The Case of Odd Looking Teeth

A 17-year-old girl in need of a cosmetic dental procedure was being seen in the Prosthodontics department. The resident in charge of her treatment was curious about the appearance of her teeth and called me for a consult.

The patient confirmed that the teeth had appeared "odd" since eruption. She was unable to recall if the primary dentition looked similar. There was history of frequent dentist visits for restoration procedures. The patient was the only child and neither of the parents was affected. Unfortunately, the parents had not accompanied the girl for the dental visit so we were unable to acquire a complete family history.

Amelogenesis Imperfecta (hypomaturation type) in a 17-year-old female

The clinical presentation and radiographs were helpful in establishing a diagnosis of amelogenesis imperfecta, hypomaturation type (see description below). Unfortunately, the resident was unwilling to share the radiographs with me for blogging purposes. The patient was given composite veneers temporarily and scheduled for permanent ones in 18 months. 

Amelogenesis Imperfecta:

Amelogensis imperfecta is a hereditary condition that results in the formation of defected enamel. The problem can occur during the phase of matrix deposition, mineralization or maturation of the enamel. 

Hypoplastic amelogenesis imperfecta is a result of insufficient or abnormal matrix formation. The defect can present as pitting or decreased thickness of enamel with either a smooth or rough surface texture. The enamel is soft and prone to attrition. 

Hypomaturation type of amelogenesis imperfecta is a failure of enamel crystals to mature properly. This results in discolored teeth of normal sizes. The enamel appears opaque and mottled. The color varies from white to brown. The enamel relatively soft and is vulnerable to chipping. 

Insufficient crystal deposition results in hypocalcified form of amelogenesis imperfecta. The teeth are of normal size at eruption but the enamel is lost over a period of time. The teeth have rough surfaces and appear yellowish-brown. 

Management of amelogenesis imperfecta usually requires restoration of caries, reducing sensitivity and improvement of esthetics. Problems associated with open bites, impactions and delayed eruption may also need to be addressed.