perimembranous ventricular septal defect with two different patterns

PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECT WITH TWO
DIFFERENT PATTERNS OF MOLAR INCISAL HYPOMINERALIZATION
1
MUHAMMAD SALMAN RASHID, BDS, FCPS-II (Trainee)
2
ALI ALTAF, BDS, FCPS-II (Trainee)
3
USMAN SHAHID, BDS, FCPS-II (Trainee)
4
BADAR MUNIR, BDS, MCPS, FCPS
ABSTRACT
Perimembranous ventricular septal defects (VSD) are chromosomal abnormality of trisomy18,
21. It usually affects the new born. The prevalence of this disease is low in Pakistan population. This
case presents with two different patterns of Molar/Incisal hypoplasia , which is not common. Treatment plan includes restoration of deciduous teeth with Glass Inomer cement and permanent teeth with
direct composite veneers. All procedures were performed under the direct supervision of restorative
consultant of de,Montmorency College of Dentistry Lahore, Pakistan.
Key Words: Ventricular septal defects, Molar Incisal hypomineralization.
INTRODUCTION
Perimembranous ventricular septal defect is one of
the congenital heart defects which affect the new born.
Perimembranous ventricular septal defects are located
in the left ventricle usually the aortic valve. Normal
closure of ventricular septum occurs during embryonic
phase by downward movement of membranous walls
to form the outlet.1 Other methods involve septum of
inlet formed by cushions of endocardium.2 Such tissue
serves as a mechanism of spontaneous closure. Apical
and middle portion of septum is formed by muscles.3
Epidemiology shows that the defects presents as 4 in
1000.4 Ventricular septal defects show 55% prevalence
in females. VSDs are classified according to the Jacobs
in 7 types according to location.6
Perimembranous VSDs are caused due to various
reasons but predominantly as a result of spontaneous
abnormalities in development. The precise etiology is
unknown. VSDs are most commonly associated with
Down syndrome.7 However many of these are not associated with chromosomal defects. Frequent maternal
cannabis intake slightly increases the incidence.8
During pregnancy the use of medications like
selective serotonin reuptake inhibitors (SSRIs) may
Resident Operative Dentistry, de,Montmorency College of Dentistry, Fort Road, Off. Ravi Road, Lahore
4
Associate Professor
Correspondence: Dr Muhammad Salman Rashid 111-C, 12/9,
Nazimabad, Karachi-74600 E-mail: dr_salman74@hotmail.com
Cell: 0345-3134108
Received for Publication: October 22, 2014
Revision Received:
November 6, 2014
Revision Accepted:
November 8, 2014
1,2,3
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
contribute to the etiology.9 Amoxicillin causes the 16.3%
MIH, while erythromycin causes 4.14% of the disease.10
The results of a literature showed that many conditions
contribute to the Molar/Incisal hypoplasia like asthma,
pneumonia, upper respiratory tract infections, otitis
media, antibiotics, dioxins in mother's milk, tonsillitis,
tonsillectomy and exanthamatous fevers of childhood.11
The conditions that are associated with the defects
are Edward syndrome, Patau syndrome and recurrent
illness of child.12 Pregnancy if encountered with diabetes
mellitus is also associated.13 Eisemenger syndrome also
frequently presents with the defects.14
CASE REPORT
A 10 year old male child came to the restorative
department with the complain of esthetically compromised teeth. After taking the written consent he
was examined. Oral examination revealed he had
mixed dentition. The diagnosis confirmed the Molar/
Incisal hypoplasia with two different patterns. His
mother informed that the child is suffering from
perimembranous ventricular septal defects. The history
record of cardiology department showed that the boy
suffered from meningitis, pneumonias and repeated
chest infection since birth till 6 years. Drug profile
showed that he had taken medicines which included
amoxicillin, erythromycin and metronidazole for septal
defects since birth till he was 9 years old. He often had
to be hospitalized due to the medical illness up to the
age of 5 years. Due to the use of certain medications and
illness it affected the tooth buds during development
which resulted in Molar/incisal hypoplasia. For further
investigation orthomopantogram was taken. The teeth
717
A Child Of Perimembranous Ventricular Septal Defect
the age and systemic/dental health. Direct composites
veneering is an affordable option for the hypoplastic
teeth.24 Restoring the anterior teeth with composites require certain expertise as many variables are
involved.
Proper shade matching for composites keeping hue,
chrome and value in consideration is essential.25 Opacifier usage before composite placement masks the dark
effect of restorations and makes it more acceptable.26,27
Fig 1
Different other treatment modalities for the restoration of molar/incisal hypolplasia depending on the
severity of the disease. These approaches include the
microabration, esthetic restorations and tooth whitening.28,29 Direct composite restorations give the acceptable
outcomes as the main goal is to restore compromised
teeth with proper function and in harmony with
occlusion.28
CONCLUSION
Children with cardiac history may suffer from the
developmental dental disorders. Following the proper
protocol for the treatment of molar/Incisal hypoplasia
with direct composites veneering seems to have a good
outcome.
REFRENCES
Fig 2
showed pitted enamel with spots of brown discoloration.
Treatment plan for anterior teeth was direct composite
veneering. Deciduous teeth were restored with Glass
Inomer cements.
1
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DISCUSSION
Perimembranous VSD are the most common among
all congenital heart abnormalities.15 The first case
was documented in early 2000 which was limited to
a muscular one.16 The defect may involve any part of
the left ventricle depending on the location and size
of defect.17 The defect can be closed by many proposed
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The molar/Incisal hypoplasia has no direct correlation
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There are many treatment options for restoring
the esthetically compromised teeth depending up-on
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A Child Of Perimembranous Ventricular Septal Defect
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