CLINICAL CHALLENGES IN THE RESTORATIVE TREATMENT OF AMELOGENESIS IMPERFECTA

Abstract

Introduction: Amelogenesis imperfecta (AI) is a hereditary anomaly that compromises the formation, structure, and appearance of dental enamel, affecting both primary and permanent dentition. It manifests in three main phenotypes: hypoplastic (failure in matrix secretion), hypocalcified (failure in initial mineralization), and hypomaturation (failure in final crystal maturation). These variations result in teeth with an opaque, rough, or yellowish appearance, frequently associated with severe hypersensitivity and early wear. Beyond biological and functional impairments, AI exerts a significant psychosocial impact, affecting self-esteem and interpersonal relationships, especially in children and adolescents. Clinical management is complex, as the dental surgeon faces severe technical limitations related to enamel fragility and deficient adhesion of traditional restorative materials. Objective: This study analyzes, through a literature review, the clinical challenges faced in the restorative treatment of amelogenesis imperfecta. The focus is on the most commonly used restorative techniques and their implications for function, aesthetics, and longevity, seeking to identify strategies that minimize complications and optimize clinical outcomes. Materials and Methods: The research is a critical literature review based on searches in the PubMed, SciELO, and Virtual Health Library (BVS) databases. The search strategy uses controlled descriptors such as “amelogenesis imperfecta”, “restorative dentistry”, and “adhesive systems”. Study selection follows the PICO methodology, considering patients with AI, conservative restorative interventions, comparison between materials, and clinical outcomes. Inclusion criteria encompass original articles, clinical trials, and case reports in Portuguese, English, or Spanish, subjected to a two-stage screening by independent reviewers to ensure the reliability of the extracted data.Results: The findings evidence that adhesion to hypomineralized enamel represents the major clinical obstacle, as the mineral alteration prevents the formation of stable micro-retentions. In moderate cases, composite resins are widely used because they are conservative and facilitate repairs, although they present a higher risk of microleakage and wear. For definitive rehabilitations in adults, lithium disilicate stands out as the gold standard due to its mechanical strength and aesthetic stability.Discussion: The discussion emphasizes that treatment success does not depend exclusively on the chosen material, but on a multidisciplinary approach that integrates pediatric dentistry, orthodontics, and prosthodontics to restore vertical dimension and occlusal harmony. The use of digital technologies, such as CAD/CAM systems and 3D printing, emerges as a promising trend to increase precision and patient comfort, although long-term longitudinal studies are still lacking.Conclusion: It is concluded that the treatment of amelogenesis imperfecta requires an individualized protocol adapted to the patient’s phenotype. There is no single solution, but rather an evolutionary rehabilitation process. Early diagnosis and continuous preventive maintenance are decisive for the prognosis. The integration of minimally invasive techniques with psychosocial support is essential to ensure functional longevity and the recovery of the patient's quality of life.