Deciduous Teeth Hypomineralisation and Perinatal Risk Factors.

Hypomineralisation defects with demarcated opacities are also observed in the deciduous dentition and have been found to be a predictive factor for hypomineralisation defects in the permanent dentition. Deciduous molar hypomineralisation (DMH) represents a qualitative enamel defect primarily afflicting deciduous second molars, albeit its presence is not limited solely to deciduous second molars, as it can manifest in deciduous canines and first molars. Thus, the presence of demarcated hypomineralisation defects in deciduous teeth could be called as deciduous teeth hypomineralisation. Clinically, these defects are characterized by demarcated opacities, posteruptive enamel breakdown, atypical caries lesions, and atypical restorations. The accurate diagnosis of DMH continues to present a clinical challenge, and the reported prevalence of this defect exhibits notable variability across different countries. Its precise etiology remains elusive; however, there is a prevailing suspicion that events occurring during the prenatal, perinatal, or early postnatal periods, particularly those unfolding during the perinatal phase, are intricately linked to DMH development. Factors such as delivery complications, neonatal complications, prematurity, and low birth weight have been associated with DMH. Notably, there exists a possibility that, the more health-related events occur during this critical period, the greater the likelihood of a child presenting with this enamel defect. Nevertheless, the establishment of these associations warrants further investigation through prospective studies. Acquiring knowledge regarding the factors associated with this defect holds paramount importance for effective diagnosis, guidance for families with affected children, and the formulation of strategies to mitigate the incidence of these contributory factors.

Systemic and Environmental Risk Factors Associated with Molar Incisor Hypomineralisation.

The etiology of molar incisor hypomineralisation (MIH) has been attributed to systemic and environmental factors since 2001. The identification of MIH etiology is fundamental to better understand this condition, for differential diagnosis, and to identify the patient group at risk of MIH. Although the etiology of MIH is still unclear, it is stated as a multifactorial origin, with an overlap of systemic and genetic risk factors. The aim of this chapter was to discuss the systemic and environmental factors associated with MIH according to scientific evidence in the literature, relating it to the basic knowledge of amelogenesis and tooth development chronology. In this chapter, amelogenesis is described and illustrated in detail. Some characteristics of the amelogenesis process could explain some clinical features of the developmental defect of enamel, especially MIH. The chronology of tooth development was also referred to as a characteristic for the occurrence of MIH. Finally, the literature about systemic and environmental risk factors was revised, and the prenatal, perinatal, and postnatal factors associated with MIH were discussed. During the prenatal period, maternal health status, including illnesses during pregnancy and maternal smoking, are the main investigated factors associated with MIH. Prematurity (<37 weeks), low birth weight, and cesarean delivery are the factors associated with MIH during the perinatal period. Moreover, postnatal factors, such as common childhood illnesses, respiratory disease, infections, and antibiotic use, have been associated with MIH. New longitudinal studies that consider the synergy between exposure to environmental factors and biological susceptibility are likely to provide a new understanding of the etiology of MIH.

Vitamin D deficiency and chronological hypoplasia with hypomineralisation: a case report.

Patients being reported for vitamin D deficiency (VDD) are increasing, particularly among the children and adolescents. This study aims to manifest the clinical and dental evaluations of a child with VDD, referred to the dental office. A 10-year-old British Asian boy was referred to the paediatric specialist dentistry clinic by the general dentist for dental management. The medical history depicted that the patient was diagnosed with VDD, secondary hyperparathyroidism and delayed growth. Moreover, his mother had the VDD during pregnancy. The patient was breast fed and had rickets in infancy. He was prescribed vitamin D supplements at the age of 16 months. He had received multiple dental treatments under local anaesthesia but with limited cooperation. Clinical examination revealed that the patient had chronological enamel hypoplasia shown as bands at the occlusal third on specific teeth. Suboptimal hygiene with general plaque induced gingivitis, dental caries in permanent and primary teeth, and delayed the teeth eruption. Preventions included appropriate oral hygiene and dietary advice, fluoride varnish application and fissure sealant placement. The treatments included anterior direct composite restoration, posterior composite restoration, stainless steel crowns and extractions. Thorough medical history is essential to understand the underlying causes of dental defects. Early dental intervention can restore the patient appearance and function and prevent further dental damage.

