Management of a Patient with Hypomineralized Teeth from the Mixed to Permanent Dentition Stage - A Case Report with 6-year Follow-up.

PURPOSE: This case report presents the management of molar incisor hypomineralization (MIH) from the mixed to the permanent dentition stage. Shortly after eruption of hypomineralized teeth, masticatory forces frequently cause rapid enamel breakdown. The MIH Treatment Need Index (MIH-TNI) provides guidelines for the treatment of MIH in relation to how severely the teeth are affected. Clinical considerations: An 11-year-old patient with permanent teeth affected by MIH was referred to us by his orthodontist for conservative dental treatment before planned orthodontic treatment. The restorative treatment varied according to the degree of severity of the affected teeth and included indirect composite resin restorations on teeth #17 (MIH-TNI 4c), #35 (MIH-TNI 4c) and #37 (MIH-TNI 4b), direct composite resin fillings on teeth #26 (MIH-TNI 2b), #27 (MIH-TNI 2a) and #16 (MIH-TNI 4c) and fissure sealants on teeth #16, 15, 14, 24, 25, 34, 36, 44, 45, 46 and 47. Orthodontic treatment was already started during the restorative phase with a bite-jumping appliance. With the conclusion of the second phase of mixed dentition at age 12, the orthodontist was able to start fixed orthodontic treatment of the maxillary and mandibular arches with all of the child's permanent teeth adequately restored. Orthodontic treatment was completed at age 14. At present, 6 years after initiation of dental treatment, all teeth are still free of decay. CONCLUSION: A carefully supervised recall program with early comprehensive care at frequent intervals and adequate, defect-driven restorations depending on how severely the teeth are affected are the basis for a favorable long-term prognosis in patients with MIH.

Treatment of an Adolescent Patient with Dentinogenesis Imperfecta Using Indirect Composite Restorations - A Case Report and Literature Review.

PURPOSE: To demonstrate the field of application and prospects of individually modeled indirect composite restorations for the treatment of children and adolescents based on a case of dentinogenesis imperfecta. Dental malformations can affect single or multiple teeth. In most cases, direct composite fillings can be placed. However, in severe cases, these restorations may be more challenging and error-prone, especially when occlusal adjustments are necessary. Since composite materials do not require a specific lamination strength and are easy to repair, they can be applied using the indirect technique, enabling conservation of more sound hard tissue than is possible when conventional restorations are used. PATIENT AND METHODS: A young patient with dentinogenesis imperfecta type II underwent interdisciplinary full-mouth rehabilitation due to massive tooth wear and loss of vertical occlusion. First, a check bite was taken, and vertical occlusion was increased using overdentures. Six months later, a construction bite was taken over the existing overdentures (focusing on the sagittal dimension) to move the mandibular position more towards the anterior, correcting the skeletal Class II malocclusion. This resulted in a Class I intercuspidation with harmonization of the facial proportions. After a further six months, all teeth were restored using individually modeled indirect composite restorations, which preserved most of the sound hard tissue and restored esthetics and function. CONCLUSION: Indirect composite restorations can be a valuable tool for improving occlusion, esthetics and function in the treatment of children and adolescents.

Laboratory-made composite resin restorations in children and adolescents with hypoplasia or hypomineralization of teeth.

Management of children and adolescents with qualitative or quantitative defects of enamel or dentin are often impeded by patient compliance, rare prevalence of disease, lack of evidence, and cost. The aim for all patients in this case series was to develop a suitable treatment strategy that required little chair time and was applicable to several conditions. Thirty-four laboratory-made composite resin restorations were placed in differently affected permanent posterior teeth of eight young patients. The ages of the patients ranged from 6 to 15 years. All restorations were adhesively inserted with the etch-and-rinse technique and are still in situ. The longevity of the restorations at present is 2 to 48 months. This treatment method allowed relatively comfortable treatment for children and adolescents who required extensive dental treatment. The outcome has been favorable with good patient compliance, brief chair time, and functional and esthetic restorations.