An 11- year- old boy presented to the dental clinic with his father, complaining of poor esthetics and delaying of eruption of teeth. Examination revealed a suspicion of amelogenesis imperfecta ( clinically & radiographically). Teeth present: 11, 21, 31, 16, 26, 36, 46, all primary molars and canines and partially erupted 12,22, 42. Patient has also angle, class III. Outline the treatment plan for such a case.
hi
can you please upload panoramic radiography and photographies?
I think the first step is to know the exact type of amelogenesis imperfecta ,if accompanied by anterior openbite it seems that the case is of hypocalcified type.
these patients report tooth sensitivity too.If dental age of the patient is late(It takes some time for the primary molars to shed),SSC seems a good choice and if needed pulp therapies must be done.for anterior teeth,composite veneers can be used until reaching full growth when they can be replaced with crowns,if needed.for first permanent molars,permanent SSC are available if they are too hypoplastic.otherwise, more conservative approaches must be used.
Most importantly,I think it will be useful to begin the patient care with preventive approaches including fluoride therapy,sealants,diet consultation and etc.
For skeletal problems as you mentioned,consult with an orthodontist, although bonding procedures is some how difficult in these patients.
these are the plans I had, and wait for hearing more extensive treatment plans.
A lot depends on the actual condition of the patient. Photographs and radiographs will be more useful in determining the treatment. ADA has given certain clinical guidelines. I am also attaching a case report that may be helpful. The third paper is also regarding management of AI. However in a 19 year female. I am also adding another case of a 12 year old male.
Hi Hayfaa. Amelogenesis Imperfecta is hereditary enamel defects unassociated with systemic disorder. It affects both primary & permanent dentitions. Clinical manifestations are variables according to type of the defect. The main problems are poor esthetic, altered vertical dimension, anterior open bite, significant structural loss, tooth sensitivity, compromised chewing function as well as increase prevalence of caries, gingival and periodontal problems. Delayed eruption, ectopic eruption, tooth impaction and ankylosis have also been reported. Management of this condition starts by proper diagnosis based on history, clinical and radiographic examinations. Genetic investigation can confirm your diagnosis. Management of such condition requires a multidisciplinary discussion of treatment plan with orthodontics, prosthodontics, periodontics and endodontics. The objectives of treatment are to maintain form and function, improve esthetics, prevent early enamel loss and caries, restore vertical dimension and functional occlusion, control tongue thrusting, reduce tooth sensitivity, and maintain the gingival health and oral hygiene. The following articles may be helpful.
Pires dos Santos AP, Cabral CM, Moliterno LFM, Oliveira BH. Amelogenesis imperfecta: report of a successful transitional treatment in the mixed dentition. J Dent Child 2008;75: 201-6.
Poulsen S, Gjorup H, Haubek D, et al. Amelogenesis imperfecta-a systematic literature review of associated dental and orofacial abnormalities and their impact on patients. Acta Odontol Scand 2008; 66:193-9.
Ng FK, Messer LB. Dental management of amelogenesis imperfect patients: a primer on genotype-phenotype correlations. Pediatr Dent 2009; 31: 20-30.
http://www.aapd.org/media/Policies_Guidelines/G_OHCHeritable.pdf
It would be easy if u could upload the clinical image of the patient. Upper anteriors can be mostly corrected by labial veneers/ laminates. For posterior molars u need stainless steel crowns.
To give a treatment plan for cases like Amelogenesis imperfecta CLINICAL PICTURES AND RADIOGRAPHS are very important. crowns for anterior and posterior teethcan be given.
Hi!
Please upload radiographs if possible. Usually in such cases stainless steel crowns remain the restoration of choice. Such a case will probably require prosthodontic correction to correct bite.
Dear colleagues:
Thanks you all for your valuable contributions and input. I beg your pardon for being late to respond to your request. I lost some of my documents for this case. It is really an interesting case that needs a multidisciplinary approach and more investigations regarding determination of its geneotype and clear photo & radiographs. I will upload a DPT (not so clear) and later photos when I got them again. Once more my gratitude to all of you and Dr. Sharma & Dr. Mona for the documents.
Stainless steel crowns in the posteriors will help to prevent furth enamel loss.
This case report represents an infant who presented with typical clinical features of AIGFS.
AIGFS is a rare autosomal recessive disease characterized by mild gingival hyperplasia and dental abnormalities including generalized thin hypoplastic amelogenesis imperfecta, intrapulpal calcifications and delay of tooth eruption. It has been described in the beginning in four patients from a consanguineous family by Martelli et al. One of the patients presented with intellectual deficit. O’Sullivan et al. identified recently a homozygous nonsense mutation in exon 2 of the FAM20A gene in a family with AIGFS .
The FAM20A gene (family with sequence similarity 20, member A) is located on chromosome 17q24.2, and consists of 11 exons; the protein FAM20A, 541 aminoacids, is expressed in ameloblasts and gingivae. FAM20A plays a fundamental role in enamel development and gingival homeostasis.
Six FAM20A mutations were reported in patients with AIGFS . The mutation c.406C > T (p.Arg136Ter) in exon 2, was identified by autozygosity mapping combined with exome sequencing, in a consanguineous family.ur results will help clinicians and molecular geneticists to determine the genetic etiology of AI patients. We suggest that mutations of FAM20A gene are causative for AIGFS and underline the recurrent character of the c.34_35delCT in two different ethnic groups.
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Infectious Diseases