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.
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.