Amelogenesis Imperfecta, hypoplastic type associated with some dental abnormalities: a case report

Amelogenesis imperfecta (AI) is a hereditary disorder expressing a group of conditions that cause developmental alterations in the structure of enamel. AI is a serious problem that reduces oral health-related quality of life and causes some physiological problems. The treatment of patients with AI may upgrade the quality of life and reinforce their self-esteem. Among the treatment options for AI, full-mouth metal reinforced porcelain restoration constitutes an important alternative because of its properties. This paper presents a case of AI of the hypoplastic rough type associated with a group of dental anomalies, and describes the prosthetic management of the patient. A 26-year-old female patient presented with a chief complaint of discolored teeth. Clinical and radiographic examination of the patient confirmed the diagnosis of rough pattern hypoplastic AI. The patient was treated with full-mouth metal reinforced porcelain fixed bridge. The adaptation of the temporomandibular joints and masticatory muscles was carefully observed periodically during 4 months and, after this period, the patient tolerated well her new vertical dimension. The patient received instructions on cleansing of the subpontic and interproximal areas. Follow-up visits were scheduled at 3 months and then at 6 months. No esthetic or functional problems were seen after the follow up period.

Amelogenesis imperfecta (AI) é uma desordem hereditária que expressa um grupo de condições que causam alterações de desenvolvimento na estrutura do esmalte. A AI é um problema grave que compromete a qualidade de vida relacionada à saúde bucal e causa alguns problemas psicológicos. O tratamento de pacientes com AI pode melhorar sua qualidade de vida e reforçar sua auto-estima. Dentre as opções de tratamento para AI, a restauração de toda a boca com porcelana reforçada com metal representa uma alternativa importante devido a suas propriedades. Este artigo apresenta um caso de AI do tipo hipoplásica rugosa associada a um grupo de anomalias dentais, e descreve o tratamento protético da paciente. Uma paciente de 26 anos apresentou-se com queixa principal de dentes manchados. O exame clínico e radiográfico da paciente confirmou o diagnóstico de AI hipoplásica rugosa. A paciente foi tratada com a construção de próteses fixas de porcelana reforçada com metal em toda a boca. A adaptação das articulações temporomandibulares e dos músculos mastigatórios foi cuidadosamente observada periodicamente durante 4 meses e, após este período, a paciente mostrou tolerar bem sua nova dimensão vertical. A paciente recebeu instruções sobre limpeza das áreas sob o pôntico e áreas interproximais. As visitas de acompanhamento foram agendadas a cada 3 meses e subseqüentemente a cada 6 meses. Não foram observados problemas estéticos ou funcionais após o período de acompanhamento.

Comparison of the pain levels of computer-controlled and conventional anesthesia techniques in prosthodontic treatment

OBJECTIVE: The objective of this study was to compare the pain levels on opposite sides of the maxilla at needle insertion during delivery of local anesthetic solution and tooth preparation for both conventional and anterior middle superior alveolar (AMSA) technique with the Wand computer-controlled local anesthesia application. MATERIAL AND METHODS: Pain scores of 16 patients were evaluated with a 5-point verbal rating scale (VRS) and data were analyzed nonparametrically. Pain differences at needle insertion, during delivery of local anesthetic, and at tooth preparation, for conventional versus the Wand technique, were analyzed using the Mann-Whitney U test (p=0.01). RESULTS: The Wand technique had a lower pain level compared to conventional injection for needle insertion (p<0.01). In the anesthetic delivery phase, pain level for the Wand technique was lower (p<0.01). However, there was no difference between the Wand and conventional technique for pain level during tooth preparation (p>0.05). CONCLUSIONS: The AMSA technique using the Wand is recommended for prosthodontic treatment because it reduces pain during needle insertion and during delivery of local anaesthetic. However, these two techniques have the same pain levels for tooth preparation.