Long term clinical outcome of dental implants placed in a patient with Singleton-Merten syndrome.

PATIENTS: Singleton-Merten syndrome is an extremely rare autosomal dominant condition with less than 10 reported cases in the literature. It is characterized by abnormal aortic calcifications and dental abnormalities. The goal of this case report is to discuss the abnormal oral clinical features and the modified treatment protocol that was used in order to achieve osseointegration of dental implants in a patient having abnormal bone density and bone turnover associated with Singleton-Merten Syndrome. DISCUSSION: Following extraction of the remaining teeth, titanium implants (Friadent GmbH, Mannheim, Germany and Straumann(®), Basel, Switzerland) were placed in the upper and lower jaw of the patient. The upper jaw which was treated with dental implants, received a bar supported implant retained prosthesis and the lower jaw an implant retained telescopic prosthesis. The patient was regularly followed up for the past 13 years during which, clinical and radiological evaluation of osseointegration was undertaken. All the loaded implants showed clinical and radiographic evidence of osseointegration. With a follow up of 13 years after insertion of the first implant, the patient reported functioning well with no complications. CONCLUSION: The treatment with dental implants in the extremely rare Singleton-Merten syndrome patients is a reasonable treatment option to rehabilitate maxillofacial aesthetics and establish normal function of the jaws.

Rehabilitation of molar-incisor hypomineralization (MIH) complicated with localized tooth surface loss: a case report.

Molar-incisor hypomineralization (MIH) is a developmental enamel hypomineralized condition characteristically involving the first permanent molars and sometimes also the incisors. The affected teeth are predisposed to tooth surface loss (TSL) which may not only compromise the esthetics and function but also endanger the pulp and longevity of the teeth. This report describes the management of a patient with MIH complicated with localized TSL and lack of occlusal clearance due to dentoalveolar compensation. The atypical TSL pattern involved all anterior teeth and required the placement of Dahl appliances on both arches.

A clinical study of direct composite full-coverage crowns: long-term results.

OBJECTIVE: Long-term assessment of the clinical behavior of direct composite full-coverage crowns using transparent strip crowns as a matrix. METHOD: A retrospective observational study without controls of 21 restorations was performed: nine teeth with hypoplasia, six conoid teeth, and six with microdontia. The mean patient age was 22.5 ± 8.2 years. The clinical procedure consisted of cleaning the tooth, acid etching and application of adhesive, after which a transparent strip crown was filled with composite and placed on the tooth. The gingival contour was polished using multifluted burs and interproximal spaces polished with polishing strips. Patients were examined after a period of 12.5 (±4.6) years by two observers who recorded the plaque index and evaluated the restorations in accordance with the modified U. S. Public Health Service (USPHS) criteria. RESULTS: Except for one case, all the scores obtained on the basis of the USPHS criteria were within the acceptable range. There were no cases of secondary caries. The statistically significant variations were anatomical form, marginal adaptation, marginal discolouration, and surface roughness. DISCUSSION: This technique is simple and noninvasive. It is a viable long-term treatment option for teeth with amelogenesis or microdonts and is especially suitable for patients still undergoing growth.

Dental rehabilitation of amelogenesis imperfecta using thermoformed templates.

Amelogenesis imperfecta represents a group of dental developmental conditions that are genomic in origin. Hypoplastic AI, hypomineralised AI or both in combination were the most common types seen clinically. This paper describes oral rehabilitation of a 9-year-old Malay girl with inherited hypoplastic AI using transparent thermoforming templates. The defective surface areas were reconstructed to their original dimensions on stone cast models of the upper and lower arches using composite, and transparent thermoform templates were fabricated on the models. The templates were used as crown formers to reconstruct the defective teeth clinically using esthetically matching composite. The usage of the templates allowed direct light curing of the composite, accurate reproducibility of the anatomic contours of the defective teeth, reduced chair-side time and easy contouring and placement of homogenous thickness of composite in otherwise inaccessible sites of the affected teeth.

Direct laminate veneers with resin composites: two case reports with five-year follow-ups.

