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1 of 8Clinical Case Reports, 2025; 13:e70552
https://doi.org/10.1002/ccr3.70552
Clinical Case Reports
CASE REPORT OPEN ACCESS
Personalized Bonding Approach for Full- Mouth Adhesive 
Rehabilitation in Dentinogenesis Imperfecta
Cyprien Clark1,2 | Olivia Kérourédan2,3,4,5,6 | Léa Massé2,7,8
1UFR Dental Sciences – College of Health Sciences, University of Bordeaux, Bordeaux, France | 2Department of Dental Medicine, University Hospital of 
Bordeaux, Bordeaux, France | 3Department of Restorative Dentistry, UFR Dental Sciences – College of Health Sciences, University of Bordeaux, Bordeaux, 
France | 4Competence Center for Oro- Dental Rare Diseases, CCMR O- Rares, University Hospital of Bordeaux, Bordeaux, France | 5Competence Center 
for Constitutional Bone Diseases, CCMR MOC, University Hospital of Bordeaux, Bordeaux, France | 6INSERM, BioTis, U1026, University of Bordeaux, 
Bordeaux, France, Bordeaux, France | 7Department of Prosthetic Dentistry, UFR Dental Sciences – College of Health Sciences, University of Bordeaux, 
Bordeaux, France | 8University of Bordeaux, CNRS, MCC, PACEA, Pessac, France
Correspondence: Léa Massé (lea.masse@u-bordeaux.fr)
Received: 31 March 2025 | Revised: 24 April 2025 | Accepted: 5 May 2025
Funding: The authors received no specific funding for this work.
Keywords: adhesion | dentinogenesis imperfecta | minimal invasive dentistry | resin infiltration
ABSTRACT
Dentinogenesis imperfecta is a rare genetic disorder impacting dentin structure, with an incidence of 1 in 6000 to 1 in 8000 indi-
viduals. This condition alters the tooth's color and structure, affecting patients aesthetically, functionally, and socially. Advances 
in adhesive dentistry offer new therapeutic possibilities, although challenges remain. This article describes the full- mouth adhe-
sive rehabilitation of a 24- year- old male patient diagnosed with DGI, who presented with generalized enamel fractures, shortened 
crowns, and chronic apical infections. Clinical and radiographic examinations revealed typical features of DGI, including bul-
bous crowns, short roots, cervical constrictions, and pulpal obliterations. Microscopic analysis of an extracted molar confirmed 
enamel and dentin structural anomalies, including a smooth dentin- enamel junction (DEJ) and obliterated dentinal tubules. 
Given the compromised DEJ and high risk of enamel fracture, a minimally invasive, full adhesive treatment plan was developed. 
The protocol involved resin infiltration (Icon, DMG) to enhance enamel bonding, followed by the placement of lithium disilicate 
ceramic crowns in the anterior region and monolithic zirconia bridges posteriorly. Vertical dimension of occlusion was increased 
using composite abutments and a digital workflow ensured accurate, tissue- preserving preparations. The treatment significantly 
improved the patient's quality of life, with the General Oral Health Assessment Index (GOHAI) increasing from 36/60 to 58/60. 
A one- year follow- up showed no prosthetic or biological complications. Further research and long- term monitoring are necessary 
to confirm the clinical stability and effectiveness of this approach in managing dentinogenesis imperfecta.
1 | Introduction
Dentinogenesis imperfecta (DGI) is a rare autosomal dominant 
genetic disorder, affecting approximately 1 in 6000 to 8000 in-
dividuals [1]. It is characterized by severe hypomineralization 
and structural defects in dentin, giving teeth an amber trans-
lucency. Dentin, composed primarily of type I collagen and 
non- collagenous proteins (DSP, dentin sialoprotein; and DPP, 
dentin phosphoprotein), is encoded by the DSPP (dentin sialo-
phosphoprotein) gene located on chromosome 4 (4q21.3) [2].
Shields et  al. classified DGI into three types (DGI- I, DGI- II, 
DGI- III) and two forms of dentin dysplasia (DD- I, DD- II) [3]. 
DGI- I is linked to osteogenesis imperfecta (OI) due to mutations 
in collagen- related genes. De La Dure- Molla later refined this 
classification, grouping all DSPP- related conditions under DGI 
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, 
provided the original work is properly cited.
