CASE QUIZ #20
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What is responsible for the appearance of this tooth?
This tooth underwent damage to the ameloblasts during enamel development resulting in the clinical presentation seen here. If this process affects multiple teeth it is likely due to a febrile event. If it is localized it is likely due to physical trauma.
1. What are your recommendations for this patient?
2. What client education points should be discussed?
Teeth with enamel defects and dentin exposure should be restored with composite restorations following strict adherence to principles of cavity preparation in removing diseased tooth structure.
2. Multiple factors may be involved in treatment recommendations for these teeth. The radiograph above of the tooth pictured shows a root malformation. This may result in periodontal disease and/or endodontic compromise resulting in attachment loss or pulp necrosis. In some cases dentinal bonding only and repeat radiography in 4-6 months may be recommended if continued tooth viability is in question, prior to definitive restoration.
Removal of diseased tooth structure in keeping with the tenets of proper cavity preparation is the first step.
Dentinal bonding and restoration utilizing composite is the final step in defect repair. This eliminates the exposed dentinal tubules preventing further microbe invasion that can compromise the pulp. Restorations of this type are very technique sensitive and should only be performed by those who have received proper training. Crowns may also be a consideration in some cases.
It must be stressed that radiographic pathology may be developing in these teeth but not readily detectable at the time of diagnosis. Therefore follow-up radiography is important and scheduled at 6 month intervals.