CATEGORY 90 AUSTRALASIAN DENTIST Abstract Management of enamel hypoplasia induced by traumatic dental injuries (TDI) can pose a challenge for clinicians. Sequela of permanent tooth TDI during odontogenesis can lead to development disturbances ranging fromminor to severe. Enamel hypoplasia is a quantitative defect leading to an increase in caries risk via the plaque retentive enamel pitting in addition to the unaesthetic discolouration. Treatment options of minor permanent tooth TDI developmental defects include bleaching, direct composite restoration (megabrasion), direct composite veneers and indirect restorations. This case report focuses on the treatment of enamel hypoplasia in a young adult utilising direct composite veneers. Learning objectives This case report discusses the management of enamel hypoplasia as a consequence of TDI. The intended learning objectives include: u Identify the different presentations of permanent tooth disturbances u Understand treatment modalities for the management of TDI induced minor disturbances to developing permanent teeth u Introduction to the Paladex and Uveneer systems in the composite restorative workflow Introduction Traumatic dental injuries (TDI) involve damage to the dentition, periodontium and orofacial structures. Most TDI have been reported in the younger age groups which coincides with the development of the permanent dentition.1 Primary tooth TDI can either, directly damage the permanent tooth germ or, indirectly via a drop in pH from primary tooth pulpal necrosis (intracanal infection) with diffuse apical periodontitis; called Turner's tooth.2 The main injuries that can alter development of permanent dentition include intrusive luxation and avulsion of the primary dentition. For intrusive primary tooth injuries, the clinician should allow spontaneous re-eruption regardless of the intrusion direction; typically, spontaneous re-eruption is seen within 6-12 months. Any avulsed primary tooth must not be replanted due to risk of trauma to the permanent germ. Radiographic assessment aids confirm suspected avulsion cases. For more comprehensive management of TDI follow the International Association of Dental Traumatology (IADT) 2020 guidelines.3 Follow-up is critical for early diagnosis of complications and management of healing. A subsequent radiograph is indicated prior eruption of permanent successors, to identify disturbances in tooth development and eruption.4 The type of permanent tooth damage sustained (Table 1) is dependent on the dental development stage in which the disturbance occurred, as well as the force and type of injury.4 Of these, minor disturbances suchas enamel discolouration with or without hypoplasia are the most common sequelae.4 Hypoplasia is a quantitative enamel defect visible with tooth eruption unlike hypomineralisation; a qualitative defect with post-eruptive breakdown. Hypoplasia presentations vary in severity and increases caries risk as the pitted enamel harbours dental plaque. This case report focuses on composite resin management of enamel hypoplasia in order to restore an individual’s confidence to smile and ultimately increase their selfesteem. Case Report An eighteen-year-old male presented concerned with the “look of [his] front teeth”. Medical history recorded no significant findings. Trauma history revealed the patient fell at the age of two while playing. All maxillary deciduous incisors were avulsed. The permanent incisors experienced delayed eruption in addition to well-demarcated areas of yellow-brown enamel opacities with hypoplasia (Table 1(b)). The patient has an edge-to-edge incisor relationship and low confidence to smile with teeth. Treatment: 1. Preoperative photographs (Fig 1). 2. Mock-up of final veneer to assess LINICAL Aesthetic management of enamel hypoplasia induced by primary teeth avulsion – case report of a young adult By Dr Sigal Jacobson and Dr Ido Landau A. White or yellow enamel discolored opacity B. Yellowbrown enamel discolored opacity with or without hypoplasia C. Yellowbrown enamel opacity with circumferentia l hypoplasia D. Partial arrest of root formation E. Root Dilaceration F. Root Angulation G. Odontomalike malformation *Adapted from Andreasen, 2011 Table 1. Disturbances to developing permanent tooth Dr Ido Landau Dr Sigal Jacobson
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