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    Amelogenesis Imperfecta-A Prosthetic Rehabilitation: A Clinical Report

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    Melisa Guerra

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    Amelogenesis Imperfecta-A Prosthetic Rehabilitation: A Clinical Report

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    Amelogenesis Imperfecta-A Prosthetic Rehabilitation: A Clinical Report

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    Melisa Guerra

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    Amelogenesis imperfecta—a prosthetic rehabilitation: A clinical report

    Dominique Bouvier, Dr Odont, PhD,a Jean-Pierre Duprez, Dr Odont, PhD,b Christian Pirel, Dr Odont,
    PhD,c and Bernard Vincent, Dr Odont, PhDd
    Faculty of Odontology, University of Claude Bernard Lyon I, Lyon, France

    Amelogenesis imperfecta is an inherited disease that


    disturbs the formation of the enamel. It can occur as 2
    main types, hypocalcification and hypoplasia. Enamel
    hypocalcification is a defect in the mineralization;
    hypoplasia is a defect in the formation of the enamel
    matrix. Both deciduous and permanent teeth are affect-
    ed, and the disorder may create unesthetic appearance,
    dental sensitivity, and attrition. Numerous treatments
    have been described for rehabilitation of amelogenesis
    imperfecta in adults1-4 and children.5-8
    This clinical report describes the stages in the com-
    plete restoration of amelogenesis imperfecta in a child
    between the ages of 7 and 12.
    CLINICAL REPORT Fig. 1. View of mixed dentition before treatment.
    A 7-year-old boy who suffered from considerable
    sensitivity and was very self-conscious about the
    appearance of his teeth was referred to the department
    of pediatric dentistry for treatment. He was diagnosed
    with hereditary amelogenesis imperfecta. On examina-
    tion, the patient had mixed dentition; first molars and
    permanent incisors had erupted, the teeth were found
    to possess little enamel, and crowns were thin and
    short. The child had good oral hygiene, was caries-free,
    and did not exhibit any periodontal problems. Attrition
    of the molars had resulted in a decrease of the vertical
    dimension of occlusion (Figs. 1 and 2).
    Temporary treatment
    The first phase of treatment lasted for a period of
    more than 3.5 years. Treatment consisted of fitting pre- Fig. 2. Panorex before treatment.
    formed Ni-Cr crowns (ION, 3M Dental Products, St
    Paul, Minn.) on the first permanent molars and on the
    second deciduous molars to stabilize the occlusion and resin crowns. Six months later, the second molars
    to halt attrition. No attempt was made to increase the erupted and were fitted with Ni-Cr crowns. Pulp vital-
    vertical dimension of occlusion. Maxillary and ity was maintained for all the teeth. Third molar tooth
    mandibular incisors were fitted with carboxylate resin germs were removed as a preventive measure.
    crowns (ION, 3M Dental Products) to improve At this point, it was decided to increase the vertical
    appearance and decrease sensitivity. Five appointments dimension of occlusion. A wax-up of the mandibular
    were required for treatment. molars and premolars was made in the laboratory. The
    During the following 22-month period, the child wax-up was duplicated and a vacuum-formed matrix was
    was monitored for eruption of permanent teeth, and fabricated. The matrix was used to produce 2 temporary
    the premolars and canines were fitted with carboxylate autopolymerizing resin mandibular fixed prostheses
    directly in the patient’s mouth, and adjustment of the
    new occlusion was carried out immediately afterward.
    aFormer Assistant Hospital Practitioner, Department of Dentistry.
    bAssociate
    Occlusal height was increased 2 mm at the incisors. The
    Professor, Department of Pediatric Dentistry.
    cProfessor, Department of Prosthodontics. patient was then monitored systematically over a 3-month
    dAssociate Professor, Department of Prosthodontics. period to check for any functional or articulatory problem
    J Prosthet Dent 1999;82:130-1. following the change in vertical dimension of occlusion.

