A 5-year-old boy was referred to Department of Pediatric Dentistry at the Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil (Figures -), with the complaint of teeth hypersensitivity during meals and presence of yellow teeth. His parents reported that no one in the family has this change. Clinical examination showed generalized tooth wear, as well as enamel loss affecting the entire primary dentition, with the exception of some cervical areas, and poor oral hygiene.\nA panoramic radiographic examination was performed and the loss of primary teeth structure was observed (). Based on the clinical and radiographic examination and on the exclusion of other possible etiologic factors, such as syndromes, dental fluorosis, or acquired enamel defects, the AI was classified as hypocalcified type. Also, the child presented pacifier use and bottle sucking, lower lip interposition, and mouth breathe. The clinical characteristics observed were abnormal phonation, anterior open bite, and loss of vertical dimension. In addition, the child presented noncooperation for the treatment.\nThe treatment of choice was oral rehabilitation with resin-filled celluloid forms for upper and lower primary incisors and canines and stainless steel crowns on the primary molars. The child's family was instructed about the oral hygiene and the oral habits and management childhood behavior was also realized. A questionnaire on daily food intake was answered by the parents and information about good feeding and eating habits was provided, since the practiced type of nutrition has a direct impact on oral and overall health; moreover, an adequate food, with a balanced intake of nutrients necessary for the proper functioning of the body, is critical to the child's growth and development, contributing to the success of treatment [–]. The initial objective during the treatment was to alleviate the dentinal teeth hypersensitivity, which was achieved by placing glass ionomer cement on the mandibular molars and fluoride varnish application on the anterior teeth (). The benefit of fluoride released from glass ionomers is to promote additional preventive effects, not only acting in the dental structure resistance, but also controlling the growth of S. mutans [, ]. Also, dentin bonding agents seek to obliterate the dentinal tubules, reducing or ceasing hypersensitivity.\nThe restoration of the maxillary and mandibular primary incisors and canines was performed using composite resin-filled celluloid forms (TDV Dental, Pomerode, SC, Brazil) in accordance with the manufacturer's instructions. The procedures were as follows: prepare the forms so they fit directly over the teeth; perforate the lingual surface to overflow the composite resin; isolate the teeth with cotton rolls; acid-etch for 30 seconds with phosphoric acid at 37% (3M/ESPE, St. Paul, MN, USA); rinse with water; change the cotton rolls; gently air-dry; apply two layers of adhesive system (Single Bond, 3M/ESPE, St. Paul, MN, USA) and light-cure following the manufacturer's instructions; apply a light-cured microhybrid resin-composite Opallis (Shade A 0,5/FGM, Joinville, SC, Brazil) inside the celluloid forms; seat the forms with finger pressure; remove material excess; light-cure the restorations; remove the outer forms; check the occlusion; and then finish and polish.\nThe stainless steel crowns were selected and the adjustments were made with carborundum disc (Saint-Gobain Abrasivos Ltd, Carapicuiba, SP, Brazil), with #114 pliers to the satisfactory fit and rubber abrasive points (KG Sorensen, São Paulo, SP, Brazil) to the polish. The interproximal and occlusal tooth surfaces were prepared with diamond burs (KG Sorensen, São Paulo, SP, Brazil). Glass ionomer cement (Vidrion R, SS. White, Rio de Janeiro, RJ, Brazil) was used according to the manufacturer's instructions and placed inside the crowns. Firm seating pressure was exerted on each crown using finger pressure alone. The patient's vertical dimension of occlusion was reestablished with the aid of the stainless steel crowns ().\nSince the mother reported that the child had trouble breathing at night with snoring, he was forwarded to the otolaryngologist. Adenotonsillar hypertrophy was diagnosed and then tonsil removal surgery was carried out. After that, the mother reported that the child had improved breathing. He was forwarded to the speech therapist due to speech difficulties and muscular hypotonia. The child has been recalled for the preventive maintenance at four-month intervals. It is expected that permanent teeth should present AI also. Along the follow-up, the respective diagnosis will be performed and the measurements regarding dietary counseling and instruction about the oral hygiene will be maintained, as well as the treatment of dentinal hypersensitivity, if necessary. Furthermore, after complete eruption of permanent teeth, aesthetic and functional rehabilitation will be performed, if indicated.