© 2025 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.
https://doi.org/10.1002/ccr3.70552
https://doi.org/10.1002/ccr3.70552
https://orcid.org/0000-0001-7967-5569
mailto:lea.masse@u-bordeaux.fr
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2 of 8 Clinical Case Reports, 2025
[2]. Molecular studies distinguish between various severities 
of DGI and dentin dysplasia, with the latter primarily involv-
ing root anomalies, while DGI associated with OI is considered 
syndromic.
Clinically, DGI presents as bluish- gray or amber translucent 
teeth with globular crowns, excessive wear, enamel fractures, 
and spontaneous infections. Radiographs typically show bul-
bous crowns, shortened roots, and pulpal obliteration, with 
these features varying widely in severity [2]. The dentin- enamel 
junction (DEJ), normally scalloped to absorb stress, appears 
smooth and wide in DGI, weakening its function and increas-
ing susceptibility to enamel fractures [4, 5]. These structural 
changes not only affect aesthetics and function but also impact 
patients' quality of life, often causing discomfort and chewing 
difficulties [6]. Personalized therapeutic solutions are essential 
in treatment. Given the compromised DEJ, partial adhesive res-
torations are not recommended, with peripheral restorations 
being preferred.7 Recently, infiltrating resin has proven its ef-
fectiveness in increasing enamel microhardness as well as adhe-
sion values for restoration [7].
This case is particularly notable for the use of resin infiltration as 
a pretreatment for full- mouth adhesive rehabilitation, a rarely de-
scribed approach in the context of DGI. The combination of struc-
tural analysis and the integration of recent adhesive techniques 
offers new insight into the treatment of such complex cases. This 
contributes significantly to the limited literature on minimally 
invasive and fully adhesive management strategies for DGI.
This article presents the case of a 24- year- old patient with 
DGI, illustrating a minimally invasive, fully adhesive rehabil-
itation using two restorative materials and bonding protocols. 
Our innovative approach enhances enamel bonding through 
resin infiltration (Icon DMG), enabling deep penetration of 
ultra- fluid resin. A follow- up on the patient's quality of life 
was conducted.
Summary
• This case report shows a minimally invasive, full 
adhesive rehabilitation for managing dentinogenesis 
imperfecta, involving a pretreatment using resin infil-
tration for enhancing enamel bond strength.
• The treatment improved quality of life, with stable 
outcomes at one- year follow- up.
TABLE 1 | GOHAI scores.
In the past 3 month Never Seldom Sometimes Often Always
1- How often did you limit the kinds or amounts of food you eat because 
of problems with your teeth?
5 4 3 2 1
2- How often did you have trouble biting or chewing any kinds of food, 
such as a firm meat or apples?
5 4 3 2 1
3- How often were you able to swallow comfortably? 1 2 3 4 5
4- How often have you teeth or dentures prevented you from speaking 
the way you wanted?
5 4 3 2 1
5- How often were you able to eat anythingg without feeling 
discomfort?
1 2 3 4 5
6- How often did you limit contacts with people because of the 
condition of your teeth or denture?
5 4 3 2 1
7- How often were you pleased or happy with the appearance of your 
teeth, gums or dentures?
1 2 3 4 5
8- How often did you use medication to relieve pain or discomfort 
around your mouth?
5 4 3 2 1
9- How often were you worried or concerned about the problems with 
your teeth, gums or dentures?
5 4 3 2 1
10- How often did you feel nervous or self- conscious because ofproblems with your teeth, gums or dentures?
5 4 3 2 1
11- How often did you feel uncomfortable eating in front of people 
because of problems with your teeth or dentures?
5 4 3 2 1
12- How often were your teeth or gums sensitive to hot, cold or sweet 
foods?
5 4 3 2 1
Note: The values highlighted in the table are those given by the patient before treatment.
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2 | Case History/Examination
A 24- year- old male patient was referred to the Bordeaux 
University hospital for aesthetic and functional management 
of his oral condition. His medical history was notable only for 
a pollen allergy, and his general health was excellent. He re-
ported localized pain on the left side (Pain Visual Analogue 
Scale Score: 4) and dissatisfaction with his smile due to struc-
tural anomalies of his teeth, impacting his quality of life 
with a General Oral Health Assessment Index (GOHAI) [8] 
score of 36/60. The domains most negatively impacted by 
his oral health were the functional and psychosocial aspects 
(Table 1). His main goals were to restore function and improve 
aesthetics.