The prevalence of developmental defects of enamel in a cohort of adults with cystic fibrosis - A cross sectional study.

OBJECTIVES: Cystic Fibrosis is an autosomal recessive condition. It is a multisystem disease treated with a broad range of pharmacological therapies, diet and nutrition, and physiotherapy. Previous studies suggest that people with cystic fibrosis have a higher prevalence of developmental defects of enamel which may place this population at a greater risk of developing oral diseases such as caries. The aim of this study was to assess a cohort of people with cystic fibrosis (PwCF) for the presence of developmental defects of enamel and compare the results with a control group of people without cystic fibrosis. METHODS: A cross sectional study involving 92 participants with cystic fibrosis and 92 controls was conducted in Cork University Dental School & Hospital. All participants completed a detailed questionnaire prior to undergoing a full clinical examination. The Developmental Defect of Enamel Index was used as a measurement index. All data was statistically analysed with the help of statisticians from Cystic Fibrosis Registry of Ireland. RESULTS: 64 % (n = 59) of PwCF had enamel defects compared to just 30 % (n = 28) of people without cystic fibrosis. The median number of teeth affected by enamel defects in the study group was 1.5, compared to 0 in the control group. CONCLUSION: In this study the cohort of PwCF had more enamel defects than people without CF. Further research is required to investigate the aetiology of these findings. CLINICAL SIGNIFICANCE: Clinicians should be vigilant after teeth have erupted in PwCF as they may have an increased susceptibility to developmental defects of enamel.

Predictors of Developmental Defects of Enamel in Primary Maxillary Central Incisors Using Bayesian Model Selection.

INTRODUCTION: Localized non-inheritable developmental defects of tooth enamel (DDE) are classified as enamel hypoplasia (EH), opacity (OP), and post-eruptive breakdown (PEB) using the enamel defects index. To better understand the etiology of DDE, we assessed the linkages amongst exposome variables for these defects during the specific time duration for enamel mineralization of the human primary maxillary central incisor enamel crowns. In general, these two teeth develop between 13 and 14 weeks in utero and 3-4 weeks' postpartum of a full-term delivery, followed by tooth eruption at about 1 year of age. METHODS: We utilized existing datasets for mother-child dyads that encompassed 12 weeks' gestation through birth and early infancy, and child DDE outcomes from digital images of the erupted primary maxillary central incisor teeth. We applied a Bayesian modeling paradigm to assess the important predictors of EH, OP, and PEB. RESULTS: The results of Gibbs variable selection showed a key set of predictors: mother's prepregnancy body mass index (BMI); maternal serum concentrations of calcium and phosphorus at gestational week 28; child's gestational age; and both mother's and child's functional vitamin D deficiency (FVDD). In this sample of healthy mothers and children, significant predictors for OP included the child having a gestational period >36 weeks and FVDD at birth, and for PEB included a mother's prepregnancy BMI <21.5 and higher serum phosphorus concentration at week 28. CONCLUSION: In conclusion, our methodology and results provide a roadmap for assessing timely biomarker measures of exposures during specific tooth development to better understand the etiology of DDE for future prevention.

Gestational Serum Retinol Deficiency Is Associated with Enamel Hypoplasia.

