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Date: 2015-10-07; view: 425.

Topicality.

Congenital developmental abnormalities of hard dental tissues: imperfect amelogenesis, dentinogenesis, dysplasia of Stenton-Kapdepon. The clinical picture, diagnostics, tactics of the pediatric stomatologist.

The congenital defects of dental development occur rarely, but they always cause substantial difficulties at diagnostics. The treatment of such children, as a rule, is a stage-by-stage process requiring participation of various specialists. The correct diagnostics, accurate knowledge of the processes in the hard dental tissues as well as the ability of correct determination of the treatment tactics at congenital dental development defects are urgent problems of development of modern pediatric stomatology.

AimsTo know clinical manifestations of the congenital defects of dental development, be able to diagnose them and make a plan of treatment.

The congenital diseases of dental enamel –incomplete amelogenesis- is a genetically predetermined defect of enamel of the temporary and permanent teeth.Pathomorphologically wemay defineinsufficient maturity of the enamel, hypomieralization, disorientation of its prisms and other changes of the structure. There are some types of the disease.

1.Hypoplastic type , related to disordered formation of the enamel matrix. It is developed at disordered maturation of the enamel matrix on the stage of tissue differentiation. In such forms there is enough enamel with small thickness, and because of this the teeth usually don't contact between themselves. The enamel surface may be smooth or uneven, the enamel often split. It is often combined with open occlusion. There are many forms of this type of incomplete amelogenesis.

2.Hypomaturation type, related to disordered enamel maturation ( hypomaturation). It may be caused with a defect of the enamel matrix formation. The enamel thickness is normal, but the content of mineral substances in it is low, and this is expressed in low roentgen density of the enamel (which is close to the dentine) and a tendency for splitting. The enamel porosity may lead to its quick pigmentation. There is possible initial enamel color change.

3.Hypocalcification type. It is developed at disordered enamel mineralization. It is usually characterized by the normal enamel thickness, changes of its luster and color (dark-yellow or brown), enamel irregularity, its low durability and often occurring splitting. It is the most frequent from all congenital enamel diseases ( its frequency is – 1:20000). The enamel is white or yellow, of normal thickness, with dull, opaque, yellow-brown areas, on the vestibular dental surfaces the enamel is very soft, gradually demarcating from the dentine, the precervical enamel may preserve for higher calcification processes. Not all teeth may be affected, but usually the teeth are affected symmetrically.

4. Disordered enamel maturation with taurodontism. The enamel formation may be disordered at stages of tissue differentiation and layering of the enamel matrix. Besides the changes in color and enamel surface, taurodontism may be diagnosed roentgenologically( teeth with multiple roots and extended pulp cavity, prolonged crown, short root and large distance from the occlusion surface to bifurcation; the distance between the place of the enamel-cement junction and root bifurcation is more than the distance from bifurcation to the root apex).

The treatment of incomplete amelogenesisusually requires for orthopaedic intervention. Sometimes, as a temporary treatment, we may use direct restorations after mineralizing preparation.