CLINICAL DENTISTRY AND RESEARCH 2013; 37(1): 51-56 DIAGNOSIS AND CONSERVATIVE REHABILITATION OF A PATIENT WITH AMELOGENESIS IMPERFECTA AND 5-YEAR FOLLOW-UP: A CASE REPORT Nihn Gönülol, DDS, PhD Assistnt Professor, Deprtment of Restortive Dentistry, Fculty of Dentistry, Ondokuz Myıs University, Smsun, Turkey Bilinç Bulucu, DDS, PhD Professor, Deprtment of Restortive Dentistry, Fculty of Dentistry, Ondokuz Myıs University, Smsun, Turkey ABSTRACT Amelogenesis imperfect (AI) is group of hereditry enmel defects, the dignosis of which is sed on the fmily history nd meticulous clinicl oservtion. Nowdys, the use of dhesive restortions hs gret populrity owing to mny improvements in the re, such s excellent esthetics, conservtive pproch nd improved wer, nd mechnicl properties etc. This clinicl report illustrtes the orl rehilittion of n 18-yer-old girl dignosed with hyperplstic type of AI with direct composite restortions nd 5-yer follow-up. In low severity of AI cses, conservtive pproches nd their long-term follow-up hve insufficient evidence to support their use so the cse to e presented in this rticle is considered to e worthy of reporting. Thus, this rticle presents the conservtive tretment nd long-term follow-up of ptient with AI disorder. Correspondence Nihn GÖNÜLOL, DDS, PhD Deprtment of Restortive Dentistry Fculty of Dentistry Ondokuz Myıs University 55139 Kurupelit- Smsun - TURKEY Phone: +90 362 312 19 19 / 4129 Fx : +90 362 457 60 32 E-mil: nihn.gonulol@omu.edu.tr Key words: Amelogenesis Imperfect, Conservtive Tretment, Direct Composite Veneer Restortion Sumitted for Puliction: 03.22.2012 Accepted for Puliction : 07.10.2012 51
CLINICAL DENTISTRY AND RESEARCH INTRODUCTION Amelogenesis imperfect (AI) hs een defined s complex group of hereditry enmel defects, existing independent of ny relted systemic disorder. 1-3 This enmel nomly ffects oth the primry nd permnent dentitions. 3-5 It is rre enmel minerlistion defect, descried y Spokes in 1980 s hereditry rown teeth with reported incidence of 1:7000 nd 1:16000, depending on the popultion studied nd the dignostic criteri used. 1,6 Three sic types of AI exist: hypoplstic, hypoclcified nd hypomture, sed on rdiogrphic findings nd clinicl hereditry criteri. 4,7 In the hypoplstic forms, the enmel does not develop to its norml thickness, ecuse of the deficient formtion of the mtrix. In the hypoclcified forms y the cuse of deficient minerliztion of the formed mtrix, the enmel is soft, frile nd cn esily e removed from the dentin fter the eruption. In the hypomturtion forms, the enmel crystls remin immture so the enmel is hrder, with mottled opque white to yellow-rown or red-rown color, nd tends to chip from the underlying dentin rther thn wer wy. 7-10 Although AI hs een ctegorized into three rod groups; t lest 15 sutypes of AI exist when phenotype nd inheritnce re considered. 1 The most common form of AI is the utosoml dominnt hypoclcified type, followed y hypomturtion, nd the hypoplstic type. 11,12 According to the literture AI ptients, regrdless of sutype, hve similr orl complictions. 4 Dentl fetures ssocited with AI includes enmel defiencies, pulpl clcifictions, turodontism nd root mlformtions, filed root eruption on impction of permnent teeth, progressive root nd crown resorption, congenitlly missing teeth nd nterior nd posterior openite occlusions. 13 As AI is genetic disorder, preventive tretment is not possile; therefore, the tretment is focused on esthetic nd functionl rehilittion. 1,7,14 Tretment depends on the severity of the prolem nd the need for esthetic enhncement, rnging from simple composite resin restortions to complete crown restortions in cses involving greter loss of tooth structure or loss of verticl dimension. 