3 | Methods (Differential Diagnosis, Investigations 
and Treatment)
The extraoral examination showed symmetric facial fea-
tures, reduced lower region, and aesthetic disharmony caused 
FIGURE 1 | Initial exobuccal examination. (a) Front view. (b) Smile 
view. (c) Profile view. The hemifaces are symmetrical; the lower facial 
third is reduced. The nasolabial folds are pronounced; the smile is in-
verted with aesthetic disharmony.
FIGURE 2 | Initial radiographs (a) Initial orthopantomogram, all 
teeth display distinctive characteristics of DI, with globular crowns, 
cervical constrictions, and short, thin roots. Pulpal obliteration is ob-
served. (b) Periapical radiograph of sector 2, a radiolucent image is pres-
ent around the apex of tooth 25. (c) Periapical radiograph of sector 3, 
tooth 36 exhibits a periapical lesion involving the apices of both roots. 
Teeth 24 and 36 are to be extracted.
4 of 8 Clinical Case Reports, 2025
by generalized dyschromia and cervical demineralization 
(Figure  1). The intraoral exam revealed class 2 canine occlu-
sion, fractures on multiple teeth, and enamel wear due to DGI. 
Panoramic radiography confirmed the typical DGI presentation, 
including bulbous crowns, cervical constriction, short and thin 
roots with pulpal obliteration. Additionally, there was evidence 
of apical infections in teeth 24 and 36, along with vertical and 
horizontal bone defects in edentulous regions (Figure 2).
The patient presented with a structural anomaly affecting all 
teeth, characterized by shortened crowns, enamel fractures, 
pulpal changes, and bone defects. Chronic apical periodontitis 
was noted in teeth 24 and 36, along with severe attritional wear 
and reduced vertical dimension of occlusion. Carious lesions 
were classified using the SiSta system, with varying scores for 
multiple teeth. Following this examination, the patient was di-
agnosed with dentinogenesis imperfecta (DGI) and was advised 
to consult a geneticist. Genetic testing confirmed a mutation in 
the DSPP gene (4q21.3), validating the diagnosis of DGI.
To confirm structural anomalies and assess the dentin- enamel 
junction (DEJ) quality, microscopic analysis was conducted on a 
vestibulo- lingual section of tooth 36, which was extracted due to 
compromised endodontic treatment and an unfavorable crown- 
to- root ratio for preservation, compared with a healthy control. 
DGI dentin exhibited marked hypomineralization, character-
ized by considerably fewer dentinal tubules that were obliter-
ated, reduced in size, and arranged in an anarchic, branched 
manner (Figure 3). In contrast, healthy dentin showed numer-
ous, larger, and well- aligned tubules. Additionally, cracks were 
visible in the DGI enamel, giving it an irregular appearance. The 
DGI DEJ appeared smooth and wide, in contrast to the scalloped 
DEJ in the control. These findings highlighted the specific struc-
tural alterations associated with DGI, underscoring the unique 
challenges encountered in bonded rehabilitation.
The primary objectives were to restore aesthetics and mastica-
tory function through a minimally invasive approach, preserv-
ing as much enamel as possible while ensuring durable bonding. 
Given the risk of enamel fracture and the compromised DEJ, the 
treatment plan prioritized peripheral restorations over partial 
adhesive techniques. The treatment plan was thoughtfully de-
vised in a collegial and multidisciplinary manner. Orthodontic 
treatment was excluded due to the risk of spontaneous abscesses 
and the complexity of implant planning. Written informed con-
sent was obtained from the patient before starting treatment and 
for the publication of this case report, including the use of per-
sonal and clinical data.
The treatment strategy involved increasing coronal height by rais-
ing the vertical dimension of occlusion (VDO) and employing full 
zirconia bridges posteriorly for strength. For the anterior regions, 
minimally invasive CAD- fabricated crowns in lithium disilicate- 
reinforced ceramics were chosen. Resin infiltration using the Icon 
(DMG) protocol was applied to optimize enamel bonding.
To establish the prosthetic plan, initial impressions were taken 
to produce study models, followed by an anterior mock- up using 
the “Direct Free- Hand Composite Up” technique [9] to adjust 
vertical dimension of occlusion (VDO) (Phase 1). Composite 
abutments were used to maintain the new VDO, recorded with a 
facebow for accurate maxillary positioning. A wax- up simulated 
final restorations, validated intraorally using the full mock- up 
technique (ATP) [10]. The patient retained the mock- up for 
1 month with weekly adjustments, ensuring comfort and adapt-
ing the final treatment plan accordingly (Figure 4).
