Amelogenesis Imperfecta: Transitional Phase of Management

greater esthetic and functional problems for patients.This report highlights the importance of transitional management of young children affecting with AI. ABSTRACT Amelogenesis Imperfecta patients are often on a restorative cycle. Early identification and execution of planned oral care is important. Multidisciplinary team approach is always admirable to achieve better rehabilitation. Transitional stage of management should be aimed, as they provide a functionally comfortable and aesthetically pleasant dentition while preserving maximum tooth structure. Timely management is well appreciated to prevent possible detrimental effect on child’s physical and social wellbeing.

: Preoperative presentation of the dentition.
Dental Panoramic Tomogram (DPT) showed all the teeth to be of reduced thickness of enamel with normal radiological contrast between the enamel and dentine. Almost all molar teeth showed pulp stones and presence of taurodontism was excluded ( Figure   2).By using the clinical and radiological features, the diagnosis was arrived as "amelogenesis imperfecta -hypoplastic type of sporadic inheritance".Preventive care was provided and all the teeth which had caries extending to dentine were restored with Composite resin.
Root canal treatment of 26 was completed in a single visit ( Figure   3). All permanent first molars received Stainless Steel Crown (SSC).

Discussion
Overall rehabilitation of this cohort of patients comprises timely management depending on their age. It can be categorized as the initial phase where the primary and mixed dentitions are managed, the transitional phase which starts from permanent dentition and continues to the permanent/definitive phase where definitive restorations are carried out in adulthood [7]. The current case describes the transitional phase of management in AI which is important in the success of future restorative care.Prevention is imperative in management to protect individual's own teeth which are structurally compromised. Routine oral hygiene practices and periodic professional care should be provided to achieve good gingival health.Root canal treatment of affected teeth in AI patients may be complicated due to presence of other dental aberrations such as taurodontism or pulp stones. Pulp stones are generally considered as an age-related feature instead of it being pathological [8]. However, according to studies they are commonly associated with teeth in AI [9]. A study by Collins et al. [10] showed that, hypoplastic AI is frequently co-segregated with pulp calcification and impacted teeth. Large pulp stones which occlude the pulp space may hinder the access to root canals, as was in this case. Significantly curved, long roots and the large pulp stone associated with 26 of this child patients added the challenge for endodontic obturation.
Teeth affected with AI should be assessed for necessary protection as soon as eruption of teeth [11]. There has been advancement in dental materials and techniques, in the field of restorative dentistry. This paved the way for improvements in the management aspects for affected dentition.Minimum preparation is invaluable in preserving maximum tooth structure possible. Preformed SSC placed with minimum preparation for permanent molar teeth can function for many years as an interim restoration until a more permanent restorative option is considered [12].
Aesthetics is highly demanded particularly by adolescents who are in a more socially active age. Direct Composite resin restorations are a viable option to renovate aesthetics and eliminate tooth sensitivity [5]. Young permanent teeth have comparatively large pulp chambers and the soft tissues are not matured. Maturation of gingival tissues will expose the tooth structure cervically which might be discolored or malformed. Refurbishment is possible with composite resin to mask exposed cervical area due to gingival maturation. With the advancement of current dentine bonding systems, composite restorations could be predictable in patients with AI5.AI patients should undoubtedly receive long term maintenance care which probably would be lifelong. Reinforcement of oral hygiene, stability of periodontium and occlusal stability should be aimed at regular appointments [11].