E-ISSN :0975-8437

E-ISSN :0975-8437

P-ISSN: 2231-2285

CASE REPORT

Conservative cosmetic treatment of Amelogenesis Imperfecta

Conservative cosmetic treatment of amelogenesis imperfecta

The clinician must consider that a dry, clean working field and
proper use of bonding protocol is the key to achieve success
in adhesive dentistry.22,23

Swetha Bollineni, P Prashanthi, P Karunakar, Raji V Solomon

Abstract
Amelogenesis imperfecta (AI) is a complex group of hereditary enamel defects, existing independent of any related
systemic disorders. This paper reports the functional and esthetic rehabilitation of a 22-year-old female patient with AI
with direct cosmetic composite resin restorations.
Keywords: Amelogenesis Imperfecta; Composite Resin; Enamel Defects; Restoration

Case Report
A 22-year-old female patient reported to the Department
of Conservative Dentistry and Endodontics, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre,
Hyderabad, India, with a chief complaint of poor esthetics
from the presence of irregularities and discolouration of upper and lower front teeth. She had a related family history.
Intra oral examination revealed that all her upper and lower
anterior teeth were yellow brown in colour with an anatom-

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The initial Phase consists of deep sub gingival scaling with

proper oral hygiene instructions. Patient was recalled after a
two weeks and assessed for improvement in gingival health.
The inflammation was subsided with no bleeding on probing.
During the second Phase suitable composite resin colour was
selected using the shade guides. Maxillary and mandibular
anterior teeth were prepared for direct composite resin laminate veneer restorations (Figure 3). Hypoplastic and darkened
enamel that may negatively affect the final esthetic appearance of the rehabilitation were removed. For this purpose 0.5
mm facial and proximal reduction was performed. Teeth were
etched with the phosphoric acid for prolonged time than normal and rinsed for 30sec and dried with absorbent paper. A
two component adhesive system was applied on the prepared
tooth surface and was light cured for 20 sec with a blue phase
LED light source. The direct veneer restorations were performed with Tetric N Ceram i.e., radiopaque nano-hybrid composite. A combination of incremental and stratified layering
technique was used to fill the teeth. The composite was added
in increments of 1.5-2mm and was light cured after each layer
according to manufacturers instructions (Figure 4). Finishing
and polishing was accomplished with ultrafine diamond burs
and composite rubber polishing burs. Completed restoration
of anterior teeth enhanced the esthetics and smile of the patient (Figure 5,6).

Discussion
The term esthetics is extremely subjective in the field of dentistry. During the evaluation of aesthetically compromised
teeth, dentists encounter adverse clinical conditions of great
complexity, marked by the invasion of the mineralized structures at depth. Amelogenesis imperfecta of anterior teeth results in poor psychologic image in young patients. This makes
the problem urgent from psycho-social point of view. Most
defects in enamel are cosmetic rather than functional dental
problems.7 The main clinical characteristic is extensive loss of
tooth tissue, carious lesions, tooth sensitivity and poor esthetics. In amelogenesis imperfecta the enamel is insufficiently
mineralized, extremely soft and may show a chalky, dull color
or a cheesy consistency with the possibility of a rapid break
down. These teeth have an abnormal shape when they erupt.
Loss of enamel from wear and staining tends to increase with
age. Interestingly, the enamel at the cervical portion is frequently better calcified than that on the rest of the crown.5
A variety of treatment approaches have been proposed to
address the esthetic concern and functional rehabilitation of
defective enamel in amelogenesis imperfecta patients. The
treatment plan is related to factors such as age, socio-economic status, type and severity of the disorder and intraoral
situation at the time the treatment.2 Attempts should be made
to achieve esthetics while keeping the loss of tooth substance
to a minimum.15
Direct veneers have been increasingly used in clinical dentistry to restore anterior teeth that have alterations in color or
anatomical shape.16 Direct veneering with composite resin is a
conservative and economical option that provides good and
long lasting esthetics and functional restoration.17 In order to
achieve good bonding strength of defective enamel, extended etching periods have been recommended for conventional
adhesive systems.18
Composite resins are challenging ceramics because they offer
excellent aesthetic potential and acceptable longevity, with
a much lower cost than equivalent porcelain restorations for
the treatment of both anterior and posterior teeth.19,20 The restoration of the tooth volume utilizing composite veneers not
only re-establish the smile but also allows the biomimetic recovery of the crowns. In cases which necessitate correction or
alteration in tooth shape or position and changes in morphology composite veneers display promising esthetic results.21