Phase 2 involved prosthetic treatment. Digital impressions were 
taken with the mock- up in place, allowing calibrated tooth prepa-
ration to maximize enamel preservation (Figure 4) [11]. Bridges 
were designed with adequate thickness and connectors based on 
location. Try- in waxes validated the fit and occlusion, and the final 
prosthetics were fabricated in the lab using monolithic ceramic. 
Prior to bonding, resin infiltration (Icon (DMG) protocol) was per-
formed on enamel to optimize adhesion (Figure 5). Two distinct 
bonding protocols were applied for the zirconia bridges [12–14] 
and glass ceramic crowns [15] to maximize bond strength and du-
rability (Figure  6). Following bonding, radiographic verification 
confirmed no excess adhesive material remained.
4 | Conclusion and Results (Outcome and 
Follow- Up)
At a two- week post- operative check, the patient expressed high 
satisfaction with the aesthetic outcome (Figure  7). Thirteen 
FIGURE 3 | Microscopic analysis. Thin slices, 10 μm thick, were pre-
pared from these sections to allow precise observation of the dental mi-
crostructure at a magnification of ×20. (a) The control section belongs 
to a healthy premolar. (b) Section from the extracted tooth 36, which is 
affected by dentinogenesis imperfecta.
5 of 8
months post- treatment, he reported significant functional and 
aesthetic improvements, with a marked enhancement in qual-
ity of life (Figure 8). The GOHAI score increased from 36/60 to 
58/60, indicating improved oral health and psychosocial well- 
being (Table 2).
This case demonstrates that a personalized bonding approach 
incorporating resin infiltration can effectively address the struc-
tural challenges of DGI, leading to stable aesthetic and func-
tional outcomes. The integration of microscopic analysis with 
advanced adhesive protocols supports a minimally invasive 
FIGURE 4 | Design of the Comprehensive Prosthetic Plan and calibrated tooth preparation. (a) Initial situation in an intraoral view. (b) Instant 
mock- up using the “Direct Free- Hand Composite Up” technique : layers of composite are applied from canine tocanine to establish the new occlusal 
vertical dimension (OVD) based on aesthetic principles. (c) After a complete wax- up is performed, the project is validated intraorally using the tech-
nique of templates or full mock- ups. (d) calibrated tooth preparation of the maxillary to maximize enamel preservation.
FIGURE 5 | Erosion- infiltration protocol, optimization of affected enamel prior to bonding. (a) strict isolation (rubber dam, clamps, ligatures). 
(b) IconEtch (DMG, Pred Laboratory): 15% HCl etching for 2 min. (c) IconDry (DMG, Pred Laboratory): Drying with 99% ethanol for 30 s. (d) 
IconInfiltrant (DMG, Pred Laboratory): Resin infiltration (TEGDMA) over the entire enamel surface for 3 min. After a 40- s light curing, a second 
infiltration for 1 min is performed, followed by another 40- s light curing.
6 of 8 Clinical Case Reports, 2025
strategy that preserves dental tissues. These findings highlight 
the potential of this approach as a conservative alternative in 
managing structurally compromised dentitions and underscore 
the need for further clinical research.
5 | Discussion
This case highlights the challenges of managing DGI through pros-
thetic rehabilitation, especially with bonding efficacy. Microscopic 
analysis showed significant enamel and dentin alterations that 
limit conventional bonding. Innovative solutions like Icon (DMG) 
resin infiltration and 10- MDP primers optimize enamel cohesion, 
while minimally invasive crowns and 360° veneers ensure enamel 
preservation, functionality, and aesthetics.
While the literature on DGI- related prosthetic treatments is lim-
ited, prior studies have explored both implant- based approaches 
and full- coverage crowns, often requiring significant tooth re-
duction and potentially exacerbating enamel and dentin fragility 
FIGURE 6 | Preparation of zirconia bridges and anterior prosthet-
ic components in lithium disilicate. (a) Preparation of the prosthetic 
intrados: From left to right, disinfection and degreasing with alcohol, 
sandblasting, cleaner application, prosthetic primer application. (b) 
Hydrofluoric acid for 20 s, treatment of over- etched areas with ortho-
phosphoric acid for 120 s, silanization for 60 s, application of universal 
adhesive on all bonding surfaces, assembly using a composite without 
adhesive potential.
FIGURE 7 | Situation 2 weeks post- bonding. Left lateral view.
FIGURE 8 | Extraoral view at 13 months post- bonding. (a, b) Lateral 
views. (c), Frontal view.