1 Using conservtive techniques desirle esthetics cn e chieved, the teeth nd supporting structures preserved nd hrmonious reltionship creted etween the occlusion nd temporomndiulr rticultion in pproprite cses. 11 The im of this pper ws to present the tretment of young femle ptient dignosed with hypoplstic type AI y using direct composite resin restortions nd five-yer follow-up. CASE REPORT Dignosis An 18-yer-old femle ptient ws referred to the Deprtment of Restortive Dentistry nd Endodontics, Fculty of Dentistry, Ondokuz Myıs University with complint of severe pin nd swelling in her left mndiulr first molr tooth. In her clinicl exmintion lmost ll the teeth were yellowrown in color ccompnied with high surfce roughness on ll enmel surfces. Except the mndiulr nterior re, there were wide pproximl cries, where interproximl contcts were disppered. The cusps of ll molr teeth were rded nd the exposed dentin ws hypersensitive. Although high cries ctivity ws detected, the orl hygiene nd gingivl helth of the ptient ws stisfctory (Figures 1 nd 2). As she ws displesed with the ppernce of her teeth, her psychologicl helth ws dversely ffected. The rdiogrphic exmintion reveled tht the occlusl spects of ll posterior teeth were worn, nd there ppered pproximl cries. However, deep crious lesions were seen in oth right nd left second mndiulr teeth. Both mxillry centrl incisors were decyed nd left mxillry centrl incisor hd peripicl rdiolucency, dditionlly, left mndiulr first molr teeth hd n enlrged periodontl spce. The morphology of the roots ws norml, the pulp chmers hd no clcifictions, nd the cementum nd ony trecultions were within norml limits (Figure 3). The fmily medicl history reveled tht the ptient s rother hd similr clinicl ppernce so it ws thought tht the ptient could hve een suffering from hereditry hypoplstic type of AI. Tretment The tretment strted with endodontic therpy of the left mndiulr first molr, which ws dignosed s cute picl scess nd mndiulr second molrs were extrcted. Susequently fter the root cnl tretment of the left mxillry centrl incisor, devitl leching procedure ws performed 100 % crmid peroxide, Endoperox poudre, Septodont, Cedex, Frnce) for eliminting the discolortion. To restore the tooth structures 37% phosphoric cid ws pplied for 15 s, rinsed nd conventionl dhesive 52
REHABILITATION OF A PATIENT WITH AMELOGENESIS IMPERFECTA c Figure 2-2. Preopertive introrl ppernces of the ptient Figure 1-1-1c. Preopertive ppernces of the ptient Figure 3. Preopertive rdiogrphic ppernce of the ptient system (Adper Single Bond 2, 3M ESPE, Germny) ws pplied ccording to the mnufcturer s instructions. The restortions of the teeth were performed with n A2 shde universl composite resin (Filtek Z250, 3M ESPE, St Pul, USA). Afterwrds, to improve the estheticl ppernce, mxillry nterior nd premolr teeth were prepred for direct composite resin lminte veneer restortions. For this purpose 0.5 mm fcil nd proximl reduction ws performed. All teeth preprtions were completed without shrp line ngles. The restortion of left mxillry centrl incisor ws delyed for two weeks due to residul hydrogen peroxide fter devitl leching procedure. The teeth 53
