Page 60 - DP Vol 19 No 6 pw_Neat

CosmetiC seCtion

Functional Aesthetics: Chairside full

mouth rehabilitation with CEREC workflow

for a patient with dentinogenesis

imperfecta- A Case Report

Dr. Gaurav Gupta, Dr. D. K. Gupta, Dr. Neelja Gupta, Dr. Richa Gupta

ABSTRACT resemble “shell teeth,” but they progressively obliterate. [6]
Dentinogenesis imperfecta (DI) is one of the most frequently Treatment focuses on protecting the affected dentin from caries,
found hereditary disorders of dentin formation. It tends to follow attrition, abrasion, and erosion. Restorative treatment commonly
an autosomal dominant pattern of transmission, affecting both includes crowns. Some authors recommend splinting the crowns,
the formation and mineralization of dentin in either primary or while others do not advice using those teeth as abutments due to
permanent dentition. It is characterized by opalescent teeth with their brittleness. [7-9] In type II, endodontic procedures are usually
irregularly formed and under-mineralized dentin, obliteration of pulp not possible due to canal obliteration. If the canals can be found,
chamber, and root canal. All this leads to rapid and extensive attrition, endodontic treatment might be possible. However, in cases where
necessitating adequate crown reconstruction. The aim of this report is endodontic treatment is not possible, post and core restorations may
to use a chairside digital approach to achieve aesthetic and functional have a questionable prognosis due to morphological changes in the
outcome using full-coverage crowns in an adult patient with DI. The tooth structure, potentially leading to tooth fracture. [10,11]
sooner it is administered, the more promising the dental treatment The aim of this clinical report is to show chairside full-mouth
will be in promoting health and minimizing damage to the affected rehabilitation in an adult patient with DI, thereby providing functional
individual. and aesthetic dentition through CAD/CAM (computer-aided
designing/ computer-aided manufacturing).
INTRODUCTION
The structural and numerical integrity of dentition depends on CASE REPORT
various external as well as internal influences, which may lead to the A 32- year-old male reported with the complaint of pale yellowish
development of several clinical disorders. Dentinogenesis Imperfecta discoloration of all his teeth. He also complained of poor aesthetics
(DI) is one such autosomal dominant disorder that affects both the due to the rapid wearing off of the teeth surfaces. The patient reported
primary and permanent dentition. [1] It is a localized mesodermal a history of similar-colored milk teeth that exfoliated. Patient’s medical
dysplasia consisting of opalescent teeth with irregularly formed and history was non-contributory, and the family history revealed similar
under-mineralized dentin, thereby obliterating the pulp chambers and features in the dentition of the mother and other siblings. Extraoral
canals. [2] examination showed a loss of vertical dimension of the face (Figures
It is classified into three types: 1a and 1b). Intraoral examination showed generalized opalescent
Type I: Teeth changes are associated with osteogenesis imperfecta [3] teeth with yellowish-brown discoloration and complete loss of enamel,
Type II: Entails dental features similar to those of Type I, although without significant caries. Labial surfaces were slightly eroded.
unrelated to osteogenesis imperfecta and are more common. [4] (Figure 1c)
Type III: Is rare and observed within a tri-racial isolated group An Orthopantomograph (OPG) revealed that all the teeth had complete
(Native American, African American, and European Caucasian) in the loss of enamel with blunt roots; pulp was partially obliterated in some
Maryland region. [5] teeth, however, root canals exhibited normal morphology (Figure 2).
In DI type II, changes are often linked to mutations in the dentin Based on clinical and radiological examinations, Dentinogenesis
sialophosphoprotein (DSPP) gene. Teeth appear as amber and Imperfecta (DI) was diagnosed.
opalescent, ranging from brownish to bluish-grey, with the pulp A traditional procedure involving veneers was followed to mask
chamber obliterated by abnormal dentin. [2,4] Although the enamel is the discolouration by the dentist. However, this approach proved
generally unaffected, it tends to fracture and detach easily due to an unsuccessful as the veneers failed due to a lack of bonding, given the
abnormal amelo-dentinal junction, causing severe and rapid dentin compromised dentin with no enamel.
attrition and marked shortening of the teeth. Radiographically, a tooth Treatment through CAD/CAM: The primary therapeutic goal was
presents bulbous crowns, due to cervical constriction, with thin and to enhance the aesthetic appearance of the teeth in order to reduce the
short roots. Initially, pulp chambers may be abnormally wide and potential for related psychological issues. For a definitive outcome, we

60 Dental Practice I November-December 2023 I Vol 19 No 6