Fixed Rehabilitation of an ACP PDI Class III Patient with Amelogenesis Imperfecta

This clinical report describes the oral rehabilitation of a 19-year-old woman diagnosed with hypoplastic-type amelogenesis imperfecta (AI). She presented with discolored and mutilated teeth, missing teeth, anterior open bite, and posterior short crowns. She was classified as an American College of Prosthodontists Prosthodontic Diagnostic Index (ACP PDI) class III patient. The aim of treatment was to restore esthetics and improve masticatory function. The patient's esthetic and functional expectations were successfully attained with porcelain laminate veneers and all-ceramic and metal-ceramic restorations after extensive crown lengthening. The patient was regularly recalled during the postoperative period. Loss of retention of one all-ceramic crown and minimal recession of the gingiva of one laminate veneer were noted at 4-year recall.     

Oral Rehabilitation of a Young Adult with Amelogenesis Imperfecta: A Clinical Report

This clinical report describes a multidisciplinary approach for the oral rehabilitation of a young adult patient diagnosed with hypoplastic amelogenesis imperfecta with a skeletal Class III malocclusion. The specific objectives of this treatment were to eliminate tooth sensitivity while enhancing esthetics and restoring masticatory function. The reverse horizontal overlap of posterior teeth was maintained. Treatment included removal of few teeth, lengthening of the maxillary and mandibular clinical crowns, and placement of anterior and posterior metal-ceramic fixed partial dentures. The third month recall examination revealed no pathology associated with the rehabilitation, and the patient's esthetic and functional expectations were satisfied.     

Amelogenesis imperfecta: a scanning electron microscopic and microradiographic study

The aim of the present study was to use scanning electron microscopy (SEM) to visualize the morphology of the enamel surface in 12 primary teeth from children with amelogenesis imperfecta (AI). The observations were correlated to genetic, clinical and microradiographic data from the same teeth and to non-affected control teeth. SEM showed similar disturbances in teeth with a clinical predominance of hypoplasias and in teeth with a predominance of hypomineralization. In the microradiographs the enamel of most teeth showed both hypoplasias and areas of hypomineralization, independently of the predominant clinical manifestation. In the one boy with an X-linked inheritance pattern, both SEM and microradiography showed the morphology of the enamel to be unique in the present study. In the other teeth, similar manifestations were found in cases with AI as an AD trait and in the sporadic cases.     

Functional and Esthetic Rehabilitation of Mutilated Dentition Associated with Amelogenesis Imperfecta

This clinical case report describes the oral rehabilitation of an adult female patient diagnosed with hypoplastic amelogenesis imperfecta with inadequate, deteriorated restorations of anterior teeth, inadequate clinical crown heights of posterior teeth due to severe attrition of hypoplastic enamel. Treatment included extraction of teeth with poor prognosis, root canal treatment and crown lengthening of severely worn out teeth & full coverage porcelain-fused-to metal fixed restoration of entire dentition. The main objectives of the selected treatment were to enhance the esthetics, restore masticatory function and eliminate the teeth sensitivity. These treatment objectives were successfully met by sequential fixed prosthodontics treatment using Pankey–Mann–Schuyler philosophy of complete occlusal rehabilitation. Treatment not only restored function and esthetic, but also showed a positive psychological impact and thereby improved perceived quality of life.     

Management of Amelogenesis Imperfecta in Adolescent Patients: Clinical Report

The oral rehabilitation of adolescent patients with amelogenesis imperfecta (AI) is complex due to the presence of mixed dentition with altered eruption sequence. In this article, the interdisciplinary treatment approach for adolescent patients with AI is discussed. The types and timing of treatments at various stages of growth are described through a literature review on this topic. AI is an inherited condition that disturbs the development of the enamel structure. Because of the presence of mixed dentition, definitive treatment options often have to be delayed until eruption of permanent dentition is complete, requiring careful treatment coordination and proper sequencing between different dental disciplines starting at a young age. Adolescent patients require prosthodontic treatment design that can be adapted to the changes in arch shapes, sizes, interarch relationship, and esthetic needs. AI patients are often challenged with both excessive and limited restorative spaces within the same arch due to the abnormal growth patterns, enamel structure, tooth size, and tooth shape. Therefore, careful determination of the required restorative space is critical to ensure optimal prognosis. This clinical report discusses treatment recommendations, timing of various treatment modalities, and involvement of appropriate interdisciplinary teams for managing adolescent patients.     

Amelogenesis imperfecta – clinical manifestations in 51 families in a northern Swedish county

Abstract – The clinical manifestations of amelogenesis imperfecta (AI) were described in 165 individuals from 51 families. The inheritance pattern for AI in these families had previously been investigated, and it was hypothesized that AI probably is solely an autosomal dominant (AD) or X-linked trait. To test this hypothesis the connection between clinical manifestation and inheritance pattern was studied. Eight different variants of AI were seen. In 33/51 families all affected individuals could be assigned to the same clinical variant. In 8/51 families those affected were assigned to different clinical variants. In the two families where an X-linked recessive (XR) inheritance pattern was found probable, the clinical manifestation differed between women and men. Except for one variant only seen as an AD trait, and the manifestation in women in families with an X-linked recessive inheritance pattern, no connection was found between a specific inheritance pattern and a specific clinical manifestation. Accordingly it seems likely that AI is solely an AD or X-linked trait. The different clinical variants observed should be regarded as a varying expressivity of the gene and in the families with X-linked inheritance probably due to lyonization. In the remaining families the modifying mechanisms are not known.     