AIM: The aim of this report is to present five-year follow-ups of two different applications for the use of direct laminate resin-based composite veneers to improve esthetics. BACKGROUND: Defects in the maxillary anterior teeth, such as enamel hypoplasia and peg lateral, can present esthetic challenges. Furthermore, a treatment plan that can be completed in a single appointment is highly desirable. This case report presents two different clinical cases involving the use of direct laminate resin-based composite veneers with five-year follow-ups. CASE REPORT: Case 1: A 17-year-old female patient was referred for treatment of her anterior teeth, which were unesthetically altered due to enamel hypoplasia and dental caries. A treatment plan was developed that included restoring the affected teeth with direct resin-based composite laminate veneers to improve the patient's appearance. The six maxillary anterior teeth were prepared for and restored with direct resin-based composite laminate veneers. At the five-year follow-up, the patient was satisfied with the restorations both esthetically and functionally. Case 2: A 15-year-old female patient also was referred for treatment to improve the appearance of her maxillary anterior teeth. A treatment plan was developed with two objectives: (1) to restore the undersized supernumerary crown in the area of the maxillary right lateral incisor and (2) to close the anterior diastemas. The facial surfaces were conservatively prepared and resin-based composite was applied with the aid of transparent crown forms. After completion of the treatment, the patient was recalled at six-month intervals. At the five-year follow-up appointment, the restorations were intact, no adverse effects were noted, and the resultant appearance was highly satisfactory for the patient. SUMMARY: The use of direct resin-based composite laminate veneers and adhesive bonding systems has been shown to provide an esthetic alternative to metal-ceramic or all-ceramic crowns for the rehabilitation of anterior teeth. This treatment option offers another advantage, namely a lower cost compared to an indirect technique. Other more complex and costly treatment options in the future are not ruled out. CLINICAL SIGNIFICANCE: In the present two cases, the initial and five-year follow-up results support the use of direct resin-based composite laminate veneers with minimal altering of healthy tooth structure. Such results should encourage clinicians to seek a cost-effective technique such as direct resin restorations to improve a patient's esthetic appearance in a single appointment.

Case series: clinical findings and oral rehabilitation of patients with amelogenesis imperfecta.

BACKGROUND: Children with amelogenesis imperfecta (AI) experience many oral difficulties including sensitivity and aesthetics. The methods of treating AI children are limited and therefore a program of care was evaluated in order to assess the clinical efficacy of providing preventive and restorative treatments. CASE REPORTS: A non-randomised convenience sample of 12 patients with AI was evaluated. A comprehensive patient history was recorded, followed by a clinical and radiographic assessment of oral health. In 8/12 patients a hypoplastic form of AI was diagnosed, in 2/12 cases hypomaturation and in 2/12 cases hypocalcified form were noted. Chief complaints were mainly related to unsatisfactory aesthetics and dental sensitivity. In 8 patients there was active dental caries. Most of the patients had gingivitis and showed fair oral hygiene. The presence of non-enamel dental anomalies was recorded in 9 patients. TREATMENT: All patients received meticulous preventive care. Initial treatment depended on AI type and oral health of the patient. During the transition period, both conventional and resin modified glassionomer cements, as well as composite resin materials, were used to restore posterior teeth. Direct composite resin restorations were used to improve the appearance of anterior teeth. In 4 patients a long-lasting interdisciplinary approach including orthodontics, metal-ceramic crowns and fixed partial dentures, and direct composite restorations was required. FOLLOW-UP: Follow-up periods varied between 2-11 years. All children have been regularly recalled at 3 monthly intervals. Caries prevalence has remained low during the follow-up postoperative period and patients have reported satisfaction with the treatment they have received. CONCLUSION: AI is associated with multiple non-enamel anomalies and requires a complex treatment. Treatment planning is related to the age of the patient, the type and severity of the disorder, and the oral health of the patient. Early diagnosis, preventive care and timely treatment are of foremost importance to improve oral health in children with AI.

Junctional epidermolysis bullosa associated with hypoplastic enamel and pervasive failure of tooth eruption: Oral rehabilitation with use of an overdenture.

This report describes a previously unreported case of generalized hypoplastic enamel and failure of eruption of the permanent maxillary teeth and only partial eruption of the permanent mandibular teeth in an 18-year-old male diagnosed with junctional epidermolysis bullosa. Similar anomalies were reported to have affected the deciduous dentition. Beginning at 4 years of age, oral rehabilitation has been conservatively managed with the fabrication of various maxillary complete overdentures. The use of this prosthesis has provided an economical, nonsurgical treatment option when oral soft tissue permits and with relative ease of construction.

Rehabilitation of an adolescent with autosomal dominant amelogenesis imperfecta: case report.

Amelogenesis imperfecta is a hereditary condition that affects tooth enamel without systemic involvement. In the most severely affected patients, teeth can present alterations in enamel thickness, color and shape, all which compromise aesthetic appearance and mastigatory function. Several treatment options have been described to rehabilitate these patients, ranging from preventive intervention to a prosthodontic approach. Advances in the search for new techniques and bonding materials have provided less invasive treatment options. This study discusses the importance of preventive procedures and describes the clinical procedures of aesthetic and functional rehabilitation of a Brazilian adolescent with autosomal dominant amelogenesis imperfecta (ADAI) involving the use of direct and indirect resin composite restorations.

Oral rehabilitation of a young adult with hypoplastic amelogenesis imperfecta: a clinical report.