A 23-year-old Indian female patient reported to the Department of Conservative Dentistry and Endodontics with a chief complaint of yellowish discoloration and poor appearance of her teeth with the rehabilitation of the same. Family history and medical history was non-contributory. Patient was unmarried, well qualified medical student and there was no history of similar condition in the family. Her parents and siblings were fine and no other family member presented with similar dental findings. Her past dental history disclosed that she underwent root canal treatment of 36 due to caries involvement. Extra-oral examination disclosed normal mouth opening and no temporomandibular joint problems. The patient was healthy with no co-morbidities.\nOn intraoral examination, the enamel thickness was highly thinned down and partially flaked off from few surfaces of teeth. Teeth revealed well defined pitted surfaces along with yellowish brown discoloration. Surfaces of teeth were rough with minimal enamel present. The teeth also revealed short clinical crowns with multiple spacing between teeth. The occlusal plane was uneven worn-down posterior teeth. On frontal view, the patient presented with deep bite with less horizontal overlap. Dentin which was exposed were brown in color. The periodontal examination revealed normal healthy gingiva with no abnormalities (Fig ).\nRadiographic examination included full mouth Orthopantomogram (OPG) and Intraoral periapical radiograph (IOPA) showed features of AI. (Fig ) Occlusion was assessed after obtaining the diagnostic casts. Based on clinical and radiological examination, it was diagnosed as hypoplastic type of amelogenesis imperfecta. Based on the arrived diagnosis, a full mouth rehabilitation was planned. A well formulated treatment plan involving endodontic, and prosthetic department was charted out to furnish a functional occlusion with good esthetics and further prevent the tooth loss. The entire treatment plan was explained to the patient and informed consent was obtained. The initial phase of the treatment consisted of endodontic therapy. Based on OPG reports, it was decided that pulp space therapies should be performed on 37, 46, 47, 16, 17, 26 followed with retreatment with respect to 36 and fixed prosthesis was planned for the entire dentition.\nTreatment protocol: Patient was asked to check her on diet to maintain oral hygiene. The mock presentation of full coverage prosthesis were executed on upper and lower casts and presented to the patient. She was contented with the anticipated outcome and prognosis of the overall treatment plan was satisfactory. The subsequent rehabilitation plan was formulated.\nDefinitive treatment plan:Patient motivation for the treatment and maintenance of oral hygiene, Endodontic treatments of #37, 47, 47, 16, 26, Providing temporary bridges on all posterior teeth for reconstruction of the lost occlusal vertical dimension, Trial of fixed partial dentures and, Periodic follow-ups at 1 year and 2 year intervals followed by augmentation of oral hygiene measures.\nEndodontic treatment was performed with respect to #37, 47, 47, 16, 26 under rubber dam and local anesthesia. 3% sodium hypochlorite (Vishal Dentocare Pvt Ltd, India) was used as irrigant in all the treated teeth. The working lengths for all teeth was obtained using hand K file (Dentsply Inc, Maillefer, Dentsply India), Root ZX II Apex locator (Morita, Irvine, CA), and finally confirmed using intraoral periapical radiograph. #16, 26 showed the presence of MB2. Cleaning and shaping of all the canals were performed with hand K files and Protaper rotary files (Dentsply Inc, Maillefer, Dentsply India) under copious irrigation with 3% sodium hypochlorite and enlarged upto F2 file size. Retreatment was performed with respect to #36. Three rounds of calcium hydroxide as intracanal medicament (CALCICURE, Voco) were placed for #36. All the access cavities were given temporary seal dressing (cotton pellet and intermediary restorative material, Cavit G, 3M ESPE GmbH, Neuss, Germany). All the obturation was completed using F2 protaper gutta percha cone (Dentsply, Maillefer, Dentsply India) with AH Plus sealer (Dentsply, Sirona, Dentsply India). The next stage of treatment was the restorative and prosthetic phase. Fixed partial dentures were planned.\nRestorative treatment included the Post endodontic restoration of # 37, 46, 47, 16, 17, 26 and 36 with composite restoration (Filtek Z 350 XT, 3M ESPE, St, Paul, MN, USA). As per radiographic findings, the impacted teeth was retained as the patient was not willing for any surgical extrusion procedure. The deciduous 63 was included in the tooth preparation. All third molars (#18, 28, 38, 48) were not extracted as they had not erupted.\nProsthetic treatment included the tooth preparation on #17, 16, 15, 14, 24, 25, 26, 27, 34, 35, 36, 37, and 44, 45, 46, 47 to receive metal ceramic crowns. Diagnostic impressions were made using alginate (3M ESPE Alginate Impression Material). The diagnostic casts were then mounted on semi adjustable articulator (Hanau Articulator, Teledyne Hanau Buffalo, NY, USA) using Hanau facebow. The tooth preparations were performed quadrant wise so that the patient was adjusted with the new occlusion. First the posterior teeth were prepared and the temporary acrylic bridges (Integrity™ Temporary Crown & Bridge Material, DENTSPLY, USA) were fixed to increase the occlusal height. Temporary acrylic crowns were placed for 1 month to assess the patient’s forbearance to the new occlusion. Once the patient was habituated to the new occlusal height, then final maxillary and mandibular impressions were prepared with poly vinyl polysiloxane impression material (Aquasil Ultra Putty Soft Regular and Aquasil Ultra LV, Dentsply USA). Interocclusal records in centric occlusion were taken and the working casts were mounted on semi-adjustable articulator (Hanau Articulator, Teledyne Hanau Buffalo, NY, USA). Trial with metal ceramic restorations was done and finally cemented with self-adhesive resin (RelyX Unicem 2 Clicker A2 Universal Self-Adhesive Universal Resin, 3M-ESPE, USA). Then the anterior teeth were prepared for metal ceramic restorations. The patient was regularly monitored at 1 week, 1 month, 3 months, 6 months and at 1 year and 2 years intervals using clinical and radiographic examinations (Figs. , and ). Patient was highly satisfied with the treatment outcome and the gingival condition was maintained, esthetic impairment and the dentinal sensitivity was resolved.