Outcome of restorative treatment in young patients with amelogenesis imperfecta. a cross-sectional, retrospective study

Amelogenesis imperfecta: Analysis of the genetic basis and treatment with a digital workflow: A clinical report

A 20-year-old woman with type I hypoplastic amelogenesis imperfecta (AI) experiencing esthetic concerns and hypersensitivity is presented. The treatment was aimed at both functional and esthetic aspects, focusing on complete mouth rehabilitation using a fully digital workflow. In an interdisciplinary approach, a multigene panel analysis was performed. Digital intraoral scans and a face scan facilitated precise virtual planning, guiding minimally invasive preparations. Long-term interim restorations milled from high-performance polycarbonate preceded definitive restorations in translucent zirconia. This approach resulted in a time- and cost-efficient treatment, helped the patient to understand her disease by highlighting the pivotal role of genetics, and demonstrated the success of collaborative dental interventions. A strict recall program will be most important for the long-term success of this patient with AI and a pathogenic frameshift variant in the AMELX gene.

Partial Amelogenesis Imperfecta: A Report of a Rare Case

Amelogenesis imperfecta is a collection of genetic disorders that impair the structure of dental enamel. The condition presents in a variety of ways, affecting enamel development, mineralization, and maturation. Amelogenesis imperfecta can follow various inheritance patterns, including autosomal dominant, autosomal recessive, sex-linked, and sporadic. This case report describes a 22-year-old female diagnosed with amelogenesis imperfecta. The patient's clinical presentation, diagnostic process, and comprehensive treatment approaches are discussed, emphasizing the importance of multidisciplinary care in improving functional and esthetic outcomes. Treatment is ongoing and aims to improve both functional and esthetic outcomes. This case report details the presentation, characteristic radiographic findings, and management discussion of a patient presented with a rare condition that is termed "partial amelogenesis imperfecta."

Surgical, orthodontic, and prosthetic management of amelogenesis imperfecta associated with severe open bite: a case report

Amelogenesis imperfecta refers to a group of hereditary diseases that affect dental enamel, often leading to a wide range of clinical manifestations and aesthetic concerns. This case report describes a female patient diagnosed with amelogenesis imperfecta associated with a skeletal open bite. The treatment approach was multidisciplinary. Periodontal therapy was initiated, followed by orthodontic treatment using brackets on temporary crowns to expand and coordinate the maxillary and mandibular arches. Subsequently, orthognathic surgery, including a LeFort I osteotomy and genioplasty, was performed. The fixed prosthodontic rehabilitation performed with metal-ceramic crowns was the last step of the treatment. The final result was both functionally and esthetically satisfactory for the patient.

Advances in clinical diagnosis and management of amelogenesis imperfecta in children and adolescents

OBJECTIVE

To summarize studies published between 2017 and 2023 examining the clinical diagnosis and restorative management of amelogenesis imperfecta (AI) in children and adolescents.

DATA

The review incorporated publications on clinical diagnosis, patient-reported outcomes, clinical trials, cohort studies, and case reports that included individuals below 19 years of age with non-syndromic AI.

SOURCES

A literature search was conducted across electronic databases, PubMed, Web of Science, and CINAHL, including papers published between 2017 and 2023. The search yielded 335 unique results, of which 38 were eligible for inclusion.

RESULTS

New evidence on the genetic background of AI makes it now advisable to recommend genetic testing to supplement a clinical AI diagnosis. The discussions of the dental profession and the public on social media do not always incorporate recent scientific evidence. Interview studies are finding that the impact of AI on quality of life is more severe than previously appreciated. New evidence suggests that single-tooth ceramic crowns should be the first choice of treatment. Due to incomplete reporting, case reports have been of limited value.

CONCLUSION

In young patients with AI symptoms of pain and hypersensitivity decreased, and aesthetics were improved following all types of restorative therapy. Resin composite restorations were mainly performed in cases with hypoplastic AI and mild symptoms. Single tooth ceramic crown restorations have a high success rate in all types of AI and can be used in young individuals with AI.

