Full-Mouth Rehabilitation in an Adolescent With Amelogenesis Imperfecta

Written by: Dr. Susan McMahon

Introduction

Amelogenesis imperfecta (AI) is a group of hereditary developmental disorders that affect the structure and clinical appearance of dental enamel, with an estimated prevalence ranging from 1:700 to 1:14,000 across populations.1,2 AI can be classified into 4 main types based on clinical and radiographic features: hypoplastic, hypomaturation, hypocalcified, and hypomaturation-hypoplastic with taurodontism.1

Patients with AI commonly present with aesthetic concerns, dental sensitivity, increased caries risk, decreased vertical dimension of occlusion, and psychosocial issues related to appearance.3 The management of AI in adolescent patients presents unique challenges due to ongoing growth and development, requiring careful consideration of long-term treatment outcomes while addressing immediate aesthetic and functional needs.

Traditional approaches to managing AI have included stainless steel crowns, direct composite restorations, and laboratory-fabricated restorations. Recent advances in digital dentistry and CAD/CAM technology have transformed treatment options, allowing for more conservative, precise, and efficient rehabilitation.4 The use of intraoral scanning, digital design, and additive manufacturing has enabled clinicians to provide high-quality restorations with reduced chair time and laboratory dependency.

This case report presents the comprehensive management of a 13-year-old male with hypocalcified AI affecting all permanent teeth. Using full-coverage restorations fabricated with the SprintRay Midas 3D printer using Crown HT material, this case highlights the application of digital workflow in pediatric/adolescent restorative dentistry.

Case Presentation

Patient History and Examination

A 13-year-old male presented to our office with chief complaints of dental sensitivity and poor aesthetics. Medical history was non-contributory. Family history revealed that the patient’s father had similar dental features, suggesting an autosomal dominant inheritance pattern.

Clinical examination revealed generalized yellow-brown discoloration of all erupted permanent teeth with rough, pitted surfaces. The enamel was soft and prone to chipping, with post-eruptive breakdown evident on multiple teeth (Figure 1). Radiographic examination showed reduced enamel density with normal dentin and pulp morphology (Figure 2). The diagnosis was consistent with hypocalcified type amelogenesis imperfecta.

Figure 1. Preoperative intraoral photograph showing generalized yellow-brown discoloration and rough, pitted enamel surfaces characteristic of hypocalcified amelogenesis imperfecta. Note the irregular tooth morphology affecting all visible permanent teeth.

Figure 2. Pre-op panoramic radiograph demonstrating reduced enamel radiodensity consistent with hypocalcified amelogenesis imperfecta. The dentin and pulp morphology appear normal, with adequate root development appropriate for the patient’s age.

Intraoral findings revealed generalized yellow-brown discoloration affecting all permanent teeth, along with multiple areas of enamel breakdown and chipping. The patient also exhibited significant dental hypersensitivity to both thermal and tactile stimuli. Mild gingivitis was present, with localized areas of moderate inflammation, while the occlusion demonstrated a bilateral Class I molar relationship. No active carious lesions were identified during the examination. Psychosocial assessment further revealed a substantial impact on the patient’s self-esteem and social interactions, as the patient expressed reluctance to smile or participate in social activities because of dental appearance.

Treatment planning focused on alleviating dental hypersensitivity, restoring aesthetics and function, protecting the remaining tooth structure, establishing proper occlusal relationships, improving oral hygiene and gingival health, and enhancing psychosocial well-being. 

After consultation with the patient and his parents, and considering the severity of enamel involvement, the patient’s age, and aesthetic concerns, the treatment plan consisted of full-coverage restorations for all permanent teeth, utilizing a digital workflow with the Midas 3D printer and Crown HT material.

Treatment Procedures

Preoperative Preparation

Initial therapy included oral hygiene instruction, professional prophylaxis, and application of desensitizing agents. A diagnostic digital wax-up was created to visualize the final outcome and guide tooth preparation.

Digital Workflow

The treatment utilized a complete digital workflow:

1. Intraoral scanning (TRIOS 4 [3Shape]) to capture the preoperative condition.
2. Digital design of restorations with adjusted vertical dimension of occlusion.
3. No or minimal preparation of teeth to preserve existing enamel.
4. Intraoral scanning of prepared teeth.
5. Final design of restorations with attention to age-appropriate morphology.
6. Restorations 3D printed using Midas printer with Crown HT material.
7. Post-processing, finishing, and polishing of printed restorations.

Clinical Protocol

Tooth preparation was conservative, preserving as much tooth structure as possible while gently smoothing the sharpest enamel. A supragingival preparation design was utilized where possible to maintain gingival health.  

The definitive restorations were printed using the Midas 3D printer with Crown HT material, selecting shade BL for anterior teeth and a shade appropriate for the patient’s age for posterior teeth to achieve a natural appearance (Figure 3). 

Figure 3. Full-arch set of definitive restorations fabricated using the SprintRay Midas 3D printer with Crown HT material prior to cementation. The restorations display accurate reproduction of age-appropriate dental anatomy and occlusal morphology designed through digital workflow.

