JDSOR
10.5005/jp-journals-10039-1035
Nitin Rastogi et al
CASE REPORT
A Comprehensive Esthetic and Conservative Approach for
Anterior Teeth with Enamel Hypoplasia
1
Nitin Rastogi, 2Ashish Agarwal, 3Mayank Shah
ABSTRACT
Enamel hypoplasia (EH) is a defect in tooth enamel that results
in less quantity of enamel than normal. The defect can be a
small pit or dent in the tooth or can be so widespread that the
entire tooth is small and/or mis-shaped. The complexity and
intensity of the dental deformity lesions will conduct the ideal
treatment-associating conservative techniques. This article
presents a case report of a restorative treatment of enamel
hypoplasia using hybrid composite resin to mask color alteration
and enamel defects. An esthetic appearance that respects the
tooth polychromatic and the self-esteem of the patient can be
achieved with this approach.
Keywords: Composite resins, Dental restoration, Enamel
hypoplasia, Enamel defects.
How to cite this article: Rastogi N, Agarwal A, Shah M.
A Comprehensive Esthetic and Conservative Approach for
Anterior Teeth with Enamel Hypoplasia. J Dent Sci Oral Rehab
2014;5(3):158-160.
Source of support: Nil
Conflict of interest: None
INTRODUCTION
Hypoplasia is defined as a quantitative defect of enamel
visually and is histomorphologically identified as an external
defect involving the surface of the enamel and associated
with reduced thickness of enamel.1 This type of defect
may cause tooth sensitivity, may be unsightly or may be
more susceptible to dental cavities. Some genetic disorders
cause all the teeth to have enamel hypoplasia (EH). Enamel
hypoplasia can occur on any tooth or on multiple teeth.
It can appear white, yellow or brownish in color with a
rough or pitted surface. In some cases, the quality of the
enamel is affected as well as the quantity. Environmental
and genetic factors that interfere with tooth formation are
thought to be responsible for EH. This includes trauma to the
1-3
Senior Lecturer
1,3
Department of Prosthodontics, Institute of Dental Sciences
Bareilly, Uttar Pradesh, India
2
Department of Periodontics, Institute of Dental Sciences
Bareilly, Uttar Pradesh, India
Corresponding Author: Nitin Rastogi, Senior Lecturer, Depart­
ment of Prosthodontics, Institute of Dental Sciences, Bareilly
Uttar Pradesh, India, Phone: 8057008321, e-mail: nrastogi302@
gmail.com
158
teeth and jaws, intubation of premature infants, infections
during pregnancy or infancy, poor prenatal and postnatal
nutrition, hypoxia, exposure to toxic chemicals and a variety
of hereditary disorders. Treatment options depend on the
severity of the EH on a particular tooth and the symptoms
associated with it. The most conservative treatment consists
of bonding a tooth colored material to the tooth to protect it
from further wear or sensitivity.2
CASE REPORT
A 22-year-old female patient was referred to the Institute
of Dental Sciences, Bareilly, Uttar Pradesh, reporting a
visual discomfort from the presence of irregularities and
discoloration in the maxillary incisors. Dental history and
clinical examination revealed that she had a soft form of
EH (Fig. 1). Clinical examination also evidenced an enamel
defect in the maxillary and mandibular canines, lateral and
central incisors, with rough surfaces with irregular limits that
principally involve the middle third of the crown (Fig. 2).
No positive history of trauma was present. Patient belongs
to low socioeconomic strata.
The clinical situation revealed that it was not possible
to re-establish esthetics and function without the use of a
restorative procedure. The position and pattern of the enamel
irregularities, the occlusion and a tooth remnant with a
large substrate suggested that a composite resin restoration
would be a reliable option for this case. The patient was
systemically healthy, presented an overall plaque index
and gingival index of below 10% and the restorative area
was free from visible plaque. A slight enameloplasty, using
a spherical 1015 F diamond bur and manual instruments,
was performed on both the irregularities and the limits of
the tooth defect. The regularization of the defects created a
good substrate that was favorable for adhesive restorations.
The color was recorded using the Vitapan classical scale,
and the shade A2/A3 was considered as the initial color.
