Journal of Investigative and Clinical Dentistry (2010), 1, 59–63
CASE REPORT
Treatment of an amelogenesis imperfecta with restorations prepared using a modified clear matrix technique ¨ zer & Emrullah Bahs¸ i Senem G. Yig˘it O Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Dicle University, Diyarbakir, Turkey
Keywords adhesive restoration, amelogenesis imperfecta, clear matrix technique, direct resin composite. Correspondence Assist. Prof. Senem G. Yig˘it O¨zer, Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Dicle University, Diyarbakir 21280, Turkey. Tel: +905-324-760051 Fax: +904-122-488100 Email: [email protected] This paper was presented as a poster in the 12th International Scientific Congress and Exhibition of EBDO, 2009, _Izmir, Turkey.
Abstract The rehabilitation of a patient with amelogenesis imperfecta (AI) from both functional and esthetic standpoints represents a challenge. A number of treatment options have been proposed. Recently, the use of adhesive restorations has gained popularity because of the improved physical properties of these materials. This article describes a treatment with direct resin composite for the restoration of teeth affected by the hypomature type of AI. A modified clear matrix technique was used during the preparation and restoration process. The use of the technique provides clinicians with reduced chair time, and the matrix can be repeated when needed; restorations can be performed relatively quickly with a minimal post-operative finishing process. This article highlights the use of direct-bonded resin composites providing satisfactory esthetics and function in restoring AI-affected teeth.
Received 14 December 2009; accepted 11 March 2010. doi: 10.1111/j.2041-1626.2010.00007.x
Introduction Amelogenesis imperfecta (AI) is a hereditary disorder that disturbs the formation of enamel in primary and permanent dentition, resulting in poorly-developed, discolored (yellow, brown, or gray), grooved, pitted, or absentlyenameled teeth.1–4 Affected teeth are prone to rapid wear and breakage. Generally, there is dentin exposure, hypersensitivity to temperature changes, and increased plaque accumulation due to malformed surface characteristics, such as pits and grooves. To date, several studies have described 14 types of AI according to its clinical, radiological, and histological appearance; the prevalence varies from 1:700 to 1:16 000, depending on the diagnostic criteria used.5–10 Based on clinical findings, there are three general types of AI: hypocalcified, hypomature, and hypoplastic.3–6 The hypocalcified type is the most common form, and teeth with this type of AI have a normal shape with an abnorª 2010 Blackwell Publishing Asia Pty Ltd
mal color and a dull appearance when they erupt. The enamel has a very low degree of mineralization, is soft and friable, and can rapidly break down.3 In the hypomature type, the enamel is softer than healthy enamel, leading to chips from underlying dentin. Abnormalities during enamel maturation induce the defects, and the tooth is opaque white to yellow-brown or red-brown.5–9 In the hypoplastic type, the enamel is correctly mineralized, but is deficient in quantity; it appears hard and shiny, but is malformed.4 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 esthetics.11 Some of the treatment techniques described to restore teeth affected by AI include all-ceramic crowns, metal–ceramic crowns, porcelain 59
Use of a modified clear matrix technique
S.G. Yig˘it O¨zer and E. Bahs¸ i
laminate veneers, onlays, and direct and indirect resin composite restorations. The use of direct and indirect resin composite restorations has gained popularity, and recent clinical studies show satisfactory results for esthetics.10,12 The present report describes a direct approach with resin composite restorations using a modified clear matrix technique to rehabilitate an adolescent with hypomature AI. Case description and results A healthy, 18-year-old female patient was referred to the Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Dicle University (Diyarbakir, Turkey). Her chief complaint was extreme dissatisfaction with her appearance. Her medical history was unremarkable, and she reported that her sister had the same problems. A detailed dental examination was performed, including photographs and radiographs (Figures 1 and 2). Maxillary canine incisors were present, but had not erupted. The anterior incisors were malformed and discolored redbrown. There were horizontal areas of exposed dentin (Figure 2) and profound caries on the maxillary first
Figure 1. Pre-treatment orthopantogram of the patient. Note the appearance of horizontal hypomature areas on the anterior incisors.