CLINICAL SIGNIFICANCE

Prosthetic rehabilitation in adolescents with severe AI is cost effective, improves esthetics, reduces tooth sensitivity, and improves oral health-related quality of life.

Dental treatment approaches of amelogenesis imperfecta in children and young adults: A systematic review of the literature

OBJECTIVE

The aim of this review was to compare various types of restorations used in children and young adults affected with amelogenesis imperfecta (AI) to determine the most effective restorative treatment.

METHODS

This systematic review included randomized controlled trials, retrospective and prospective cohorts conducted on children and young adults diagnosed with amelogenesis imperfecta and written in French or English. A systematic search was conducted using four databases, namely Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, Science Direct and Scopus, using a selection of MeSH terms: "Amelogenesis Imperfecta," "Therapeutics," "Treatment Outcome," "Adult, young," "Child," "Dental Restoration, Permanent," "Dental Restoration, Temporary," and "Esthetics, Dental."

RESULTS

Out of 138 articles identified in the initial search, four articles met all the inclusion criteria. The results showed that ceramic restorations had better quality scores and longevity compared to other restorations.

CONCLUSION

Ceramic restorations could be considered the restorative treatment modality of choice for AI-affected children and young adults. However, more high-quality clinical trials involving young patients affected with AI are required to evaluate and compare the outcomes of different restorative approaches.

CLINICAL SIGNIFICANCE

Young patients affected with amelogenesis imperfecta usually suffer from low self-esteem, psychological problems and social avoidance, caused by the alteration of teeth such as discoloration, sensitivity, fractures and reduced size. For the dentist, selecting the appropriate restorative treatment for AI in young patients could be a veritable challenge. Therefore, it is important to have an evidence-based modality. For this reason, in this review, the different restorative approaches used in AI-affected young patients were compared to recommend the most effective treatment.

Etiology, Classification, and Restorative Management of Amelogenesis Imperfecta Among Children and Young Adults: A Scoping Review

Amelogenesis imperfecta (AI) is a rare genetic disorder affecting children and adults. Knowledge about AI is limited to clinical representation and radiographical findings. Various treatments are provided to children with AI, yet no definitive treatment guideline has been suggested in the literature. This scoping review highlights the knowledge of the etiology and classification of AI and synthesizes these findings in a comprehensive review, focusing mainly on the various forms of AI in children and management with a restorative conservative approach. Five electronic databases, namely, PubMed, Google Scholar, Embase, Web of Science, and Scopus, were searched for the relevant articles. The search was performed in two phases: first for title and abstract, and second for full-text articles. The studies included in this scoping review were published from 2013 to August 2023. The data extraction was done on a customized sheet. A total of 33 studies were included in this review, of which 19 were reports and series, seven were observational, and seven were reviews. Most patients included in this review suffered from the hypoplastic type of AI (54%), followed by hypomatured (36%), and hypocalcified (10%). The treatment modalities explained were divided into the following three phases: temporary, transient, and permanent. Almost all included reports suggested the requirement for guidelines for treating AI among young children. This scoping review suggests the need for guidelines for treating AI in children. Moreover, pediatric dentists should prioritize early diagnosis and treatment and long-term follow-up for AI in children to effectively enhance the patient's psychological well-being and overall quality of life.

Digital restorative workflows for developmental dental defects in young patients: A case series

BACKGROUND

Digital technology is rapidly changing the provision of oral health care, although its adoption for the oral health care of young patients has lagged. The authors describe digitally supported treatment approaches for managing treatment of developmental dental defects in the early permanent dentition.

CASE DESCRIPTION

Four adolescent patients with amelogenesis imperfecta received transitional anterior restorations for esthetic and functional rehabilitation using a variety of digital workflows. Combinations of restoration type, materials, and fabrication methods were selected to meet the needs of each patient on the basis of their specific amelogenesis imperfecta phenotype and chief symptoms. These cases highlight the application of digital technology in pediatric and adolescent dentistry for managing the treatment of developmental dental defects.

PRACTICAL IMPLICATIONS

Digitally supported restorative approaches, as described in this report, offer broad applicability of materials and techniques directed at treating the complex restorative needs of young patients in the transitional and early permanent dentition.

