Minimally Invasive Transitional Full-Mouth Adhesive Rehabilitation of a Patient With Amelogenesis Imperfecta Using Direct and Indirect Composite Restorations: A Case Report.

Abstract

Background: Amelogenesis imperfecta (AI) comprises a group of inherited conditions affecting enamel formation and mineralization, with significant esthetic, functional, and psychosocial consequences. Management of adolescents with hypocalcified AI remains challenging because of the compromised enamel structure, ongoing craniofacial growth, and need to preserve future restorative options. This report describes a staged direct and indirect composite approach in an adolescent with hypocalcified AI and concomitant Bartter syndrome, including its short-term clinical performance and limitations.

Case presentation: A 15-year-old girl with hypocalcified AI and concomitant Bartter syndrome was referred with chief complaints of poor esthetics, hypersensitivity, and difficulty maintaining oral hygiene. Clinical and radiographic examinations revealed generalized enamel defects, discoloration, attrition, anterior open bite, and gingivitis. Given the patient's age, systemic condition, and ongoing skeletal growth, a minimally invasive transitional rehabilitation was planned. Following digital diagnostic wax-up and mock-up evaluation, the maxillary arch was restored predominantly with indirect composite crowns, whereas the mandibular arch was restored with direct composite restorations without tooth preparation. Treatment was completed over 3 months.

Results: At the 3- and 14-month follow-up examinations, the restorations were evaluated descriptively. They remained clinically functional and esthetically acceptable, except for debonding of the direct full-coverage composite restoration on the retained mandibular right primary second molar, which was subsequently restored with a stainless-steel crown. The patient reported subjective improvements in dental hypersensitivity, ability to maintain oral hygiene, smile appearance, and self-confidence.

Conclusion: Adhesive rehabilitation using a combination of indirect and direct composite restorations may provide a conservative transitional treatment option for adolescents with hypocalcified AI. In this case, the digital diagnostic wax-up, mock-up evaluation, and staged treatment facilitated communication and preoperative assessment of the proposed outcome while supporting preservation of the remaining tooth structure. Continued follow-up is required, and the need for repair, replacement, or more definitive rehabilitation should be reassessed after further growth and maturation.