Developmental Anomalies in Dentistry

Genetic factors can influence the emergence and development of teeth in patients, especially if a family history exists for a certain condition.

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Missing incisors or bicuspids are the most common examples of how genetics can interfere, at least temporarily, with the development of a nice smile or full set of teeth.

For a young person, it is no fun having a smile that no one wants to show off.

Growth spurts and developmental milestones prevent young patients from seeking treatment that is commonly available to adults. Missing anterior teeth are most often treated or corrected with dental implants only when known developmental stages have been completed.

Amelogenesis Imperfecta

Developmental dental needs, whether functional or aesthetic, impact children at a significant level. Some genetic issues hit harder than others.

Amelogenesis Imperfecta, caused by a chromosomal defect, causes teeth to be unusually small, discolored, pitted or grooved, and prone to rapid wear and breakage. Current studies show that 14 known types now exist. About 1 in 14,000 people are affected.

amelogenesis_imperfecta_1

Pictured here is a full mouth view of a 12 year old female. The severe deterioration of tooth enamel, underlying structures and inevitable tooth breakage is very evident.

Parents (perhaps more so) and their affected child deal with the functional problems and aesthetic issues as best they can. For the young patient, important developmental pre-teen and teen aged years can be especially difficult.

The cumulative effects of rapidly failing tooth enamel, dentin exposure and routine tooth breakage creates bizarre physical forces that impact normal growth patterns of a young person’s upper and lower jaws.

amelogenesis_imperfecta_2

In time, orthodontic events occur, further complicating growth patterns the young patient has yet to undergo.

Because of the rarity of the condition, most general dentists don’t possess the practical experience to treat the condition satisfactorily. Treatment at a specialized maxillofacial practice is most often not accessible by most families.

Functional Devastation

Despite the rather obvious cosmetic implications of having this condition, the more serious functional issue is the major disturbance in bite, or occlusion. The adjacent photo displays the amount of physical change that can occur within jaw structures and bone height.

amelogenesis_imperfecta_bite-1

Notice how, with the rearmost teeth (posterior teeth) closed down, an enormous open bite exists. Routine eating behaviors and everyday speech is significantly impaired.

Combining Prosthodontic Physics with Composite Resin Restoratives

The patient’s young age and lack of access to specialists were obstacles for her parents to overcome in their search of a reasonable or workable treatment.

Consults with several general dentists confirmed their assumption that nothing could be done until adulthood.

Upgradeable Dentistry Concepts

Dr. Winter’s orientation to upgradeable dental procedures (i.e., with finite funding-do what makes the most sense for now, and later), he was able to generate treatment plan recommendations that would immediately address the cosmetic concerns and initiate a logical path of upgradeable procedures that will achieve the long term goal of having a normal bite.

amelogenesis_imperfecta_rehabilitation

More importantly, from the family’s perspective… the upgrade path was affordable.

Prosthodontic assessments were used to create a “better” bite and dental function. Instead of conventional prosthetics, due to the patient’s young age, composite restorative products were used to produce or mimic a prosthodontic result.

The last photo shown here displays the cosmetic impact possibilities of composite resin products. Our young patient now has an attractive smile she is happy to show off.

The prosthodontic features of Dr. Winter’s restorations now enable the patient to undergo interim orthodontic services that will start correcting the occlusal features of her bite. Occlusal plane normalization, rehabilitating the alignment of incisal surfaces of the upper and lower jaws and optimization of tooth size and shape symmetry will be achievable milestones in the future.

As time progresses, additional restorative treatments will replace whatever components need to be changed as her jaw development and overall dentition reaches adult stages.

For the present, our pre-teen patient will be able to have a better dental function NOW… along with cosmetic features she no longer needs to hide.


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