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1
DEVELOPMENTAL
DISTURBANCES OF TEETH
2
CONTENTS:
• INTRODUCTION
• CLASSIFICATION
• DEVELOPMENTAL DISTURBANCES IN
SIZE
• DEVELOPMENTAL DISTURBANCES IN
NUMBER
• DE...
• CONCLUSION
• REFERENCES
4
INTRODUCTION
• DEVELOPMENT
• The orderly and sequential changes that occur
with the passage of time as an organism moves
f...
INTRODUCTION
• Development of teeth and face is regulated
by genes
• Dental developmental anomalies appear as
a result of ...
INTRODUCTION
• But the genetic programme is very sensitive to
disturbances in the environment such as exposure
to infectio...
8
INTRODUCTION
• Developmental disturbances means
an abnormality where the pathology
starts in the embryonic stage of
human ...
• SIZE OF TEETH
• SHAPE OF TEETH
• NUMBER OF TEETH
• STRUCTURE OF TEETH
• GROWTH (ERUPTION) OF TEETH
10
CLASSIFICATION
Developmental disturbances in the
size of the teeth
Microdontia
Macrodontia
Developmental disturbances in t...
Developmental disturbances in the number of the teeth
Anodontia
Hypodontia
Supernumerary teeth
Predeciduous dentition
Post...
Anomalies at different stages of tooth
development
13
Dental lamina formation stage
Anodontia
Initiation and proliferation...
14
Morphodifferentiation ( defects in size & shape
Macrodontia / Microdontia
Dens invaginatus / Dens evaginatus
Hutchinson...
Microdontia: it is described as teeth
are smaller than usual.
1. True Generalized Microdontia
2. Relative Generalized Micr...
 all teeth are smaller than
normal
teeth are well formed
 occur in some cases of
down syndrome.
pituitary dwarfism
 ex...
 normal or slightly smaller than
normal teeth.
 are present in jaws that are
somewhat larger than normal
 Inheritance o...
 common condition
 affects most often maxillary
lateral incisior + 3rd
molar
 these 2 teeth are most often
congenitally...
 common forms of localized
microdontia is that which
affects maxillary lateral
incisior
 peg lateral
 instead of parall...
 sides converge or taper
together incisally
 forms cone-shaped crown
 root is frequently shorter
than usual
TREATMENT
•...
MACRODONTIA
Also called as megalodontia or megadontia.
It refers to teeth that are larger than usual.
21
(1) True General...
 all teeth are larger than
normal
 associated with
pituitary gigantism,pineal
hyperplasia with hyperinsulinism.
 exceed...
 normal or slightly larger than
normal teeth in small jaws
 results in crowding of teeth
 insufficient arch space
(2) R...
 uncommon condition
 unknown etiology
True marodontia often confused
with fused teeth.
 usually seen with
mandibular 3...
TREATMENT
25
􀂄 Stripping to reduce tooth size.
􀂄 Can be combined with build – up of
antimere if only one tooth is affected...
DEVELOPMENTAL DISTURBANCES IN SHAPE AND FORM
26
 Crown
 Fusion
 Gemination
 Taurodontism
 Talon’s Cusp
 Leong’s Cusp...
 Root
 Concresence
 Enamel Pearl
 Dilaceration
 Ankylosis
Shape and Form
27
DOUBLE TEETH
28
􀂄joined by crown,root or both
 Gemination and fusion
􀂄 May have very similar clinical appearance
􀂄 Higher...
GEMINATION
29
 an attempt of single tooth bud to divide with resultant
formation of tooth with bifid crown.
 partial cle...
30
TWINNING:
• Designate the production of equivalent
structures by division resulting in one normal
and one supernumerary...
FUSION
31
Fusion of adjacent tooth buds with resultant formation of
joined tooth with confluence of dentin.
 Fusion may ...
32
FUSION
 Contact occurs before calcification – two teeth may
be completely united to form a single large tooth.
Contac...
Differentiating factors
Check for number of teeth.
Check for root canal
33
Treatment of Gemination
and fusion
34
Deciduous dentition:
can results in Crowding, abnormal
spacing, delayed eruption of ...
TAURODONTISM-(tauro bull, don’t_ teeth)
35
Taurodontism’ was originated by Sir Arthur
Keith in 1913.
