Full-Mouth Rehabilitation for a Patient With Dentinogenesis Imperfecta: A Clinical Report
Dentinogenesis imperfecta (DI) is a genetic disorder affecting the structural integrity of the dentin that can result in weakened dentin. The affected teeth, especially posterior teeth, often need to be extracted due to severe wear or fracture. This frequently yields a loss of posterior occlusion and occlusal vertical dimension. Besides wear and fracture, anterior teeth often have an unesthetic appearance because of discoloration. Current treatments of choice, including composite bonding restorations and, more recently, all-ceramic restorations, are typically suggested to preserve the remaining teeth and tooth structure. However, there are a limited number of studies on dental implants in patients with DI. The effectiveness of dentin bonding and dental implants in patients with DI is not known. This clinical report describes a 32-year-old Asian woman with DI who underwent full-mouth rehabilitation. The posterior occlusion, mostly in the molar areas, was restored with dental implants and ceramometal restorations. The anterior teeth and premolars were restored with bonded lithium disilicate glass-ceramic pressed veneers and crowns made with computer-aided design/computer-aided manufacturing. This case demonstrates that restoring functional occlusion and esthetics for a patient with DI can be completed successfully using contemporary implant therapy and adhesive dentistry.
Pretreatment assessment. (a) Extra-oral photograph. (b) Maxillary arch. (c) Panoramic radiograph. (d) Right occlusion in maximal intercuspal position (MIP). (e) Front occlusion in MIP. (f) Left occlusion in MIP. (g) Mandibular right posterior. (h) Mandibular anterior teeth and premolars/ (i) mandibular left posterior.
Diagnostic wax-up: Pretreatment study casts were used to fabricate a diagnostic wax-up at the centric relation (CR) position with increased occlusal vertical dimension. (a) Maxillary occlusal view. (b) Mandibular occlusal view. (c) Right view in occlusion. (d) Frontal view in occlusion. (e) Left view in occlusion.
and 4. Figure 3. Provisional Prostheses fabricated based on the diagnostic wax-up at increased occlusal vertical dimension were used for 12 weeks. (a) Frontal, (b) maxillary occlusal, and (c) mandibular occlusal views. Figure 4. Fabrication of the definitive prostheses. Because of the delayed placement of implant #12, the mandibular prostheses were fabricated first based on the patient's provisional prostheses (a and b). The maxillary prostheses (c) were then fabricated after the #12 implant healed.
Definitive prostheses. In the maxillary arch, teeth #3, 4, 5, 13, and 14 were restored with ceramometal crowns, and teeth #6, 7, 8, 9, 10, and 11 were restored with all-ceramic lithium disilicate glass-ceramic crowns made using computer-aided design/computer-aided manufacturing (CAD/CAM) techniques; implant #12 was restored with a Zirconia CAD/CAM milled abutment and an all-ceramic lithium disilicate glass-ceramic crown CAD/CAM. In the mandibular arch, implants #18, 19, 30, and 31 were restored with titanium custom CAD/CAM abutments and splinted ceramometal crowns; teeth #20,21, 28, and 29 were restored with all-ceramic lithium disilicate glass-ceramic CAD/CAM crowns; and teeth #22, 23, 24, 25, 26, and 27 were restored with all-ceramic lithium disilicate glass-ceramic pressed veneers.
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