Enamel hypoplasia (EH) is a prevalent developmental defect of teeth that can result from various insults, including prenatal nutrient deficiencies. This study aimed to evaluate the association between prenatal serum retinol deficiency and EH in the deciduous teeth of offspring at 2-y of age. A cohort of 1,450 pregnant women was enrolled, and their prenatal nutritional status was assessed between 12 and 14 wk of gestation. Maternal serum retinol, serum 25-hydroxyvitamin D (25OHD), hemoglobin, body mass index, and birth outcomes, infant feeding practices, family socioeconomic status, and demographic information were recorded. Oral health examinations were conducted for the children semiannually, and EH was diagnosed using the Modified DDE index on all the surfaces of erupted teeth. A modified Poisson regression analysis was used to assess the cumulative risk of EH over a period of 2-y. A total of 920 (63.4%) mother-child pairs completed the study, and the cumulative EH prevalence among offspring after 2-y of follow-up was 16.5% (N = 152; 87/1,114 children in the first year and 132/920 in the second year, with 20/920 having EH only in the first year). After adjusting for potential confounders, maternal serum retinol deficiency significantly increased the risk of deciduous EH (risk ratio [RR], 2.0; 95% confidence interval [CI], 1.1-3.7). In addition, deficient serum 25OHD (RR, 6.5; 95% CI, 4.0-10.7), caesarean delivery (RR, 1.6; 95% CI, 1.0-2.4), Muslim (RR, 2.9; 95% CI, 2.0-4.1) and Christian (RR, 2.4; 95% CI, 1.6-3.5) versus Hindu religions, and very preterm birth (RR, 1.7; 95% CI, 1.1-2.9) increased the risk of EH. Children presenting with EH had 2 or more teeth affected, and the maxillary incisors were the most frequently affected, followed by the first primary molars and canines. In conclusion, maternal serum retinol deficiency during the 12 to 14 wk of gestation may increase the risk of deciduous EH, besides the well-established 25OHD deficiency.

Validity of partial protocols to evaluate the prevalence of developmental defects of enamel in permanent dentition: a birth cohort study in Southern Brazil.

OBJECTIVES: To evaluate the validity of partial protocols (PP) to assess the prevalence of developmental defects of enamel (DDE) in permanent teeth and identify the strength of the association between DDE and some risk factors, using PP compared to the full-mouth (FM) exam. MATERIALS AND METHODS: This study was conducted in a population-based birth cohort of children born in 2004 in Pelotas, Southern Brazil. Socioeconomic, demographic, pre-, per-, and post-birth variables were collected. A subsample of 994 children was clinically examined for DDE in 2017, using the modified DDE index, using the "full- mouth" (FM) protocol. After FM had been performed, a dataset was created. Two different partial protocols (PP) were simulated from FM data: "only buccal surfaces (BS)" and "incisive and molars only (IM)." Sensitivity, absolute and relative bias, and inflation factors were calculated. RESULTS: For any DDE, FM had prevalence of 40.8%. The prevalence of DDE was 38.8% and 36.0%, for BS and IM protocols, respectively. When tested for any DDE, PP "BS" and "IM" showed high sensitivity. The underestimation of the true prevalence did not exceed 6.9% for PP "BS" and 16.1% for PP "IM." All protocols showed similar magnitude of association with the selected risk factors. CONCLUSION: Both PP "BS" and "IM" can be used to estimate the prevalence of DDE in epidemiological studies. CLINICAL RELEVANCE: Oral health surveys now have the option of using PP to collect DDE prevalence and investigate their association with risk factors, being less time-consuming, expensive, and labor intensive.

The Association of Developmental Dental Defects and the Clinical Consequences in the Primary Dentition: A Systematic Review of Observational Studies.

Purpose: Assess whether children with developmental defects of enamel (DDE) in primary teeth have a higher risk of having dental caries or a higher prevalence of clinical consequences due to the disease than those without DDE. Methods: Search was performed in PubMed, Scopus, Web of Science™, Cochrane Library, LILACS, BBO, Embase databases and in gray literature. Three independent reviewers were involved in study selection, data extraction, and bias assessment. Risk of bias was evaluated by the Newcastle-Ottawa scale. DDE and its subtypes (demarcated opacities, hypoplasia, hypomineralized second primary molars (HSPM), and fluorosis) were regarded as exposure. Dental caries and clinical consequences of untreated caries were also assessed. In the meta-analyses, odds ratio (OR) was used in the random effects model for dichotomous outcomes. Quality of evidence was assessed using the Grading Recommendations Assessment, Development and Evaluation (GRADE). Results: The search yielded 5,750 studies, 39 of which were included in the systematic review and 20 in the meta-analysis. The risk of bias ranged from 4 to 9 points. Children with DDE were more prone to primary tooth caries (OR=2.79; 95% CI:1.29-6.03), and so were those with demarcated opacities (OR=1.75; 95% CI:1.09-2.78), hypoplasia (OR=2.84; 95% CI:1.73-4.67), and HSPM (OR=2.89; 95% CI:1.65-5.06). Fluorosis was not associated with caries (OR=1.39; 95% CI:0.97-1.98). Regarding tooth as a unit of analysis, DDE was highly associated with caries (OR=2.34; 95% CI:1.74-3.16). As for the clinical consequences of caries, only the qualitative analysis was conducted and there was no consensus in the studies. Conclusion: DDE is associated with higher primary tooth caries experience.

