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 12-year-old male patient came with a complaint of yellow brown discoloration of his upper anterior teeth since 4-5 years. His parents were aware of discolored deciduous teeth. Family history was unremarkable. Patient had mixed dentition present with deciduous molar root pieces. On examination, brownish discoloration was present in 21, 11, 36, 46 and chalky white discoloration was present in relation with all other teeth. Incisal edges of 33, 34, 43, 44 were thin with dentin exposed. Enamel was softer in consistency with chipping of enamel on probing []. On the basis of clinical examination, provisional diagnosis of hypomaturation AI was made. Panoramic radiograph was advised which showed presence of a thin layer of enamel with radiodensity of enamel more than dentin and taurodontism of 16, 26 []. Final diagnosis of hypoplastic-hypomaturation-AI with taurodontism of 16, 26 was made.