Managing vertical dimensions in patients with Amelogenesis Imperfecta: A case report

Amelogenesis imperfecta (AI) is a heterogeneous group of conditions characterized by inherited developmental defects of enamel. Patients with AI often have progressive and severe loss of occlusal vertical dimensions (OVD), resulting in challenging dental rehabilitation. In this case report, we present the management of a 24-year-old male patient who previously underwent orthodontics, direct and indirect restorations, and continued to have progressive tooth wear. His vertical dimensions were restored in two phases, firstly with provisional restorations at the improved OVD, followed by a combination of monolithic zirconia and lithium disilicate full-coverage crowns. A removable acrylic appliance was then constructed to protect his teeth. This report emphasizes the importance of preserving and protecting the OVD from an early age to prevent more costly and complicated management in future.

Identification of a Novel FAM83H Mutation and Management of Hypocalcified Amelogenesis Imperfecta in Early Childhood

Amelogenesis imperfecta (AI) is a heterogeneous group of rare genetic disorders affecting amelogenesis during dental development. Therefore, the molecular genetic etiology of AI can provide information about the nature and progress of the disease. To confirm the genetic etiology of AI in a Korean family with an autosomal dominant inheritance, pedigree and mutational analyses were performed. DNA was isolated from the participating family members and whole-exome sequencing was performed with the DNA sample of the father of the proband. The identified mutation was confirmed by Sanger sequencing. The mutational analysis revealed a novel nonsense mutation in the FAM83H gene (NM_198488.5: c.1363C > T, p.(Gln455*)), confirming autosomal dominant hypocalcified AI. Full-mouth restorative treatments of the affected children were performed after the completion of the deciduous dentition. Early diagnosis of AI can be useful for understanding the nature of the disease and for managing the condition and treatment planning.

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.

Patient-reported outcome measures in individuals with amelogenesis imperfecta: a systematic review

PURPOSE

Amelogenesis imperfecta (AI) is a hereditary condition which affects the composition and structure of enamel in terms of hypoplasia and/or hypomineralization. The condition severely affects patients facing such difficulties as hypersensibility, loss of tooth substance and poor aesthetics. The objective is to perform a systematic review of patient-reported outcome measures (PROMs) in patients with amelogenesis imperfecta.

METHODS

Inclusion criteria were articles written in English, including PROMs from patients with amelogenesis imperfecta. The databases PubMed, Scopus and Web of Science were searched on April 27, 2022, and eligible articles were screened. Exclusion criteria were articles based on proxy reports and single case reports.

RESULTS

405 studies were screened in terms of title and abstract, with 31 articles eligible for full-text screening, resulting in a total of 11 articles eligible for inclusion, (articles including 4-82 patients). The content was analyzed, resulting in the outcome divided into seven domains: Oral Health-Related Quality of Life (OHRQoL), Dental fear, Esthetics, Psychosocial factors, Function, Dental hypersensitivity, and Treatment outcome.

CONCLUSION

The limited quantity of research on PROMS from patients with AI indicates a significant impact of OHRQoL and daily life. A large variety of approaches have been presented in the articles. Patients report concerns of esthetics, hypersensitivity, function, and a general impact on well-being and social interaction. This highlights the importance for the need of early dental treatment.

PROSPERO REGISTRATION NUMBER

256875.

Esthetic and Functional Rehabilitation of an Adolescent Patient with Severe Dental Fluorosis: A Clinical Report

Dental fluorosis is a developmental defect affecting amelogenesis. It presents clinically in different forms depending on the concentration, duration, and time of exposure to fluoride. Several therapeutic modalities have been described to manage mild and moderate forms of dental fluorosis; however, limited literature is available on the restorative management of severe forms of dental fluorosis, specifically in young individuals. This clinical report describes a complete prosthodontic rehabilitation of an adolescent patient with severe dental fluorosis affecting his permanent dentition. The patient was treated with a combination of monolithic, minimally-veneered zirconia crowns and direct composite resins. At the 1-year follow-up appointment, there were no complications, and both the patient's oral health and the integrity of the restorations remained stable.