The printed restorations were bonded using a self-adhesive resin cement (PANAVIA V5 [Kuraray America]) following the manufacturer’s instructions. Occlusal adjustments were performed to establish stable occlusal contacts and functional movements.

The entire rehabilitation process was completed over 2 months with a total of 4 appointments.

Results

Immediate Outcomes

Post-treatment evaluation revealed significant improvement in aesthetics, with natural-looking restorations that harmonized with the patient’s facial features (Figure 4). Functional assessment demonstrated proper occlusal contacts in maximum intercuspation and smooth, interference-free excursive movements.

Figure 4. Postoperative extraoral photograph demonstrating excellent aesthetic outcomes and significant improvement in the patient’s confidence and smile. The restorations exhibit natural appearance with appropriate translucency and color integration.

The patient reported immediate resolution of dental sensitivity and significant improvement in masticatory efficiency. Gingival response to the restorations was favorable, with no signs of inflammation at the 1-month followup.

Figure 5. Post-op extraoral photograph at 15-month followup. The maxillary left canine has erupted and is restored. The ceramo-resin hybrid restorations are wearing well.

DISCUSSION

This case highlights several important aspects in the management of amelogenesis imperfecta in adolescent patients:

Material Considerations

The use of Crown HT material with the Midas 3D printer provided several advantages in this case:

1. Mechanical properties: Adequate strength to withstand masticatory forces while exhibiting wear characteristics similar to natural dentition.
2. Optical properties: Excellent translucency and color stability, allowing for age-appropriate aesthetics.
3. Precision: High accuracy in reproducing designed morphology and occlusal details.
4. Efficiency: Reduced laboratory time and costs compared to traditional fabrication methods.

Digital Workflow Benefits

The digital workflow employed in this case offered significant advantages:

1. Conservative preparation: Precise planning allowed for minimal tooth reduction.
2. Streamlined process: Reduced number of appointments and treatment time.
3. Predictable outcomes: Digital previsualization enabled patient and parent involvement in treatment planning.
4. Archivable data: Digital records allow for easy fabrication of replacement restorations if needed during growth.

Considerations for Adolescent Patients

Treatment of AI in adolescent patients requires special consideration of several factors:

1. Growth and development: Potential changes in occlusion and facial morphology.
2. Pulp morphology: Larger pulp chambers requiring more conservative preparation.
3. Long-term planning: Consideration of future treatment needs as the patient matures.
4. Psychosocial impact: Addressing self-esteem and social development concerns.

The severity of enamel involvement and functional compromises guided our approach of full-coverage restorations. Alternative approaches, such as direct composite restorations or partial-coverage designs, may be appropriate in less severe cases or for younger patients.

Continued monitoring is essential to evaluate long-term performance and address any emerging issues related to growth and development.

CONCLUSION

This case report demonstrates the successful rehabilitation of a 13-year-old patient with amelogenesis imperfecta using CAD/CAM technology and 3D-printed Crown HT material. The digital workflow with the Midas 3D printer provided an efficient, precise, and predictable treatment approach that addressed both functional and aesthetic concerns while considering the specific needs of an adolescent patient.

The immediate follow-up results indicate excellent clinical performance of the restorations with significant improvement in the patient’s quality of life. This approach represents a promising treatment modality for young patients with severe developmental dental anomalies, leveraging digital technology to achieve optimal outcomes.

Future research should focus on the long-term performance of 3D-printed restorations in growing patients and further refinement of materials and protocols specific to pediatric and adolescent populations.

REFERENCES

1. Witkop CJ Jr. Amelogenesis imperfecta, dentinogenesis imperfecta and dentin dysplasia revisited: problems in classification. J Oral Pathol. 1988;17(9-10):547–53. doi:10.1111/j.1600-0714.1988.tb01332.x
2. Crawford PJ, Aldred M, Bloch-Zupan A. Amelogenesis imperfecta. Orphanet J Rare Dis. 2007;2:17. doi:10.1186/1750-1172-2-17
3. Pousette Lundgren G, Dahllöf G. Outcome of restorative treatment in young patients with amelogenesis imperfecta. a cross-sectional, retrospective study. J Dent. 2014;42(11):1382–9. doi:10.1016/j.jdent.2014.07.017
4. Das R, Børstad E, Jullumstrø Feuerherm A, et al. Early ceramic crown intervention in adolescents with severe amelogenesis imperfecta: a clinical case series. Clin Case Rep. 2025 Oct 8;13(10):e71202. doi: 10.1002/ccr3.71202. 

ABOUT THE AUTHOR

Dr. McMahon is a graduate of the University of Pittsburgh (Pitt) School of Dental Medicine. She maintains a private practice focused on cosmetic dentistry in Pittsburgh. Dr. McMahon is accredited by the American Academy of Cosmetic Dentistry and is an invited Fellow of the prestigious American Society for Dental Aesthetics. She is a past clinical instructor in prosthodontics and operative dentistry at Pitt. Dr. McMahon frequently lectures across the United States on minimally invasive dentistry and conservative cosmetic dentistry for teenagers and young adults and has been annually voted by her peers as a top dentist in Pittsburgh for more than 20 years. She can be reached at [email protected].

Disclosure: Dr. McMahon reports no disclosures.