Briefly, the dental surface was acid etched (35% phosphoric
acid), rinsed for 30 seconds and dried with absorbent paper. A
two-component adhesive system (AdheSE, Ivoclar Vivadent
AG, Schaan, Liechtenstein) was applied on the dentin and the
enamel and was light-cured for 10 seconds with an intensity
of 1400 mW/cm2. A two-component adhesive system was
applied on the dentin and on the enamel. A combination of
JDSOR
A Comprehensive Esthetic and Conservative Approach for Anterior Teeth with Enamel Hypoplasia
Fig. 1: Prerestorative frontal view
Fig. 2: Prerestorative Iateral view
Fig. 3: Incremental laying of composite resin
Fig. 4: Postrestorative view
the incremental and stratified layering technique was used to
fill the tooth using a highly esthetic nanohybrid composite
resin, IPS-Empress (Ivoclar Vivadent AG) (Fig. 3). The
composite was added in increments of 1.5 to 2 mm and was
light-cured after every layer, according to the manufacturer’s
instructions. First, the dentin was simulated with a thin layer
of a microhybrid composite (DA 3) and a final layer with an
enamel composite (EA 2). The contouring was refined using
30-blade carbide trimming bur, and the final polishing was
performed with a high-luster polishing paste using goat-hair
brushes and cotton buffs. Patient was advised not to take the
food stuffs which may cause staining of the restored teeth.
Four months after the restoration, a good final aspect was
observed and the smile view exhibited an imperceptible
restoration (Fig. 4).
rough or pitted surface. Both dentitions could be affected by
enamel hypoplasia; however, the incidence is more severe
in permanent dentition. Hypoplasia is most common in the
permanent, or adult, teeth and represents episodes of arrested
growth in infancy or childhood, while these teeth were still
developing. Once the enamel forms, it can no longer be
affected. A variety of environmental and genetic factors have
been shown to contribute to the formation of these defects,
including malnourishment, mechanical trauma, racial or
ethnic background, and lack of prenatal care. Significance
of EH includes: poor esthetic, tooth sensitivity, malocclusion
and structurally damaged tooth particularly vulnerable to
dental caries.3,4
Hypoplasia was categorized into the following types by
Silberman et al:
• Type I hypoplasia: Enamel discoloration due to
hypoplasia
• Type II hypoplasia: Abnormal coalescence due to
hypoplasia
• Type III hypoplasia: Some parts of enamel missing due
to hypoplasia
• Type IV hypoplasia: A combination of previous three
types of hypoplasia.1
DISCUSSION
Hypoplasia is quantitative or qualitative defect in enamel
synthesis. Enamel hypoplasia can occur on any tooth or
on multiple teeth. Clinically, hypoplasia of enamel is seen
as a break in conti­nuity of enamel with the reduction in its
layer, can appear white, yellow or brownish in color with a
Journal of Dental Sciences and Oral Rehabilitation, July-September 2014;5(3):158-160
159
Nitin Rastogi et al
Treatment options depend on the severity of the EH
on a particular tooth and the symptoms associated with
it. The most conservative treatment consists of bonding a
tooth colored material to the tooth to protect it from further
wear or sensitivity. In some cases, the nature of the enamel
prevents formation of an acceptable bond. Less conservative
treatment options, but frequently necessary include use of
stainless steel crowns, permanent cast crowns or extraction
of affected teeth and replacement with a bridge or implant.4
An early diagnosis and treatment planning as well as
prognostication is required. Following approaches can be
useful:
• Risk recognition
• Early diagnosis
• Anticipation of early cries posteruption break out
• Remineralization and desensitization
• Restoration and extraction
• Maintenance.
Various treatment protocols may be performed, depen­ding
on the level of involvement and the severity of the lesions.
Usually, these approaches include: enamel microabrasion,
esthetic conservative restorations and dental whitening.
Composite resin restorations are fully capable of reproducing
the appearance of a natural tooth with highly esthetic
outcomes.5
Restoration with glass ionomer cement, composite, stain­
less steel crown, full veneer metal ceramic crown, fixed
remo­val partial dentures and or implant are the different
160
treat­ment options that are discussed in various treatment
studies. Extraction should be considerable if teeth are not
restorable.6,7
CONCLUSION
This case report demonstrates that restorative rehabilitation,
in addition to promoting health, may provide a more favor­
able esthetic appearance for the smile, matching the tooth
polychromatic and raising the self-esteem of the patient.
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