Al Siyabi, Husam Hashil Hamed; (2021) Bonding Strength to Teeth with Amelogenesis Imperfecta. Doctoral thesis (D.Dent), UCL (University College London).

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Abstract

Background Amelogenesis Imperfecta (AI) is an inherited dental condition of enamel, which can cause increased tooth sensitivity, difficulties maintaining oral hygiene, rapid tooth loss or enamel fractures, as well as defects in enamel thickness, colour, and shape. All these factors may impair aesthetic appearance and masticatory ability, requiring dental treatment for a lifetime which may affect their overall quality of life. Aim: 1. To assess the burden of care for children with AI attending the Paediatric Dental Department at the Eastman Dental Hospital (EDH). 2. To review the available scientific evidence on the adhesive interface between AI affected teeth and restorative materials. 3. To analyze different AI classifications quoted in the literature, to determine the consistency and standardization of reporting on AI classifications. Material and method: A service evaluation of AI patients being treated in the department from 2002- 2019. Two systematic searches were conducted using search terms in both electronic and hand search journals. Results: The burden and impact of care audit showed the average number of appointments per year was 5, (SD=2.5). The average distance travelled to the hospital was 33.7 miles (SD =30 miles) and the treatment provided included: • Extractions - majority in hypoplastic group (78%, n=10). • Composite restorations - hypoplastic (66%, n=18), mixed (16%, n=4). • Indirect coronal restorations – hypoplastic (67%, n=17), mixed (12%, n=3). • Bleaching and microabrasion - most performed in hypomature group (56%, n= 8 and 67%, n=5 respectively). • More failed composite restorations occurred in hypocalcified (25%, n=4) and mixed type (23%, n=40) with debonding being the most common reason. In the systematic review of bonding strength to AI affected teeth, studies showed a lower bonding strength of AI affected teeth in comparison to sound teeth. The bonding strength of composite was not significantly different when using self-etch compared with etch and rinse adhesives and deproteinization with sodium hypochlorite had no effect on shear bond strength, but chlorine dioxide and sodium fluoride showed better values in enhancing bonding strength. In the review of classification of AI papers did not use or cite a classification (n=12, 36%) and 43% only described the phenotype with no information regarding the basic genetic information if known. Those results are elaborated in each chapter in detail. Conclusion: The service evaluation provides data on the burden of care for children with AI. The high number of appointments, treatment needs, and miles travelled illustrate the scope of complications that can occur and stress the need for comprehensive management of this condition. Lower bonding strength values and durability of restorations to AI affected teeth requires further laboratory studies. There are variations and inconsistencies of classification used for studies published from 2015.

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