marked (588HFig. 10.23 (a)-(c)). Alternatively, localized composite or glass ionomer
cement restorations may be placed over areas of hypoplasia.
The emphasis should remain on minimal tooth preparation until the child gains
adulthood. At this point, if clinically indicated, full mouth rehabilitation may be
considered and should have a good prognosis in view of the conservative approach
that has been adopted throughout the early years (589HFig. 10.24 (a) and (b)). Patients with
dentinogenesis imperfecta should be treated with caution. The characteristic form of
the teeth in this condition is unfavourable for crowning; the teeth being supported by
short, thin roots. The permanent dentition, like the primary dentition, is prone to
spontaneous abscesses and the prognosis for endodontic treatment is very poor. The
long-term plan for these patients is often some form of removable prosthesis, either an
overdenture placed over the worn permanent teeth or a more conventional complete
denture. The role of implants in these patients has yet to be defined fully.
Aesthetics
Aesthetics is not usually a problem in the primary dentition. Where the child is
sufficiently co-operative the use of glass ionomer cements to restore and improve the
appearance of primary incisors can be useful in gaining the respect and support from
the patient and parent. In a few exceptional cases the loss of primary teeth may cause
upset, but can be compensated for by constructing dentures. In cases of
dentinogenesis imperfecta where the teeth are very worn but remain asymptomatic,
overdentures can be constructed to which young children adapt remarkably well.
These will need to be remade regularly as the child grows.
As the permanent incisors erupt they must be protected from chipping of the enamel.
The placement of composite veneers not only improves the appearance but also
promotes better gingival health and protects the teeth from further wear. In a few
cases the quality of the enamel is so poor that the bond between composite and tooth
will be unsuccessful. It should be noted that in these cases porcelain veneers are also
likely to be unsuccessful and full coronal restorations are the only option.
Early consultation with an orthodontist is advisable in order to keep the orthodontic
requirements simple. Treatment for these patients is possible and in many cases
proceeds without problems. The use of removable appliances, where appropriate, and
orthodontic bands rather than brackets will minimize the risk of damage to the
abnormal enamel. The problem is twofold: there may be frequent bond failure during
active treatment or the enamel may be further damaged during debonding. Some
orthodontists prefer to use bands even for anterior teeth, while others will use glass
ionomer cement as the bonding agent in preference to more conventional resin-based
agents. In other instances cosmetic restorative techniques (veneers and crowns) may
be more appropriate than orthodontic treatment.