Cumhuriyet Üniversitesi Dişhekimliği Fakültesi Dergisi Cilt 5, Sayı 1,2002
MANAGEMENT OF AMELOGENESIS IMPERFECTA
(Amelogenesis İmperfecta Tedavisi)
Doç. Dr. Mübin ULUSOY*, Doç. Dr. Zuhal TUĞSEL* ÖZET
Amelogenesis imperfekta, diş dokularında gelişim yeter-sizliği, dişlerde hassasiyet ve estetik bozukluk ile karakterli, en-der rastlanılan mine gelişim anomalisidir.
ileri düzeydeki amelogenezis imperfekta hastalarının te-davisi, dişhekimleri için oldukça karmaşık olabilmektedir.
Estetik şikayetleri olan 20 yaşındaki erkek amelogenesis imperfekta olgusu; protetik olarak tedavi edilerek özgüveninin artması sağlanmıştır.
Anahtar Kelime: Amelogenezis imperfekta, Metal
des-tekli seramik.
SUMMARY
Amelogenesis impertecta is a rare developmental abnormality of enamel, the main clinical problems of which are extensive loss of tooth tissue, poor aesthetics and tooth sensitivity.
The treatment of pattents with severe forms of ameloge-nesis İmperfecta presents an interesting chailenge to the den-tal team.
A 20 year oto male presented with poor esthetics had lo-wered first self-esteem.
The final treatment result provided this patient with aest-hetics that greatly enhanced his self-image.
Key Words : Amelogenesis İmperfecta,
porcelain-fu-sed-to-metat crowns
INTRODUCTION
Amelogenesis Imperfecta is a hereditary di-sorder that disturbs the formation of the dental enamel both in the primary and the permanent dentition.1'2 Resulting in poor development or
complete absence of the enamel of the teeth.{3,4} II occurs in the general population in the app-roximate range of 1 in 14.000 to 1 in 16.000 5'6°'°8
It can occur as 2 main typies, hypocalcificati-on and hypoplasia. The hypocalcifted type is the most common form of amelogenesis imperfecta.
Enamel hypocalcification is a defect in the mi-neralization ; the teeth are often stained yellow to dark brown. The enamel may show a chalky dull color or a cheesy consistency and may rapidly bre-ak down.
Hypocalcified teeth have a normal shape when they erupt but have an abnormal color and dull appearance. Loss of enamel from wear and staining tend to increase with age hypoplasia is a defect in the formation of the enamel matrix.9
Therefore, the entire enamel of primary as well as permanent teeth is affected, the teeth may ör may not be discolored and often tnere is consi-derable occlusal wear.10
The disorder may create unaesthetic appea-rance, dental sensitivity and attrition.
in these patients, the pulp and denlin are usu-, ally normal and the teeth are caries resistant.11
Amelogenesis İmperfecta cases can tax the skills of the clinician, numerous treatments have been described for rehabilitalion of amelogenesis İmperfecta in adults and children.9'12
CASE REPORT
The patient a 20 year old maie, was referred by his general dental practitioner to îhe depart-ment of proslhodontics.
The patient expressed extreme dissatisfaction with his appearance, and his molher confirmed that the patient had been socially alfected by this problemrThe teeth were yellow (dentin), irregular in shape and much smaller than vvould normally be expected. There were congenitally missing leeth and a anlerior open-bite. Attrition of îhe molars had resulted in decrease of the vertical dimension of occlusion. ( Fiğ. 1 )
Fig 1: The appearance of 20 years old male patient's teeth with amelogenesis imperfecta. The roots of ali teeth appeared to be normal in shape and size in radiographic evalualion. However, the teeth had rather large pulp chambers that would increase the risk of pulpal damage during tooth preparation.
*Ege Üniversitesi Dişhekimliği Fakültesi, Protetik Diş Tedavisi Anabilim Dalı.
