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A Case Report of Enamel Hypoplasia

Alka Hazari,1 Rana K Varghese,2 Aditya Mitra,3 Nivedita V Bajantri 4

ABOUT THE AUTHORS

Abstract
1. Dr Alka Hazari
Reader Amelogenesis imperfecta (AI) represents a group of developmental conditions, genomic in
Oral medicine, Diagnosis & origin, which affect the structure and clinical appearance of enamel of all or nearly all the
radiology teeth. The enamel may be hypoplastic, hypomineralised or both and teeth affected may be
New Horizon Dental discolored, sensitive or prone to disintegration. The condition presents problems of
College & Research socialization, function and discomfort but may be managed by early intervention, both
Institute, Sakri, Bilaspur preventively and restoratively, with treatment continued throughout childhood and into adult
life. When an individual with amelogenesis imperfecta presents with malocclusion, it is an
2. Dr Rana K Varghese orthodontic concern as etching is compromised. Presented here is a case of AI treated in a
Dean & Prof & HOD of multidisciplinary approach.
Conservative Dentistry &
Endodontics, KEYWORDS: Amelogenesis imperfecta (AI), enamel abnormality, orthodontic treatment,
New Horizon Dental prosthetic rehabilitation, porcelain.
College & Research
Institute, Sakri, Bilaspur

3. Dr Aditya Mitra
Professor
Conservative Dentistry & Introduction
Endodontics,
New Horizon Dental
College & Research
Enamel, dentin and cementum are the three major constructive components of human
1
Institute, Sakri, Bilaspur teeth (Schroeder,1992 ). Tooth enamel is the highly mineralized structure in the
human body with 85% of its volume occupied by unusually large and highly organized
2 3
4. Dr Nivedita V Bajantri hydroxyapatite crystals (Robinson et al, 1979 ; Simmer and Fincham,1995 ). The
Professor physical properties and physiological function of enamel are directly related to the
Oral medicine, Diagnosis & composition, orientation and morphology of the mineral components within the tissue
radiology 4
(Mahoney et al,2003 ). During organogenesis, the enamel transitions from a soft and
Vasant Dada Patil Dental 5
pliable tissue to its final form, almost entirely devoid of protein (Paine et al, 2001 ).
College
Sangli, Maharashtra
Amelogenesis Imperfecta
Corresponding Author:
AI represents a group of inherited disorders which are clinically heterogenous and
Dr Alka Hazari exhibit tooth enamel defects in the absence of systemic manifestations (Witkop,
6
Reader 1998 ). Both primary and permanent dentitions are affected (Aldred and Crawford,
Oral medicine, Diagnosis & 7
1995 ). The predominant clinical manifestations of affected individuals are enamel
radiology hypoplasia (enamel is mineralized but very thin), hypomineralization (subdivided into
New Horizon Dental
hypomaturation and hypocalcification), or a combined phenotype, which is seen in
College & Research 8 6
most cases (Backman and Holmgren, 1998 ; Witkop, 1998 ; AIdred and Crawford
Institute, Sakri, Bilaspur 7
Email: 1995 ). The hypocalcified type is the most common form of amelogenesis imperfecta.
[email protected]
Clinical description

Enamel hypocalcification is a defect in the mineralization; the teeth are often stained
25 yellow• NOVEMBER,
IJCDS to dark brown. The© 2011
2011 • 2(4) enamel may
Int. Journal show
of Clinical a chalky dull color or a cheesy
Dental Science
Clinical description treatment during childhood has been described as a
16
temporary phase followed by a transitory phase . In
Enamel hypocalcification is a defect in the mineralization; infancy, the primary dentition is protected by the use of
the teeth are often stained yellow to dark brown. The preformed metal crowns on posterior teeth. Either
enamel may show a chalky dull color or a cheesy polycarbonate crowns or composite restorations are
consistency and may rapidly break down. Hypocalcified used on anterior teeth. Adults with permanent dentition
teeth have a normal shape when they erupt but have an can opt for ceramic or zirconia crowns.
abnormal color and dull appearance. Loss of enamel
from wear and staining tend to increase with age. Case report
Hypoplasia is a defect in the formation of the enamel
9
matrix . Therefore, the entire enamel of primary as well A male patient aged 21 years reported with unesthetic
as permanent teeth is affected, the teeth may ör may not appearance of teeth both in terms of colour and
be discolored and often there is considerable occlusal arrangement. Clinical examination revealed a class I
10,11
wear . The disorder may create unaesthetic molar relation on right side while maxillary first molar is
appearance, dental sensitivity and attrition. missing on the left side. Severe crowding is seen in both
Amelogenesis İmperfecta cases can tax the skills of the the upper and lower arches. Though the patients main
clinician, numerous treatments have been described for complaint was unesthetic appearance of the teeth, a
rehabilitalion of amelogenesis İmperfecta in adults and treatment plan was formulated consisting of levelling
9,12
children . and aligning teeth and further rehabilitation, as it was
difficult to place crowns on the crowded teeth. (Fig. 1)
Treatment
The treatment plan consisted of extraction of all first
premolars followed by retraction of canine and aligning
The supportive clinical care needed by these individuals the anteriors. As it is not advisable to etch and bond as
is substantial both in terms of clinical and emotional necessary for bonding brackets on to the AI affected
demands. The prosthetic rehabilitation of Al patients has teeth, it was decided to band all the teeth and weld
13,14,15
been previously presented in several case reports . brackets onto the bands. 022 Roth PEA (3M Gemini)
Treatment is as ever based on the principles of appliance was used and levelling and aligning was
prevention before intervention. However, in these completed in three months, retarction was completed in
patients' cases, intervention will likely be earlier and 4 months and finishing and detailing in another 4
more radical than for others. The progression of months and the appliance was debonded. (Fig. 2)

