann Schuyler philosophy, 2 cases (7.69%) by Hobo twin table and 9 cases (34.61%) by Hobo twin stage philosophy. 21 out of 26 cases were introduced for category no. 1 (80.76%) and 4 cases for category no. 2 (15.38%) and only 1case presented for category no.3 (3.84%) of Turner and Missirlian classification.

Conclusion:

No philosophies are universally applicable. Although the most commonly used philosophy is Pankey Mann Schuyler. Hobo Twin stage philosophy is the second most commonly used followed by Hobo Twin table. Maximum patients with worn out dentition are grouped under category no.1 of Turner and Missirlian classification system. Maximum cases of this category are treated by Pankey Mann Schuyler's philosophy.

Immediate Desensitization in Teeth Affected by Amelogenesis Imperfecta

The aim of this paper was to describe a clinical case of immediate dental desensitization using a self-etch adhesive system in an adolescent patient diagnosed with amelogenesis imperfecta (AI). AI was associated with severe tooth sensitivity, treated by the application of a universal adhesive system for desensitization of the teeth affected by AI. Reduction of tooth sensitivity was assessed using a visual analog scale during all reevaluations. The technique was effective for reducing tooth sensitivity. It was concluded that the adhesive system for tooth desensitization had an immediate effect and maintained its effectiveness during a 12-month follow-up period.

Characterization of the nanoscratch, microstructure, and composition in hypoplastic amelogenesis imperfecta

Hypoplastic amelogenesis imperfecta is a widespread hereditary disease that causes the loss of enamel. The purpose of this study was to investigate the nanoscratch resistance of hypoplastic amelogenesis imperfecta for providing a reference for restorative treatment. Four unerupted third molars from a patient diagnosed with hypoplastic amelogenesis imperfecta and seven unerupted third molars from normal individuals were compared. Atomic force microscopy and energy-dispersive X-ray spectroscopy were used to observe the microstructure and composition of the teeth (enamel and dentin). The nanoscratch tests of teeth (enamel and dentin) were investigated using a nanoscratch tester, scanning electron microscopy, and a stylus profilometer. The results indicated that hypoplastic amelogenesis imperfecta teeth had different microstructures compared to normal teeth. Hypoplastic amelogenesis imperfecta demonstrated a higher composition of organic substance. Meanwhile, the friction coefficient of hypoplastic amelogenesis imperfecta was higher than that of normal teeth, and inferior frictional resistance of hypoplastic amelogenesis imperfecta teeth was observed. The main damaging mechanisms observed in hypoplastic amelogenesis imperfecta under nanoscratch were the combination of delamination, debris, and cracks in enamel with delamination, debris, and plastic deformation in dentin. Our findings suggested that new dental restorative materials should be selected to match the mechanical properties of hypoplastic amelogenesis imperfecta.

Noninvasive and multidisciplinary approach to the functional and esthetic rehabilitation of amelogenesis imperfecta: a pediatric case report

Case Report. An 8-year-old girl with amelogenesis imperfecta (AI) reported unsatisfactory aesthetics, difficulty in mastication, and dental hypersensitivity. The intraoral examination observed mixed dentition, malocclusion in anteroposterior relationships, anterior open bite, and dental asymmetry. A hypoplastic form of AI was diagnosed in the permanent dentition. A multidisciplinary planning was performed and divided into preventive, orthopedic, and rehabilitation stages. Initially, preventive treatment was implemented, with fluoride varnish applications, in order to protect the fragile enamel and reduce the dental sensitivity. In the second stage, the patient received an interceptive orthopedic treatment to improve cross-relationship of the arches during six months. Finally, the rehabilitation treatment was executed to establish the vertical dimension. In the posterior teeth, indirect composite resin crowns were performed with minimally invasive dental preparation. Direct composite resin restorations were used to improve the appearance of anterior teeth. Follow-Up. The follow-up was carried out after 3, 6, 12, and 18 months. After 18 months of follow-up, The restoration of integrity, oral hygiene, and patient satisfaction were observed . Conclusion. Successful reduction of the dental hypersensitivity and improvement of the aesthetic and functional aspects as well as quality of life were observed.