Figure 2. Frontal view at pre-treatment. Note the red-brown discoloration and accompanying surface defects.
60
Figure 3. Maxillary arch, occlusal view. Profound caries are present on the maxillary first molars.
molars (Figure 3). A supernumerary tooth was detected between the roots of the mandibular right canine and premolar teeth. The vertical dimension was within normal limits, with class I occlusion. Diastemata were evident due to unerupted maxillary canines. Defects on the central incisors were horizontally positioned and had a radiolucent appearance in the radiographs (Figure 1). It was concluded that the patient suffered from hypomature AI. A treatment plan was developed to restore the carious teeth and improve esthetics. The patient complained about her untimely travel to another country and requested a one-session treatment. For this reason, direct resin restorations were performed using the clear matrix technique. The advantages of the technique are that it is easy to use, is accomplished directly in the mouth, and provides a quick functional and esthetic result. Moreover, the clear matrix can be repeated in the event of a failure. In this case, before taking a maxillary full-arch impression, maxillary and mandibular incisor teeth were restored conventionally without using the clear matrix technique. Maxillary incisors were restored by applying composite resin incrementally to form dentin and enamel color for better esthetics before the management of the maxillary first molars. Incisor preparation involved smoothing surface irregularities and the removal of weakened, unsupported enamel with little dentin. A self-etch, single-step bonding system (Prompt L-Pop; 3M/ESPE, St Paul, MN, USA) was applied on the surfaces of incisors, and composite resin (Filtek Z 250, shade UD, A2, I; 3M/ESPE) was used for the restoration. Before the finishing and polishing procedure of the maxillary incisors, caries were removed from the ª 2010 Blackwell Publishing Asia Pty Ltd
S.G. Yig˘it O¨zer and E. Bahs¸ i
Use of a modified clear matrix technique
Figure 4. Functional cusps were beveled (arrows), and margins were prepared for restoration. Figure 6. A clear matrix made of transparent plate (Raintree Essix) was used during the application of the clear matrix technique.
maxillary first molars, and functional cusps were beveled (Figure 4). The maxillary full-arch impression was made with silicone impression material (Speedex; Coltene Whaledent, Altsta¨tten, Switzerland), and a diagnostic cast model was obtained by another clinician to accelerate the total working time. Teeth with caries and malformations were reconstructed by wax modeling to obtain teeth with their original size and shape (Figure 5). A transparent plate (Raintree Essix; Dentsply, Sarasota, FL, USA) was prepared for use as an impression tray (Figure 6), and holes were drilled in the tray to allow the removal of excess composite resin prior to curing. In a clear matrix technique, silicone impressions are generally used as a carrier for placing the composite resin; however, because of unsatisfactory polymerization related to this material, a transparent plate was prepared and used.
Figure 5. Teeth affected by amelogenesis imperfecta and decay were reconstructed to be similar to their original anatomical forms.