    130 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 82 NUMBER 2


    BOUVIER ET AL THE JOURNAL OF PROSTHETIC DENTISTRY

    Transitional treatment
    Transitional treatment spanned 8 weeks. At 12 years
    of age, the patient was ready for the second prosthetic
    phase. Jaw relation was recorded with wax wedges
    (Moyco Industries Inc, Philadelphia, Pa.). Because of
    the difficulty in managing a young patient, 2-stage
    impressions (Express 3M dental products) were made on
    each arch and from these, impression copings (Duralay
    resin) on teeth and individual trays covering them, were
    made in the laboratory in preparation for final impres-
    sions. Impression copings were secured by Duralay resin
    in groups of 3 or 4 copings. Cervical adjustment of the
    impression copings on the preparations was checked in
    the patient’s mouth and the final impression was made
    for each arch. Impression copings were first filled with Fig. 3. View of prostheses 6 months after fitting.
    syringed impression material (3M Express, 3M Dental
    Products) and placed on the prepared teeth. Then, indi-
    vidual trays were filled with medium consistency impres-
    sion material (3M Express, 3M Dental Products) and goal is to establish an esthetic appearance and efficient
    placed in position over the complete set of impression masticatory function until adulthood.
    copings. When the impression material had set, the cop- In treating amelogenesis imperfecta in children, it is
    ings and trays were removed together. important to allow for mandibular and maxillary
    From these impressions, casts were made and growth9 by using individual restorations on teeth.
    mounted in an articulator to produce 24 individual We wish to thank the firm having produced the prosthesis in the
    frameworks for ceramic-metal crowns and 4 alloy laboratory (Société Pfeffer), Professor D. Bois, and the Hospices
    crowns for the second molars. The precious alloy used Civils de Lyon for their financial support.
    was 73.8% gold and 9.0% platinum by weight
    (Degunorm, Degussa AG, Hanau, Germany). The REFERENCES
    frameworks were tried in the patient’s mouth to check 1. Rada ER, Hasiakos PS. Current treatment modalities in the conservative
    the marginal fit and centric relation position. The cos- restoration of amelogenesis imperfecta: a case report. Quintessence Int
    metic coating, a low-fusion ceramic (Ducera, Degussa 1990;21:937-42.
    2. Greenfield R, Iacono V, Zove S, Baer P. Periodontal and prosthodontic
    AG), was then applied. A fitting session, before the treatment of amelogenesis imperfecta: a clinical report. J Prosthet Dent
    glazing of the ceramic material, enabled final occlusal 1992;68:572-4.
    refinement. The crowns were then finished in the labo- 3. Konis AB. Treatment of enamel hypoplasia in young adults. NY State Dent
    J 1993;59:38-40.
    ratory and cemented with glass ionomer cement (Fuji I, 4. Lumley PJ, Rollings AJ. Amelogenesis imperfecta: a method of recon-
    GC Corporation, Tokyo, Japan). struction. Dent Update 1993;20:252-5.
    The patient was monitored at 3-month intervals for 5. Bedi R. The management of children with amelogenesis imperfecta.
    Restorative Dent 1989;5:31-4.
    1 year (Fig. 3), and then once a year. 6. Mackie IC, Blinkhorn AS. Amelogenesis imperfecta: early interception to
    prevent attrition. Dent Update 1991;18:79-80.
    SUMMARY 7. Wright JT, Waite P, Mueninghoff L, Sarver DM. The multidisciplinary
    approach managing enamel defects. J Am Dent Assoc 1991;122:62-5.
    The rehabilitation of amelogenesis imperfecta in a 8. Bouvier D, Duprez JP, Bois D. Rehabilitation of young patients with amel-
    child must take into account the development of the ogenesis imperfecta: a report of two cases. ASDC J Dent Child 1996;
    child’s teeth, the health of the periodontal tissues, and 63:443-7.
    9. Planas P. La réhabilitation neuro-occlusale. Paris: Masson; 1992. p. 23-
    the mandibular and maxillary growth. As demonstrated 44.
    in this clinical report, this was performed in 2 stages.
    The immediate temporary treatment, during the Reprint requests to:
    DR DOMINIQUE BOUVIER
    period of mixed dentition, is designed to reduce sensi- 115 RUE TÊTE D’OR
    tivity in the teeth, prevent attrition of erupting teeth, 69006 LYON
    and restore appearance and masticatory function. Dur- FRANCE
    FAX: 33-4-72-74-92-03
    ing this first phase, the vertical dimension of occlusion
    was increased if necessary. It is essential to monitor this Copyright © 1999 by The Editorial Council of The Journal of Prosthetic
    new occlusion closely over several months and to con- Dentistry.
    0022-3913/99/$8.00 + 0. 10/1/99195
    serve pulp vitality in immature permanent teeth so they
    can complete their growth cycle.
    The second stage involves the transitional treatment
    and begins when all permanent teeth are in place. The

    AUGUST 1999 131

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