Fig 1. Preoperative intra oral Photographs

IJCDS • NOVEMBER, 2011 • 2(4) © 2011 Int. Journal of Clinical Dental Science 26
 Fig 2. During and post fixed orthodontic therapy

Fig 3a,b: Pre Treatment Post Treatment With Crowns

After debonding, porcelain fused to a precious metal Conclusion

alloy approach was utilized for the restoration of the
posterior teeth, while all ceramic crowns were fabricated Amelogenesis imperfecta is a condition affecting the
for the anterior teeth. Both the marginal fit and the color enamel of the teeth. The teeth are unesthetic in
acceptability of the restorations were satisfactory. appearance and the enamel is brittle in nature with some
Though there was a midline discrepancy post treatment, cases presenting with no enamel. The definitive
the patient was very much satisfied with the overall treatment of such teeth is by placing crowns. Cases with
result of the treatment.(fig 3a,b)

27 IJCDS • NOVEMBER, 2011 • 2(4) © 2011 Int. Journal of Clinical Dental Science
malocclusion can be orthodontically treated prior to 8. Bouvier D., Duprez J.P.,Pirel C. and Vincent B.:
cosmetic correction. Amelogenesis imperfecta - a prosthetic rehabilitation. A
clinical report. J Prosthet Dent 1999 : 82; 130-131
References 9. RadaR.E., Hasiakos P.S.: Current treatment modalities
in the conservative restoration of amelogenesis
1. Schroeder HE (1992). Oral structure biology. New York: imperfecta:A case report. Ouintessence Int. 1990:21; 937-
Thieme. 942
2. Robinson C, Briggs HD, Atkinson PJ, Weatherell JA 10. De Şort K.D.: Amelogenesis imperfecta : The genetics,
(1979). Matrix and mineral changes in developing classification and treatment. J Prosthet Dent, 1983 : 49f
enamel. J Dent Res 58(Spec Iss B):871-882. 6); 786-792
3. Simmer JP, Fincham AG (1995). Molecular mechanisms 11. Mackie l,C.,Blinkhorn A.S.: Amelogenesis imperfecta :
of dental enamel formation. Crit Rev Oral Biol Med 6:84- Early interception to prevent attrition. Dent Update 1991
108. March :18(2): 79-8
4. Mahoney EK, Rohanizadeh R, Smail FSM, Kilpatrick 12. Nel JC, Pretorius JA, Weber A, Marais JT. Restoring
NM, Swain MV (2003). Mechanical properties and function and esthetics in a patient with amelogenesis
microstructure of hypomineralized enamel of permanent imperfecta. Int J Periodontics Restorative Dent 1997;17:
teeth. Biomaterials 25:5091-5100. 478-483.
5. Paine ML, White SN, Luo W, Fong H, Sarikaya M, 13. Bouvier D, Duprez JP, Pirel C, Vincent B.
Snead ML (2001). Regulated expression dictates enamel Amelogenesis imperfecta-a prosthetic rehabilitation: a
structure and tooth function (review). Matrix Biol 20:273- clinical report. J Prosthet Dent 1999;82: 130-131
292. 14. Greenfield R, Iacono V, Zove S. Periodontal and
6. Witkop CJJ (1988). Amelogenesis imperfecta, prosthodontic treatment of amelogenesis imperfecta: a
dentinogenesis imperfecta and dentin dysplasia revisited clinical report. J Prosthet Dent 1992;68: 572-574.
problems in classification (review). J Oral Pathol 17:547- 15. Bouvier D, Duprez JP, Bois D: Rehabilitation of young
553. patients with amelogenesis imperfecta: a report of two
7. Aldred MJ, Crawford PJ (1995). Amelogenesis cases.ASDC J Dent Child 1996, 63:443-447.
imperfecta—towards a new classification. Oral Dis 1:2-5.

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