Does primary trauma lead to developmental defects in permanent teeth?

Introduction A systematic review of existing evidence to determine if trauma in the primary dentition causes alteration in the development of the underlying permanent dentition.Data sources Six electronic databases (PubMed, Medline, MEDES, Scopus, Lilacs and Embase) were used to search a range of dental terms relating to dental trauma to locate studies between 1972-2020.Study selection Study selection was carried out by two authors by reviewing title, abstract and then full articles. A third author was consulted if consensus for inclusion was needed. Eligibility criteria included all scientific articles concerning sequalae to the human permanent dentition following trauma to the primary dentition. Only English, German and Spanish languages were included. For evaluation, the studies must have satisfied the following: a) minimum sample of 50 children to be representative; b) radiographic examination; and c) appropriate follow-up period up to permanent successor eruption.From 537 studies, 18 studies were identified for consideration in the review, comprising of 13 cross-sectional studies, two cohort studies and three case control studies.Data extraction and synthesis The Newcastle-Ottawa Scale was used to extract data and determine study quality. Only studies determined as high quality were included in the review. Four cross-sectional studies and three case control studies, totalling seven studies, were used. Data from these high-quality studies was summarised into table format.Results Large variation in study sample size existed from 138-753 traumatised teeth and 78-879 children. Both sexes were included in all studies and the children were aged between 0-17 years.Some studies found there was no difference in rate of trauma between girls and boys, while others found there was a higher incidence of trauma in boys than girls. The most frequently traumatised teeth were the upper primary central incisors. Whilst most studies covered all types of primary trauma, two only studied intrusion and one specified the type of primary trauma as luxation or fracture injuries.Whilst some of the studies concluded a higher frequency of defects to permanent teeth following primary intrusion trauma aged four and under, others showed no significant differences between the age of intrusion and the effect to the successor incisor.Enamel defects of the permanent teeth were the most common sequalae with a wide prevalence reported between 4.5-68.8%. Enamel defects were classified as hypoplasia and hypocalcification. Ectopic or altered eruption, crown or root dilacerations and odontoma development were observed less often, with the latter very rarely.Conclusions Primary tooth intrusion trauma causes the highest proportion of sequalae presenting as enamel defects. Younger patients experiencing primary trauma are more likely to obtain damage to the succeeding dentition. The existing quality of evidence is limited due to the observational nature of the studies available.

Prevalence and Possible Etiological Factors of Molar-Incisor Hypomineralization (MIH) in Population of Silesian Children in Poland: A Pilot Retrospective Cohort Study.

(1) Background: This pilot retrospective cohort research study regarded the frequency of the prevalence of molar-incisor hypomineralization (MIH) in a population of Silesian children in Poland. The evaluation of the potential environmental etiological factors was performed and the correlation between the environmental factors and MIH was analyzed. (2) Methods: A total of 613 children were randomly enrolled in the pilot study (9.0 years ± 1.9). A survey was carried out with mothers regarding the potential exposure to environmental etiological factors of MIH in their children. The patients' clinical assessments were carried out in the dental unit. (3) Results: The frequency of prevalence of MIH in the population of Silesian children was established at the level of 6.2% (p < 0.05). MIH symptoms were significantly associated with otitis in early childhood (OR = 2.50), atopic dermatitis (OR = 5.69), and premature delivery before 38 weeks of pregnancy (OR = 2.88). (4) Conclusions: MIH was observed in 6.2% of the population of Silesian children, and there was a relationship between environmental risk factors such as otitis, atopic dermatitis, premature birth, and MIH expression. Therefore, further research is needed to determine the influence of pre-, peri-, postnatal, and prophylactic factors on the frequency and severity of MIH symptoms in children.

