Dr MariYa ShakoOr
Comprehensive management of a patient with Amelogenesis Imperfecta, Hypoplastic type.
Full mouth restorations with Porcelain Fused to metal crowns at increased vertical dimension of occlusion
26 years old female, student by profession, reported with a chief complaint of small sized discolored teeth and problem in chewing.
Expectation was to have pearl white teeth with better chewing efficiency
The clinical intra oral examination revealed small crowns of all teeth, chipped off enamel, generalized discoloration, Crowding, plaque and calculus deposits.. Soft tissues showed mild generilized gingival inflamation
extra-oral examination revealed a slight asymmetrical face without any facial swelling.. mouth opening was adequate with no deviations.. TMJ ws normal with no detectable pathology. Though lower facial height of the pt was decreased
On the basis of history, thorough clinical examination and radiographic assessment the diagnosis of Amelogenesis Imperfecta hypocalcified type was made with consultation of the department of operative dentistry.
Following treatment options were thoroughly discussed with the patient:
Anterior veneers and posterior onlays
Full coverage restorations ( All ceramics/ Metal ceramics)
Overlay Denture
Over Denture
The patient opted for full coverage metal restorations.
This treatment plan was formulated .. All factors, including the amount of tooth structure removal, need for endodontic therapy, expected clinical longevity, and duration of treatment was discussed and explained to the patient in detail
treatment was started with oral prophylaxis, thorough scaling/root planing was done. Since pt had decrease lower facial height it was planned to raise vertical around 2mm. Occlusal splint was fabricted to evaluate patient to altered VDOand she wsa kept for an observational phase for 3months. She was compliant as She tolerated increase OVD width no sign/symptoms of muscle soreness/TMJ pain
in the mean time those teeth requiring endodontic treatment underwent root canal therapy.
Panoramic radiograph showing endodontic treatment of all erupted teeth
After elective Root Canal Therapy were completed .. maxillary and mandibular complete arch impressions were made using alginate
Diagnostic casts were poured using type II dental plaster
A face bow transfer was made to record the cranio-maxillary and maxillo-mandibular relationship
Lucia jig was used to raise vertical around 2mm at the incisal region and intraocclusal Centric relation record was made with putty
These records helped in mounting the casts in centric relation and at a raised bite on a semi-adjustable articulator
PAP approach was followed for full mouth rehablitation. We started with Crown preperation of lower right posteriors, impression was recorded using PolyVinylSiloxane
Temporary crowns were made n cemented chairside, splint was adjusted.. The crown preperation of lower left posteriors were done and the same procedure was repeted that is impression recording n provisional crowns cementations
trial was carried out to check the marginal fit .. proximal contact and shade of the restorations.
At the same appointment upper right and left posteriors was prepared. and then lower crowns were cemented 
Upper cast was articulated against the stone matrix of lower cast 
trial was done and was found to be adequate so Upper Permanent crowns were cemented temporarily
Than i moved on to the prepration of upper anterior teeth .. Retraction cord of size 0 was placed first followed by subgingival prep of the upper teeth. Impression was recoreded .. Cast was poured and articulated. Metal framework tral was done
Bite was then transferred to the articulators and Custom anterior guide table was fabricated using the recoreded bite .. anterior guidance was developed on the cast .. Lower cast showing centric stops
Upper cast showing centric stops
Centric and eccentric occlusal stops were checked/adjusted intraorally as well as on the articulated casts.
the pt was kept under observation for 1month. After 1month, as she was compliant , so we planned for permanent cementation. After a follow up of 3 and 6 months the patient was satisfied with both function and esthetics 
