Dr. Ester Dellasega
A complex enamel hypoplasia case
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A 12 years old boy, presenting dental fear and suffering from severe dental hypersensitivity came to our attention in 2007. A severe form of enamel hypoplasia involving all erupted teeth was diagnosed, accompanied by improper oral hygiene, caries on 46 and 55, 75, 85 partially erupted. Considering the young age and the dental fear, the patient was treated for caries and maintained with optimal oral hygiene for the following 5 years.
In 2012, at the age of 17, the functional and aesthetic situation is considered not anymore tolerable from the patient as it influences also his social life. Together with the parents, it was decided to restore the full mouth situation, given two restrictions that the patient raised: he did not want to undergo surgical procedures nor orthodontic corrections. Therefore, we collected all data needed for a careful treatment planning, including clinical pictures, study models, radiographs and aesthetic analysis both from oral and facial perspective.
Diagnosis: severe generalized enamel hypoplasia. Atypical dimension and shape of teeth with hypo plastic enamel and dentine exposure. Angle class II second division molar and canines, overbite 9mm and overjet 5 mm. TMJ examination negative. Reduced dimension of keratinized tissue in the lower arch and thick biotype in the upper. One supernumerary lower incisor. Retention of wisdom teeth, 34 and 37. Dental fear.
The patient refused extractions or extrusion of the retained teeth. Given the prosthetic space needed, an increase of the vertical dimension was deemed necessary: therefore an occlusal bite in centric relation was prepared to check patient’s adaptation to the new vertical dimension. After the patient has tested the bite for some weeks, the new vertical dimension was used in the lab to prepare a diagnostic waxing and therefore a direct temporary mock up. All esthetic and functional correction was done in the mouth on the mock up, so that the patient could give a direct feed back.
The functional objectives were: anterior protection and canine guide.
When esthetic and functional objectives were reached, the final restorations were realized according to the principles of a minimally invasive procedure. First the posterior teeth were prepared and restored, with zirconium and ceramic crowns or overlay full feldspatic ceramic according to quality and quantity of the residual enamel.
Anterior teeth were prepared and restored afterwards by the use of full feldspatic ceramic crowns cemented with adhesive technique and the use of a rubber dam. A night guard was provided to the patient, which was also enrolled in a maintenance program with 3 to 6 months checks according to individual needs.
The esthetic and functional objectives have been obtained with full satisfaction of the patient.
Now the patient has reached the 3rd year of follow-up with no complaints or complication, referring to be satisfied of the achieved results.
DT: Arlanch Stefano (Rovereto)
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