Treatment of enamel hypoplasia with bioactive material: clinical case report

Tratamento da hipoplasia do esmalte com material bioativo: relato de caso clínico

ABSTRACT

Enamel hypoplasia is a quantitative defect that presents as grooves or depressions that facilitate the accumulation of biofilm bacteria that cause caries lesions. These injuries affect the functionality and aesthetics of the teeth, and it is necessary to intervene in a restorative way. The treatment of enamel hypoplasia can be challenging and the use of materials with good indication helps to achieve aesthetics and function again. This report shows the clinical case of a 12-year-old male patient with enamel hypoplasia in tooth 34 and aesthetic and functional rehabilitation using bioactive restorative material.

Indexing terms
Amelogenesis; Dental materials; Dental enamel hypoplasia

RESUMO

A hipoplasia de esmalte é um defeito quantitativo que se apresenta como sulcos ou depressões que facilitam o acúmulo de bactérias do biofilme que causam lesões de cárie. Essas lesões afetam a funcionalidade e estética dos dentes, sendo necessário intervir de maneira restauradora. O tratamento da hipoplasia de esmalte pode ser desafiador e a utilização de materiais com boa indicação ajudam a alcanç ar estética e função novamente. Este relato mostra o caso clínico de um paciente do sexo masculino, 12 anos, com presença de hipoplasia de esmalte no dente 34 e a reabilitação estética e funcional utilizando material restaurador bioativo.

Termos de indexação
Amelogênese; Materiais dentários; Hipoplasia do esmalte dentário

INTRODUCTION

Enamel hypoplasia is an imperfection that quantitatively modifies tooth enamel during its formation phase, characterized as a localized defect and/or opacity. Its origin has no specific determination [¹,²]. Before the enamel is completely formed, any structural modifications can cause permanent deformations. The stage at which the ameloblasts are affected determines whether the defect is in quantity or quality [³]. These alterations that occur during amelogenesis can be inherited from the family [⁴].

The result of these changes in the first phase of enamel formation affects the tooth permanently [⁵]. Because when the enamel matrix is being formed, the hydroxyapatite is organized without its position and once a malformation occurs, the enamel defect is determined, and can be hypoplastic or hypocalcified [⁶].

In the clinical routine of the dental surgeon, hypoplasia presents itself in an opaque way, without clear demarcation or with very well-defined limits in the enamel, in which the causal reasons are not always established, and may occur during the formation of the fetus in the womb, during or after the birth of the baby [⁷].

Teeth that have enamel defects, such as porosities and irregularities characteristic of hypoplasia, are more susceptible to caries disease, due to the greater ease in the accumulation of biofilm and difficulties in brushing. As for location, hypoplasia occurs more frequently in the incisals of the teeth, but it can affect the cervical region, in addition to being more common in the permanent dentition because it is easier to diagnose [⁵,⁷].

Defects caused by enamel hypoplasia can affect the shape, function, and aesthetics of these teeth, requiring approaches that aid in recovery and are minimally invasive [⁸]. The use of materials that provide durability and aesthetics help in the success of the treatment. Bioactive materials currently found in the dental market have characteristics that interact well with this type of dental structure and contribute to the recovery of aesthetics [⁹].

Bioactive materials have good durability, in addition to being materials that release fluoride, helping to fight caries disease and contributing to the balance of the oral region. Rehabilitation through restorations with bioactive material is an important alternative because the material communicates very well with the oral tissue, generating the sharing of minerals and important substances for the tooth [⁹].

The objective of this case report, therefore, is to present the clinical case of a 12-year-old male patient with the presence of enamel hypoplasia in tooth 34, performing aesthetic and functional rehabilitation using bioactive restorative material.

CASE REPORT

AndThis case report was approved by the Research Ethics Committee of the São Leopoldo Mandic School – Campinas under number 7.430.670/CAAE 8571 1 525.8.0000.5374.

A 12-year-old male patient attended the Pediatric Dentistry Clinic of Faculdade São Leopoldo Mandic, Grande Vitória campus, with his mother for a routine dental consultation. The family complained of tooth fractures that caused food accumulation, as well as darkened stains on some lower teeth and sensitivity.

In the anamnesis and clinical examination, the presence of a depression in the enamel of tooth 34 with exposed dentin was observed (figure 1). Radiographic evaluation showed a depression in the enamel, with no pulp involvement (figure 2). The periodontium was intact and within normal standards.