It is an enlargemen...
36
Hereditary
Mutation resulting from odontoblastic deficiency during
dentinogensis of roots
A primitive pattern.
Failure ...
Radiographic features
37
Rectangular in
shape
Pulp chamber is large
Bifurcation or
trifircation few
millimeter
Lack of
con...
TREATMENT
38
Requires no specific therapy
Pulp therapy in taurodonts :
Challenging task
bleeding during access
Canal loca...
39
ACCESSORY CUSPS
40
Cuspal morphology of the teeth exhibit
minor variations:
 CUSP OF CARABELLI
 TALONS CUSP
 DENS EVAG...
 An accessory cusp located onAn accessory cusp located on
the palatal surface of thethe palatal surface of the
mesiolingu...
PROTOSTYLID
•Occasionally on the mesiobuccal cusp of
mandibular permanent or deciduous molar
42
TALON CUSP
43
Eagle’s talon.
•A well delineated additional cusp that is located on the surface
of an anterior tooth & exte...
•In primary dentition maxillary central incisor most
common site.
PATTERNS OF TALON CUSPS: three types based
on morphology...
TREATMENT
45
•Occlusal interference.
• Prophylactically restoring the groove to
prevent caries. Or
•Fissure sealants to pr...
DENS EVAGINATUS
Also called Leong’s premolar, Evaginated odontome
46
•It is a developmental condition that appears
clinica...
Extra cusp can lead to:
•Incomplete eruption
•Displacement of teeth
•Pulp exposure following occlusal wear or
fracture.
Ra...
SHOVEL SHAPED INCISOR
48
•Associated with dens evaginatus
•Affected incisors demonstrate prominent
lateral margins creatin...
DENS INVAGINATUS
49
• Also called as Dens In Dente, Dilated
composite odontome
• It is a deep surface invagination of the ...
Oehlers (1957) divided this condition into 2
forms:
Coronal: Type 1,2,3.
Radicuar
Coronal dens invaginatus has been class...
Type II
Extends below the CEJ & ends in the blind sac that
may or may not communicate with adjacent dental
pulp.
51
Type III:
Extends through the root & perforates in the
apical or lateral radicular area without any
immediate communicati...
RADICULAR TYPE:
53
•Radicular invagination results from infolding
of hertwig’s sheath and origin is within the
root after ...
Radiograph:
•Affected tooth demonstrate an enlargement of the
root.
•Dilated invagination lined by enamel
• Radiographs re...
Treatment:
Small type I opening of the invagination is
restored to prevent carious involvement.
Large type:
Contents of th...
MULBERRY MOLARS (MOONS MOLAR)
56
•Molars have multiple poorly developed cusps.
•Seen in congenital syphilis.
•Mulerry mola...
HUTCHINSON INCISOR
57

characteristic of congenital
syphilis
lateral incisors are peg-shaped
or screwdriver-shaped
 wid...
SHAPE AND FORM
58
ROOT
Concrescence
 Union of two adjacent teeth by
cementum alone.
 May occur before or after eruption
...
FACTORS ASSOCIATED:
59
LOCAL FACTORS
•Abnormal occlusal trauma
•Adjacent inflammation
•Unopposd tooth;impacted , ,without ...
60
•Diagnosed by radiographic
examination
Histopathology
•Deposition of excessive cementum over the original layer of
prim...
TREATMENT
61
often requires no therapy
unless union interferes with
eruption; then surgical
removal may be warranted
sin...
DILACERATION
62
Abnormal angulation or bend in root or less frequently crown of tooth.
Majority due to trauma to tooth g...
TREATMENT
63
Vary according to severity
 Extraction: if it is non vital then surgical removal is
suggested.
 Can be pro...
ECTOPIC ENAMEL
64
Thought to arise from localized bulging in
the odontoblastic layer with prolonged
contact between HERS ...
ENAMEL PEARLS
65
CERVICAL ENAMEL PROJECTION
66
Represent dipping of enamel from the CEJ
toward the bifurcation of molar teeth.
Mandibular...
TREATMENT
67
Oral hygiene should be maintained.
Flattening or removal of enamel
pearl or furcation plasty can be done.
SUPERNUMERARY ROOTS
68
Refers to the development of an increased
number of roots on a tooth
compared with that
described ...
