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Minimally invasive adhesive full mouth reconstruction of a patient with amelogenesis imperfecta

From Volume 45, Issue 6, June 2018 | Pages 547-555

Authors

Morteza Mazinanian

BSc, BDS, MFDS RCS(Ed), MClindent, MPROS RCS(Ed)

Specialist in Prosthodontics, Implant Surgery, Aesthetic and Reconstructive Dentistry, Senior Teaching Fellow at Eastman Dental Hospital, University College London (UCL), 256 Grays Inn Road, London WC1X 8LD, UK

Articles by Morteza Mazinanian

Abstract

Abstract: The successful management of patients with amelogenesis imperfecta has traditionally involved use of conventional more destructive methods. Amelogenesis imperfecta has a prevalence of 1:700 to 1:14,000, according to the populations studied.1 The affected enamel can be hypomineralized and/or hypoplastic, causing the affected individual aesthetic concerns as well as potential sensitivity. In this case, the author aims to present a minimally invasive full mouth reconstruction of a patient affected by amelogenesis imperfecta using a combination of direct and indirect methods.

CPD/Clinical Relevance: The clinical management of amelogenesis imperfecta can provide clinicians with challenges that are not faced daily. In this case report, minimally invasive management of such patients will be demonstrated.

Article

Amelogenesis imperfecta (AI) is a dental condition affecting the structure and condition of dental enamel with occasional involvement of other oral structures. AI has been classified many times, both clinically and genetically; Table 1 demonstrates an example of one such classification.

Amelogenesis imperfecta has traditionally been managed in a hospital setting and, depending on the severity of the enamel condition, the treatment has involved paediatrics, orthodontics and restorative departments.3

Historically, treatment has involved conventional cast restoration for posterior teeth using gold or porcelain bonded to metal crowns to overcome problems with fracture and sensitivity, while anterior teeth were restored using porcelain veneers to improve aesthetic deficiencies caused by discoloration associated with amelogenesis imperfecta.

However, such approaches are destructive to tooth structure with the potential for irreversible damage to pulpal status.4 Preparation of teeth for indirect conventional cast restorations have been demonstrated to cause pulpal necrosis and subsequent periapical periodontitis.4 This, in combination with the fact that the presenting patients are very young individuals, reduces the long-term prognosis of the dentition, thereby speeding up the restorative cycle.

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