ª 2010 Blackwell Publishing Asia Pty Ltd
Since the mandibular anterior teeth had very small defects, they were restored conventionally using the same resin composite during the construction of a transparent plate by another clinician. The finishing and polishing procedure of maxillary and mandibular incisors was also performed at this stage. Maxillary right and left first molars were restored using the modified clear matrix technique. Occlusal reduction was limited to the removal of affected areas of pigmented grooves. A resin-modified glass ionomer (Photac Fil Quick Aplicap; 3M/ESPE) was used as a liner to prevent hypersensitivity, since dentin was removed for caries disposal. Cotton rolls were used for isolation, and adjacent teeth were lubricated with petroleum gel to facilitate the removal of excess light-cured composite resin. The color of the composite resin was chosen to match the intact mandibular incisors. A self-etch, single-step bonding system (Prompt L-Pop) was used for both teeth because manipulating a single-step bonding saves time, is easy to perform when compared with two-phased systems, eliminates procedural errors, and provides sufficient retention for the restoration. The axial walls of the molar area in the transparent plate were filled with resin composite. The occlusal surface was left free of resin to allow excess resin to flow into those areas with digital pressure. The transparent plate was carefully seated in place and kept in position with slight digital pressure. Excess composite resin was seen flowing through the holes in the plate, and it was gently removed before polymerization. A curing unit (Eliplar FreeLight 2 LED; 3M/ESPE), with a light intensity of 1.000 mw/cm2, was activated through the plate, from its occlusal, facial, and palatinal aspects, on both molars for 10 s per surface. After the removal of 61
Use of a modified clear matrix technique
Figure 7. Maxillary arch immediately after operation; occlusal view.
Figure 8. Frontal view at baseline.
the transparent plate, each surface was polymerized for an additional 30 s. Cervical overextensions were trimmed, and any unsealed areas along the margins were filled with flowable resin (Filtek Supreme Plus Flow; 3M/ ESPE) (Figure 7). The procedures, except the application of the flowable resin, were performed hands-free. Contouring, finishing, and initial polishing of the resin crowns were accomplished with finishing and polishing discs (Soft-Lex; 3M/ESPE). After the restorative procedures, satisfactory esthetics were established (Figure 8). Discussion Patients with AI present a variety of difficulties for the clinician. When the structures of enamel and dentin are developmentally altered, the ability of the teeth to bond and retain restorative materials is compromised. Patients’ expectations and requests should be fully understood to ensure overall satisfaction. For optimal results, the 62
S.G. Yig˘it O¨zer and E. Bahs¸ i
treatment of AI-affected teeth should be evaluated individually. There are a number of alternative treatment techniques for AI-affected teeth. The treatment plan is related to many factors, such as the age and socioeconomic status of the patient, the types and severity of the defects, the general hygiene of the patient, and the time needed to complete the procedure.13 In a number of cases, fixed partial dentures with complete crowns have produced highly esthetic results.12,14 However, that approach necessitates the removal of a substantial amount of intact tooth structure12,15,16 and cooperation with a dental laboratory. Considering the adverse effects of that approach, direct resin composite restorations offer an alternative conservative treatment that provides sufficient esthetics and function, with the preparation of teeth being limited to only those areas of affected unsupported enamel. As well as this, treatment can be completed in one session at a dental clinic. Direct resin composite restorations are not indicated in some AI cases.17 When the dentin and enamel are fully damaged, adhesion problems might occur due to the destruction of the surface structure. Under these conditions, a prosthodontical approach, including fixed prosthodontics (all-ceramic crowns, metal–ceramic crowns, or porcelain laminate veneers), is more convenient and reliable.18 The present study reports the application of a direct resin composite using a modified clear matrix technique. Factors influencing the treatment plan for this case are as follows: (a) there was adequate sound dentin after the removal of the hypomatured content; (b) discoloration was eliminated after tooth preparation; (c) the patient’s oral hygiene was adequate; (d) there was no sensitivity in the teeth before the treatment; (e) the patient was moving to another country and was unable to consider multiple treatments due to time limitations; (f) the patient’s economic status prevented the use of fixed prosthodontics. Orthodontic and periodontal treatments were not planned because of the same reason; and (g) the patient was informed about the long-term usage quality of direct resin composite for her AI condition. The potential disadvantages of the interim rapid, but inexpensive, treatment modality was accepted by the patient. The use of the modified clear matrix technique considerably simplified the multiple restorative procedures by allowing the resin material to be built around the teeth in one application and at the same time. All restorations were manipulated hands-free, and chair time was significantly reduced, as compared with a one-by-one ª 2010 Blackwell Publishing Asia Pty Ltd
S.G. Yig˘it O¨zer and E. Bahs¸ i
Use of a modified clear matrix technique
manipulation. Gingival tissues were preserved because strip bands were not used to isolate teeth.
function in restoring AI-affected teeth if the prosthodontical approach is not feasible.