DEVELOPMENTAL DISTURBANCES IN
NUMBER OF TEETH
69
Anodontia
Hypodontia
Hyperdontia
Oligodontia
Supernumerary teeth
ANODONTIA
70
•Congenital absence of teeth
Etiology:
Hereditary
Autosomal dominent
Hereditary ectodermal
dysplasia
Cleidocr...
71
Clinical features:
Women
Mongoloid
Whites
True total anodontia:
All teeth missing
Can be either deciduous or
permanent
...
72
False anodontia:
Due to extraction of teeth
Pseudoanodontia:
Due to multiple unerupted teeth
HYPODONTIA
73
lack of development of one or more
teeth.
Common dental anomaly
Etiology:
• Familial tendency – point mutat...
74
 3.5%-8% (excluding third molars)
 Female predominance about 1.5:1
 Uncommon in primary dentition
(<1%)
 About 20-2...
75
Syndromes associated with
hypodontia
 Ectodermal dysplasia
 Chondroectodermal
dysplasia (Ellis-van
Creveld)
 Progeri...
76
 Prevalence of supernumerary teeth is
about 1%-3% (higher rate in Asians)
 Single tooth hyperdontia represent 75%-
85...
77
Syndromes associated with
hyperdontia
 Cleidocranial dysplasia
 Oral-Facial-Digital
 Apert syndrome.
cleidocranial
d...
78
Classification of
supernumerary teeth
Modified Howard s classification‟
Supplemental supernumerary teeth
Accessory su...
79
Supplemental supernumerary teeth:
These teeth duplicate the typical anatomy of
anterior and posterior teeth
Mesiodens:
...
80
DISTOMOLARS:
Found in molar region
Located distal to 3rd
molars
Generally these teeth are smaller
than normal 2nd
& ...
81
PARAMOLARS:
It is an supernumerary molar
Usually small and rudimentary
Situated buccally or lingually to one of the m...
TRANSPOSITION
82
Normal teeth erupting into an
inappropriate position.
•Usually involves the canine and
first premolars.
•...
83
Developmental disturbances in
the growth/eruption of the teeth
Premature eruption.
Delayed eruption.
Ankylosed teeth.
S...
84
NATAL TEETH
Premature eruption of teeth like
structures
Present at birth
They are hyper mobile because of
their limi...
85
Sharp incisal edges
may cause laceration of
lingual surface of tongue
→ RIGA–FEDE
DISEASE
Associated with Ellis-
van ...
86
Neonatal teeth
These are the teeth or teeth like structures
that erupt prematurely during neonatal
period
From birth to...
87
TREATMENT
Extraction of teeth (if causing
inconvenience)
Or
Rounding of the sharp angles
of the teeth
Extraction should...
88
ERUPTION SEQUESTRUM
Anomaly associated with tooth eruption in children.
 Described by Starkey and Shafer
.
 It is a ...
89
CLINICAL FEATURES
 The child may complain of slight soreness in the
area during function.
 The spicule directly overl...
DELAYED ERUPTION
90
In deciduous and permanent teeth, it is
difficult to assess unless a gross variation is
present.
•Caus...
91
IMPACTED TEETH
 occurs due to obstruction
from crowding
 from some other physical
barrier
 occasionally, may be due
...
92
Any tooth may be impacted –usually
mandibular third molars(22%),
maxillary third molars(18%) and
maxillary cuspids(0.9...
ANKYLOSIS
93
fusion of a tooth to surrounding
bone
 with focal loss of periodontal
ligament, bone + cementum
become inex...
94
Reported prevalence of clinically
detectable ankylosis- 1.5% to 9%
 Primary molars are most commonly
involved teeth w...
95
•Diagnosis is suspected clinically and confirmed
with radiographs.
•There is partial absence of the periodontal ligamen...
96
DEVELOPMENTAL DISTURBANCES
IN THE STRUCTURE OF THE TEETH
Amelogenesis imperfecta
Dentinogenesis imperfecta
Regional odo...
AMELOGENESIS IMPERFECTA
97
 also known as:
 Hereditary Enamel Dysplasia
 Hereditary Brown Enamel
 Hereditary Brown Opa...
98
Group of conditions caused by
defects in the genes encoding
enamel matrix proteins
 genes that encode for enamel
prot...