Authors Affilations

1. Swetha Bollineni, MDS, Senior Lecturer, Department of Conservative Dentistry and Endodontics, Pinnamaneni Siddhartha Institute of
Dental Sciences, Vijayawada, Andhra Pradesh, India, 2. P Prashanthi,
MDS, Department of Conservative Dentistry and Endodontics, Pinnamaneni Siddhartha Institute of Dental Sciences, Vijayawada, Andhra
Pradesh, India, 3. Karunakar P, MDS, Professor and Head, Department
of Conservative Dentistry and Endodontics, Panineeya Institute of
Dental Sciences and Research Centre, Hyderabad, Andhra Pradesh,
India, 4. Raji.V.Solomon, MDS, Professor, Department of Conservative
Dentistry and Endodontics, Panineeya Institute of Dental Sciences
and Research Centre, Hyderabad, Andhra Pradesh, India.

References
1. Gnlol N, Bulucu B. Diagnosis and conservative rehabilitation
of a patient with amelogenesis imperfecta and 5-year follow-up:
a case report. Clinical dentistry and research. 2013;37(1):51-6.
2. Sengun A, Ozer F. Restoring function and esthetics in a patient
with amelogenesis imperfecta: a case report. Quintessence international (Berlin, Germany: 1985). 2002;33(3):199-204.
3. Musale PK, Yadav TK, Bijle MNA. Clinical Management of an Epigenetic Enamel Hypoplasia-A Case Report. International Journal
of Clinical Dental Science. 2011;1(1):77-80.
4. Hu J-C, Chun YH, Al Hazzazzi T, Simmer JP. Enamel formation and
amelogenesis imperfecta. Cells Tissues Organs. 2007;186(1):7885.
5. Akin H, Tasveren Sh, Yeler DY. Interdisciplinary approach to treating a patient with amelogenesis imperfecta: A clinical report.
Journal of Esthetic and Restorative Dentistry. 2007;19(3):131-5.
6. Coley-Smith A, Brown CJ. Case report: radical management of
an adolescent with amelogenesis imperfecta. Dental update.
1996;23(10):434-5.
7. Seow WK. Clinical diagnosis and management strategies
of amelogenesis imperfectavariants. Pediatric dentistry.
1992;15(6):384-93.
8. Dawasaz AA, Zakirulla M, Allahbaksh M. Hypocalcified autosomal recessive amelogenesis imperfectaA case report. Open
Journal of Stomatology. 2012;2:251-4.
9. Oliveira IK, Fonseca JF, do Amaral FL, Pecorari VG, Basting RT,
Frana FM. Diagnosis and esthetic functional rehabilitation of
a patient with amelogenesis imperfecta. Quintessence international (Berlin, Germany: 1985). 2011;42(6):463-9.
10. Saha MK, Saha SG. Restoration of anterior teeth with direct composite veneers in Amelogenesis Imperfecta. International Journal of Dental Clinics. 2011;3(2).
11. Chengappa M, Ramamoorthi M, Sivagami N. Rehabilitation of
Mutilated Natural Dentition associated with Amelogenesis ImperfectaA Case Report. International Journal of Dental Clinics.
2010;2(4).

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2014 Volume 6 Issue 2

As Amelogenesis Imperfecta is a genetic disorder, preventive

treatment is not possible; therefore, the treatment is focused
on esthetic and functional rehabilitation.1,9-11 Treatment depends on the severity of the problem and the need for esthetic enhancement, ranging from simple composite resin
restorations to complete crown restorations in cases involving
greater loss of tooth structure or loss of vertical dimension.1
The use of adhesive restorations has great popularity owing
to many improvements such as excellent esthetics, conservative approach and improved wear and mechanical properties.
Minimal invasive conservative techniques obtain desirable esthetics. The teeth and supporting structures were preserved
and a harmonious relationship was maintained between the
occlusion and temporomandibular articulation.12 The use of
laminate veneers and composite resins has matured to a predictable treatment methods in terms of longevity, periodontal
status and patient satisfaction.13,14 This paper reports the functional and esthetic rehabilitation of a 22-year-old female patient with AI with direct cosmetic composite resin restorations
with two-year follow-up.

ic variation. This includes macro sized upper central incisors

and micro sized conoid lateral incisors (Figure 1,2). Diastema
was noted in the lower anterior region (Figure 1,2). Incisal edges of both upper and lower anterior teeth were chipped off
and irregular on palpation. Posterior teeth had white opaque
frosted appearance with intact enamel. All teeth had surface
roughness with enamel pitting. Examination of the periodontium revealed unhealthy gingival condition with presence of
generalized marginal papillary gingivitis, calculus deposition
and unsatisfactory oral hygiene. She was displeased with the
appearance of teeth which had an adverse impact on her
self image. Once the patient had expressed her treatment expectations a detailed clinical examination, photographs and
stone casts were prepared for initial documentation. Based on
clinical examination and diagnostic tools the existing problems and major elements of the treatment were explained to
the patient. The treatment plan included oral prophylaxis and
re-anatomization by direct resin bonded restorations for anterior teeth and written consent was taken.