Cost analysis of prosthetic rehabilitation in young patients with Amelogenesis imperfecta

OBJECTIVES

Children and adolescents with amelogenesis imperfecta (AI) have extensive treatment needs, but costs have not been explored previously. We calculated the costs of prosthetic rehabilitation and analyzed whether costs of treatment begun in early adolescence are lower compared with in early adulthood.

METHODS

Data from the dental records of 25 patients with AI and 25 age- and sex-matched controls were analyzed. Patients were followed for a mean period of 12.3 ± 1.5 years. Number of dental visits, dental treatment costs, and indirect costs were calculated during three time periods, before, during and after prosthetic therapy. Swedish national reference prices for general and specialist dental care were used.

RESULTS

The mean number of visits was significantly higher in the AI group: 43.3 ± 19.7 (controls: 17.5 ± 19.8; p < .001). Mean total costs were 8.5 times higher for patients with AI: €16,257 ± 5,595 (controls: €1,904 ± 993). Mean number of crowns made in patients with AI was 12 ± 7 (range 1 - 31). Indirect costs were significantly higher in the AI group and constituted 22% of the total costs. After crown therapy, costs between groups ceased to differ significantly. Calculations of total costs in the hypothetical scenario (discount rate at 3% annually) were €18,475 for prosthetic rehabilitation began at age 12 years compared with €20,227 if treatment began at 20 years of age.

CONCLUSIONS

Prosthetic rehabilitation costs for children and adolescents with AI can be high. Early crown therapy is associated with lower costs and a lower number of dental visits.

CLINICAL IMPLICATIONS

Early crown therapy in children and adolescents with severe AI is a cost-reducing treatment associated with few complications and reduced need of dental care during adolescence compared with treatment begun at age 20.

DMF Index among Amelogenesis Imperfecta Patients: Systematic Review of the Literature

Objectives

The aim of this study was to explore the literature in order to assess systematically the association between amelogenesis imperfecta (AI) and caries development and to evaluate the DMF index among AI patients. Basic Research Design. PubMed was used to explore the database Medline. The key words used were “Amelogenesis Imperfecta” [Mesh], “Dental Caries” [Mesh], “Tooth Loss” [Mesh], “DMF Index” [Mesh], and “Dental Restoration, Permanent” [Mesh]. Moreover, an ad hoc search was performed in order to make the study as exhaustive as possible.

Results

Fifty-five articles were retained. The total number of patients gathered was 499. A percentage of 68.8% of the articles dealt with cases with a relatively low dental caries process, 20.8% dealt with cases in which the dental caries process was relatively moderate, and 10.4% dealt with cases in which the dental caries process was severe. Teeth extraction due to dental caries was mentioned in 10 articles. Eleven articles, concerning 53 patients, mentioned dental fillings. Four patients did not have dental filling due to dental caries. DMF index was very low in 2 articles and low-to-high in 3 articles.

Conclusion

Low dental caries susceptibility with AI patients was noticed in this study. A possible factor could be the lack of proximal contacts and elimination of fissures through enamel loss. The lack of dental caries susceptibility was also explained by the microbacterial specificity of hypoplastic AI patients. Moreover, it was also noted that the prevalence of dental caries among AI patients depends on sociodemographic change.

Restorative Treatment of Amelogenesis Imperfecta with Prefabricated Composite Veneers

This case report presents the use of prefabricated composite veneers for restorative treatment of amelogenesis imperfecta (AI). This technique bridges the gap between a conventional direct technique and a conventional indirect technique and introduces an alternative semidirect restorative technique for AI patients. The aim of this case report is to describe restoration of a young girl with severe AI using prefabricated composite veneers and to discuss the benefits and limitations of this technique compared to the alternative restorative techniques.

A custom screw-retained implant-supported prosthesis for a patient with amelogenesis imperfecta: An 8-year clinical follow-up

This clinical report with an 8-year follow-up describes the multidisciplinary management of a patient diagnosed with amelogenesis imperfecta. The rehabilitation included horizontal-guided bone regeneration, implant placement, use of a fixed interim prosthesis to preview the correction of occlusal disharmonies, and placement of a custom screw-retained definitive implant-supported restoration with a design that was retrievable and minimized maintenance problems.