CLINICAL DENTISTRY AND RESEARCH were etched with the phosphoric cid for 15 s nd rinsed. After pplying the dhesive system (Adper Single Bond 2, 3M ESPE, Germny) it ws cured for 20 s with qurtz tungsten hlogen light source (Smrt Lite, Benlioğlu; Ankr, Turkey) with n intensity of 500mW/cm 2. The direct veneer restortions were performed with the sme A2 shde hyrid composite resin (Filtek Z250, 3M ESPE, St Pul, USA). The finishing nd polishing procedures were performed with 16-fluted tungsten cride finishing urs nd Sof-Lex (3M ESPE, St. Pul, MN, USA) luminum oxide discs for 15 s for ech discs (corse, medium, fine nd superfine). After the restortive procedures were completed, stisfctory functionl nd estheticl ppernce ws estlished (Figure 4). The ptient ws reclled t 6-month intervls. During the control in the first yer, clinicl nd rdiogrphic exmintion reveled new pproximl crious lesion in left mxillry first premolr nd frcture t left mxillry second premolr s veneer restortion (Figure 5). The tretment of the crious ffected teeth nd frctured restortion ws performed y using the sme dhesive nd composite resin mterils. Five yers fter the tretment significnt discolortion ws oserved on uccl nd fcil surfces due to the consumption of stining nutrients nd drinks. Also, in left mxillry incisor crck ws detected t the incisl third of the veneer restortion (Figure 6). The frcture ws restored with the sme trde dhesive nd composite resin mterils; finlly, the discolortion ws eliminted with polishing procedures. Except these filures the restortions remined intct nd there ws no new crious lesion. c DISCUSSION In the present cse the results of clinicl nd rdiogrphicl evlutions nd fmily history indicted tht the ptient hd hypoplstic form of AI. There re numer of lterntives for esthetic nd functionl rehilittion of defective enmel in melogenesis ptients. The tretment pln is relted to mny fctors such s ge, socio-economic sttus, type nd severity of the disorder, nd introrl sitution t the time the tretment ws plnned. 10 Sundell et l. 15 reported tht prosthetic restortions would e essentil for hypoclcified forms of AI while stisfctory results could e otined y dhesive resin restortions of hypoplstic forms. With the technologic development of dhesive systems nd composite resins, especilly with respect to their d Figure 4--c-d. Postopertive ppernces of the ptient 54
REHABILITATION OF A PATIENT WITH AMELOGENESIS IMPERFECTA c Figure 5. The rrow shows the frcture t left mxillry second premolr s veneer restortion during the control in the first yer Figure 5. The rrow shows the new pproximl crious lesion in left mxillry first premolr restortion during the control in the first yer mechnicl nd opticl properties, direct veneers hve een incresingly used in clinicl dentistry to restore nterior teeth tht hve ltertions in color or ntomicl shpe. 16 Lygidkis et l. 17 stted tht complex composite restortions in permnent hypominerlized molrs with defective enmel offer good, long term performnce. They lso stted the fct tht gret ttention should e given to the removl of ll cliniclly defective, soft enmel in order to ensure stronger onds with the underlying, possily norml enmel. Venezie et l. 18 reported tht onding resin composites to Figure 6. The crck t the incisl third of the veneer restortion 5-yers fter the tretment Figure 6-c. Introrl ppernces 5-yers fter the tretment AI-ffected enmel cn e prolemtic, especilly in res of poorly minerlized, frile enmel. Thus, cse selection must e crefully considered when using direct-onded 55
