Terapêuticas clínicas em dentes afetados pela amelogênese imperfeita e dentinogênese imperfeita

Abstract

Amelogenesis imperfecta and dentinogenesis imperfecta are hereditary character developmental dental anomalies, classified according to the presentation of their phenotypic characteristics. They are diagnosed by clinical and radiographic examinations and family medical history and must be classified correctly to determine an effective treatment plan. They can cause discomfort, esthetic poverty, tooth sensitivity, malocclusion, phonetic, masticatory and psychosocial difficulties. The present study aims to analyze the most frequently adopted clinical conducts for restorative treatments of teeth with developmental defects classified as amelogenesis imperfecta or dentinogenesis imperfecta, by performing a literature review. The study was performed by collecting scientific articles referring to research with important outcomes on enamel properties in amelogenesis imperfecta and dentin properties in dentinogenesis imperfecta, as well as on short to long term case reports or clinical research, between the years 2000 and 2020. This search was conducted through the following databases: Pubmed, Lilacs, Scopus and SciELO. Several types of treatments for both dental anomalies were found, but it was observed that they all followed three phases in common: the preventive phase for oral environment adequacy and health maintenance; the provisional phase, seeking to preserve dental remnants and ensure bone and tooth maturation, exemplified by the use of glass ionomer cements (CIV), resin sealants, fluorotherapy, cementation of long-term provisional restorations, exodontia of deciduous teeth and orthodontics; and, the restorative phase, represented by definitive restorative treatments through direct and/or indirect techniques. Due to changes in enamel and dentin structures, the longevity of direct restorations tends to be shorter than that of indirect restorations, which explains the great preference for indirect restorative treatments for cases of amelogenesis imperfecta or dentinogenesis imperfecta among professionals. It can be concluded, therefore, that the treatment of these dental anomalies is complex, multidisciplinary, and requires an individualized approach. It is the responsibility of the dentist to choose the best treatment for the patient, considering the alterations in the mechanical properties of the restorative materials when associated to modified and weakened enamel and dentin. The importance of publishing more longitudinal clinical studies considering the possibility of effective treatments for AI and DI is emphasized.