Restorative treatment in a case of amelogenesis imperfecta and 9-year follow-up: a case report

Background

Amelogenesis imperfecta is a hereditary malformation showing various manifestations regarding enamel dysplasia. This case report shows a 9-year follow-up after restorative treatment of a 16-year old female patient affected by a hypoplastic type of amelogenesis imperfecta. The caries-free, hypersensitive teeth of the patient were restored by direct dentin adhesive composite restorations performed in total etch technique.

Case presentation

After rehabilitation the patient reported a marked improvement of the mastication ability and quality of life especially during food intake. Accumulation of plaque was reduced and the ability to perform adequate oral hygiene was improved. During follow-up of 9 years recurring secondary caries and debonding of fillings were recognized and retreated.

Conclusions

The retrospective assessment exhibits that the performed restorative treatment prolonged the time until further treatment has to be considered, such as prosthetic treatment.

Gingival inflammation, enamel defects, and tooth sensitivity in children with amelogenesis imperfecta: a case-control study

Gingival conditions and tooth sensitivity of young patients with amelogenesis imperfecta lack in depth studies. This case-control study aimed to compare (1) the gingival inflammation, the presence of enamel defects, and tooth sensitivity in young patients with and without amelogenesis imperfecta and (2) to investigate if any difference exists between subtypes of amelogenesis imperfecta.

Comparison of four different treatment strategies in teeth with molar-incisor hypomineralization-related enamel breakdown-A retrospective cohort study

BACKGROUND

There is little information available on the longevity of non-invasive glass ionomer cement (GIC) and composite restorations as well as conventional composite and ceramic restorations placed on permanent teeth with enamel breakdowns due to molar-incisor hypomineralization (MIH).

AIM

To compare the longevity of the abovementioned treatment procedures.

DESIGN

Of 377 identified MIH patients, 118 individuals received restorative treatment and were invited for clinical examination, including caries and MIH status. Finally, survival data from 204 MIH-related restorations placed on 127 teeth were retrospectively collected from 52 children, monitored between 2010 and 2018. Descriptive and explorative analyses were performed, including Kaplan-Meier estimators and the Cox regression model.

RESULTS

The mean patient observation time was 42.9 months (SD = 35.1). The cumulative survival probabilities after 36 months-7.0% (GIC, N = 28), 29.9% (non-invasive composite restoration, N = 126), 76.2% (conventional composite restoration, N = 27) and 100.0% (ceramic restoration, N = 23)-differed significantly in the regression analysis.

CONCLUSIONS

Conventional restorations were associated with moderate-to-high survival rates in MIH teeth. In contrast, non-invasive composite restorations, which were predominately used in younger or less cooperative children, were linked to lower survival rates.

Amelogenesis imperfecta with Class III malocclusion, reduced crown size and decreased OVD: A multi-disciplinary management and a 5-year follow-up

This clinical report describes the oral rehabilitation of a 22-year-old-man diagnosed with a variant of hypoplastic amelogenesis imperfecta. The treatment approach was multi-disciplinary, and it included the surgical procedure of Lefort I osteotomy, surgical crown lengthening, and metal-ceramic-fixed dental prostheses. The patient was satisfied with the esthetic and functional outcome.

Retrospective study of patients with amelogenesis imperfecta treated with different bonded restoration techniques

OBJECTIVE

The aim of this retrospective study was to evaluate clinical success and satisfaction of patients with amelogenesis imperfecta treated with three different types of bonded restorations at a university clinic.

MATERIALS AND METHODS

One hundred fifty-four restorations in 15 subjects with mean age of 17.3 years (SD 8.2) were evaluated after treatment with three different types of bonded restorations: all ceramic enamel-dentin bonded restorations, prefabricated composite veneers, and direct composite resin restorations. A modified version of the Californian Dental Association system for quality evaluation of dental care and a questionnaire assessing patient satisfaction were used for classification. The restorations were evaluated with respect to patient satisfaction, esthetics, technical, and biological complications.

