Treating patients with a specific developmental dental disorder (amelogenesis imperfecta)

Amelogenesis imperfecta is a disorder of tooth development in which there is abnormal enamel formation. People with amelogenesis imperfecta have sensitive, misshapen and discolored teeth (usually yellow, brown or gray) that are very soft and vulnerable to decay.

This is an inherited, genetically linked condition. But, since several genes affect the formation of enamel, amelogenesis imperfecta can have different inheritance patterns depending on which gene is altered.

It is not possible to grow new enamel on teeth afflicted with amelogenesis imperfecta, but patients should receive treatment in order to eliminate their dental sensitivity and to improve their dental health and appearance. Left untreated, these patients would usually lose their teeth as a result of cavities. Crowns can prevent or eliminate the tooth decay associated with this condition, and they are the first line of defense and treatment. However, if decay has already progressed too far, teeth may have to be extracted, necessitating the use of implants or dentures to replace the missing teeth.

Case Presentation

The following case presentation is typical of the complexity of treatment that amelogenesis imperfecta patients may present. This patient is gracious enough to allow us to present her case in the hopes that it will help to create a better understanding of amelogenesis imperfecta and the type of treatment that patients can expect from Drs. Bryant and Pavinee.

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Our patient first presented for treatment at 14 years of age [see photo #1]. She expressed concern about the appearance and sensitivity of her teeth and her difficulty eating. This was a source of great distress to her and her family, who were already familiar with amelogenesis imperfecta. The patient’s father, aunt and sister were also afflicted with this congenital anomaly.

At this stage, all of her teeth required new crowns, but because of her young age and continuing growth, it was not prudent to place permanent porcelain restorations on all of her teeth [see photo #2]. In addition, she had a malocclusion (“bad bite”) that would require orthodontic treatment and jaw surgery. Furthermore, her gums were overgrowing some of the teeth and would require periodontal surgery in order to expose them. We developed a comprehensive restorative treatment plan and a team of specialists to address her many concerns. In addition to prosthodontic treatment, she would also require an orthodontist, oral surgeon, endodontist and periodontist over several years in order to complete her treatment.

Initial treatment began with removing the stainless steel crowns that were previously placed by her childhood dentist. This was followed by surgical periodontal crown lengthening to fully expose all teeth. Impressions were then made in preparation for the creation and placement of long-term temporary restorations. The acrylic temporary crowns were fabricated and attached to each tooth [see photo #3].

Our patient then proceeded with orthodontic treatment to create an ideal alignment as she continued to grow [see photo #4]. Completion of orthodontic treatment and jaw surgery created ideal positions for her teeth and bite. Finally, the acrylic temporary crowns were removed, and all teeth were prepared for permanent porcelain restorations [see photo #5]. This reconstruction with porcelain restorations created a beautiful smile with a perfect bite and normal function [see photos #6 and #7]. Although this extensive treatment took over eight years to complete, without treatment, all teeth would have been lost as a result of dental cavities.

This case represented the “ultimate restorative challenge,” because there was no frame of reference regarding the correct size, proportion or position of each tooth. Heightened aesthetic and technical skills were essential in designing her smile and creating restorations that look and function like normal, healthy teeth. This transformation not only changed her smile and outward appearance, but it also greatly contributed to her improved physical and emotional well-being.

This patient is typical of the type of service and coordination of treatment that Drs. Bryant and Pavinee provide. If you know of anyone with amelogenesis imperfecta, or other developmental anomaly of their teeth, we would be honored for your referral and to provide their personalized care.

If you have a congenital tooth abnormality and would like to find out more information about treatment, please call our office for a complimentary consultation.

We would like to thank our patient once again for allowing us to present her case.


Medical Dental Building, Suite 1438
509 Olive Way
Seattle, WA 98101

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