Amelogenesis imperfecta: prevalence and incidence in a northern Swedish county

Abstract The aim of the study was to establish the prevalence and incidence of amelogenesis imperfecta (AI) in the county of Vasterbotten, northern Sweden using the criteria of Witkop & Sauk (1976). The diagnoses were based upon clinical and radiographic evidence. The study-population consisted of all 3-19-yr-olds born in the county from 1963 to 1979. AI was diagnosed in 79 children, 41 girls and 38 boys, giving a prevalence of 1.4:1000. The mean incidence 1963-79 was 1.3:1000. Half of the children with AI had brothers or sisters in the group. The hypoplastic form was the most common (58 children) followed by the hypomaturation form (16 children). Only five children had the hypomineralization form.     

Prevalence of developmental enamel defects in children with cerebral palsy

Enamel defects observed in primary anterior teeth of 123 children with congenital cerebral palsy (CP) born 1983 through 1985 in four northern California counties were categorized using an adaptation of the Developmental Defects of Enamel Index. Nineteen children (15%) had crowns or loss of tooth substance (LTS) due to attrition. Missing enamel (ME) including horizontal groove, was observed in 39 children (32%). Twenty-four children without ME (20%) had enamel pits, vertical grooves, or colored enamel opacities. Forty-one (33%) had clinically normal enamel. ME children did not differ significantly from those with normal enamel with respect to race, sex, singleton vs twin, severity or type of CP, or presence of dysmorphic features. ME children more often had shorter gestational ages than children with normal enamel. More ME children, even those who were not low in birth weight, were reported by parents to have required neonatal intensive care.     

Epidemiologic study of idiopathic enamel hypomineralization in permanent teeth of Swedish children

In the late seventies an increasing number of children showing extensive and severe idiopathic hypomineralization of the enamel of incisors and permanent first molars was reported within the Public Dental Services in Sweden. An epidemiologic study was initiated to analyze the prevalence, extension and severity in Swedish children born in 1970 and in the years before and after. 2252 children born in 1966-74 were examined according to well defined criteria on enamel hypomineralization. It was found that 15.4% of the children born in 1970 showed such changes. The corresponding figures for children born in 1966, 1969, 1971, 1972 and 1974 were 6.3, 7.3, 7.1, 5.2 and 4.4, respectively.     

Rehabilitation of a bulimic patient using endosteal implants

This article describes the dental rehabilitation of a bulimic patient using endosteal implants. Although the patient, a 31-year-old woman with a long history of bulimia nervosa, had been receiving medical and psychological treatment, the condition was not completely controlled. Clinical examination revealed multiple crowns with extensive cervical caries. The prognosis for all remaining teeth was poor. After extractions, implant therapy was implemented to provide support for fixed prostheses. After the implants were uncovered and during provisional therapy, the peri-implant tissue exhibited inflammation and lack of keratinized tissue requiring additional periodontal procedures before definitive restorations could be placed. Because of the difficulty in managing the peri-implant tissue during the many phases of implant therapy, treatment was challenging. One year after treatment, the patient's low self-esteem had improved substantially and her restorations provided satisfactory esthetics and function.     

Scanning electron microscopy of fluorideinduced disturbances on the enamel surface of rat molars

Abstract — Rats were given a single high dose of fluoride at the age of 5 days and killed after 24 h, 10 or 15 days. The maxillary Erst molars were prepared for scanning electron microscopic examination. It was concluded that a single dose of fluoride, preferentially affecting ameloblasts with a high secretory activity, leads to the formation of subameloblastic cysts and enamel hypoplasias covered with granular deposits.     

Occlusal Rehabilitation of Pseudo‐Class III Patient

To treat a patient with anterior crossbite, the clinician should first assess if it is a genuine class III or a pseudo‐class III malocclusion. Cephalometric analysis is important; however, registering a patient's centric relation (CR) is simple, quick, and costless and can play a decisive role in a differential diagnosis for this type of patient profile. This clinical report depicts a patient clinically diagnosed as class III. After mandible manipulation in CR, it was noted that the patient in question was a pseudo‐class III. The treatment was based on the pseudo‐class III diagnosis. Therefore, the patient was rehabilitated by occlusal adjustments and conventional and implant‐supported prostheses and without the need for invasive orthognathic surgery.     