RESULTS

Mean observation period for the restorations was 42.5 months (SD 35.6). All restorations were in place at the time of the examination. Surface and color calibration showed a success of 95% for the ceramic enamel-dentin bonded restorations, 44% for the direct composite resin restorations, and 0% for the prefabricated composite veneers. The same pattern was evident for anatomy and marginal integrity. The subjects reported a high degree of satisfaction with both the esthetics and function of their restorations.

CONCLUSION

The results indicated that all ceramic restorations demonstrated the best results for patients with amelogenesis imperfecta.

Diversity of clinical, radiographic and genealogical findings in 41 families with amelogenesis imperfecta

Amelogenesis imperfecta (AI) is a group of enamel development disorders that alter the structure and chemical composition of the tissue. There is great variability in the clinical presentation; according to Witkop, AI can be categorized into 14 subtypes, which makes its diagnosis extremely complex.

OBJECTIVE

This study aimed to describe and determine the frequency of clinical and radiographic features and inheritance patterns found in 41 Chilean families diagnosed with diverse types of AI.

MATERIAL AND METHODS

We analyzed the clinical records, photographs, pedigrees and radiographs of 121 individuals recruited between 2003 and 2016. All of the information was included in a database that was analyzed using the application Stata 14.

RESULTS

The 72 affected individuals had average age of 16 years, and no sex association with the presence of AI was found. The most frequent clinical subtypes were as follows: 43% hypomature, 25% hypoplastic, 21% hypomature/hypoplastic, 7% hypocalcified and 4% hypocalcified/hypoplastic. The number of severely affected teeth was 22, which occurred in the patients with hypocalcified and hypocalcified/hypoplasic AI who presented the highest number of damaged teeth. Caries and periodontal disease were found in 47 and 32% of the patients, respectively. Malocclusions were observed in 43% of the individuals with AI, with open bite being the most frequent. Radiographically, the thickness of the enamel decreased in 51% of the patients, and 80% showed decreased radiopacity of the enamel compared to that of dentin. Autosomal dominant inheritance pattern was found in 37% of the families with hypoplastic AI, and autosomal recessive pattern was present in 56% of the other clinical subtypes, but more frequently in those affected with hypomature and hypocalcified AI.

CONCLUSION

Of the five clinical subtypes, autosomal recessive hypomature, autosomal dominant hypoplastic and autosomal recessive hypomature/hypoplastic AI were the most prevalent subtypes in this group.

Experiences of Being a Parent to a Child with Amelogenesis Imperfecta

Amelogenesis imperfecta (AI) is a hereditary developmental disorder affecting the enamel of teeth. Affected patients present with tooth hypersensitivity, rapid tooth wear, or fractures of enamel as well as alterations in color and shape, all of which compromise esthetic appearance and masticatory function. Chronic conditions in childhood severely impact the whole family, affecting normal family routines and/or increasing the family’s financial burden. The aim of this study was to explore experiences and the impact on daily life of being a parent to a child with severe forms of amelogenesis imperfecta. Parents of children and adolescents with AI participated in an interview with a psychologist. The transcribed interviews were analyzed using thematic analysis. The parents talked about several concerns about having a child with AI. Four main themes emerged from the interviews: Feelings associated with passing on a hereditary disorder, knowledge decreases stress, unfamiliarity with the diagnosis, and psychosocial stress. In these main categories we identified several subthemes. Feelings associated with passing on a hereditary disorder included the subtheme of guilt/shame; knowledge decreases stress included knowledge about diagnosis in the family and support from dental health care professionals; Unfamiliarity with diagnosis included missed diagnosis, fear of not getting correct treatment, and insufficient pain control; finally, the subtheme Psychosocial stress included fear of child being bullied and emergency dental visits. The findings show that parents of children with severe amelogenesis imperfecta report similar experiences as do parents of children with other chronic and rare diseases.

Amelogenesis imperfecta: therapeutic strategy from primary to permanent dentition across case reports

Background

Hereditary enamel defect diseases are regrouped under the name “Amelogenesis Imperfecta” (AIH). Both dentitions are affected. Clinical expression is heterogeneous and varies between patients. Mutations responsible for this multigene disease may alter various genes and the inheritance can be either autosomal dominant or recessive, or X-linked. Until now, no therapeutic consensus has emerged for this rare disease.

