Restorative therapy of primary teeth severely affected by amelogenesis imperfecta

Objective: Primary teeth severely affected by amelogenesis imperfecta (AI) often show an extensive loss of enamel. Such defects are difficult to restore with resin composites, since neither the correct anatomic form nor the marginal fit can be guaranteed. Methods and materials: After clinical and scanning electron microscopic examinations were performed on replica models of 5 patients with primary teeth affected by AI, impressions were made without previous preparation by rotary instruments. Composite crowns and veneers were manufactured and luted adhesively using the total bonding technique and low-viscosity resin composite. Results: The pre-restorative scanning electron microscopic analysis showed that the dentinal tubules were exposed and that the border of the residual enamel was in the process of splitting. The preoperative oral examination had revealed tooth discoloration, masticatory disturbances, hypersensitivity, and speech problems. After placement of the restorations, patients reported improvements in tooth sensitivity, articulation, and mastication. Conclusions: A new protocol for restoration of primary teeth with an extensive loss of enamel is offered. It is quick and easy to perform, highly esthetic, and can be applied in children younger than 4 years old. Keywords: amelogenesis imperfecta, composite crown, composite veneer, total bonding