Predisposing factors involved in the aetiology of Molar Incisor Hypomineralization: a case-control study.

AIM: The aetiology of Molar Incisor Hypomineralisation (MIH) is currently unclear. Over time, several aetiological hypotheses have come forward, including pre- and perinatal medical problems and postnatal illness. The aim of this case-control study is the identification of possible predisposing factors involved in MIH aetiology. METHODS: Methods Study Design: By hypothesising the probability of at least one predisposing factor present 2.5 times more in MIH cases than in controls, with an estimated prevalence of MIH patients requiring therapy equal to 30%, at a unilateral alpha level of 5% and a power of 80%, 63 couples of subjects are needed with an allocation ratio of 1:1; individual matching for age and gender was carried out. After clinical examination, 78 children with MIH (EAPD criteria) were recruited (mean age 9.36 years). An anamnestic form filled-in by a parent was used to collect data on possible predisposing factors including demographic characteristics, pregnancy, birth, childhood medical illness and medications' intake. STATISTICS: One-tail McNemar chi square test was used to evaluate the significance of the association between predisposing factor and MIH; odds ratio and 95% confidence intervals were computed. CONCLUSION: A multifactorial aetiology may be advocated for MIH development; in particular, further investigations are required to confirm and clarify the role of genetic factors.

Worldwide trends on molar incisor and deciduous molar hypomineralisation research: a bibliometric analysis over a 19-year period.

AIM: To identify the worldwide trends in scientific evidence and gaps in knowledge regarding molar incisor hypomineralisation (MIH) and deciduous molar hypomineralisation/hypomineralised second primary molars (DMH/HSPM), exploring the contribution of authors and countries, possible etiological factors and proposed treatments, in order to guide future research in the area. METHODS: Searches were conducted in MEDLINE, Scopus, Web of Science, Cochrane Library, Lilacs/BBO, Embase and Google Scholar. Studies employing the terms MIH, DMH/HSPM and their linguistic variations were included. The following data were extracted: title, authors, year and journal of publication and first author's affiliation country. Studies were categorized according to topic, dentition, study design, etiological factors and types of treatments. Categories were analysed in relation to their distribution, co-occurrence, cross-correlation and/or autocorrelation. RESULTS: Five hundred and three studies were included. The most published authors were Manton D (n = 47), de Souza JF (n = 22) and Ghanim A (n = 22) and four main collaboration clusters have been identified. Most of the studies were conducted on permanent dentition (MIH) (87.4%); with observational design (57.2%). The "European Archives of Paediatric Dentistry" was the most published journal (13.3%) and a significant increase in the number of publications was observed in the last decade. MIH was most studied in relation to prevalence/incidence, systemic factors involved in its aetiology and treatment with composite restorations, while a gap in knowledge was observed for extraction and sealants. Less studies were published on DMH/HSPM and most of them evaluated risk factors or prevalence/incidence. The gap of knowledge was observed in relation to treatments and patient's quality of life. CONCLUSIONS: This bibliometric review provided a comprehensive overview of research in MIH and DMH/HSPM over the past 19 years. Within the limitations of the present study, the following conclusions can be drawn: global trends point to an increasing peak of scientific publication, especially in the last decade, while there is a shortage of clinical studies on treatments, mainly evaluating tooth extractions. Finally the multifactorial nature should be further explored, considering environmental and systemic factors together.

Perinatal hypoxia and the risk of severe Molar-Incisor Hypomineralisation (MIH): a retrospective analysis of the pH value of umbilical arterial blood after birth.