Case presentation

The purpose of this article was to report treatments of AIH patients from childhood to early adulthood. Treatment of three patients of 3, 8 16 years old are described. Each therapeutic option was discussed according to patients’ age and type of enamel alteration. Paediatric crowns and resin based bonding must be preferred in primary teeth. In permanent teeth, non-invasive or minimally invasive dentistry should be the first choice in order to follow a therapeutic gradient from the less invasive options to prosthodontic treatments.

Conclusion

Functional and aesthetic issues require patients to be treated; this clinical care should be provided as early as possible to enable a harmonious growth of the maxillofacial complex and to prevent pain.

Restorative Treatment in Patients with Amelogenesis Imperfecta: A Review

PURPOSE

To summarize the contemporary scientific evidence available regarding restorative dental treatment in patients with Amelogenesis imperfecta (AI).

METHODS

An electronic literature search was conducted using the search term "Amelogenesis imperfecta" and the PubMed/MEDLINE database as well as Google Scholar. Prospective and retrospective clinical studies that investigated the outcome of direct and/or indirect dental restorative treatment in patients with AI, were published in English, and had an observation time of at least 1 year were included in this review. The articles identified were screened and analyzed by two reviewers according to inclusion and exclusion criteria in three review rounds.

RESULTS

Six prospective or retrospective clinical studies analyzing longevity and complications associated with dental restorative treatment in patients with AI met the inclusion criteria. Extracted data suggest that in patients with AI, indirect restorations feature superior predictability and longevity than direct restorations.

CONCLUSIONS

As endodontic complications were infrequently observed and periodontal parameters regularly improve with the insertion of indirect restorations, dental treatment in patients with AI should focus on indirect restorations as soon as possible. While adhesive bonding techniques to enamel surfaces in patients with AI feature merely limited predictability and longevity and as the available data is scarce, further laboratory and clinical studies should be performed to investigate the performance of minimally invasive indirect restorations bonded to enamel in patients with AI.

RECOMMENDATION

Scientific evidence indicates that indirect restorations should be preferred over direct restorations in patients with AI.

Conservative anterior treatment with CAD-CAM technology and polymer-infiltrated ceramic for a child with amelogenesis imperfecta: A 2-year follow-up

Amelogenesis imperfecta is a genetic disorder that affects the structure of enamel and consequently the function, esthetics, and psychology of young patients. Restoring the dentition of a child with minimal tooth preparation is achievable with polymer-infiltrated ceramics. The treatment of a 12-year-old child presenting with amelogenesis imperfecta is described. An in-office computer-aided design and computer-aided manufacturing (CAD-CAM) system and polymer-infiltrated ceramic blocks were used in a noninvasive procedure. The definitive clinical outcome showed a major esthetic improvement and allowed for the normal eruption of the permanent dentition.

Amelogenesis Imperfecta and Early Restorative Crown Therapy: An Interview Study with Adolescents and Young Adults on Their Experiences

Patients with Amelogenesis imperfecta (AI) can present with rapid tooth loss or fractures of enamel as well as alterations in enamel thickness, color, and shape; factors that may compromise aesthetic appearance and masticatory function. The aim was to explore the experiences and perceptions of adolescents and young adults living with AI and receiving early prosthetic therapy. Seven patients with severe AI aged 16 to 23 years who underwent porcelain crown therapy participated in one-to-one individual interviews. The interviews followed a topic guide consisting of open-ended questions related to experiences of having AI. Transcripts from the interviews were analyzed using thematic analysis. The analysis process identified three main themes: Disturbances in daily life, Managing disturbances, and Normalization of daily life. These themes explain the experiences of patients living with enamel disturbances caused by AI and receiving early crown therapy. Experiences include severe pain and sensitivity problems, feelings of embarrassment, and dealing with dental staff that lack knowledge and understanding of their condition. The patients described ways to manage their disturbances and to reduce pain when eating or drinking, and strategies for meeting other people. After definitive treatment with porcelain crown therapy, they described feeling like a normal patient. In conclusion the results showed that adolescents and young adults describe a profound effect of AI on several aspects of their daily life.

