Dentinogenesis Imperfecta: Management of Severe Primary Tooth Abrasion and Enamel Fracture in Mixed Dentition

Image: 
Severity: 
Emergency

Zoom 100% & Deep Examination (Detailed Color Analysis)

Feature Observation (Image A & B) Analysis based on Dentinogenesis Imperfecta (DI)
Primary Teeth (Deciduous) Severely abraded, flat, and worn down (Image B, showing upper primary molars). Color appears amber/yellow-brown (opalescent) in Image B. This severe wear is characteristic of DI. The poorly mineralized dentin and weakened dentin-enamel junction cause the brittle enamel to fracture easily, leading to rapid wear of the underlying dentin.
Lower Permanent Incisors The biting (incisal) edges are very translucent/opalescent (Image A), and the enamel appears to be chipping or breaking away. This is the defining feature of DI: "Hereditary Opalescent Dentin." The abnormal dentin is responsible for the gray/bluish-brown or amber color and translucency. The enamel loss is due to the lack of proper support from the abnormal dentin.
Overall Color A mix of white/translucent (permanent teeth enamel breaking away) and deep amber/brown/yellow (exposed, abnormal primary dentin). The different colors reflect the different stages of the disease—the abnormal dentin is what gives DI its characteristic opalescent color.

 

Full Analysis and Diagnosis

  • Condition: Dentinogenesis Imperfecta (Type I or II)—A hereditary developmental disorder of the dentin.

  • Pathology: The dentin structure is defective, resulting in teeth that are often discolored, bulbous-shaped, and structurally weak.

  • Clinical Problems:

    1. Enamel Fracture: The abnormal dentin-enamel junction leads to brittle enamel that fractures easily, exposing the soft, poorly mineralized dentin.

    2. Severe Abrasion: The exposed dentin wears down rapidly, leading to loss of vertical dimension, affecting chewing function, and potentially damaging the permanent teeth as they erupt.

    3. Pulp Exposure/Necrosis: The severe wear can quickly lead to pulp exposure and infection, even if the pulp chambers are often initially obliterated (a common finding in DI).

 

Process to Execute (Treatment Plan)

The goal is to protect the teeth from wear, maintain function, and preserve vertical dimension. This is a long-term, multi-stage process:

  1. Immediate Protection of Primary Teeth:

    • Full-coverage restorations (e.g., Stainless Steel Crowns (SSCs)) for the primary molars to prevent further abrasion and maintain the bite space until the permanent teeth erupt.

    • Composite or resin restorations may be used on anterior teeth to protect the exposed dentin and prevent sensitivity.

  2. Protection of Permanent Teeth (As they Erupt):

    • Prompt placement of full-coverage restorations (crowns), often ceramic or composite, on permanent teeth (especially incisors and molars) immediately after they erupt and the gum tissue has matured. This prevents the enamel from fracturing and the underlying dentin from wearing away.

  3. Long-Term Management:

    • Restoration of Vertical Dimension: As the child grows, a final full-mouth rehabilitation (using crowns, fixed bridges, or possibly implants later in adulthood) will be necessary to restore the height and function of the bite.

    • Orthodontic Consultation: May be required to align the bite properly for the final restorations.

 

Time Frame to Heal & If Takes 14 Days

  • No Healing Time: DI is a genetic, non-curable condition. The "healing" concept is replaced by "management" and "protection."

  • Time Frame for Treatment: The management is lifelong.

    • Placing protective crowns/restorations on primary teeth may take 2-4 dental visits.

    • Protecting the permanent teeth is an ongoing process over many years as they erupt.

What Will Be the Issue That Will Scale Up (If rushed or ignored)?

If the teeth are not protected quickly, the issue will scale up rapidly:

  • Accelerated Tooth Loss: Unprotected, the teeth will wear down extremely fast, leading to total loss of tooth structure and bite height (vertical dimension).

  • TMJ Problems: The loss of vertical dimension forces the jaw joint (TMJ) into an unnatural position, causing pain, clicking, and long-term joint damage.

  • Pulp Necrosis and Infection: The wear will quickly expose the pulp (nerve) of the teeth, leading to infection, abscesses, and the need for root canals or extractions.

  • Psychosocial Impact: The severe discoloration and poor appearance can significantly affect the child's self-esteem and social development.

 

Comments

This case highlights the critical need for early diagnosis and aggressive, preventive restoration (e.g., full-coverage crowns) to manage Dentinogenesis Imperfecta. The protective restorations act as a physical shield against rapid wear, which is the most destructive aspect of the condition.

 

 Visit Nearest Location Area

Given the complexity of this genetic condition, it is vital to see a specialist, ideally a Pediatric Dentist or a Prosthodontist experienced in managing DI.

You can use the directory listing to start your search:

https://cebudentalimplants.com/map-dental-clinic