99
A heterogeneous group of hereditary
disorders that demonstrate developmental
alterations in the structure of enamel in...
100
Formation of enamel a multistep
process
Formation of enamel matrix
Mineralization of matrix
Maturation of matrix
Hered...
101
Amelogenesis imperfecta
Witkop classification
102
Hypoplastic
Amelogenesis Imperfecta
 Inadequate formation of matrix
FEATURES
Teeth erupt with insufficient amounts
...
103
•Hypoplastic generalized pitted
pattern.
•Hypoplastic localized patern.
•Hypoplastic autosomal dominant smooth
pattern...
104
HYPOPLASTIC GENERALIZED
PITTED PATTERN

Pin point to pin head sized
pits scattered.
Buccal surfaces affected
mure se...
105
HYPOPLASTIC LOCALIZED
PATTERN

Horizontal rows of pits,a linear
depression.
Middle third of buccal surfaces of
teeth...
106
HYPOPLASTIC AUTOSOMAL
DOMINANT SMOOTH PATTERN
Enamel of all teeth exhibit smooth
surface,thin hard glossy surface.
A...
SMOOTH PATTERN
107
HYPOPLASTIC ROUGH PATTERN
108
Enamel is thin with hard
rough surface
Teeth taper towards
incisal-occlusal surfaces.
ope...
109
•ENAMEL AGENESIS
•Demonstrate total lack of enamel
•Teeth are shape and colour of dentin with yellow brown hue
•Open c...
HYPOMATURATION TYPE
110
Enamel matrix is laid down properly and
begins to mineralize but there is a
defect in
maturation o...
111
AUTOSOMAL DOMINANT
HYPOMATURATION TYPE
AUTOSOMAL
RECESSIVE
X LINKED RECESSIVE
HYPOMATURATVE-AUTOSOMAL
DOMINANT
112
Commonly in males
Both permanent and
primary
primary teeth-ground
glass opaque whi...
HYPOMATURATIVE-AUTOSOMAL
RECESSIVE
113
Both primary and permanent
dentition
Enamel shows milky to shiny
agar brown deepl...
HYPOPLASTIC X-LINKED RECESSIVE
114
Aeffects both dentitions
White opaque areas on
enamel of incisal and
occlusal third o...
HYPOCALCIFIED –AMELOGENESIS
IMPERFECTA
115
Proper amount of enamel matrix is
formed but but
it doesn’t mineralize properly...
HYPOMATURATION HYPOPLASTIC TYPE
116
•Enamel hypomaturation is the
dominant feature.
•Enamel is yellowish white to‐
yellowi...
HYPOPLASTIC-HYPOMATURATIVE AD
117
•Enamel hypoplasia is the dominant
feature.
•Enamel is thin
BOTH PATTERNS SEEN IN
TRICHO...
TRICHO-DENTO-OSSEOUS SYNDROME
118
•Autosomal dominant disorder.
•Shows hypoplastic hypomaturation‐
with severe taurodontis...
TREATMENT
119
Vary accoring to sub type and severity
Main problems associated are
esthetics,sensitivity,and loss of vert...
DENTINOGENESIS IMPERFECTA
120
•Called Hereditary opalescent dentin,
Capdepont’s teeth.
•Only the mesodermal portion of the...
CLINICAL FEATURES
121
Deciduous teeth are more severely affected
•Gray to brownish violet or yellowish brown
with a charac...
122
Enamel may be lost earlyon incisal and occlusal
surfaces due to the abnormal DEJ
.
•DEJ lacks the usual scalloping.
•D...
123
CLASSIFICATION BY SHIELDS
124
Type I –DI that always occur with OI–
autosomal dominant.
•Type II –DI that never occurs wit...
 1 in 8000
occurs in families with
Osteogenesis Imperfecta
 primary teeth are more severely
affected than permanent tee...
 Radiographically:
 partial or total obliteration
of pulp chambers + root canals
 by continued formation
of dentin
 ro...
 never occurs in association
with osteogenesis imperfecta
unless by chance
 most frequently referred to as
hereditary op...
 Radiographically:
 partial or total obliteration
of pulp chambers + root canals
 by continued formation
of dentin
 ro...