Oral health of Australian children using surface and artesian water supplies

Abstract Oral health parameters were compared for 6–8 and 10–11-year-old children living in neighbouring N. S. W. towns, where the community water supplies consisted of artesian and river water respectively. The demographic characteristics, living pattern and dietary carbohydrate challenge were similar in the two areas and effective oral hygiene practices were uniformly lacking. Children in the artesian water area had 40% lower caries prevalence (DIMFT), 50% less severe carious lesions (SR) and significantly better oral hygiene (OHI) and gingival condition (PI) and correspondingly lesser treatment needs than those supplied by river water. The findings were examined in relation to the concentrations of 10 elements in roof catchment, river and artesian water. Apart from a contribution by fluoride to better oral health, the results implicate lithium as a possible beneficial element.     

Medical-dental findings and management of a child with infantile Refsum disease: a case report

Infantile Refsum disease (IRD) is a peroxisome biogenesis disorder (PBD), and is part of a larger group of diseases called leukodystrophies, which are inherited conditions that damage the white matter of the brain and affect motor movements. Multiple signs and symptoms of IRD begin in infancy and progress through early childhood, including hearing and visual impairment, intellectual and growth impairment, seizures, liver involvement, and orofacial and dental abnormalities. This paper presents a case history of a 12-year-old female patient with IRD who underwent dental rehabilitation in the operating room under general anesthesia and includes a 2-year follow-up. Medical, dental, and management considerations in the care of this child's condition are presented. This paper also discusses the importance of a multidisciplinary approach in the management of children with special needs.     

Amelogenesis imperfecta: a classification and catalogue for the 21st century

Amelogenesis imperfecta (AI) is a collective term for a number of conditions with abnormal enamel formation. Many cases are inherited, either as an X-linked, autosomal dominant or autosomal recessive trait. Several classifications have evolved since 1945, based primarily on phenotype with the mode of inheritance being used in some systems as a secondary factor in allocating a case into a particular category. The benefits and shortcomings of these systems are reviewed. As we move into an era of establishing the molecular basis of AI we propose a robust mechanism for classification and cataloguing of the disorder which parallels systems used in medical genetics. This system is applicable to individuals and families irrespective of current or future knowledge of the molecular defect involved. We argue that this system is of more benefit to these individuals and families than previous classifications.     

Influence of educational background on stated retreatment choices for suboptimal fixed prosthodontic conditions.

PURPOSE: The aim of this study was to compare the stated retreatment choices for defined, suboptimal fixed prosthodontic scenarios among groups of dental professionals with differing levels of education. MATERIALS AND METHODS: The study population (n = 75) comprised interns (n = 27), various categories of graduate students (n = 32), and specialist staff (n = 16) from the same institution. Participants were required to record their choices of retreatment or no retreatment for 22 suboptimal fixed prosthodontic scenarios. RESULTS: Participants' choices varied within and between groups, with regard to specific scenarios. Intergroup differences that were statistically significant were for faulty occlusion (p= 0.013), open margin (p= 0.019), defective root filling (p= 0.001), periapical radiolucency (p= 0.011), and improper pontic design (p= 0.005), when no signs and symptoms, no caries, or no inflammation were present. The results confirm the widely-acknowledged variability in decision making that exists among dental professionals in general. CONCLUSION: The tendency for a significantly more interventive approach by those on a training pathway focused on imparting primarily clinical/technical skills than those enrolled in more conventional, academically-based programs, suggests that an educational dimension cannot be overlooked in the characterization of dentists' stated retreatment decision choices.     

Implant‐Supported Oral Rehabilitation of a Patient with Pemphigus Vulgaris: A Clinical Report

Pemphigus vulgaris (PV) is a rare mucocutaneous vesiculobullous disease characterized by the development of autoantibodies against the desmosomal proteins. Current treatment is largely based on systemic immunosuppression using systemic corticosteroids. Immunosuppressive drugs used in the treatment of the disease may increase the risk of infection and delayed healing, which are of concern in dental treatment procedures in this group of patients. The clinical outcomes of implants in PV have not been investigated. We present a case of PV rehabilitated with an implant‐supported prosthesis with a 32‐month follow‐up and discuss the important points in the surgical and prosthodontic phases.     

遗传性釉质发育不全家系致病基因的定位研究

目的定位遗传性釉质发育不全（AI）家系的致病基因。方法收集1个常染色体显性AI家系,提取该家系19名成员（其中患者9例）的外周血DNA,选择横跨釉蛋白基因、成釉蛋白基因、釉丛蛋白基因、基质金属蛋白酶基因、丝氨酸蛋白酶基因5个候选基因的短串联重复序列（STR）,进行PCR扩增,经变性聚丙烯酰胺凝胶电泳确定基因型,并进行连锁分析。结果得到19名个体的8个STR位点的基因型,分别为D1s498、D1s2343、D4s1543、D4s2361、D4s2969、D11s1339、mmp20、D19s246。连锁分析结果显示各位点的LOD值在重组率为0时均小于1,不支持该家系的致病基因与5个侯选基因上的STR位点的连锁关系。结论连锁分析结果不支持该家系致病基因定位于已知基因座处,提示至少某些常染色体显性AI家系的致病基因不是文献所报道的AI候选基因,进一步证实了常染色体显性遗传性釉质发育不全的遗传异质性。