Amelogenesis Imperfecta or AI is a rare congenital disease of the tooth. In Amelogenesis imperfecta, there will be abnormal development of the Enamel. Tooth with Amelogenesis Imperfecta will be small, yellow or brown in color and very prone to damage. The incidence of the disease varies from 1:700 to 1:1400 people depending on the geography((Crawford PJ, Aldred M, Bloch-Zupan A. Amelogenesis imperfecta. Orphanet J Rare Dis. 2007;2:17.)). It is also known as Enamel dysplasia, AI, Brown Enamel or Brown Opalescent Teeth.
Amelogenesis imperfecta is a rare genetical disease caused by mutation of some genes. The genes are AMELX, ENAM, and MMP20 etc. These genes are responsible for creating a protein which helps in the maturation of Enamel. Due to the mutation in these genes, they fail to create that protein and tooth maturation does not take place adequately. These proteins are Enamalin, Amelogenin, Ameloblastin, Tuftelin etc.
Amelogenesis Imperfecta is classified on the basis of its clinical features, radiographic features, and appearance of Enamel.
The hypoplastic form of amelogenesis imperfecta is characterized by –
The hypocalcified form of AI is the most common type and is characterized by-
Hypomaturation form of AI is characterized by-
In hypoplastic-hypomaturation with taurodontism form-
AI is generally diagnosed by a dentist. The dentist will take a family history and perform the oral examination to check your enamel. Radiographs are also an important tool to check enamel from inside. Usually, the diagnosis can be made by visual examination of the tooth.
Radiographs can help the dentist to check the density of the enamel. With the help of radiographs, the dentist will determine which type of treatment you need.
The main objectives of treatment are pain relief, preserving the patient’s remaining dentition, and to treat and preserve the patient’s occlusal vertical height.
Some examples of treatment options include:
High-density dental plastic materials such as composite resins, ceramic veneers are attached to the tooth to fill the gaps. Bonding is generally used in the hypoplastic type of AI because it has enough tooth strength to hold the bonding materials.
In the hypocalcified and hypomaturation type of AI, the enamel is usually weak to hold bonding materials. For this type of AI, placement of crown over the tooth is the good option for treatment. Crown also helps in preventing tooth decay.
Orthodontic treatment may also be needed in the person with AI. It is not to straighten the tooth but to create enough space for restoration.
Maintaining good oral hygiene is very important in patients with AI. Gingivitis leads to improper placement or difficulty in placement of the restoration.
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