 “Bradwine type”
 racial isolate in Maryland
 multiple pulp exposures in
deciduous not seen in type
I or II
 periapica...
 enamel appears normal
 large size of pulp chamber
is due not to resorption but
rather to insufficient + defective
denti...
HISTOLOGIC FEATURES
131
•Dentin has irregular tubules with large areas
of uncalcified matrix.
•Tubules are larger in diame...
132
•The odontoblasts with limited ability to
form well organized dentinal matrix,‐
appear to degenerate readily and get
e...
 Treatment:
DENTINOGENESIS IMPERFECTA
133
oPreservation of vertical dimension of occlusion
o Continued commitment & suppo...
 also known as “Rootless Teeth”
 rare disturbance of dentin
formation
atypical dentin formation
DENTIN DYSPLASIA
134
Fi...
135
Rare autosomal-dominant
condition that affects dentin
 Prevalence about 1:100,000
 abnormal pulpal morphology
CLASSIFICATION
136
Shields:
Type I –dentin dysplasia
Type II –anomalous dysplasia of dentin
•Witkops:
Type I –Radicular de...
 Classification:
 Type I (Radicular Type)
 Type II (Coronal Type)
DENTIN DYSPLASIA
137
 both dentitions are of
normal color
Most common type
 prevalence 1:100000
Type I (Radicular Type)
138
(Rootless
teeth)...
 Radiographically:
 roots are extremely short
 pulps almost completely
obliterated
 periapical radiolucencies:
• granu...
 autosomal dominant
Root length is normal.
Colour blue -amber to brown
translucency
 coronal pulps are usually large
(...
 Radiographically:
(Deciduous)
 roots are extremely short
 pulps almost completely
obliterated
(Permanent)
 abnormally...
 also known as:
 Odontogenic Dysplasia
 Odontogenesis Imperfecta
 Ghost Teeth
142
REGIONAL
ODONTODYSPLASIA
 one or several teeth in a
localized area are affected
 maxillary teeth are involved
more frequently than
mandibular are...
 teeth affected may exhibit
a delay or total failure in
eruption
 shape is altered, irregular in
appearance
144
 Radiographically:
 marked reduction in
radiodensity
 teeth assume a “ghost”
appearance
 both enamel + dentin appear
v...
 Treatment:
 poor cosmetic appearance
of teeth
 extraction with restoration
by prosthetic appliance
146
ENAMEL HYPOPLASIA
147
An incomplete or defective formation of the
organic enamel matrix of teeth.
•It occurs only when th...
Hereditary type enamel hypoplasia
148
•This is an ectodermal disturbance that occurs during the
embryonic development of t...
Environmental type enamel hypoplasia-
149
This is caused by the environmental factors that causes
damage to the enamel ce...
150
CLINICAL FEATURES
151
Mild:
Few small grooves, pits or fissures on
enamel surface
Moderate:
Enamel may exhibit rows of dee...
TREATMENT
152
Treatment of enamel hypoplasia is always
individualized and depends on the location and
severity of then con...
153
Posterior teeth –
1. For sensitive teeth with minimal wear, desensitizing agent
(such as potassium nitrate) can be use...
CASE REPORTS
154
155
A CASE REPORT OF A PATIENT AFFECTED BY
AMELOGENESIS
IMPERFECTASHOWING A POSSIBLE MINIMAL
AND CONSERVATIVE ADHESIVE TRE...
156
In the posterior area conservative resin composite onlays
were realized , whereas in the anterior area
freehand bonded...
157
Intraoral view of the preparations for freehand bonded composite
restorations and clinical view after teeth rehydratio...
158
Clinical views at the end of the treatment, together with the final treatment status at the 3-month recall. Except
for...
159
•case report describes a possible application of a
minimally invasive approach for treating amelogenesis
imperfecta in...
160
Dan Emil GEORGESCU, Rodica LUCA and Elisa
Mădălina CHIRCA
Conducted study to assess the frequency of development
anoma...
161
Dental size anomalies (0.44%) - one fusion and one
gemination and 9 abnormal maxillary frenum attachment
(3.98%).
Dent...
162
Endodontic treatment of developmental
anomalies in posterior teeth: Treatment of
geminated/fused teeth Nelly Steinbock...
163
 Two separate endodontic access cavities were prepared in the
fused crown in the molar
and the premolar area
•Five ca...
