Amelogenesis imperfecta—a prosthetic rehabilitation: A clinical report

Dominique Bouvier, Dr Odont, PhD,a Jean-Pierre Duprez, Dr Odont, PhD,b Christian Pirel, Dr Odont,
PhD,c and Bernard Vincent, Dr Odont, PhDd
Faculty of Odontology, University of Claude Bernard Lyon I, Lyon, France

Amelogenesis imperfecta is an inherited disease that

disturbs the formation of the enamel. It can occur as 2
main types, hypocalcification and hypoplasia. Enamel
hypocalcification is a defect in the mineralization;
hypoplasia is a defect in the formation of the enamel
matrix. Both deciduous and permanent teeth are affect-
ed, and the disorder may create unesthetic appearance,
dental sensitivity, and attrition. Numerous treatments
have been described for rehabilitation of amelogenesis
imperfecta in adults1-4 and children.5-8
This clinical report describes the stages in the com-
plete restoration of amelogenesis imperfecta in a child
between the ages of 7 and 12.
CLINICAL REPORT Fig. 1. View of mixed dentition before treatment.
A 7-year-old boy who suffered from considerable
sensitivity and was very self-conscious about the
appearance of his teeth was referred to the department
of pediatric dentistry for treatment. He was diagnosed
with hereditary amelogenesis imperfecta. On examina-
tion, the patient had mixed dentition; first molars and
permanent incisors had erupted, the teeth were found
to possess little enamel, and crowns were thin and
short. The child had good oral hygiene, was caries-free,
and did not exhibit any periodontal problems. Attrition
of the molars had resulted in a decrease of the vertical
dimension of occlusion (Figs. 1 and 2).
Temporary treatment
The first phase of treatment lasted for a period of
more than 3.5 years. Treatment consisted of fitting pre- Fig. 2. Panorex before treatment.
formed Ni-Cr crowns (ION, 3M Dental Products, St
Paul, Minn.) on the first permanent molars and on the
second deciduous molars to stabilize the occlusion and resin crowns. Six months later, the second molars
to halt attrition. No attempt was made to increase the erupted and were fitted with Ni-Cr crowns. Pulp vital-
vertical dimension of occlusion. Maxillary and ity was maintained for all the teeth. Third molar tooth
mandibular incisors were fitted with carboxylate resin germs were removed as a preventive measure.
crowns (ION, 3M Dental Products) to improve At this point, it was decided to increase the vertical
appearance and decrease sensitivity. Five appointments dimension of occlusion. A wax-up of the mandibular
were required for treatment. molars and premolars was made in the laboratory. The
During the following 22-month period, the child wax-up was duplicated and a vacuum-formed matrix was
was monitored for eruption of permanent teeth, and fabricated. The matrix was used to produce 2 temporary
the premolars and canines were fitted with carboxylate autopolymerizing resin mandibular fixed prostheses
directly in the patient’s mouth, and adjustment of the
new occlusion was carried out immediately afterward.
aFormer Assistant Hospital Practitioner, Department of Dentistry.
bAssociate
Occlusal height was increased 2 mm at the incisors. The
Professor, Department of Pediatric Dentistry.
cProfessor, Department of Prosthodontics. patient was then monitored systematically over a 3-month
dAssociate Professor, Department of Prosthodontics. period to check for any functional or articulatory problem
J Prosthet Dent 1999;82:130-1. following the change in vertical dimension of occlusion.

130 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 82 NUMBER 2

BOUVIER ET AL
Transitional treatment
Transitional treatment spanned 8 weeks. At 12 years
of age, the patient was ready for the second prosthetic
phase. Jaw relation was recorded with wax wedges
(Moyco Industries Inc, Philadelphia, Pa.). Because of
the difficulty in managing a young patient, 2-stage
impressions (Express 3M dental products) were made on
each arch and from these, impression copings (Duralay
resin) on teeth and individual trays covering them, were
made in the laboratory in preparation for final impres-
sions. Impression copings were secured by Duralay resin
in groups of 3 or 4 copings. Cervical adjustment of the
impression copings on the preparations was checked in
the patient’s mouth and the final impression was made
for each arch. Impression copings were first filled with
syringed impression material (3M Express, 3M Dental
Products) and placed on the prepared teeth. Then, indi-
vidual trays were filled with medium consistency impres-
sion material (3M Express, 3M Dental Products) and
placed in position over the complete set of impression
copings. When the impression material had set, the cop-
ings and trays were removed together.
From these impressions, casts were made and
mounted in an articulator to produce 24 individual
frameworks for ceramic-metal crowns and 4 alloy
crowns for the second molars. The precious alloy used
was 73.8% gold and 9.0% platinum by weight
(Degunorm, Degussa AG, Hanau, Germany). The
frameworks were tried in the patient’s mouth to check
the marginal fit and centric relation position. The cos-
metic coating, a low-fusion ceramic (Ducera, Degussa
AG), was then applied. A fitting session, before the
glazing of the ceramic material, enabled final occlusal
refinement. The crowns were then finished in the labo-
ratory and cemented with glass ionomer cement (Fuji I,
GC Corporation, Tokyo, Japan).
The patient was monitored at 3-month intervals for
1 year (Fig. 3), and then once a year.
SUMMARY
The rehabilitation of amelogenesis imperfecta in a
child must take into account the development of the
child’s teeth, the health of the periodontal tissues, and
the mandibular and maxillary growth. As demonstrated
in this clinical report, this was performed in 2 stages.
The immediate temporary treatment, during the
period of mixed dentition, is designed to reduce sensi-
tivity in the teeth, prevent attrition of erupting teeth,
and restore appearance and masticatory function. Dur-
ing this first phase, the vertical dimension of occlusion
was increased if necessary. It is essential to monitor this
new occlusion closely over several months and to con-
serve pulp vitality in immature permanent teeth so they
can complete their growth cycle.
The second stage involves the transitional treatment
and begins when all permanent teeth are in place. The
AUGUST 1999
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 3. View of prostheses 6 months after fitting.
goal is to establish an esthetic appearance and efficient
masticatory function until adulthood.
In treating amelogenesis imperfecta in children, it is
important to allow for mandibular and maxillary
growth9 by using individual restorations on teeth.
We wish to thank the firm having produced the prosthesis in the
laboratory (Société Pfeffer), Professor D. Bois, and the Hospices
Civils de Lyon for their financial support.
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Reprint requests to:
DR DOMINIQUE BOUVIER
115 RUE TÊTE D’OR
69006 LYON
FRANCE
FAX: 33-4-72-74-92-03
Copyright © 1999 by The Editorial Council of The Journal of Prosthetic
Dentistry.
0022-3913/99/$8.00 + 0. 10/1/99195
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