PURPOSE: Molar-Incisor Hypomineralisation (MIH) remains a widespread developmental disorder of the teeth with a still largely unknown etiology. Perinatal events were blamed in previous studies for the development of MIH. The aim of the present study was to evaluate the influence of perinatal hypoxia-determined by the pH value of the umbilical cord blood-and to investigate its correlation with severe MIH retrospectively. In addition, cesarean section was recorded as differentiation variable. METHODS: A total number of 138 children (mean age 8.0 years ± 1.7), who were treated for severe MIH in a dental office in Berlin between the years 2008 and 2019, were included in the study. The control group was comprised of patients with the same date of birth (44 children, mean age 7.7 years ± 1.7). Information on the pH value of the arterial blood from the umbilical cord taken immediately after birth, whose recording is mandatory in Germany, was received from the parents by letter survey requesting the entries from the German Child Health Booklet. RESULTS: In the group of the male children born without cesarean section, the pH value of the control group was significantly lower (7.19 ± 0.09) than the pH value of the MIH group (7.27 ± 0.07, p = 0.0008). In female children born with or without cesarean section as well as in male children born by cesarean section there were no significant differences between the MIH and control group. CONCLUSIONS: No significant association between MIH and the pH value of the umbilical cord blood or birth by cesarean section could be found in the examined patient population.

Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document.

AIM: To update the existing European Academy of Paediatric Dentistry (EAPD) 2010 policy document on the 'Best Clinical Practice guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH).' METHODS: Experts, assigned the EAPD, worked on two different topics: (A) Aetiological factors involved in MIH, and (B) Treatment options for the clinical management of MIH. The group prepared two detailed systematic reviews of the existing literature relevant to the topics and following a consensus process produced the updated EAPD policy document on the 'Best Clinical Practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH).' The GRADE system was used to assess the quality of evidence regarding aetiology and treatment which was judged as HIGH, MODERATE, LOW or VERY LOW, while the GRADE criteria were used to indicate the strength of recommendation regarding treatment options as STRONG or WEAK/CONDITIONAL. RESULTS: (A) Regarding aetiology, it is confirmed that MIH has a multifactorial aetiology with the duration, strength and timing of occurrence of the aetiological factors being responsible for the variable clinical characteristics of the defect. Perinatal hypoxia, prematurity and other hypoxia related perinatal problems, including caesarean section, appear to increase the risk of having MIH, while certain infant and childhood illnesses are also linked with MIH. In addition, genetic predisposition and the role of epigenetic influences are becoming clearer following twin studies and genome and single-nucleotide polymorphisms analyses in patients and families. Missing genetic information might be the final key to truly understand MIH aetiology. (B) Regarding treatment options, composite restorations, preformed metal crowns and laboratory indirect restorations provide high success rates for the posterior teeth in appropriate cases, while scheduled extractions provide an established alternative option in severe cases. There is great need for further clinical and laboratory studies evaluating new materials and non-invasive/micro-invasive techniques for anterior teeth, especially when aesthetic and oral health related quality of life (OHRQoL) issues are concerned. CONCLUSIONS: MIH has been studied more extensively in the last decade. Its aetiology follows the multifactorial model, involving systemic medical and genetic factors. Further focused laboratory research and prospective clinical studies are needed to elucidate any additional factors and refine the model. Successful preventive and treatment options have been studied and established. The appropriate choice depends on the severity of the defects and the age of the patient. EAPD encourages the use of all available treatment options, whilst in severe cases, scheduled extractions should be considered.

Molar-incisor hypomineralisation: an updated view for aetiology 20 years later.

BACKGROUND: The term Molar-Incisor Hypomineralisation (MIH) was introduced in 2001 by Weerheijm, Jälevik and Alaluusua, and describes a defect of systemic origin that affects one to four first permanent molars, often associated with permanent incisors. In the past 20 years, this definition dictated the work regarding MIH prevalence, associated risk factors, association with dental caries, impact on quality of life, and therapeutic options. PURPOSE: In this report, we offer an updated and comprehensive view of MIH centred on the patient and the tooth. CONCLUSION: MIH today is globally recognized as a potential public health problem and it is not a defect of purely systemic origin but rather a condition with complex aetiology that in some instances may be the result of gene-environmental interactions.