CLINICAL DENTISTRY AND RESEARCH restortions, s insufficient evidence is ville to support their use in these situtions. 19 In the present cse the tretment ws performed with direct composite resin veneers ecuse of low severity of the cse nd serious dvntges, such s preserving tooth structure, no lortory stges, less working time nd lower cost. Gökçe et l. 13 reported the tretment of ptients with AI should strt with erly dignosis nd intervention to prevent lter restortive prolems. In this cse the ptient ws 18 yers old; it ws seen tht with the completion of the restortions, progressive loss of the tooth structures cn hve een prevented. Also the ptient s esthetic complints disppered, nd the functionl results needed y the ptient were otined. CONCLUSION The present report underlines the dvntges of using direct resin composite restortions for conservtive tretment of hypoplstic type of AI. The rehilittion included multiple nterior nd posterior composite resin restortions to improve esthetics nd restore function. The long-term follow-up of the restortions indicted tht composite veneer restortions would e preferle for pproprite forms of AI disorder. REFERENCES 1. Roinson FG, Huenreich JE. Orl rehilittion of young dult with hypoplstic melogenesis imperfect: A clinicl report. J Prosthet Dent 2006; 95: 10-13. 2. Weinmnn JP, Svood JF, Woods RW. Hereditry disturnces of enmel formtion nd clcifiction. J Am Dent Assoc 1945; 32: 397-418. 3. Aldred MJ, Svriryn R, Crwford PJ. Amelogenesis imperfect: clssifiction nd ctlogue for the 21st century. Orl Dis 2003; 9: 19-23. 4. Akin H, Tsveren S, Yeler DY. Interdisciplinry pproch to treting ptient with melogenesis imperfect: clinicl report. J Esthet Restor Dent 2007; 19: 131-135. 5. Coley-Smith A, Brown CJ. Cse report: rdicl mngement of n dolescent with melogenesis imperfect. Dent Updte 1996; 23: 434-435. 6. Ro S, Witkop CJ Jr. Inherited defects in tooth structure. Birth Defects Orig Artic Ser 1971; 7: 153-184. ptient with melogenesis imperfect. Quintessence Int 2011; 42: 463-469. 8. Ağçkirn E, Tümen EC, Celenk S, Bolgül B, Atkul F. Restoring esthetics nd function in young oy with hypomture melogenesis imperfect: cse report. ISRN Dent 2011; 2011: 586854. 9. Witkop CJ Jr, Kuhlmnn W, Suk J. Autosoml recessive pigmented hypomturtion melogenesis imperfect. Report of kindred. Orl Surg Orl Med Orl Pthol 1973; 36: 367-382. 10. Sengun A, Ozer F. Restoring function nd esthetics in ptient with melogenesis imperfect: cse report. Quintessence Int 2002; 33: 199-204. 11. Sholpurkr AA, Joseph RM, Vrghese JM, Neelgiri K, Achry SR, Hegde V et l. Clinicl dignosis nd orl rehilittion of ptient with melogenesis imperfect: cse report. J Contemp Dent Prct 2008; 9: 92-98. 12. Stephnopoulos G, Greflki ME, Lyroudi K. Genes nd relted proteins involved in melogenesis imperfect. J Dent Res 2005; 84: 1117-1126. 13. Gokce K, Cnpolt C, Ozel E. Restoring function nd esthetics in ptient with melogenesis imperfect: cse report. J Contemp Dent Prct 2007; 8: 95-101. 14. Sidt H, Alikhsi M, Mirfzelin A. Rehilittion of ptient with melogenesis imperfect using ll-cermic crowns: clinicl report. J Prosthet Dent 2007; 98: 85-88. 15. Sundell S. Hereditry melogenesis imperfect. I. Orl helth in children. Swed Dent J 1986; 10: 151-163. 16. Frnco EB, Frncischone CE, Medin-Vldivi JR, Bseggio W. Reproducing the nturl spects of dentl tissues with resin composites in proximoincisl restortions. Quintessence Int 2007; 38: 505-510. 17. Lygidkis NA, Chlisou A, Siouns G. Evlution of composite restortions in hypominerlised permnent molrs: four yer clinicl study. Eur J Peditr Dent 2003; 4: 143-148. 18. Venezie RD, Vdiks G, Christensen JR, Wright JT. Enmel pretretment with sodium hypochlorite to enhnce onding in hypoclcified melogenesis imperfect: cse report nd SEM nlysis. Peditr Dent 1994; 16: 433-436. 19. Ymguti PM, Acevedo AC, de Pul LM. Rehilittion of n dolescent with utosoml dominnt melogenesis imperfect: cse report. Oper Dent 2006; 31: 266-272. 7. Oliveir IK, Fonsec Jde F, do Amrl FL, Pecorri VG, Bsting RT, Frnç FM. Dignosis nd esthetic functionl rehilittion of 56