Figure1,2. Preoperative, Figure 3. Teeth prepared for composite restoration, Figure 4. Composite restoration done, Figure 5,6. Post operative.

In conclusion, The use of direct laminate veneer technique

with adhesive bonding system and composite resin materials
benefits, correction of tooth shapes and dimensions that result in improved tooth proportions with an aesthetically pleasing appearance.

I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S

Amelogenesis Imperfecta (AI) has been defined as a complex

group of hereditary enamel defects, existing independent of
any related systemic disorder.1,2 Dental enamel disturbance
that occurs during the stages of enamel formation will impact
the quality and/or quantity of the enamel formed, depending on phase of amelogenesis.3,4 This enamel anomaly affects
both the primary and permanent dentitions. Amelogenesis
Imperfecta is a rare enamel mineralisation defect, described
by Spokes in 1980 as hereditary brown teeth.1,5,6 Amelogenesis Imperfecta cases necessitate careful diagnoses to improve
function and esthetics because they present with a complex
set of problems, such as decreased occlusal vertical height,
deep bite, rampant caries attributable to plaque accumulation, abnormalities in dental eruption, tooth sensitivity, and
psychosocial problems related to poor aesthetics.7,8

Conclusion

I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S

2014 Volume 6 Issue 2

Introduction

P-ISSN: 2231-2285

E-ISSN :0975-8437

P-ISSN: 2231-2285

Bollineni et al
12. Sholapurkar AA, Joseph RM, Varghese JM, Neelagiri K, Acharya
SR, Hegde V, et al. Clinical diagnosis and oral rehabilitation of a
patient with amelogenesis imperfecta: a case report. The journal
of contemporary dental practice. 2007;9(4):92-8.

20. Peumans M, Van Meerbeek B, Lambrechts P, Vanherle G. The

5-year clinical performance of direct composite additions to
correct tooth form and position. Clinical oral investigations.
1997;1(1):12-8.

13. Pena CE, Viotti RG, Dias WR, Santucci E, Rodrigues JA, Reis AF. Esthetic rehabilitation of anterior conoid teeth: comprehensive approach for improved and predictable results. Eur J Esthet Dent.
2009;4(3):210-24.

21. Magne P, Belser UC. Novel porcelain laminate preparation approach driven by a diagnostic mockup. Journal of Esthetic and
Restorative Dentistry. 2004;16(1):7-16.

14. Magne P. Composite resins and bonded porcelain: the

postamalgam era? Journal of the California Dental Association.
2006;34(2):135-47.

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15. Toksavul S, Ulusoy M, Trkn M, Kmblolu O. Amelogenesis

imperfecta: the multidisciplinary approach. A case report. Quintessence international (Berlin, Germany: 1985). 2004;35(1):11-4.
16. Franco EB, Francischone CE, Medina-Valdivia JR, Baseggio W. Reproducing the natural aspects of dental tissues with resin composites in proximoincisal restorations. Quintessence international-english edition-. 2007;38(6):505.
17. Lygidakis NA, Chaliasou A, Siounas G. Evaluation of composite restorations in hypomineralized permanent molars: a four
year clinical study. European journal of paediatric dentistry.
2003;4:143-8.
18. Lopes GC, Vieira LC, Monteiro S, de Andrada MC, Baratieri CM.
Dentin bonding: effect of degree of mineralization and acid
etching time. Operative dentistry-university of washington-.
2003;28(4):429-39.
19. Macedo G, Raj V, Ritter AV, Swift EJ. Longevity of anterior composite restorations. Journal of Esthetic and Restorative Dentistry.
2006;18(6):310-1.

22. Magne P, So W. Optical integration of incisoproximal restorations using the natural layering concept. Quintessence Int.
2008;39(8):633-43.
23. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. European Journal of Esthetic Dentistry. 2008;3(1):14-29.

How cite this article

Bollineni S, Prashanthi P, Karunakar P, Solomon RV. Conservative cosmetic treatment of amelogenesis imperfecta. International Journal of
Dental Clinics. 2014;6(2):32-34.

Address for Correspondence

Dr. Swetha Bollineni, MDS,
Senior Lecturer,
Department of Conservative Dentistry and Endodontics,
Pinnamaneni Siddhartha Institute of Dental Sciences,
Vijayawada, Andhra Pradesh, India
Email: drswethakotagiri@gmail.com

Source of Support: Nil

Conflict of Interest: None Declared

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