Extraction of first permanent molars severely affected by molar incisor hypomineralisation: a retrospective audit.

AIM: The aim of this study was to evaluate possible spontaneous space closure after extraction of first permanent molars in children and their eventual need for orthodontic treatment. METHODS: Twenty-seven children with at least one first permanent molar planned for extraction were enrolled in the study. The children were referred to the Department of Paediatric Dentistry, University of Oslo, between 2009 and 2017. All extracted teeth were severely affected by Molar Incisor Hypomineralisation and/or caries. The children and their parents had consented to extraction and follow-up. Data were analysed with SPSS 26. RESULTS: The age of the children was between 5.5 and 12.1 years (mean 8.7) at extraction. The mean follow-up time was 3.2 years (range 1.1-6.3). Sixteen children (59.3%) had all four molars extracted, five (18.5%) had three, five had two and one had one molar extracted. In the maxilla, the second permanent molar had erupted in the place of the first molar in all the children, and none of them needed orthodontic space closure. In the mandible, eight children (29.6%) needed orthodontic treatment to close the spaces after extraction. In three children, the second molar was not yet erupted and treatment need was not settled. CONCLUSION: Extraction of severely affected first permanent molars before the eruption of the second molar is a treatment option causing little additional treatment in the majority of cases.

Enfoque de Tratamiento de una Adolescente con Amelogénesis Imperfecta / Treatment Approach for an Adolescent with Amelogenesis Imperfecta

La amelogénesis imperfecta (AI) es un grupo de tras-tornos hereditarios, clínica y etiológicamente hete-rogéneos, derivados de mutaciones genéticas, que se caracterizan por anomalías cualitativas y cuanti-tativas del desarrollo del esmalte, pudiendo afectar la dentición primaria y/o permanente. El tratamiento del paciente con AI es complejo y multidiscliplinario; supone un desafío para el odontólogo, ya que por lo general están involucradas todas las piezas dentarias y afecta no solo la salud buco dental sino el aspecto emocional y psicológico de los pacientes. Con el obje-tivo de describir el tratamiento integral y rehabilita-dor realizado en una paciente con diagnóstico de AI tipo III, se reporta el caso de un adolescente de sexo femenino de 13 años, que concurrió en demanda de atención a la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), cuyo motivo de consulta fue la apariencia estética y la hipersensibilidad de sus pie-zas dentarias. Durante el examen clínico intraoral, se observó que todas las piezas dentarias presentaban un esmalte rugoso, blando, con irregularidades y una coloración amarronada, compatible con diagnóstico de Amelogénesis Imperfecta tipo III hipomineralizada. Conclusión: El tratamiento rehabilitador de la AI en los pacientes en crecimiento y desarrollo estará diri-gido a intervenir de manera integral y temprana para resolver la apariencia estética y funcional, evitar las repercusiones sociales y emocionales, y acompañar a los pacientes y sus familias (AU)

Amelogenesis imperfecta (AI) is a group of clinically and etiologically heterogeneous hereditary disorders, derived from genetic mutations, characterized by qualitative and quantitative anomalies of enamel development, which can affect primary and/or permanent dentition. The treatment of patients with AI is complex and multidisciplinary, it is a challenge for the dentist, since in general all the teeth are involved and it affects not only oral health but also the emotional and psychological aspect of the patients. Objective: To describe the comprehensive and rehabilitative treatment carried out in an adolescent patient with a diagnosis of type III AI. Case report: The case of a 13-year-old female patient, who required dental attention at the Department of Dentistry for Children of the School of Dentistry of the University of Buenos Aires, whose reason for consultation was esthetic appearance and hypersensitivity of her teeth. In the intraoral clinical examination, it was observed that all the teeth had rough, soft enamel, with irregularities and a brownish color, compatible with the diagnosis of type III hypomineralized Amelogenesis Imperfecta. Conclusion: Rehabilitative treatment of AI in growing and developing patients will be aimed at early and comprehensive intervention to resolve esthetic and functional appearance, avoid social and emotional repercussions and accompany patients and their families (AU)