164
The second is a 16-year-old boy with ‘double’
second and supernumerary mandibular molars, who
was diagnosed with irrev...
165
Working length determination radiograph
demonstrating five of the six canals.
•Irrigated with 3% sodium hypochlorite s...
166
Dental Anomalies in Chinese Children with
Cleft Lip and Palate
Hai Ming Wong1*, Moon Cheung Lai2 and Nigel Martyn
King...
167
•Approximately 10% of BCLP, UCLP and CP children
were found to have taurodontism
Taurodontism of permanent maxillary f...
CONCLUSION
168
Anomalies on tooth have
aesthtic,functional,psychological
impact on the individual.so any
abnormalities or ...
References:References:
 BooksBooks
 Neville, et al: Oral and Maxillofacial PathologyNeville, et al: Oral and Maxillofaci...
 Burkits textbook of oral medicine.11th
edition.
 DentalAnomalies inChineseChildrenwithCleft LipandPalate
HaiMingWong1*,...
171
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Developmental disturbances ofteeth sem

  1. 1. 1
  2. 2. DEVELOPMENTAL DISTURBANCES OF TEETH 2
  3. 3. CONTENTS: • INTRODUCTION • CLASSIFICATION • DEVELOPMENTAL DISTURBANCES IN SIZE • DEVELOPMENTAL DISTURBANCES IN NUMBER • DEVELOPMENTAL DISTURBANCES IN SHAPE • DEVELOPMENTAL DISTURBANCES IN STRUCTURE • DEVELOPMENTAL DISTURBANCES IN ERUPTION. • REVIEW LITERATURE 3
  4. 4. • CONCLUSION • REFERENCES 4
  5. 5. INTRODUCTION • DEVELOPMENT • The orderly and sequential changes that occur with the passage of time as an organism moves from conception to death. • Also referred to as gradual growth which indicates changes in character. 5
  6. 6. INTRODUCTION • Development of teeth and face is regulated by genes • Dental developmental anomalies appear as a result of disruption in the odontogenesis process by the action of certain disruptive factors • The disruptive factors can be genetic factors or environmental factors or even combinations of these factors. 6
  7. 7. INTRODUCTION • But the genetic programme is very sensitive to disturbances in the environment such as exposure to infection or toxic chemicals, including drugs 7 DISTURBANCES OF TEETH 􀂄 Environmental 􀂄 Developmental
  8. 8. 8
  9. 9. INTRODUCTION • Developmental disturbances means an abnormality where the pathology starts in the embryonic stage of human life , before the formation of the dentition. 9
  10. 10. • SIZE OF TEETH • SHAPE OF TEETH • NUMBER OF TEETH • STRUCTURE OF TEETH • GROWTH (ERUPTION) OF TEETH 10
  11. 11. CLASSIFICATION Developmental disturbances in the size of the teeth Microdontia Macrodontia Developmental disturbances in the shape of the teeth Gemination Fusion Concresence Dilaceration Talon’s cusp Dens-in-dente Dens evaginatus Taurodontism Supernumerary root 11
  12. 12. Developmental disturbances in the number of the teeth Anodontia Hypodontia Supernumerary teeth Predeciduous dentition Post permanent dentition Developmental disturbances in the structure of the teeth Amelogenesis imperfecta Dentinogenesis imperfecta Regional odontodysplasia Dentin dysplasia Developmental disturbances in the growth/eruption of the teeth Premature eruption Delayed eruption Ankylosed teeth Submerged teeth/ impacted teeth 12
  13. 13. Anomalies at different stages of tooth development 13 Dental lamina formation stage Anodontia Initiation and proliferation Oligodontia Supernumerary teeth Geminated / fused teeth Histodifferentiation -defects in multiple dental tissues Regional odontodysplasia