Conclusion
Acknowledgment
Direct-bonded resin restorations using the modified clear matrix technique can provide satisfactory esthetics and
This project was supported by Dicle University, research fund # 08-DH-32.
References 1 Coley-Smith A, Brown CJ. Case report: radical management of an adolescent with amelogenesis imperfecta. Dent Update 1996; 23: 434–5. 2 Bouvier D, Duprez J.P, Bois D. Rehabilitation of young patients with amelogenesis imperfecta: a report of two cases. ASDC J Dent Child 1996; 63: 443–7. 3 Atasu M, Biren S, Mumcu G. Hypocalcification type ameloogenesis imperfecta in permanent dentition in association with heavily worn primary teeth, gingival hyperplasia, hypodontia and impacted teeth. J Clin Pediatr Dent 1999; 23: 117–22. 4 Atasu M, Genc¸ A, Namdar F. Lokal hypoplastic type of amelogenesis imperfecta: a clinical, genetic, radiological and dermatoloyphic study. J Clin Pediatr Dent 1996; 20: 337–42. 5 Winter GB. Hereditary and idiopathic anomalies of tooth number structure and form. Dent Clin North Am 1969 13: 355–73. 6 Winter GB, Lee KW, Johnson NW. Hereditary amelogenesis imperfecta
ª 2010 Blackwell Publishing Asia Pty Ltd
7
8
9
10
11
12
a rare autosomal dominant type. Br Dent J 1969; 127: 157–64. Witkop CJ, Kuhlmann W, Sauk J. Autosomal recessive pigmented hypomaturation amelogenesis imperfecta. Report of a kindred. Oral Surg Oral Med Oral Pathol 1973; 36: 367–82. Witkop CJ. Partial expression of sex-linked recessive amelogenesis imperfecta in females compatible with the Lyon hypothesis. Oral Surg Oral Med Oral Pathol 1967; 23: 174–82. Rao S, Witkop CJ. Inherited defects in tooth structure. Birth Defects 1971; 7: 153–84. Sabatini C, Guzma´n-Armstrong S. A conservative treatment for Amelogenesis Imperfecta with direct resin composite restorations: a case report. J Esthet Restor Dent 2009; 21: 161–70. Seow WK. Clinical diagnosis and management strategies of amelogenesis imperfecta variants. Pediatr Dent 1993; 15: 384–93. Akin H, Tasveren S, Yeler DY. Interdisciplinary approach to treating a patient with amelogenesis
13
14
15
16
17
18
imperfecta: a clinical report. J Esthet Restor Dent 2007; 19: 131–6. Sengun A, Ozer F. Restoring function and esthetics in a patient with amelogenesis imperfecta: a case report. Quintessence Int 2002; 33: 199–204. Ulusoy M, Tug˘sel Z. Management of amelogenesis imperfecta Cumhuriyet ¨ niv Dis¸ hek Derg 2002; 5: 31–2. U Ozturk N, Sari Z, Ozturk B. An interdisciplinary approach for restoring function and esthetics in a patient with amelogenesis imperfecta and malocclusion: a clinical report. J Prosthet Dent 2004; 92: 112–5. Robinson FG, Haubenreich JE. Oral rehabilitation of a young adult with hypoplastic amelogenesis imperfecta: a clinical report. J Prosthet Dent 2006; 95: 10–3. Yamaguti PM, Acevedo AC, de Paula LM. Rehabilitation of an adolescent with autosomal dominant amelogenesis imperfecta: case report. Oper Dent 2006; 31: 266–72. Williams WP, Becker LH. Amelogenesis imperfecta: functional and esthetic restoration of severely compromised dentition Quintessence Int 2000; 31: 397–403.