7 of 8
[16, 17]. Etienne et al. [18] advocate for more conservative ap-
proaches, similar to those recommended for tooth wear, but 
with covering and peripheral preparation forms due to enamel 
and DEJ defects. The fully adhesive and minimally invasive ap-
proach in this case adheres to the therapeutic gradient, balancing 
structural preservation with aesthetic and functional outcomes. 
The choice of monolithic ceramics, especially zirconia for pos-
terior restorations, offers high survival rates and resistance to 
fracture, suitable for high- stress areas, as demonstrated in the 
literature [19, 20]. Our findings are consistent with reports of 
enamel alterations, including cracks and irregularities, in DGI 
cases [21–24], and they underscore the potential of resin infiltra-
tion to reinforce weakened enamel and optimize bonding.
The therapeutic compromises, including skipping prior ortho-
dontic alignment and minimal gingival adjustments, slightly af-
fected occlusal and aesthetic outcomes but did not significantly 
impact overall results. Continued follow- up and longitudinal 
studies are needed to confirm the long- term stability of this ap-
proach, including resin infiltration- based pretreatment, but ini-
tial outcomes show promising improvements in patient quality 
of life and treatment durability.
Follow- up studies are needed to validate the long- term stabil-
ity of this resin- infiltration- based approach, but initial out-
comes suggest enhanced patient quality of life and durable 
results.
Author Contributions
Cyprien Clark: resources, validation, visualization, writing – original 
draft, writing – review and editing. Olivia Kérourédan: conceptual-
ization, data curation, methodology, writing – review and editing. Léa 
Massé: conceptualization, data curation, methodology, supervision, 
writing – original draft, writing – review and editing.
Acknowledgments
The authors would like to thank Mr. Eric Pubert, assistant engineer at 
the University of Bordeaux, for his invaluable contribution to this clinical 
case, particularly in preparing thin sections at the PACEA Laboratory. 
The authors also extend their gratitude to the Corus Laboratory for their 
expertise and support in prosthetic fabrication.
Ethics Statement
The publication of this case report was approved by the Bordeaux 
University Hospital Research Ethics Committee (CER- BDX 2024- 324).
Consent
Written informed consent was obtained from the patient for the publi-
cation of this case report, including the use of personal and clinical data 
in accordance with the journal's patient consent policy.
Conflicts of Interest
The authors declare no conflicts of interest.
TABLE 2 | GOHAI scores.
In the past 3 month Never Seldom Sometimes Often Always
1- How often did you limit the kinds or amounts of food you eat because 
of problems with your teeth?
5 4 3 2 1
2- How often did you have trouble biting or chewing any kinds of food, 
such as a firm meat or apples?
5 4 3 2 1
3- How often were you able to swallow comfortably? 1 2 3 4 5
4- How often have you teeth or dentures prevented you from speaking 
the way you wanted?
5 4 3 2 1
5- How often were you able to eat anythingg without feeling 
discomfort?
1 2 3 4 5
6- How often did you limit contacts with people because of the 
condition of your teeth or denture?
5 4 3 2 1
7- How often were you pleased or happy with the appearance of your 
teeth, gums or dentures?
1 2 3 4 5
8- How often did you use medication to relieve pain or discomfort 
around your mouth?
5 4 3 2 1
9- How often were you worried or concerned about the problems with 
your teeth, gums or dentures?
5 4 3 2 1
10- How often did you feel nervous or self- conscious because of 
problems with your teeth, gums or dentures?
5 4 3 2 1
11- How often did you feel uncomfortable eating in front of people 
because of problems with your teeth or dentures?
5 4 3 2 1
12- How often were your teeth or gums sensitive to hot, cold or sweet 
foods?
5 4 3 2 1
Note: The values highlighted in the table are those given by the patient after treatment.
8 of 8 Clinical Case Reports, 2025
Data Availability Statement
Research data are not shared.
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	Personalized Bonding Approach for Full-Mouth Adhesive Rehabilitation in Dentinogenesis Imperfecta
	ABSTRACT
	1   |   Introduction
	2   |   Case History/Examination
	3   |   Methods (Differential Diagnosis, Investigations and Treatment)
	4   |   Conclusion and Results (Outcome and Follow-Up)
	5   |   Discussion
	Author Contributions
	Acknowledgments
	Ethics Statement
	Consent
	Conflicts of Interest
	Data Availability Statement
	References