  14. 14. 14 Morphodifferentiation ( defects in size & shape Macrodontia / Microdontia Dens invaginatus / Dens evaginatus Hutchinson s incisors, mulberry molars‟ Talon cusp Taurodontism Apposition ( defects in structure of enamel & dentin ) Amelogenesis imperfecta Enamel Hypoplasia Dentinogenesis imperfecta Dentin dysplasia
  15. 15. Microdontia: it is described as teeth are smaller than usual. 1. True Generalized Microdontia 2. Relative Generalized Microdontia 3. Focal or Localized Microdontia DEVELOPMENTAL DISTURBANCES OF SIE OF TEETH 15 MICRODONTA MACRODONTIA
  16. 16.  all teeth are smaller than normal teeth are well formed  occur in some cases of down syndrome. pituitary dwarfism  exceedingly rare (1) True Generalized Microdontia 16
  17. 17.  normal or slightly smaller than normal teeth.  are present in jaws that are somewhat larger than normal  Inheritance of jaw size from one parent and tooth size from other parent can lead to this variations. (2) Relative Generalized Microdontia 17
  18. 18.  common condition  affects most often maxillary lateral incisior + 3rd molar  these 2 teeth are most often congenitally missing (3) Focal/Localized Microdontia 18
  19. 19.  common forms of localized microdontia is that which affects maxillary lateral incisior  peg lateral  instead of parallel diverging mesial + distal surfaces 19
  20. 20.  sides converge or taper together incisally  forms cone-shaped crown  root is frequently shorter than usual TREATMENT • Composite / Porcelain Veneers 20
  21. 21. MACRODONTIA Also called as megalodontia or megadontia. It refers to teeth that are larger than usual. 21 (1) True Generalized Macrodontia  (2) Relative Generalize Macrodontia  (3) Focal or Localized Macrodontia
  22. 22.  all teeth are larger than normal  associated with pituitary gigantism,pineal hyperplasia with hyperinsulinism.  exceedingly rare (1) True Generalized Macrodontia MACRODONTIA 22
  23. 23.  normal or slightly larger than normal teeth in small jaws  results in crowding of teeth  insufficient arch space (2) Relative Generalized Macrodontia 23
  24. 24.  uncommon condition  unknown etiology True marodontia often confused with fused teeth.  usually seen with mandibular 3rd molars (3) Focal/Localized Macrodontia 24
  25. 25. TREATMENT 25 􀂄 Stripping to reduce tooth size. 􀂄 Can be combined with build – up of antimere if only one tooth is affected. 􀂄 Extraction & replacement by prosthesis.
  26. 26. DEVELOPMENTAL DISTURBANCES IN SHAPE AND FORM 26  Crown  Fusion  Gemination  Taurodontism  Talon’s Cusp  Leong’s Cusp  Dens Invaginatus  Peg-shaped Lateral  Hutchinson Incisor  Mulberry Molar
  27. 27.  Root  Concresence  Enamel Pearl  Dilaceration  Ankylosis Shape and Form 27
  28. 28. DOUBLE TEETH 28 􀂄joined by crown,root or both  Gemination and fusion 􀂄 May have very similar clinical appearance 􀂄 Higher frequency in anterior and maxillary regions 􀂄 Rate is about 0.1% in permanent dentition and 0.5% in deciduous 􀂄 Bilateral cases more infrequent. 􀂄 Etiology unknown but trauma has been Suggested. Clinical importance 􀂄 Crowding / spacing 􀂄 Periodontal problem 􀂄 Caries 􀂄 Eruption disturbance 􀂄 Aesthetics
  29. 29. GEMINATION 29  an attempt of single tooth bud to divide with resultant formation of tooth with bifid crown.  partial cleavage  appearance of 2 crowns that share same root canal  trauma has been suggested as possible cause.
