Aesthetic composite veneers for an adult patient with amelogenesis imperfecta: a case report

Novel trends, challenges and new perspectives for enamel repair and regeneration to treat dental defects

Dental enamel is the hardest tissue in the human body, providing external protection for the tooth against masticatory forces, temperature changes and chemical stimuli. Once enamel is damaged/altered by genetic defects, dental caries, trauma, and/or dental wear, it cannot repair itself due to the loss of enamel producing cells following the tooth eruption. The current restorative dental materials are unable to replicate physico-mechanical, esthetic features and crystal structures of the native enamel. Thus, development of alternative approaches to repair and regenerate enamel defects is much needed but remains challenging due to the structural and functional complexities involved. This review paper summarizes the clinical aspects to be taken into consideration for the development of optimal therapeutic approaches to tackle dental enamel defects. It also provides a comprehensive overview of the emerging acellular and cellular approaches proposed for enamel remineralization and regeneration. Acellular approaches aim to artificially synthesize or re-mineralize enamel, whereas cell-based strategies aim to mimic the natural process of enamel development given that epithelial cells can be stimulated to produce enamel postnatally during the adult life. The key issues and current challenges are also discussed here, along with new perspectives for future research to advance the field of regenerative dentistry.

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.

Alternative prosthodontic-based treatment of a patient with hypocalcified type Amelogenesis Imperfecta

The Amelogenesis Imperfecta is associated with malocclusion and usually requires an interdisciplinary treatment. Due to the patient's refusal of orthodontic treatment, prosthodontics‐based treatments alternative was considered and planned. The patient was treated with zirconia‐based fixed partial dentures, which resulted in improved occlusion, better oral health, and improved esthetic appearance.

Amelogenesis imperfecta - lifelong management. Restorative management of the adult patient

The biggest challenge restorative dentists face in rehabilitating patients with amelogenesis imperfecta (AI) is trying to restore aesthetics, function and occlusal stability while keeping the treatment as conservative as possible. The goals of treatment should be to prolong the life of the patient's own teeth and avoid or delay the need for extractions and subsequent replacement with conventional fixed, removable or implant retained prostheses. In order to achieve these goals a stepwise approach to treatment planning is required starting with the most conservative but aesthetically acceptable treatment. This article discusses the management of AI and presents the various treatment options available for restoring the adult patient who presents to the dentist with AI.

15-year follow-up of a case of amelogenesis imperfecta: importance of psychological aspect and impact on quality of life

BACKGROUND

Amelogenesis imperfecta (AI) represents a group of hereditary conditions which affects enamel formation in the primary and permanent dentitions. Gene mutations alter the quality and/or quantity of enamel. AI often has severe consequences for the patient such as high tooth sensitivity, low aesthetic quality of the dentition, and poor mechanical properties of the dental tissues. This can result in reduced oral health-related quality of life.

CASE REPORT

We present the case of a child affected by AI which had been diagnosed at the age of 9 years. Teeth presented many enamel defects. The patient presented thin brown to yellow enamel and the surface was rough and granular. He revealed short clinical crowns, occlusal wear with exposed dentine in posterior areas. He also presented a lateral open bite and lingual lateral interposition due to partial destruction of deciduous molars. Panoramic radiograph showed no differences between enamel and dentine appearance and also coronary destruction of permanent molars.

TREATMENT

The initial treatment consisted of adaptation of composite resins on permanent incisors to improve aesthetics. Preformed metal crowns were placed on first permanent molars to prevent their premature destruction.

FOLLOW-UP

This was disrupted for a variety of reasons. Fourteen years later, after a dental nomadism, the patient consulted by chance a dentist who identified his genetic pathology and was aware of its consequences. Extensive prosthodontic treatment was needed, but oral hygiene was poor and gingivitis remained.

CONCLUSION

Dealing with high loss of motivation has been one of the main challenges because this patient had a lot of psychological problems. He was concerned, as are many patients affected by AI or other enamel abnormalities. This paper highlights the difficulties of long-term care of this dental abnormality. Psychological aspects of the quality of life, which is a common feature in patients suffering from many kinds of enamel anomalies, are very important.