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 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 ().