An interdisciplinary approach for rehabilitating a patient with amelogenesis imperfecta: a case report

Influence of short-span scans on trueness in the digital transfer of the maxillomandibular relationship

OBJECTIVES

This study aimed to assess the influence of the location and distribution of short-span scans, serving as intermediate registration data, on the trueness of digitally transferring the maxillomandibular relationship in full-mouth rehabilitation.

METHODS

Maxillary and mandibular complete-arch preparation casts mounted on an articulator were scanned, with and without interim restorations, using an intraoral scanner. Four types of short-span scans-right anterior, left anterior, right posterior, and left posterior-were captured from maxillary and mandibular casts. Each scan comprised two prepared teeth and two crowned teeth arranged alternately. These short-span scans served as intermediate data and were cross-registered with complete-arch interim restorations and preparation casts to transfer the maxillomandibular relationship. Based on the number (1 or 2), location (anterior or posterior), and distribution (unilateral or bilateral) of short-span scans, they were categorized into six groups. Trueness was assessed by evaluating the mandibular 3-dimensional (3D), spatial distance, angle, and linear distance deviations between the test and reference scans.

RESULTS

Significant differences in the trueness of digital cross-mounting were observed among the six groups (P < .05). The group registering the bilateral posterior areas exhibited the smallest 3D, spatial distance, angle, and linear distance deviations, whereas the group registering one anterior area showed the largest deviations.

CONCLUSION

The number, location, and distribution of the registered short-span scans significantly affected the trueness of transferring the maxillomandibular relationship. A posterior short-span scan had higher trueness than an anterior scan. The symmetrical distribution of the two registered larger short-span scans over the cross-arch enhanced the registration trueness.

CLINICAL SIGNIFICANCE

Digital cross-mounting in full-mouth rehabilitation using short-span scans enhances transfer accuracy, improves patient comfort, and increases chairside efficiency.

Clear Aligners in Patients with Amelogenesis and Dentinogenesis Imperfecta

Dentinogenesis imperfecta (DI) and amelogenesis imperfecta (AI) are hereditary abnormalities of dental hard tissues. Dental abnormalities may also be accompanied by symptoms of disorders such as osteogenesis imperfecta. AI and DI have a significant burden on socializing, function, and comfort; therefore, frequent screening and accurate diagnosis is the cornerstone of managing such conditions. Both AI and DI could be treated with many strategies, including restorative, prosthetic, periodontal, surgical, and orthodontics treatment. The interdisciplinary combination of orthodontic, prosthodontic, and periodontic treatment has been proven to improve the prognosis of AI and DI. Regarding orthodontic treatment, the most difficult element of orthodontic therapy may be maintaining a high level of motivation for what might be a prolonged form of treatment spanning several years. There are many forms of orthodontic management for AI and DI, including removable appliances, functional appliances, and fixed appliances. Clear aligner therapy (CAT) contains a broad range of equipment that works in different ways, has different construction processes, and is compatible with different malocclusion procedures. The application of CAT in patients with AI and DI is favorable over the fixed applicants. However, the available evidence regarding the application of CAT in AI is weak and heterogeneous. In this review, we discussed the current evidence regarding the application of clear CAT in patients with AI and DI.

Full mouth functional and aesthetic rehabilitation of a patient affected with hypoplastic type of amelogenesis imperfecta

The management of Amelogenesis imperfecta often poses a challenge for the dentists. It not only includes aesthetic and functional rehabilitation of the patient, but also requires a positive rapport building with the patient due to psychosocial issues. The treatment plan is driven by patient demands, age, cost-affordability, severity of the disease and the presenting condition. The present case report elucidates step by step management of a 20 year-old female who presented with generalized hypersensitivity, intermittent pain associated with multiple decayed posterior teeth, poor dental aesthetics and anterior deep bite. The management consisted of endodontic treatments in all teeth, crown lengthening to gain ferrule in some teeth, provision of provisional bridges at an increased vertical dimension for six weeks followed by full mouth all ceramic crowns on all teeth. The prosthetic management aimed at reorganized occlusal scheme. There was a significant improvement in the aesthetics, deep bite, and along with correction of the vertical dimension of occlusion. Key words:Amelogenesis imperfecta, hypoplastic enamel, mouth rehabilitation, dental esthetics.

Diagnosis, Treatment Planning, and Full-mouth Rehabilitation in a Case of Amelogenesis Imperfecta

Amelogenesis imperfecta is a genetic condition affecting the teeth resulting in aberrations of the structure and clinical appearance of enamel. The treatment of amelogenesis imperfecta involves a multidisciplinary treatment approach requiring a comprehensive examination, diagnosis, and effective treatment planning strategy along with satisfaction of patient-related factors. The clinical case described here involves judicious involvement of different disciplines to formulate a treatment plan best suitable to confirm with the patient's needs and expectations, at the same time maintaining the integrity and harmony of associated hard and soft tissues.