Team Approach for the Management of Amelogenesis Imperfecta

Amelogenesis imperfecta is a developmental disturbance that interferes with normal enamel formation in the absence of a systemic disorder. This case report describes a multidisciplinary team approach for the oral rehabilitation of a young adult patient diagnosed with hypocalcified amelogenesis imperfecta with anterior single tooth crossbite. The specific objectives of this treatment were to enhance esthetics, eliminate tooth sensitivity and restore masticatory function. Treatment included maintenance of gingival health, correction of crossbite, surgical crown lengthening of the maxillary and mandibular posterior teeth and placement of full mouth metal-ceramic crowns. The patient was highly satisfied with the aesthetic and functional outcome of the treatment.


INTRODUCTION
Amelogenesis imperfecta (AI) is a developmental disturbance that interferes with normal enamel formation in the absence of a systemic disorder.¹ Amelogenesis is a two-staged process where a protein rich matrix is initially laid down during the secretary phase, followed by the mineralisation phase where the proteins are replaced by hydroxyapatite crystals.
This results in the highly mineralized enamel structure. AI affects the formation of the enamel matrix or the enamel mineralisation process of both the primary and secondary dentition and affects the quantity and quality of the enamel structure and the overall appearance of all or nearly all the teeth.² In its mildest form, AI causes discoloration while in its most severe presentation; the enamel is hypomineralised causing it to be abraded from the teeth shortly after their emergence into the oral cavity.³ Apart from enamel defects, AI has also been associated with abnormalities in dental eruption, while preventing further tooth loss, to maintain mastication and to improve the appearance as this has great psychological impact on the patient. 6 This case report presents the diagnosis and treatment planning of a 17-year-old girl whose chief concern was unaesthetic appearance of her teeth.          restoration was given in all the quadrants (Figure 11). After six weeks tooth preparation for porcelain fused to metal crown restoration was started for all teeth and final restoration was given ( Figure 12).

DISCUSSION
Clinical appearances of AI may vary among individuals, from discoloration of teeth (yellow, brown or gray) to generalized areas of exposed dentine and enamel pitting.
Increased susceptibility to plaque accumulation, caries, hypersensitivity and loss of vertical dimensions are the common clinical presentations. 6 Management of patients with AI provides great challenges to clinicians both from a functional and an esthetic perspective. 7 Treatment objectives may vary depending on the age of the patient, socioeconomic status of the patient, severity of the disorder and the intraoral status at the time of treatment planning. 8 The primary goal of the treatment should address each concern as it presents but with an overall comprehensive plan that outlines the anticipated future treatment needs. 9 Hence a multidisciplinary team approach is very much essential to treat patients with AI.
In the present case, the patient's chief complaint was her poor esthetics. All of her posterior teeth were attrited causing severe sensitivity. So, full coverage porcelain fused to metal crowns were planned. Due to severe sensitivity her oral hygiene was poor leading to gingival overgrowth almost covering the already short clinical crowns. We all know that periodontal health is the cornerstone of any successful restorative procedure. Therefore, the correct handling of the periodontal tissues during restoration of the tooth is important for the long term success of the restoration.10 Thus, it is necessary to prepare periodontal tissues properly before restorative treatment to ensure good form, function, and esthetics of masticatory apparatus and patient comfort.
So, scaling and root planing was performed and surgical crown lengthening was done where required to maintain the biologic width during restoration.
Hence, early treatment of patient with AI is necessary to prevent progressive damage of dentition and the psychological impact of this condition on the patient. Unfavorable effects on aesthetic, function, occlusion necessitate different approaches from traditional dental treatments. So, by systematic and sequential interdisciplinary treatment approach patient's esthetic and functional requirements can be fulfilled.