Gunilla Pousette Lundgren

Information Letter – Gunilla Pousette Lundgren

My research area focuses on early intervention treatment of the enamel defect Amelogenesis imperfecta (AI). I have been interested in this field ever since I worked as a student assistant in oral histopathology during my dental training. During my first position at a single‑dentist clinic, I met a young girl with severe AI and completely carious tooth stumps beneath plastic crowns on her anterior teeth. This further increased my interest in finding solutions to these problems.

As a newly graduated pediatric dentist, trained in Örebro and later working in the Dalarna region, I once again encountered young patients with AI. At that time, prosthodontists recommended treatment with acrylic crowns. According to all guidelines, placing permanent crowns at a young age was considered inappropriate, and the recommendation was therefore to wait until the patient reached adulthood.

With advances in dental materials and the ability to fabricate increasingly thin and durable permanent crowns—also without visible metal margins—I saw greater potential to help these patients. Therefore, in collaboration with Professor Göran Dahllöf, I initiated a research project to investigate whether severe AI could be treated with permanent crown therapy already during adolescence. We examined the quality and durability of treatments before and after early crown therapy, as well as how this affected patients’ perceived oral health–related quality of life (OHIP).

The results showed that the treatments previously offered to these patients required many retreatments and did not resolve the pain issues, aesthetic concerns, or OHIP‑related problems. However, the questionnaire on OHIP did not fully capture the patient perspective, so psychologist Tove Hasselblad conducted interview studies with both patients and parents regarding their experiences of having, or having a child with, AI. The impact on OHIP proved to be significant, and a clear improvement was observed after crown therapy.

Concerns were raised that the treatment was expensive and would likely need to be redone in adulthood. Therefore, we performed a cost‑analysis study. The results showed that early crown therapy was less costly for both the patient and society.

To investigate whether the crowns indeed need to be replaced in adulthood, we now have a follow‑up study in manuscript. After 13 years, crown therapy still shows few complications and no need for retreatments. The few endodontic complications observed occurred in patients who were 19 years or older at the time of crown cementation—precisely the age at which permanent treatment had traditionally been considered appropriate.

The process of publishing the article is ongoing, as is work on another manuscript concerning OHIP data 13 years after treatment. Our work is now frequently cited in articles on the treatment of severe AI, and recommendations in the literature are increasingly shifting toward supporting early crown therapy for severe AI.