This clinical report describes the oral rehabilitation of a young adult patient diagnosed with hypoplastic amelogenesis imperfecta. The specific objectives of this treatment were to eliminate tooth sensitivity while enhancing esthetics and restoring masticatory function. Treatment included removal of several teeth, lengthening of the maxillary and mandibular clinical crowns, and placement of anterior and posterior metal-ceramic fixed partial dentures. The 2-year recall examination revealed no pathology associated with the rehabilitation, and the patient's esthetic and functional expectations were satisfied.

Molar incisor hypomineralisation: restorative management.

AIM: The methods for the restoration of permanent molars and incisors affected by Molar Incisor Hypomineralisation are reviewed. The special problems associated with restoring these teeth, such as sensitivity, occlusion and aesthetics are discussed. The various options for restoration are outlined and recommendations made as to the appropriate types of restoration.

Evaluation of composite restorations in hypomineralised permanent molars: a four year clinical study.

AIM: The objective of this investigation was to evaluate the clinical performance of composite restorations in enamel hypomineralised posterior teeth. METHODS: 52 composite restorations were placed in 52 permanent molars of 46 children, aged 8-10 years. All the teeth were clinically diagnosed as hypomineralised and restorations were placed on two or more surfaces of the teeth, including cusps. All treated teeth had at least 2 sound surfaces, thus excluding defective teeth with total disruption of the crown. The materials used were a hybrid composite and a fourth generation one-bottle adhesive material and manufacturer's instructions were carefully followed. The restorations were initially evaluated 7 days after the treatment and subsequent evaluation was performed at 12, 24, 36, 48 months. Clinical evaluation of the restorations was made according to the criteria of Ryge [1980]. RESULTS: In 6 cases, postoperative complaint was relieved after occlusal re-adjustment at the second appointment, 7 days later. At the end of the 48 months study period, 49 restorations were available for evaluation, all with full retention. Radiographically there was no periapical pathology. Problems were found in colour match in 10, surface appearance in 3 and anatomic form in 4 restorations. Hypersensitivity was recorded in 17 teeth after one week and in 3 teeth one year later. All teeth were sensitivity free after two years and until the end of the study period. CONCLUSIONS: Composite resin restorations using contemporary materials, in certain cases of hypomineralised permanent molars, can be an acceptable restorative procedure with satisfactory long-term results.

Oral rehabilitation of young adults with amelogenesis imperfecta.

PURPOSE: This article describes the restorative management of two patients in whom the diagnosis of amelogenesis imperfecta was not made until young adulthood. MATERIALS AND METHODS: Amelogenesis imperfecta is a variable developmental abnormality of the tooth enamel that affects relatively few persons. Previous case reports have focused largely on the early management of children and young adolescents. However, some patients may not be diagnosed correctly or may not request dental treatment until they are older, as with the two cases presented. In some instances, parents fail to appreciate the importance of early intervention. RESULTS: Both patients required intensive preventive therapy and extensive restorative treatment over several years. The correct sequencing of treatment phases was required to achieve relief of pain and provide satisfactory function and esthetics. CONCLUSION: The two cases presented illustrate the degree of complexity that extended restorative treatments can involve, especially following severe tooth wear and poor bonding of restorations to the affected enamel.

Esthetic rehabilitation of anterior teeth affected by enamel hypoplasia: a case report.

UNLABELLED: Alterations during tooth structure formation, mainly on anterior teeth, are known to severely compromise esthetics. This article presents a case report in which the etiology and clinical characteristics of anterior teeth affected by enamel hypoplasia are analyzed. The restoration treatment sequence is also discussed, demonstrating that the use of a hybrid and a microfilled composite associated with tooth hybridization (interdiffusing zone) can be used to conservatively rehabilitate a smile. CLINICAL SIGNIFICANCE: This article presents a simple and conservative technique for restoring disfiguring areas of enamel hypoplasia to achieve an optimally esthetic result.

Dentine-bonded ceramic crowns: two case reports.

The dentine-bonded ceramic crown is a full coverage restoration luted to the underlying tooth tissue via a dentine bond and resin composite luting system. The main advantage of using this technique is that removal of tooth tissue can be kept to a minimum. Additionally, the final aesthetic results may be excellent. In this paper, the provision of dentine-bonded crowns on the upper anterior teeth for two patients is described.

Porcelain CAD-CAM veneers. Some new uses explored.

With a new CAD-CAM technique, we restored and provided esthetic treatment for both natural teeth and fixed prostheses with worn or broken surfaces.

Creating the appearance of white enamel dysmineralization with bonded resins.

In special cases, white enamel discoloration can be stimulated using bonded resin materials. This paper describes a method of using bright white visible light-polymerized resin sealant material as an enamel bonding agent, which is overlayed with composite resin to enhance wear resistance of the restoration.