A 4-year-old male patient reported to the Department of Pedodontics and Preventive Dentistry with a chief complaint of decayed upper front teeth. Patient's medical history was noncontributory. Patient's mother gave a history of breast feeding for 1 year after which the child was bottle fed for 3 years. Intraoral examination revealed a complete set of deciduous dentition. It was observed that 55, 52, 51, 61, 62, 65, 71, 72, 73, 74, 75, 81, 82, 83, 84, and 85 were affected by dental caries (). Intraoral periapical radiographs revealed pulp involvement with 52, 51, 61, and 62 (). Diet analysis, counseling, and oral prophylaxis were done. 74 and 75 were grossly carious and were indicated for pulpectomy followed by a stainless steel crown (). 52, 51, 61, and 62 were indicated for pulpectomy, followed by glass fibre-reinforced composite resin posts and composite buildups. 55 and 65 presented with pit and fissure caries and were indicated for composite resin restorations.\nThe treatment plan was divided into 2 steps for 51, 52, 61, and 62.\nAn infraorbital block was administered for 61 and 62, and labial and palatal infiltration was carried out for 51 and 52. Gross carious lesions were removed with a no. 330 round carbide steel bur. Unsupported enamel was not removed so as to preserve as possible. The pulp chamber was opened and working length determination IOPA was taken with a no. 10 K-file.The pulp tissue was extirpated using no. 10–no. 35 K-files. After irrigation with copious amounts of 2.5% NaOCl and normal saline, the root canal was dried using paper points. A thick mix of Endofloss paste was then condensed with lentulo spiral into the canal. The obturated material was allowed to set for 10 minutes ().\nThe post space was prepared 1 week after the endodontic treatment was completed. The post space was created by removing approximately 4 mm of Endofloss material using a thin straight fissure bur. All visible Endofloss cement on the walls of the post space was removed.\nThe prepared post space was then cleaned with saline, air dried, and acid etched with 37% phosphoric acid for 15 seconds. This space was rinsed and air dried with oil-free compressed air. A light-cured bonding agent was brushed on the etched surface and uniformly dispersed by a compressed air blast. It was then light cured with for 20 seconds. The GFRC post was then cured for 20 seconds in order to gain rigidity, before insertion into the post space. Light cured flowable composite resin was then inserted into the canal chamber after which the GFRC post was inserted (). The fiber post and composite were then cured with together for 60 seconds. The coronal portion of the glass fibre-reinforced composite post was splayed to increase the surface area for the retention of the core.\nThe coronal enamel was then etched for 20 seconds, rinsed with water and air dried followed by application of bonding agent—which was then light cured. The coronal post was then covered with the flowable composite for core build up, followed by light curing it for 60 seconds, and finally teeth were restored with hybrid composite. The final finishing and polishing was done with finishing burs. Occlusal interferences in normal and paranormal mandibular movements were removed ().
An 11-year-old girl reported to the Department of Pedodontics and Preventive Dentistry, Dr. D.Y. Patil Dental College and Hospital, Pune, with the chief complaint of discolored teeth since childhood.\nThis little girl's parents did not seek any treatment previously, thinking that since the condition was not resulting in any other systemic manifestations and since she had inherited the condition from her father, there was little they could really do about it and accepted it as part of her appearance. It was only now, when they realized that the girl avoided hard food substances, they got her to a dentist.\nOn enquiry, it was revealed that her deciduous teeth were also similarly discolored, and her father, younger brother of eight years, and younger sister of six years, also suffered from the same condition. The pedigree chart could be constructed as in .\nApart from this, her past medical history was noncontributory. The history did not reveal any eruption disturbances. From a functional point of view, she had been avoiding hard food substances; at the same time, remaining caries free, except for a sole proximal carious lesion in 36, involving the enamel and dentin.\nOn intraoral examination, it was found that she had a normal complement of teeth. The thickness of enamel was reduced on the teeth and was completely chipped off from some teeth exposing the dentin. The surfaces of the teeth were rough. The teeth, in general, exhibited a yellowish brown discoloration, with diffuse pitting present on the exposed tooth surfaces, more prominent on the labial and buccal aspects. The emergence pattern and timing of teeth seemed to be within the normal range. No open bite was present. Examination of the periodontium revealed the presence of chronic, generalized, marginal, and papillary gingivitis, with calculus deposition and unsatisfactory oral hygiene [Figures –].\nA provisional diagnosis of hypoplastic, rough autosomal dominant AI was proposed along with a differential diagnosis of environmental enamel hypoplasia, dentinogenesis imperfecta, dentin dysplasia, regional odontodysplasia, and the tricho-dento-osseous syndrome.\nRadiographic investigations included an orthopantomogram (OPG) and full mouth intraoral periapical (IOPA) radiographs. The OPG showed the presence of all unerupted third molars, as well as a seemingly normal pattern and timing of eruption of teeth []. Examination of the IOPA radiographs revealed a normal pulp chamber and root canal spaces with no signs of obliteration. The enamel was almost half its expected thickness, but was more radiodense than the dentin.\nThe ground section of an over-retained deciduous molar extracted from the girl showed that the enamel was thin and was composed of laminations of irregularly arranged enamel prisms. No abnormality was apparent in the dentin []. shows a ground section of a normal tooth, where regularly arranged enamel prisms along with the normal thickness of enamel can be appreciated [].\nThe diagnosis of hypoplastic, rough, autosomal dominant AI was confirmed on the basis of typical, clinical, radiographic, and histopathological features.\nEsthetics along with functional limitations were the reason the patient's parents brought her to the hospital for treatment. The treatment proposed for her ranged from bonded veneer restorations to tooth preparations for the placement of a full crown. Restoration of the carious lesion in 36 would be accompanied by a full coverage restoration. The coronal pulp in these children tends to recede faster than in normal teeth and hence crown preparations for full coverage crowns can often be done for relatively young patients.\nAttrition of teeth is a major problem in cases of AI. Therefore, the use of stainless steel crowns as a preventive measure is advocated. Hand scaling was advocated and oral hygiene instructions were given to the patient. Regular brushing of the teeth using the modified Bass technique was taught to the patient to be practiced twice a day (morning and at night before going to bed) using a soft toothbrush and a fluoridated toothpaste (containing 1000 ppm of available fluoride) followed by rinsing with 2% w/v of chlorhexidine gluconate for 15 days.