Abstract
Background: Incisor-molar hypomineralization (IMH) presents various clinical characteristics that generate confusion for differential diagnosis with other enamel abnormalities such as amelogenesis imperfecta (AI). Purpose: To analyze dental, facial, and skeletal characteristics in people with IMH and compare them to those with AI in order to identify diagnostic differences between these two enamel defects. Methods: Analytical observational study. Twelve 7-to-10-year-olds with IMH and 10 8-to-49-year-olds with AI were studied. IMH was assessed according to the European Academy of Pediatric Dentistry’s diagnostic criteria, Mathu Maju’s criteria (2006), and Neeti Mittal’s phenotypic classification (2016), while Witkop’s criteria (1989) were used to analyze AI. Clinical, radiographic, facial, and skeletal analyses were performed to establish IMH phenotypes, information that was fed into an Excel® database for subsequent statistical analysis (SPSS 22.0) (p<0.05). Results: Statistically significant differences were found between IMH and AI. Only patients with IA presented dilaceration, dental agenesis, and taurodontism. There are similarities regarding facial features such as facial asymmetry, increased intercanthal distance, decreased lower third, biprochelia and convex profile, and occlusal features such as molar relationship, canine relationship, and overjet. Concerning transverse relationships, micrognathism was more frequent in IMH and in vertical relationships, deep overbite was greater in IMH than in AI. Conclusions: The main differences between IMH and AI were evident in skeletal characteristics and associated dental alterations.
Highlights
Incisor-molar hypomineralization (IMH), called incisor-molar syndrome, was a term proposed by Weerheijm et al in 2001 and has been defined as a series of differentiated enamel defects of systemic origin, mainly affecting first molars, with or without incisors, they can sometimes affect multiple teeth [1]
A recent study indicates that the gene that codes for transforming growth factor alpha (TGFA), which contributes to cell regulation, and the gene that codes for interferon regulatory factor 6 (IFR6), which acts in the development of head and neck, may be associated in the etiology of IMH [5]
This is supported by studies such as Padavala et al [38], who indicate that IMH is an autosomal recessive disorder, with a possible association with genes related to enamel formation, such as ameloblastin (AMBN) and tuftelin (TUFT1) genes interacting with protein 11 (TFIP11), which indicates its origin seems to have a strong genetic component
Summary
Incisor-molar hypomineralization (IMH), called incisor-molar syndrome, was a term proposed by Weerheijm et al in 2001 and has been defined as a series of differentiated enamel defects of systemic origin, mainly affecting first molars, with or without incisors, they can sometimes affect multiple teeth [1]. Severe cases are accompanied by dental sensitivity that makes eating difficult and cause poor aesthetics generating low self-esteem [28]. This pathology has been associated with dental alterations such as dental agenesis, taurodontism, and apical dilaceration. IMH is a public health problem that is suffered by, at least, one in five children This pathology expresses in several ways making differential diagnosis with other enamel abnormalities confusing [33]. The research question was: What are the phenotypic differences between two IMH and AI that would support differential diagnosis?
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