Download restoration of anterior teeth with direct composite veneers in

RESTORATION OF ANTERIOR TEETH WITH DIRECT COMPOSITE
VENEERS IN HEREDITARY ENAMEL DYSPLASIA
1
MUHAMMAD SALMAN RASHID, BDS, FCPS-II (Trainee)
2
ALI ALTAF, BDS, FCPS-II (Trainee)
3
USMAN SHAHID, BDS, FCPS-II (Trainee)
4
BADAR MUNIR, BDS, MCPS, FCPS
ABSTRACT
Amelogenesis imperfecta (AI) is a collection of inherited diseases that exhibit quantitative or
qualitative tooth enamel defects in the absence of systemic manifestations. Also known by varied names
such as Hereditary enamel dysplasia, Hereditary brown enamel, Hereditary brown opalescent teeth.
This defect is of ectodermal in origin. The AI trait can be transmitted by either autosomal dominant/
recessive, or X-linked inheritance. Genes implicated in autosomal forms are genes encoding enamel
matrix proteins, namely: enamelin and ameloblastin, tuftelin, MMP-20 and kallikrein – 4. This report
shows the less invasive treatment modality for the disease.
Key Words: Composit, Veneers, hereditary enamel dysplais.
INTRODUCTION
Amelogenesis imperfecta is a hereditary disorder
that affects the enamel of the dental enamel structure.
This disease affects both the primary and permanent
dentition resulting in poor development or complete
absence of the enamel of the teeth.1-2
Amelogenesis Imperfecta include quantitative
and qualitative enamel defect, sensitivity, unaesthetic appearance, reduced vertical dimension, multiple
impacted teeth, congenitally missing teeth and root
malformation.3 The disorder address with unaesthetic
appearance, dental sensitivity and attrition.4 There are
various classification systems for different amelogenesis
Imperfecta type. The most commonly used of these are
hypocalcified, hypoplastic, or hypomature.5
CLASSIFICATION AND FEATURES
Hypo- plastic form of AI is characterized by thin
enamel with yellowish-brown color, rough/ smooth and
glossy, square-shaped crown, lack of contact between
opposing teeth. While histology of hypo- plastic type
is defect in enamel matrix formation.6-8 Hypocalcified
form is the most common entity and is characterized by
normal size and shape of clinical crown, softer enamel
which wears down rapidly and can be removed by an
Resident Operative Dentistry, de,Montmorency College of Dentistry, Fort Road, Off. Ravi Road, Lahore
4
Associate Professor
Correspondence: Dr Muhammad Salman Rashid 111-C, 12/9,
Nazimabad, Karachi-74600 Email: [email protected]
Cell: 0345-3134108
Received for Publication: October 22, 2014
Revision Received:
November 6, 2014
Revision Accepted:
November 8, 2014
1,2,3
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
instrument. Histologically defects in matrix structure
and mineralization are seen.6-8
Hypomaturation type has normal thickness of
enamel but it is softer than normal, while harder than
hypocalcified type. Histologically, the studies show the
alterations in enamel rod and rod sheath structures.6-8
Hypoplastic-hypomaturation is associated with taurodontism in molars; the enamel is thin, mottled yellow to
brown, and pitted. Teeth have enlarged pulp chambers.9
CASE REPORT
A female patient of 18 years old reported to the
restorative department with the chief complaint of
unaesthetic teeth. On clinical examination she had a
moderate form of amelogenesis imperfecta with absence
of the enamel. The teeth were stained dark yellow, had
no deep carious lesions and the exposed dentine was
relatively softer than the normal dentine. The teeth
were vital, firm, and not tender to percussion. The
periodontal tissues were not healthy.
Treatment objectives for this patient were set to be
a) prevention of caries and gingivitis, b) improvement
of esthetics, c) prevention of further deterioration of
the remaining dentition and d) patient education and
motivation. The patient demanded minimal cost for
the restoration. The OPG showed enamel of similar
thickness as dentine, which showed hypomaturation
type of defect. The patient was first referred to periodontology department for scaling and advised to come
back after 2 weeks. Preoperative pictures were taken
at every stage. Now the less invasive plan was direct
composite laminate veneers on anterior teeth.
A 1mm tooth was prepared for both maxillary
and mandibular anterior teeth and the finish line was
720
Enamel dysplasia/direct composite Veneers
say that the direct composites veneers are also a very
significant esthetic option in comparison to prosthetic
replacement.
CONCLUSION
Cosmetic replacement from direct composite veneers allow less time on chair side. Reasonable results
are achieved, moreover less tooth structure is compromised and periodontal health is also maintained.
REFRENCES
Fig 1
1
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Rajendran R. Developmental disturbances of oral and paraoral
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Fig 2
extended interproximally. All the preparations were
made without sharp line angles. A self etch composite
bonding (3M ESPE) was used. Postoperative pictures
were taken and patient was advised follow up after
every three months.
DISCUSSION
Amelogenesis Imperfecta is an inherited disorder
that mainly affects the form and amount of enamel
formation.10 As both the primary and permanent
dentition is affected, preventive measures should be
started, even before the teeth erupt. The case mentioned
showed teeth discoloration and no pulpal involment.
Surface pitting was also not evident. There are many
treatment options depending on the several factors.11
Many clinicians suggest the full mouth porcelain crowns
which may be aesthetically reasonable but may cause
severe damage to periodontal health.12 Surrounding
tooth structure is also compromised when preparation
is made. Moreover, porcelain veneers, full coverage
crowns, metal crowns all cause the food impaction and
compromise the gingival health.13
Direct composite veneers allow minimal tooth tissue
removal and less invasive treatment. In addition to
that, composite veneers have the advantage of being
repaired at the chair side and require no laboratory
support.14 Placement of these veneers provide the more
acceptable results as various shades and opacifiers are
available. Discoloration was the concern for composites
as the use of small particle size generation reasonably
mask the issue.15 After the review of literature,16 one can
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
10 Pindborg JJ. Aetiology of developmental enamel defects not
related to fluorosis. International Dental Journal. 1982; 32(2):
123-34.
11 Patel RR, Hovijitra S, Kafrawy AH, Bixler D. X-linked (recessive) hypomaturationamelogenesisimperfecta: A prosthodontic,
genetic, and histopathologic report. J Prosthet Dent 1991; 66:
398-402.
12 Patel RR, Hovijitra S, Kafrawy AH, Bixler D. X-linked (recessive) hypomaturationamelogenesisimperfecta: A prosthodontic,
genetic, and histopathologic report. J Prosthet Dent 1991; 66:
398-402.
13 Chengappa M, Ramamoorthi M, Sivagami N. Rehabilitation
of Mutilated Natural Dentition associated with Amelogenesis
Imperfecta–A Case Report. International Journal of Dental
Clinics. 2010; 2(4): 77-79.
14 Robinson S, Nixon PJ, Gahan MJ, Chan MF. Techniques for
restoring worn anterior teeth with direct composite resin. Dent
Update. 2008; 35: 551-2, 555-88.
15 Srivastava R. Denture Tooth Selection: Size Matching of
Natural Anterior Tooth Width with Artificial Denture Teeth.
International Journal of Dental Clinics. 2010; 2(3): 17-22.
16 Nazirkar G, Meshram S. An Evaluation of Two Modern
All-Ceramic Crowns and their comparison with Metal Ceramic
Crowns in terms of the Translucency and Fracture Strength.
International Journal of Dental Clinics. 2011; 3(1): 5-7.
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