10.59987/ads/2017.1.34-38
Aim. The aim of the study was to report the use of an elastodontic therapy in a growing patient affected by Dentinogenesis Imperfecta, second class malocclusion, deep bite and lower arch crowding from the deciduous dentition to permanent one.
Case report. At first, the 5-year-old patient was treated with an elastodontic device known as “Nite-Guide”. When the patient was 7 years old, during her first permanent molars and incisors eruption and after optimal house-practices, an Occlus-o-Guide Series G was placed at night and on daylight (two hours a day) performing exercises aimed to activate facial muscles and facilitate the deep bite reopening. At 9 years of age, with totally deep bite resolution, she used the Occluso-Guide only at night to hold down previous results and follow patient’s dental growth. At 11 years of age, after successful teeth switching, we prescribed an Occlus-o-Guide Series N, which is functional for permanent dentition and guaranteed an eruptive guide for last dental elements.
Conclusions. This clinic case could be considered an example of approach for all those patients with systemic and/or dental diseases that do not allow adequate dental retention, which is necessary for most orthodontic appliances; elastodontic devices do not require adequate dental retention and define a minimum intervention on the surfaces of the teeth.
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Annali di stomatologia
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Minimally invasive orthodontics: elastodontic therapy in a growing patient effected by Dentinogenesis Imperfecta
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Minimally invasive orthodontics: elastodontic therapy in a growing patient effected by Dentinogenesis Imperfecta
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                                                                                                 Original article


    Minimally invasive orthodontics: elastodontic
    therapy in a growing patient affected by
    Dentinogenesis Imperfecta




                                                                                                              i
                                                                                             n              al
    Gaetano Ierardo DDS, PhD                              elastodontic devices do not require adequate
    Valeria Luzzi DDS, PhD                                dental retention and define a minimum interven-
    Giuliana Nardacci DDS                                 tion on the surfaces of the teeth.




                                                                                          io
    Iole Vozza DDS, PhD
    Antonella Polimeni MD, DDS                            Key words: dentinogenesis imperfecta, orthodon-
                                                          tics, elastodontic device.




                                                              az
    Department of Oral and Maxillofacial Sciences,
    “Sapienza” University of Rome, Rome, Italy
                                                          Introduction

                                                          Dentinogenesis Imperfecta (DI) is a disorder of tooth




                                                            rn
                                                          development. It’s characterized by severe hypominer-
                                                          alization of dentin and altered dentine structure (1-3).
                                                          In 1973, Shield determined a classification of three
    Giuliana Nardacci                                     dentinal disorders: type I, II and III Dentinogenesis




                                                          te
    Corresponding author:

    Department of Oral and Maxillofacial Sciences,        Imperfecta and two types of dentin dysplasia (1).
    “Sapienza” University of Rome                         Dentinogenesis Imperfecta type I is the phenotype
    Via Caserta 6                                         that is often related to a genetic fragile bone condi-
    00161 Rome, Italy
                                                     In   tion, Osteogenesis Imperfecta. This is usually
    E-mail: giuliananardacci@hotmail.it                   caused by a defect in the two genes encondin type I
                                                          collagen (1).
                                                          The type I is also related to other systemic diseases,
                                                          such as Ehlers-Danlos and Goldblatt syndromes (1).
                                         ni

                                                          This type is characterized by opalescent brown dis-
                                                          coloration in both dentitions, and due to reduced sup-
    Summary
                                                          port of the dentin, the overlying enamel fractured eas-
                                 io


                                                          ily (1). There are also several steps of progressive
    Aim. The aim of the study was to report the use of
                                                          pulp obliteration which usually begins as soon as the
    an elastodontic therapy in a growing patient af-
                                                          eruption of the teeth occurs.
                          iz


    fected by Dentinogenesis Imperfecta, second
                                                          Clinically teeth are often opalescent.
    class malocclusion, deep bite and lower arch
                                                          The second type of Dentinogenesis Imperfecta is an
    crowding from the deciduous dentition to perma-
                                                          autosomal dominant condition with a prevalence rate
             Ed




    nent one.
                                                          of approximately 1:8000. It’s caused by a mutation of
    Case report. At first, the 5-year-old patient was
    treated with an elastodontic device known as          DSPP gene.
    “Nite-Guide”. When the patient was 7 years old,       The clinical and radiographic features are similar to
    during her first permanent molars and incisors        the first type, even though they are expressed more
    eruption and after optimal house-practices, an        consistently (1).
                                                          Dentinogenesis Imperfecta type III is also caused by
 IC




    Occlus-o-Guide Series G was placed at night and
    on daylight (two hours a day) performing exercis-     the same DSPP mutation as type II, but shows vari-
    es aimed to activate facial muscles and facilitate    able discoloration and morphology of the teeth, rang-
                                                          ing from normal appearing teeth to shell teeth with
                                                          dentin formation reduction (1, 4, 5).
    the deep bite reopening. At 9 years of age, with
C




