Multidisciplinary treatment of a case of dentine dysplasia. A case report

A patient who presents with dentin dysplasia is always included in the high risk group of losing teeth when young. When such cases are diagnosed they require additional care from the dentist: the patient should be constantly monitored and offered consultations with doctors of many specialties such as maxillofacial surgeons, periodontists, orthodontists and prosthetists. It is true that almost every patient comes in contact specialities they represent in his life: for example, with conservative dentistry when he is edentate, with orthodontics as a youngster, and usually with prosthetics and periodontics in the later period of his life. There are also other situations like dental trauma or a complicated extraction requiring the assistance of a dental surgeon. The question is: must patients with dentine dysplasia be monitored from the earliest years of their lives?

Dentine dysplasia is a disorder of the structure of the hard tissue of the tooth affecting mostly dentine. It is hereditary condition. It is a heritable autosomally. It affects one patient in the population of one hundred thousand. The aetiology of this disease is yet unknown. The migration of the epithelium cells of Hertwig´s sheath to the tooth germ and inducing odontoblasts to differentiate and apposition dentine can be the cause. Lesions are seen in deciduous dentition, but can also be present in permanent dentition (1, 2, 3, 4, 5, 6). Such lesions affect the crown of the tooth, its roots or both. Attributes of dentine dysplasia include: (1) proper shape and size of the crown, poor mineralization of teeth, susceptibility to attrition and sometimes increased mobility. Radiographically, this disease is manifested by: lack of root canals, the presence of dentinoma, presence of periradicular pathology and thinning of the cementum of the root. Dentine dysplasia mostly is divided into two types (1, 2, 3, 6).

Type I – concerns changes in both deciduous teeth and permanent teeth that clinically have proper shape, color and hardness. Radiographically, milk teeth demonstrate total obliteration of pulp chambers and canals, permanent ones are characterized by crescent-like shape of obliterated chambers and the presence of periapical pathology in generally caries-free teeth (5, 7, 8, 9). According to Carroll et al. type I dentine dysplasia is divided according to the progression of dysplastic changes as seen on radiographic examination. The following subtypes were proposed: 1a, 1b, 1c, 1d (4, 5). DD1a – total pulpal obliteration and no root development; DD1b – with crescent-shaped remnants of the pulp chamber and minimal root development; DD1c with two crescent-shaped radiolucent lines and significant but incomplete root development; DD1d with radiographically visible pulp chambers, oval pulp stones and bulging roots

Type II – lesions in primary dentition and permanent dentition differ. Milk teeth have brownish or blue-brown discoloration, and are susceptible to attrition. Radiograph

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