Figure 1
Initial condition.

Figure 2
Initial radiograph.

Once the diagnosis was established as Enamel Hypoplasia affecting tooth 34, the proposed treatment was restoration using bioactive restorative material: Beautifil II Shofu.

The procedure was performed under infiltrative anesthesia (Alphacaine 2% 1:100,000 DFL) in the gingival region for the placement of absolute isolation using a dental rubber sheet (Madeitex).

Acid etching was performed with 37% phosphoric acid (37% AllPrime Phosphoric Acid Conditioner), washing and drying of the cavity. Application of the adhesive system (3M Single Bond Universal Adhesive). The increment of the Beautifill II Shofu restorative material color A2 was performed throughout the depression of tooth 34, returning the anatomical shape (figure 3 and 4).

Figure 3
Application of the liner base.

Figure 4
Application of the bioactive restorative material.

Finishing was performed with diamond tips, polishing with paste and rubber cup, and occlusal contact checking (figure 5).

Figure 5
Immediate post.

Two months after the restorative treatment, the patient returned for follow-up. In a new evaluation, the absence of sensitivity reported by the patient was noted, with the restoration being well adapted and without fracture points. The gingival tissues remained healthy and without any further modifications (figure 6).

Figure 6
Clinical follow-up 60 days.

DISCUSSION

The hard tissue parts that make up the tooth undergo genetic transformations and are influenced by the environment. Changes in these transformations can cause a decrease in the amount of tissue formed and defects. Directly related to enamel hypoplasia, the structure can present itself in different ways, from an enamel full of depressions to the absence of it, once the insult occurs in the enamel matrix, as presented in the case report above [⁴,¹⁰].

Several genetic mutations that affect tooth enamel can occur, giving it its defective characteristics. Some authors have reported that for the differentiation of a well-formed enamel from an affected one, part of the responsibility can be attributed to the response of the rough endoplasmic reticulum to stress and the attempts to maintain its integrity, causing the enamel to have some proteins that participate in its formation, such as ameloblastine, generating failures in cell formation [⁴,⁵].

Therefore, in the case of Enamel Hypoplasia, it is interesting to use a bioactive restorative material when restoring shape to a tooth, due to the various positive factors it offers and, especially in pediatric patients, it is interesting to have materials that offer help in protecting against dental caries, which, according to studies on bioactive materials. The authors proved that this material in question has an antibacterial effect, the ability to neutralize acids and strengthen the tooth structure [¹¹].

When compared to conventional materials, bioactive materials with GIOMER technology have good marginal adaptation and better surface roughness, which facilitates oral hygiene, reducing the accumulation of biofilm on the restored face in this case [¹²].

The use of bioactive restorative materials combined with the philosophy of minimal intervention can bring numerous benefits to the oral health of children and adolescents. In the case presented, the material used will help in the conservation of the malformed tooth structure, returned the aesthetics to the patient and facilitated the execution of good and correct oral hygiene. However, complementary studies are needed for new materials and new treatment protocols to be established in order to seek a result based on scientific evidence for cases of hypoplasia and other malformations.

CONCLUSION

The correct diagnosis of a malformation associated with a minimally invasive treatment plan, with the use of bioactive restorative materials, is shown to be an advance in the search for the best result, providing quality of life to the patient, restoring form, function and aesthetics.

• Article aligned with the Good Health and well-being goal of the Sustainable Development Goals (SDGs).
• How to cite this article
  Butcovsky BF, Sartori SP, Fazoli V, Gadioli MB, Posses BP, Corteleti JF, Imparato JCP. Treatment of enamel hypoplasia with bioactive material: clinical case report. RGO, Rev Gaúch Odontol. 2026;74:e20260009. http://dx.doi.org/10.1590/1981-86372026000920250119

Data Availability

The research data are available in the body of the document.