                                                          This clinic condition can be related to Osteogenesis
    totally deep bite resolution, she used the Occluso-

                                                          Imperfecta (6, 7).
    Guide only at night to hold down previous results

                                                          From a radiographic point of view, teeth affected from
    and follow patient’s dental growth. At 11 years of

                                                          DI are called “specter teeth” because of the empti-
    age, after successful teeth switching, we pre-
@




                                                          ness appearance which makes possible to observe
    scribed an Occlus-o-Guide Series N, which is

                                                          only the polished outlines.
    functional for permanent dentition and guaran-

                                                          In these patients with a no real retention and sub-
    teed an eruptive guide for last dental elements.

                                                          stance of the teeth, a good anchorage is hard to ob-
    Conclusions. This clinic case could be consid-

                                                          tain; for this reason this study offers a treatment pos-
    ered an example of approach for all those pa-

                                                          sibility in order to solve some orthodontic problems of
    tients with systemic and/or dental diseases that

                                                          these patients.
    do not allow adequate dental retention, which is
    necessary for most orthodontic appliances;

    34                                                                       Annali di Stomatologia 2017;VIII (1):34-38
    Minimally invasive orthodontics: elastodontic therapy in a growing patient affected by Dentinogenesis Imperfecta


    In order to correct second class malocclusions there           DI, second class malocclusion, deep bite and lower
    are a lot of different orthodontic appliances described        arch crowding from the deciduous dentition to perma-
    in literature although in the last years the elastodontic      nent one.
    devices are the most used.
    The elastodontic appliances are made with a vinyl
    resin that is called Elvax® which has optimal charac-
    teristics of resilience.




                                                                                                                       i
                                                                   Case report




                                                                                                                     al
    These appliances are removable, easy to use, com-              The study reports the case of a 5 years old age child
    fortable, safe and simple in construction and function,        (G.P.) affected by DI.
    and they are indicated both in primary and in sec-             She was totally treated with elastomeric devices




                                                                                                       n
    ondary dentition.                                              since five years to twelve years of age.
    They are both functional devices and positioners (8).          The extraoral exam underlined these orthodontic
    They are realized in order to correct different ortho-         characteristics: long face and flat profile with a verti-




                                                                                                    io
    dontic problems: mandibular crowing, deep-bite,                cal asymmetry (12).
    open-bite, increased overjet, mandible retrusion.              The intra-oral exam showed: deep-bite, distal step on
    These appliances are characterized by a preformed              the right and on the left, deep dental wear (Fig. 1).




                                                                       az
    bite construction that allows a mandibular advance-            The cephalometric analysis underlined increased
    ment, concurrently with a vertical opening in the ante-        overjet (3, 7), increased overbite, normal divergence
    rior region to provide a greater vertical development          (FMA=23), SNA=73.2, SNB=72, Jarabak poly-
    of the posterior teeth (9).                                    gon=400 (Figs. 2, 3).




                                                                     rn
    Positioners usually achieve minor tooth movement af-           At first, the patient was treated with an elastodontic
    ter orthodontic treatment as a result of the elastomer-        device known as “Nite-Guide”, which is only for pri-
    ic material (8).                                               mary dentition from 5 to 7 years old kids. It guides the




                                                                   te
    They use the lip-bumper effect thanks to their labial          eruption of primary mandibular incisors and defines a
    and oral “shields”.                                            first class of malocclusion and corrects overjet and
    Depending on the type of elastomeric devise, the               overbite (13).
    teeth have their recesses that guide the correct posi-         She carried the Nite-Guide device both at night and
                                                         In
    tion in the mouth.                                             on daylight (two hours a day) performing exercises
    Hence elastomeric devices can solve not only the               aimed to activate facial muscles and facilitate the
    second class malocclusions through a mandibular ad-            deep bite reopening (Fig. 4). Waiting for mandibular
    vancement and increase in lower and anterior face              permanent incisors eruption, overjet and overbite
                                                 ni
    height, but also determines a lot of important dental          were corrected. Because of the lower crowding we
    effect: lingual tipping and regression of the maxillary        extracted the deciduous mandibular incisors.
    incisors, correction of molar relationships, decrease          At a later stage, when the patient was 7 years old,
                                        io


    overjet and overbite (10).                                     during her first permanent molars and incisors erup-
    They can solve these orthodontic problems with a               tion and after optimal house-practices, an Occlus-o-
    minimum operation on teeth, because they don’t                 Guide Series G was placed.
                              iz



    need much anchoring. Hence they can be as well                 This kind of Occlus-o-Guide is used in mixed dentition
    used in some cases with oral/systemic diseases (11).           in order to: correct second class of malocclusion and
    The aim of the study was to report the use of an               guide the permanent teeth in the right position in the
               Ed




    elastodontic therapy in a growing patient affected by          arch as well as to decrease the overjet and overbite.