Oral health-related quality of life before and after crown therapy in young patients with amelogenesis imperfecta

BACKGROUND

Amelogenesis imperfecta (AI) is a rare, genetically determined defect in enamel mineralization associated with poor esthetics and dental sensitivity. Because the condition is associated with negative social outcomes, this study evaluated oral health-related quality of life (OHRQoL), dental fear, and dental beliefs before and after early prosthetic crown therapy for AI during adolescence.

METHODS

The study included 69 patients with AI, aged 6-25 yr: 33 males and 36 females (mean age 14.5 ± 4.3); healthy controls (n = 80), patients with cleft lip and palate (CLP; n = 30), and patients with molar incisor hypomineralization (MIH; n = 39). All matched in age and gender, and all but the CLP group insocioeconomic area. Patients completed three questionnaires measuring OHRQoL (OHIP-14), dental fear (CFSS-DS), and dental beliefs (DBS-R). Twenty-six patients with severe AI between ages 9 and 22 yr received crown therapy and completed the questionnaires twice: before and after therapy.

RESULTS

OHIP-14 scores were significantly higher among patients with AI (7.0 ± 6.7), MIH (6.8 ± 7.6) and CLP (13.6 ± 12.1) than healthy controls (1.4 ± 2.4) (p < 0.001). After crown therapy, quality of life problems in the 26 patients with severe AI decreased significantly, from 7.8 ± 6.1 to 3.0 ± 4.8 (p < 0.001). Early prosthetic therapy did not increase dental fear or negative attitudes toward dental treatment.

CONCLUSIONS

OHRQoL increased after early crown therapy in patients with severe AI. Therapy did not increase dental fear or negative attitudes toward dental treatment.

A Randomized Controlled Trial of Crown Therapy in Young Individuals with Amelogenesis Imperfecta

Amelogenesis imperfecta (AI) is a rare, genetically determined defect in enamel mineralization. Existing treatment recommendations suggest resin-composite restorations until adulthood, although such restorations have a limited longevity. New crown materials allow for minimal preparation techniques. The aim of this study was to compare the quality and longevity of 2 crown types—Procera and IPS e.max Press—in adolescents and young adults with AI. A secondary aim was to document adverse events. We included 27 patients (11 to 22 y of age) with AI in need of crown therapy in a randomized controlled trial using a split-mouth technique. After placing 119 Procera crowns and 108 IPS e.max Press crowns following randomization, we recorded longevity, quality, adverse events, and tooth sensitivity. After 2 y, 97% of the crowns in both crown groups had excellent or acceptable quality. We found no significant differences in quality between Procera and IPS e.max Press crowns. Tooth sensitivity was significantly reduced after crown therapy ( P < 0.001). Endodontic complications occurred in 3% of crowns. The results show that it is possible to perform crown therapy with excellent results and without severe complications in young patients with AI. The study is registered at http://www.controlled-trials.com (ISRCTN70438627).

Aesthetic and functional rehabilitation of the primary dentition affected by amelogenesis imperfecta

The objective of this case report was to describe the oral rehabilitation of a five-year-old boy patient diagnosed with amelogenesis imperfecta (AI) in the primary dentition. AI is a group of hereditary disorders that affects the enamel structure. The patient was brought to the dental clinic complaining of tooth hypersensitivity during meals. The medical history and clinical examination were used to arrive at the diagnosis of AI. The treatment was oral rehabilitation of the primary molars with stainless steel crowns and resin-filled celluloid forms. The main objectives of the selected treatment were to enhance the esthetics, restore masticatory function, and eliminate the teeth sensitivity. The child was monitored in the pediatric dentistry clinic at four-month intervals until the mixed dentition stage. Treatment not only restored function and esthetic, but also showed a positive psychological impact and thereby improved perceived quality of life. The preventive, psychological, and curative measures of a young child with AI were successful. This result can encourage the clinicians to seek a cost-effective technique such as stainless steel crowns, and resin-filled celluloid forms to reestablish the oral functions and improve the child's psychosocial development.