63
CASE REPORT
Treatment of an amelogenesis imperfecta with restorations prepared using a modified clear matrix technique ¨ zer & Emrullah Bahs¸ i Senem G. Yig˘it O Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Dicle University, Diyarbakir, Turkey
Keywords adhesive restoration, amelogenesis imperfecta, clear matrix technique, direct resin composite. Correspondence Assist. Prof. Senem G. Yig˘it O¨zer, Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Dicle University, Diyarbakir 21280, Turkey. Tel: +905-324-760051 Fax: +904-122-488100 Email: [email protected] This paper was presented as a poster in the 12th International Scientific Congress and Exhibition of EBDO, 2009, _Izmir, Turkey.
Abstract The rehabilitation of a patient with amelogenesis imperfecta (AI) from both functional and esthetic standpoints represents a challenge. A number of treatment options have been proposed. Recently, the use of adhesive restorations has gained popularity because of the improved physical properties of these materials. This article describes a treatment with direct resin composite for the restoration of teeth affected by the hypomature type of AI. A modified clear matrix technique was used during the preparation and restoration process. The use of the technique provides clinicians with reduced chair time, and the matrix can be repeated when needed; restorations can be performed relatively quickly with a minimal post-operative finishing process. This article highlights the use of direct-bonded resin composites providing satisfactory esthetics and function in restoring AI-affected teeth.
Received 14 December 2009; accepted 11 March 2010. doi: 10.1111/j.2041-1626.2010.00007.x
Introduction Amelogenesis imperfecta (AI) is a hereditary disorder that disturbs the formation of enamel in primary and permanent dentition, resulting in poorly-developed, discolored (yellow, brown, or gray), grooved, pitted, or absentlyenameled teeth.1–4 Affected teeth are prone to rapid wear and breakage. Generally, there is dentin exposure, hypersensitivity to temperature changes, and increased plaque accumulation due to malformed surface characteristics, such as pits and grooves. To date, several studies have described 14 types of AI according to its clinical, radiological, and histological appearance; the prevalence varies from 1:700 to 1:16 000, depending on the diagnostic criteria used.5–10 Based on clinical findings, there are three general types of AI: hypocalcified, hypomature, and hypoplastic.3–6 The hypocalcified type is the most common form, and teeth with this type of AI have a normal shape with an abnorª 2010 Blackwell Publishing Asia Pty Ltd
mal color and a dull appearance when they erupt. The enamel has a very low degree of mineralization, is soft and friable, and can rapidly break down.3 In the hypomature type, the enamel is softer than healthy enamel, leading to chips from underlying dentin. Abnormalities during enamel maturation induce the defects, and the tooth is opaque white to yellow-brown or red-brown.5–9 In the hypoplastic type, the enamel is correctly mineralized, but is deficient in quantity; it appears hard and shiny, but is malformed.4 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 esthetics.11 Some of the treatment techniques described to restore teeth affected by AI include all-ceramic crowns, metal–ceramic crowns, porcelain 59
Use of a modified clear matrix technique
S.G. Yig˘it O¨zer and E. Bahs¸ i
laminate veneers, onlays, and direct and indirect resin composite restorations. The use of direct and indirect resin composite restorations has gained popularity, and recent clinical studies show satisfactory results for esthetics.10,12 The present report describes a direct approach with resin composite restorations using a modified clear matrix technique to rehabilitate an adolescent with hypomature AI. Case description and results A healthy, 18-year-old female patient was referred to the Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Dicle University (Diyarbakir, Turkey). Her chief complaint was extreme dissatisfaction with her appearance. Her medical history was unremarkable, and she reported that her sister had the same problems. A detailed dental examination was performed, including photographs and radiographs (Figures 1 and 2). Maxillary canine incisors were present, but had not erupted. The anterior incisors were malformed and discolored redbrown. There were horizontal areas of exposed dentin (Figure 2) and profound caries on the maxillary first
Figure 1. Pre-treatment orthopantogram of the patient. Note the appearance of horizontal hypomature areas on the anterior incisors.