                                                                                    Figure 1. Clinical case at 5 years of age.
 IC
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@




    Annali di Stomatologia 2017;VIII (1):34-38                                                                              35
    G. Ierardo et al.


                                                            At 9 years of age, with totally deep bite resolution,
                                                            she used the Occlus-o-Guide only at night to hold
                                                            down previous results and follow patient’s dental
                                                            growth.
                                                            At 11 years of age, after successful teeth switching,
                                                            we prescribed an Occlus-o-Guide Series N, which is
                                                            functional for permanent dentition and guaranteed an




                                                                                                                i
                                                                                                              al
                                                            eruptive guide for last dental elements.
                                                            In these series the recesses are also for first and sec-
                                                            ond molars in order to preserve and define the over-
    Figure 2. Initial Orthopanoramics.




                                                                                               n
                                                            bite and the correction of second class of malocclu-
                                                            sion.
                                                            She carried the device just at night in order to pre-




                                                                                            io
                                                            serve the correct overbite and improve the molar rela-
                                                            tionship (Figs. 6-8).




                                                                az
                                                            Discussion and Conclusions

                                                            Dentinogenesis imperfecta (DI) is a genetic disorder




                                                              rn
                                                            affecting the structural integrity of the dentin and re-
                                                            sulting in weakened dentin. The posterior teeth often
                                                            need to be extracted due to severe wear or fracture.




                                                            te
                                                            This frequently yields a loss of posterior occlusion
                                                            and occlusal vertical dimension. This case shows as
                                                            the patient optimally corrected her second class mal-
                                                            occlusion, deep bite and dental misalignment without
                                                     In
                                                            a severe intervention on surfaces of the teeth.
                                                            The elastodontic devices allowed a proper eruptive
                                                            guide for all teeth in different steps of dentition. G.P.
                                                            used all these appliances with comfort and facility
                                             ni
    Figure 3. Initial cephalometric skull.                  and only few hours a day.
                                                            Very early, she carried the devices only at night be-
                                                            cause the deep-bite was corrected in the initial steps
                                         io


    The recesses are for all teeth except first molars in   of therapy.
    order to have an extrusion of these teeth and an ad-    On Literature there are no case report about ortho-
    ditional decrease of the overbite.                      dontic rehabilitation of patients affected by DI in
                              iz



    G.P. used Occlus-o-Guide all night long and 2-4         mixed dentition. Bencharit et al. (14) demonstrated
    hours in the afternoon at home and she did the exer-    that restoring functional occlusion and esthetics for
    cises to activate the muscle (Fig. 5).                  adult patient with DI can be completed successfully
               Ed




                                                                             Figure 4. Intraoral photos with Nite-
                                                                             Guide at 7 years of age and correction
                                                                             of deepbite.
 IC
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    36                                                                         Annali di Stomatologia 2017;VIII (1):34-38
    Minimally invasive orthodontics: elastodontic therapy in a growing patient affected by Dentinogenesis Imperfecta


                                                                                      Figure 5. Intraoral photos with Occlus-
                                                                                      o-Guide series G at 9 years of age.




                                                                                                                     i
                                                                                                      n            al
                                                                                                   io
                                                                       az
                                                                     rn
                                                                                      Figure 6. Intraoral photos with Occlus-
                                                                                      o-Guide series N at 11 years of age.




                                                                   te
                                                         In
                                                 ni
                                        io
                              iz
               Ed
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    using implant therapy and adhesive dentistry. Row et           as a transitional treatment step for the anterior teeth
    al. (15) proposed a multidisciplinary approach for a           of an eight-year old boy with DI. This clinic case
@




    seventeen-year old patient through adhesive den-               could be considered an example of approach for all
    tistry, periodontal surgery, implant-supported prosthe-        those patients with systemic and/or dental diseases
    ses, orthodontic treatment and orthognathic surgery.           that do not allow adequate dental retention, which is
    Huth (16) proposed restoration of the primary teeth            necessary for most orthodontic appliances;
    with stainless steel crowns and composite crowns in            elastodontic devices do not require adequate dental
    a 4-year-old child. Ubaldini et al. (17) described an          retention and define a minimum intervention on the
    esthetic solution through composite resin restorations         surfaces of the teeth (18).

    Annali di Stomatologia 2017;VIII (1):34-38                                                                            37
    G. Ierardo et al.


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                                                                             2015 Jul;60(7):1013-1020.
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                                                                             li M, Zambrano A, Franchi L, Polimeni A. Osteogenesis im-
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