|Year : 2015 | Volume
| Issue : 1 | Page : 47-50
Full mouth rehabilitation of a patient with amelogenesis imperfecta: A clinical report
Dhanraj Ganapathy, Siddharth Sasikumar, Prathap Sekhar
Department of Prosthodontics, Saveetha Dental College, Chennai, Tamil Nadu, India
|Date of Web Publication||26-Aug-2015|
Dr. Dhanraj Ganapathy
Department of Prosthodontics, Saveetha Dental College, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Amelogenesis imperfecta is a debilitating disease involving the enamel with characteristic manifestations of discolored teeth, severe dental attrition, and loss of vertical dimension. Full mouth rehabilitation with fixed metal ceramic restorations can be a very effective treatment regimen to treat this condition comprehensively.
Keywords: Amelogenesis imperfecta; full mouth rehabilitation; metal ceramic restorations
|How to cite this article:|
Ganapathy D, Sasikumar S, Sekhar P. Full mouth rehabilitation of a patient with amelogenesis imperfecta: A clinical report. Indian J Multidiscip Dent 2015;5:47-50
|How to cite this URL:|
Ganapathy D, Sasikumar S, Sekhar P. Full mouth rehabilitation of a patient with amelogenesis imperfecta: A clinical report. Indian J Multidiscip Dent [serial online] 2015 [cited 2019 Jan 17];5:47-50. Available from: http://www.ijmdent.com/text.asp?2015/5/1/47/163656
| Introduction|| |
Amelogenesis imperfecta is a hereditary disease involving the enamel of the tooth manifesting itself as hypo-plastic, hypo-calcified, and hypo-maturative types. This disease can seriously impair function and esthetics of stomatognathic system and imposes psychological and physiological alterations in the quality of life. Amelogenesis imperfecta affects dental aesthetics due to the rapid attrition of the enamel exposing the underlying dentin, which is subjected to marked discoloration and wear thus resulting in the significant loss of vertical dimension and difficulty in chewing. The management of this condition is very challenging and requires precise execution of clinical procedures. Full mouth rehabilitation with fixed restorations is an effective treatment regimen available to treat this condition. This case report presents a comprehensive management of this condition with full mouth metal ceramic restorations with a corrected vertical dimension of occlusion.
| Clinical Report|| |
A 26-year-old female patient reported to the Department of Prosthodontics with the chief complaint of unsightly appearance and the collapse of the facial height and the difficulty in chewing food. Extra-oral examination revealed loss of lower facial height, drooping upper lip and everted lower lip with over closed angular lip commissure. Intraoral examination revealed that all the teeth were severely worn-out and discolored, periodontal health was satisfactory and the absence of mandibular first and second molar was observed. Radiographic examination revealed that endodontic treatment of mandibular right lateral incisor and right second premolar were done earlier. The clinical diagnosis was inferred as amelogenesis imperfecta with hypo-calcified type. All the treatment options viz., removable overlay dentures, tooth-supported complete over-dentures, implant-supported complete dentures, full mouth fixed restorations were discussed, and patient chose the treatment option of full veneer fixed restorations involving the entire dentition. The following clinical steps were executed subsequently.
- Diagnostic impressions were made with irreversible hydrocolloid (Plastalgin, Septodont, France) and casts were poured with type III dental stone (Kalabhai, Karson, Mumbai, India). The casts were articulated in Hanau Wide-vue Arcon 183-2 (Whip Mix Corporation, Louisville, Kentucky, USA) following face bow transfer with Hanau Spring-bow (Whip Mix Corporation, Louisville, Kentucky, USA)
- Vertical dimension at rest was measured as 7 cm and vertical dimension at occlusion was measured as 6.1 cm and patient exhibited freeway space of 9 mm measured in the premolar region
- An anterior deprogramming device [Figure 1] was used and vertical dimension was increased by 5 mm  and interocclusal records were made. The records were transferred to the articulator and the incisal pin was adjusted and a complete maxillary occlusal splint was fabricated in the articulator with clear auto polymerizing resin (DPI, India) and tried in the patient's mouth and refined
- The patient was asked to use this splint for a period of 4 weeks , and no pain or discomfort in temporomandibular joint (TMJ) and oro-facial region were observed
- The splint was transported to the articulator and a Broadrick Occlusal Plane Analyzer [Figure 2] was placed over the upper member and the plane of occlusion was established. A lateral silicone putty index (Aquasil, Dentsply, UK) was made on the buccal aspect and carved to correspond to the newly established occlusal plane.