Figure 2. Frontal view at pre-treatment. Note the red-brown discoloration and accompanying surface defects.
60
Figure 3. Maxillary arch, occlusal view. Profound caries are present on the maxillary first molars.
molars (Figure 3). A supernumerary tooth was detected between the roots of the mandibular right canine and premolar teeth. The vertical dimension was within normal limits, with class I occlusion. Diastemata were evident due to unerupted maxillary canines. Defects on the central incisors were horizontally positioned and had a radiolucent appearance in the radiographs (Figure 1). It was concluded that the patient suffered from hypomature AI. A treatment plan was developed to restore the carious teeth and improve esthetics. The patient complained about her untimely travel to another country and requested a one-session treatment. For this reason, direct resin restorations were performed using the clear matrix technique. The advantages of the technique are that it is easy to use, is accomplished directly in the mouth, and provides a quick functional and esthetic result. Moreover, the clear matrix can be repeated in the event of a failure. In this case, before taking a maxillary full-arch impression, maxillary and mandibular incisor teeth were restored conventionally without using the clear matrix technique. Maxillary incisors were restored by applying composite resin incrementally to form dentin and enamel color for better esthetics before the management of the maxillary first molars. Incisor preparation involved smoothing surface irregularities and the removal of weakened, unsupported enamel with little dentin. A self-etch, single-step bonding system (Prompt L-Pop; 3M/ESPE, St Paul, MN, USA) was applied on the surfaces of incisors, and composite resin (Filtek Z 250, shade UD, A2, I; 3M/ESPE) was used for the restoration. Before the finishing and polishing procedure of the maxillary incisors, caries were removed from the ª 2010 Blackwell Publishing Asia Pty Ltd
S.G. Yig˘it O¨zer and E. Bahs¸ i
Use of a modified clear matrix technique
Figure 4. Functional cusps were beveled (arrows), and margins were prepared for restoration. Figure 6. A clear matrix made of transparent plate (Raintree Essix) was used during the application of the clear matrix technique.
maxillary first molars, and functional cusps were beveled (Figure 4). The maxillary full-arch impression was made with silicone impression material (Speedex; Coltene Whaledent, Altsta¨tten, Switzerland), and a diagnostic cast model was obtained by another clinician to accelerate the total working time. Teeth with caries and malformations were reconstructed by wax modeling to obtain teeth with their original size and shape (Figure 5). A transparent plate (Raintree Essix; Dentsply, Sarasota, FL, USA) was prepared for use as an impression tray (Figure 6), and holes were drilled in the tray to allow the removal of excess composite resin prior to curing. In a clear matrix technique, silicone impressions are generally used as a carrier for placing the composite resin; however, because of unsatisfactory polymerization related to this material, a transparent plate was prepared and used.
Figure 5. Teeth affected by amelogenesis imperfecta and decay were reconstructed to be similar to their original anatomical forms.
ª 2010 Blackwell Publishing Asia Pty Ltd
Since the mandibular anterior teeth had very small defects, they were restored conventionally using the same resin composite during the construction of a transparent plate by another clinician. The finishing and polishing procedure of maxillary and mandibular incisors was also performed at this stage. Maxillary right and left first molars were restored using the modified clear matrix technique. Occlusal reduction was limited to the removal of affected areas of pigmented grooves. A resin-modified glass ionomer (Photac Fil Quick Aplicap; 3M/ESPE) was used as a liner to prevent hypersensitivity, since dentin was removed for caries disposal. Cotton rolls were used for isolation, and adjacent teeth were lubricated with petroleum gel to facilitate the removal of excess light-cured composite resin. The color of the composite resin was chosen to match the intact mandibular incisors. A self-etch, single-step bonding system (Prompt L-Pop) was used for both teeth because manipulating a single-step bonding saves time, is easy to perform when compared with two-phased systems, eliminates procedural errors, and provides sufficient retention for the restoration. The axial walls of the molar area in the transparent plate were filled with resin composite. The occlusal surface was left free of resin to allow excess resin to flow into those areas with digital pressure. The transparent plate was carefully seated in place and kept in position with slight digital pressure. Excess composite resin was seen flowing through the holes in the plate, and it was gently removed before polymerization. A curing unit (Eliplar FreeLight 2 LED; 3M/ESPE), with a light intensity of 1.000 mw/cm2, was activated through the plate, from its occlusal, facial, and palatinal aspects, on both molars for 10 s per surface. After the removal of 61
Use of a modified clear matrix technique
Figure 7. Maxillary arch immediately after operation; occlusal view.