REFERENCES

• ¹ Salanitri S, Seow WK. Developmental enamel defects in the primary dentition: aetiology and clinical management. Aust Dent J. 2013;58(2):133-40. doi: https://doi.org/10.1111/adj.12039
  » https://doi.org/10.1111/adj.12039
• ² Castro EMR, Ruiz MDSR, Solís JMS, Rosales MAB, Pozos AG, Garrocho JAR. Prevalence of developmental dental anomalies in pediatric patients and assessment of students’ knowledge in two Mexican dental schools: a cross-sectional study. Odovtos. 2024;26(3):283-92. doi: http://dx.doi.org/10.15517/ijds.2024.60208
  » https://doi.org/10.15517/ijds.2024.60208
• ³ Faustino DDS, Rocha AF, da Rocha BS, Stein C. Use of antibiotics in early childhood and dental enamel defects in to 12 year old children in primary health care. Acta Odontol Latinoam. 2020 [cited 2025 Mar 21];33(1):6-13. Available from: https://pubmed.ncbi.nlm.nih.gov/32621593/
  » https://pubmed.ncbi.nlm.nih.gov/32621593/
• ⁴ Pescetto N, Céspedes A, Bologna RM, Pereira VP. Molecular mechanisms of imperfect amelogenesis. A review of genes ENAM, AMBN, FAM83H, MMP20 and KLK4. Odontoestomatología. 2021;23(38):306. doi: https://doi.org/10.22592/ode2021n37e306
  » https://doi.org/10.22592/ode2021n37e306
• ⁵ Hoffmann RHS, De Souza ML, Cypriano S. Prevalence of enamel defects and their relationship with dental caries in the deciduous and permanent dentition, indaiatúba, São Paulo, Brazil. Cad Saúde Pública. 2007;23(2):435-44. doi: https://doi.org/10.1590/S0102-311X2007000200020
  » https://doi.org/10.1590/S0102-311X2007000200020
• ⁶ Fernandes MJC, Rodrigues BV, Leite ABL, Lyra ACA, Amorim KMB, Ferreira JGN. Hypoplastic amelogenesis imperfecta: report of two familial cases. Rev Cubana Estomatol. 2020 [cited 2025 Mar 21];57(2):1-13. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75072020000200018&lng=es
  » http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75072020000200018&lng=es
• ⁷ Souza AR, Souza GF, Kuchler EC, Vasconcelos KRF, Souza JF, Kirschneck C, et al. Association of defects of enamel with polymorphisms in the vitamin D receptor and parathyroid hormone genes. Braz Dent J. 2024;35(1):1-8. doi: https://doi.org/10.1590/0103-6440202405900.
  » https://doi.org/10.1590/0103-6440202405900
• ⁸ Ramírez CJB. Minimally invasive aesthetic rehabilitation in the anterior region affected by enamel hypoplasia: clinical case report. Odovtos. 2019;21(3):17-31. doi: http://dx.doi.org/10.15517/ijds.v0i0.36764
  » https://doi.org/10.15517/ijds.v0i0.36764
• ⁹ Ramos NBP, Felizardo KR, Berger SB, Guiraldo RD, Lopes MB. Comparative study of physical-chemical properties of bioactives glass ionomer cement. Braz Dent J. 2024;35(1):98-107. doi: https://doi.org/10.1590/0103-6440202405728
  » https://doi.org/10.1590/0103-6440202405728
• ¹⁰ Seow WK. Developmental defects of enamel and dentine: challenges for basic science research and clinical management. Aust Dent J. 2014;59(1):143-54. doi: https://doi.org/10.1111/adj.12104
  » https://doi.org/10.1111/adj.12104
• ¹¹ Gordan VV, Mondragon E, Watson RE, Garvan C, Mjör IA. A clinical evaluation of a self-engraving primer and a giomer restorative material: results at eight years. J Am Dent Assoc. 2007;138(5):621-7. doi: https://doi.org/10.14219/jada.archive.2007.0233 17473040
  » https://doi.org/10.14219/jada.archive.2007.0233
• ¹² Neto CCL, das Neves AM, Arantes DC, Sa TCM, Yamauti M, de Magalhães CS, et al. Evaluation of the clinical performance of GIOMERs and comparison with other conventional restorative materials in permanent teeth: a systematic review and meta-analysis. Vid-Based Dent. 2022. doi: https://doi.org/10.1038/S41432-022-0281-8
  » https://doi.org/10.1038/S41432-022-0281-8

Edited by

• Assistant editor
  Luciana Butini Oliveira

Publication Dates

• Publication in this collection
  20 Apr 2026
• Date of issue
  2026

History

• Received
  28 Nov 2025
• Accepted
  23 Dec 2025