*Ege Üniversitesi Dişhekimliği Fakültesi, Oral Diagnoz ve Radyoloji Anabilim Dalı. Bornova / iZMiR
C.Ü. DİŞHEKİMLİĞİ FAKÜLTESİ DERGİSİ 2002 CiLT: 5, SAYI: 1 The patient was informed of the diagnosis and
ali the possible treatment options. The patient and his mother expressed little concern about the ulti-mate conservation of the teeth and was insistent on a lull oral rehabilitation.
The patient was placed on an intensive oral hygiene program because of his inadeguate oral hygiene. Following periodontal trealment teeth we-re pwe-repawe-red porcelain-fused-to melal crowns and fixed partial dentures were considered when the preparations were made. Teeth were reduced to allovv for 1.5 mm of restorative material on the occ-fusal and incisal surfaces. The margins were pre-pared with a wide chamfer. Final impressions were laken with an addition cured silicone impression material. Accurate occlusal relation records were obtained and the casts were articulated on a semi-adjustable articulator. Finished and polished por-celain-fused-metal crowns and fixed partial dentu-res were cemented. ( Fig 2 )
tia and impacted teeth. J Clinical Pediatr Dent. 1999; 23 (2): 117-122
4. Atasu M., Genç A., Namdar F.: Lokal hypoplastic type of amelogenesis imperfecta: a clinical, genetic, radiological and dermatoloyphic study. J Clinical Pediatr Dent 1996: 20(4); 337- 342
5. Greenfield R.Jacono V.,Zove S and Baer P.: Periodon tal and prosthodontic treatment of amelogenesis impertecta.: J Prasthet Dent 1992 : 68 (4); 572-574
6. Burznski N J., Gonzales W.E.r Snawder K.D.: Autoso-
mal dominant smooth hypoplastic amelogenesis imperfecta. Oral Surg. 1973 : 36 (6); 818-823
7. Collins M.A., Mauriello S.W., Tyndall D.A.,et al.: Dental anornalies associated with amelogenesis imperfecla. Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 1999; 88: 358-64
8. Hail R.K., Phakey P.,Palamara J and Mc Creüie D.A.; Amelogenesis imperfecta and nephrocalcinosis syndrorne. Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 1995: 79; 583- 92
9. Bouvier D., Duprez J.P.,Pirel C. and Vincent B.: Amelo genesis imperfecta - a prosthetic rehabilitation. A clinical re port. J Prosthet Dent 1999 : 82; 130-131
10. RadaR.E., Hasiakos P.S.: C u rrent treatment modaliti- es in the conservative restoration of amelogenesis imperfecta: A case report. Ouintessence Int. 1990:21; 937-942
11. De Şort K.D.: Amelogenesis imperfecta : The gene- tics, classification and treatment. J Prosthet Dent, 1983 : 49f 6) ; 786-792
12. Mackie l,C.,Blinkhorn A.S.: Amelogenesis imperfecta : Early interception to prevent attrition. Dent Update 1991 March :18(2): 79-8
Yazışma Adresi: Doç.Dr. Mübin ULUSOY E.Ü. Dişhekimliği Fakültesi,
Protetik Diş Tedavisi Anabilim Dalı. 35100 Bornova/İZMİR
Fax: 0 232 3880325 Fig 2: After prosthetic restoration of the
same patient.
CONCLUSION
The cosmetic rehabilitation of a patient with amelogenesis imperfecta has been described. The restoration of aesthetics and function in patients with amelogenesis imperfecta may be achieved with a dedicated team approach.
The use of modern dental materials and a jus-tifiable reliance on the predictable artistic abilities of the dental technologist allowes both aesihetic and durable restorations.
REFERENCES
1. Coley-Smilh A.,Brown C.J.: Case report: Radical ma- nagement of an adolescent with amelogenesis imperfecta Dem Updale 1996 Dec;23(10) 434-435
2. Bouvier D.,Duprez J.P.,Bois D.: Rehabilitation of young patienls with amelogenesis imperfecta: A report of two cases. ASDC. J Dert Child 1996 Nov-Dec; 63(6): 443-7.
3. Atasu M., Biren s., Mumcu G.: Hypocalcification type
ameiogenesis imperfecta in perrnanent dentition in association with heavily worn primary teeth, gingivai hyperplasia, hypodon-