Figure 8. Frontal view at baseline.
the transparent plate, each surface was polymerized for an additional 30 s. Cervical overextensions were trimmed, and any unsealed areas along the margins were filled with flowable resin (Filtek Supreme Plus Flow; 3M/ ESPE) (Figure 7). The procedures, except the application of the flowable resin, were performed hands-free. Contouring, finishing, and initial polishing of the resin crowns were accomplished with finishing and polishing discs (Soft-Lex; 3M/ESPE). After the restorative procedures, satisfactory esthetics were established (Figure 8). Discussion Patients with AI present a variety of difficulties for the clinician. When the structures of enamel and dentin are developmentally altered, the ability of the teeth to bond and retain restorative materials is compromised. Patients’ expectations and requests should be fully understood to ensure overall satisfaction. For optimal results, the 62
S.G. Yig˘it O¨zer and E. Bahs¸ i
treatment of AI-affected teeth should be evaluated individually. There are a number of alternative treatment techniques for AI-affected teeth. The treatment plan is related to many factors, such as the age and socioeconomic status of the patient, the types and severity of the defects, the general hygiene of the patient, and the time needed to complete the procedure.13 In a number of cases, fixed partial dentures with complete crowns have produced highly esthetic results.12,14 However, that approach necessitates the removal of a substantial amount of intact tooth structure12,15,16 and cooperation with a dental laboratory. Considering the adverse effects of that approach, direct resin composite restorations offer an alternative conservative treatment that provides sufficient esthetics and function, with the preparation of teeth being limited to only those areas of affected unsupported enamel. As well as this, treatment can be completed in one session at a dental clinic. Direct resin composite restorations are not indicated in some AI cases.17 When the dentin and enamel are fully damaged, adhesion problems might occur due to the destruction of the surface structure. Under these conditions, a prosthodontical approach, including fixed prosthodontics (all-ceramic crowns, metal–ceramic crowns, or porcelain laminate veneers), is more convenient and reliable.18 The present study reports the application of a direct resin composite using a modified clear matrix technique. Factors influencing the treatment plan for this case are as follows: (a) there was adequate sound dentin after the removal of the hypomatured content; (b) discoloration was eliminated after tooth preparation; (c) the patient’s oral hygiene was adequate; (d) there was no sensitivity in the teeth before the treatment; (e) the patient was moving to another country and was unable to consider multiple treatments due to time limitations; (f) the patient’s economic status prevented the use of fixed prosthodontics. Orthodontic and periodontal treatments were not planned because of the same reason; and (g) the patient was informed about the long-term usage quality of direct resin composite for her AI condition. The potential disadvantages of the interim rapid, but inexpensive, treatment modality was accepted by the patient. The use of the modified clear matrix technique considerably simplified the multiple restorative procedures by allowing the resin material to be built around the teeth in one application and at the same time. All restorations were manipulated hands-free, and chair time was significantly reduced, as compared with a one-by-one ª 2010 Blackwell Publishing Asia Pty Ltd
S.G. Yig˘it O¨zer and E. Bahs¸ i
Use of a modified clear matrix technique
manipulation. Gingival tissues were preserved because strip bands were not used to isolate teeth.
function in restoring AI-affected teeth if the prosthodontical approach is not feasible.