- The splint was removed and inserted into the patient's mouth and the diagnostic tooth preparation and diagnostic wax-up was done using the putty index as the guide. The cusp-fossa relationship and the mutually protected occlusal scheme with canine guidance were established in the articulator
- An addition silicone putty impression (Aquasil, Dentsply, UK) was made for the diagnostic wax-up [Figure 3] and used as a receptacle for fabrication of provisional restorations. Tooth preparations were done for all the teeth to receive metal ceramic restorations and shoulder finish lines were prepared. The occlusal reduction was done minimally as the vertical dimension was to be increased
- Retraction cords "00" and "2" (Ultrapak, Ultradent, Utah) were packed around the gingiva and the final impressions [Figure 4] and [Figure 5] were made with (Aquasil, Dentsply, UK) and two sets of casts were poured and provisional restorations fabricated using the putty template made from the diagnostic wax-up
- Provisional restorations were tried in the patient's mouth and occlusal contacts were refined and the patient was observed for a period of 4 weeks for tolerance of the provisional restorations 
- The master casts were cross mounted in a semi-adjustable articulator Hanau Wide Vue Arcon 183-2 (Whip Mix Corporation, Louisville, Kentucky, USA) and metal copings were fabricated
- Metal try-in [Figure 6] was done and copings returned to the articulator and were subjected to ceramic veneering using medium fusing porcelain (VITA Zahnfabrik H, Bad Sδckingen, Germany).
A mutually protected occlusion with canine guidance was established in the articulator and tried in the patient's mouth. Occlusal adjustments were done and the restorations were glazed and cemented [Figure 7] with type II glass ionomer cement (GC America, Illinois, USA) and patient was recalled at regular intervals, oral hygiene instructions were given, and the patient was followed up for 3 months. The patient acknowledged the improved esthetics and function. She remained totally asymptomatic during the follow-up period and expressed complete satisfaction with the therapeutic outcome.
| Discussion|| |
Amelogenesis imperfecta is a hereditary disease affecting the enamel matrix formation and mineralization. Since the enamel matrix is defective, and the histological scalloping present in the dentino-enamel junction is obliterated, enamel is subjected to delamination, rapid wear and damage.  Once the enamel is breached, dentin offers less resistance to abrasion and occlusal forces, the patient invariably lands with severe attrition, hypersensitivity, discoloration and loss of vertical dimension.
The therapeutic goals are to treat aforementioned sequel of amelogenesis imperfecta in the most comprehensive manner. Hypersensitivity can be managed by fluoride varnishes, ion electrophoresis, laser desensitization, desensitizing toothpaste and complete veneer crowns. Endodontic treatment may be indicated in cases not responding to the conventional treatment and in cases with pulp exposure. Another huge challenge for the clinician lies in the restoration of aesthetics and re-establishing the lost vertical dimension.
Aesthetics is best restored with ceramic restorations. Metal ceramic restorations combine the quality of the esthetics, strength , and function in the pragmatic manner suitable for full mouth rehabilitation. Metal, ceramic restorations offer excellent biocompatibility and tissue compliance.
Tooth preparation can be a difficult aspect due to the compromised height of the abutments  in conditions like amelogenesis imperfecta, this requires modifications in the preparation by incorporation of parallel walls and additional retentive features such as slots, boxes, and grooves. Retention can be improved by resin luting agents. Crown lengthening can be done to increase the height of the abutments.
Establishing jaw relation and occlusal harmony is the most crucial aspect in full mouth rehabilitation. , Orientation jaw relation established by a face bow is mandatory in patients requiring full mouth rehabilitation. Kinematic face bow can offer a precise recording of the true hinge axis and improve treatment outcome. The increase in the vertical dimension by splints, ,,, has to be monitored to ensure tolerance and health of TMJ and supporting tissues. Once tolerance is established, the occlusion should be meticulously established. The desired occlusion should be mutually protected with the canine guidance in lateral excursions. However, group function may be established in periodontally compromised situations and multiple missing teeth. Sandblasting the intaglio surface  of the metal ceramic restoration and using the resin luting cement can improve the retention. Once the luting cement is set, discrete care should be exercised to remove the remnants of the cement in the gingival and interproximal sulcular crevices. Periodic periodontal maintenance and oral health care are essential for prolonged success.
| Conclusion|| |
Amelogenesis imperfecta can be effectively managed by full mouth occlusal rehabilitation with complete veneer restorations that can holistically improve the health of the stomatognathic system by restoring the lost aesthetics, function and vertical dimension of occlusion.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]