Conclusion
Acknowledgment
Direct-bonded resin restorations using the modified clear matrix technique can provide satisfactory esthetics and
This project was supported by Dicle University, research fund # 08-DH-32.
References 1 Coley-Smith A, Brown CJ. Case report: radical management of an adolescent with amelogenesis imperfecta. Dent Update 1996; 23: 434–5. 2 Bouvier D, Duprez J.P, Bois D. Rehabilitation of young patients with amelogenesis imperfecta: a report of two cases. ASDC J Dent Child 1996; 63: 443–7. 3 Atasu M, Biren S, Mumcu G. Hypocalcification type ameloogenesis imperfecta in permanent dentition in association with heavily worn primary teeth, gingival hyperplasia, hypodontia and impacted teeth. J Clin Pediatr Dent 1999; 23: 117–22. 4 Atasu M, Genc¸ A, Namdar F. Lokal hypoplastic type of amelogenesis imperfecta: a clinical, genetic, radiological and dermatoloyphic study. J Clin Pediatr Dent 1996; 20: 337–42. 5 Winter GB. Hereditary and idiopathic anomalies of tooth number structure and form. Dent Clin North Am 1969 13: 355–73. 6 Winter GB, Lee KW, Johnson NW. Hereditary amelogenesis imperfecta
ª 2010 Blackwell Publishing Asia Pty Ltd
7
8
9
10
11
12
a rare autosomal dominant type. Br Dent J 1969; 127: 157–64. Witkop CJ, Kuhlmann W, Sauk J. Autosomal recessive pigmented hypomaturation amelogenesis imperfecta. Report of a kindred. Oral Surg Oral Med Oral Pathol 1973; 36: 367–82. Witkop CJ. Partial expression of sex-linked recessive amelogenesis imperfecta in females compatible with the Lyon hypothesis. Oral Surg Oral Med Oral Pathol 1967; 23: 174–82. Rao S, Witkop CJ. Inherited defects in tooth structure. Birth Defects 1971; 7: 153–84. Sabatini C, Guzma´n-Armstrong S. A conservative treatment for Amelogenesis Imperfecta with direct resin composite restorations: a case report. J Esthet Restor Dent 2009; 21: 161–70. Seow WK. Clinical diagnosis and management strategies of amelogenesis imperfecta variants. Pediatr Dent 1993; 15: 384–93. Akin H, Tasveren S, Yeler DY. Interdisciplinary approach to treating a patient with amelogenesis
13
14
15
16
17
18
imperfecta: a clinical report. J Esthet Restor Dent 2007; 19: 131–6. Sengun A, Ozer F. Restoring function and esthetics in a patient with amelogenesis imperfecta: a case report. Quintessence Int 2002; 33: 199–204. Ulusoy M, Tug˘sel Z. Management of amelogenesis imperfecta Cumhuriyet ¨ niv Dis¸ hek Derg 2002; 5: 31–2. U Ozturk N, Sari Z, Ozturk B. An interdisciplinary approach for restoring function and esthetics in a patient with amelogenesis imperfecta and malocclusion: a clinical report. J Prosthet Dent 2004; 92: 112–5. Robinson FG, Haubenreich JE. Oral rehabilitation of a young adult with hypoplastic amelogenesis imperfecta: a clinical report. J Prosthet Dent 2006; 95: 10–3. Yamaguti PM, Acevedo AC, de Paula LM. Rehabilitation of an adolescent with autosomal dominant amelogenesis imperfecta: case report. Oper Dent 2006; 31: 266–72. Williams WP, Becker LH. Amelogenesis imperfecta: functional and esthetic restoration of severely compromised dentition Quintessence Int 2000; 31: 397–403.
63