  30. 30. 30 TWINNING: • Designate the production of equivalent structures by division resulting in one normal and one supernumerary tooth :
  31. 31. FUSION 31 Fusion of adjacent tooth buds with resultant formation of joined tooth with confluence of dentin.  Fusion may be complete or incomplete based on the stage of tooth development at the time of fusion.  Union of two separate tooth buds. When counted ,tooth count reveals missing tooth when anamalous tooth is counted as one. Fusion of (a) molar tooth with supernumerary, (b) maxillary premolar with fused roots, (c) premolars
  32. 32. 32 FUSION  Contact occurs before calcification – two teeth may be completely united to form a single large tooth. Contact after calcification of the crowns, the roots may be united Tooth may have fused or seperated root cnals
  33. 33. Differentiating factors Check for number of teeth. Check for root canal 33
  34. 34. Treatment of Gemination and fusion 34 Deciduous dentition: can results in Crowding, abnormal spacing, delayed eruption of permanent teeth.  Extraction. Otherwise: Surgical division & endodontic treatment is done
  35. 35. TAURODONTISM-(tauro bull, don’t_ teeth) 35 Taurodontism’ was originated by Sir Arthur Keith in 1913. It is an enlargement of the body and pulp chamber of a tooth with apical displacement of the pulpal floor . Shaw’ classified taurodont teeth according to degree of apical displacement of pulpal floor. Hypotaurodont: mild Mesotaurodont: moderate Hypertaurodont: severe
  36. 36. 36 Hereditary Mutation resulting from odontoblastic deficiency during dentinogensis of roots A primitive pattern. Failure of Hertwig's epithelial root sheath to invaginate at proper horizontal level Clinical Features : The deciduous or permanent dentition (more common). Molars.(3rd ,2nd ,1st ) May be unilateral or bilateral. Increased frequency in patients with cleft lip/palate, also associated with syndromes like downs syndrome, klinefelter syndrome,trichodento-oseous syndrome. Oculo‐dental‐digital dysplasia.Orofacial digital synd.ectodermal displasia •Sex chromosomal aberrations.Amelogenesis imperfecta IE,IV CAUSES
  37. 37. Radiographic features 37 Rectangular in shape Pulp chamber is large Bifurcation or trifircation few millimeter Lack of constriction
  38. 38. TREATMENT 38 Requires no specific therapy Pulp therapy in taurodonts : Challenging task bleeding during access Canal locating , instrumenting , obturating difficult
  39. 39. 39
  40. 40. ACCESSORY CUSPS 40 Cuspal morphology of the teeth exhibit minor variations:  CUSP OF CARABELLI  TALONS CUSP  DENS EVAGINATUS
  41. 41.  An accessory cusp located onAn accessory cusp located on the palatal surface of thethe palatal surface of the mesiolingual cusp of a maxillary molar.mesiolingual cusp of a maxillary molar. May be seen in deciduous or permanent teethMay be seen in deciduous or permanent teeth & varies from cusp to small indented pit or fissure& varies from cusp to small indented pit or fissure.. 41 CUSP OF CARABELLI 90% in whites and rare in Asians90% in whites and rare in Asians Requires no therapy unless deep groove is present.Requires no therapy unless deep groove is present.
  42. 42. PROTOSTYLID •Occasionally on the mesiobuccal cusp of mandibular permanent or deciduous molar 42
  43. 43. TALON CUSP 43 Eagle’s talon. •A well delineated additional cusp that is located on the surface of an anterior tooth & extends at least half the distance from the CEJ to the incisal edge.(lingual side) •Composed of normal enamel and dentin and contains a horn of pulp tissue. •Prevalence ranges from 1%-8% • Chawla et al-7.7% prevalence- north Indian children.
  44. 44. •In primary dentition maxillary central incisor most common site. PATTERNS OF TALON CUSPS: three types based on morphology • Trace talon •Semi-talon •Talon Forms : T –form ; Y -shaped •Seen in patients with rubinstein teybi syndrome,struge weber syndrome,mohr syndrome. •Radiographically,the cusp is seen overlying the central portion of crown & includes enamel and dentin •Clinical problems include esthetics, caries control and occlusal accombidation. 44
  45. 45. TREATMENT 45 •Occlusal interference. • Prophylactically restoring the groove to prevent caries. Or •Fissure sealants to prevent caries around the margins
  46. 46. DENS EVAGINATUS Also called Leong’s premolar, Evaginated odontome 46 •It is a developmental condition that appears clinically as an accessory cusp or a globule of enamel on the occlusal surface between the buccal and lingual cusps of premolars, •unilaterally or bilaterally. •Rare in whites 15% in asians. •Occurs in persons of mongoloid ancestry–chinese, japanese, filipinos, eskimos and american indians.‐ •Evolves by proliferation and evaginationof an area of the inner enamel epithelium and subjacent odontogenic mesenchyme into the dental organ during early tooth development
  47. 47. Extra cusp can lead to: •Incomplete eruption •Displacement of teeth •Pulp exposure following occlusal wear or fracture. Radiographic features •Occlusal surface exhibits a tuberculated apearance, and often pulpal extension is seen in the cusp Treatment Extraction is indicated if tooth is nonvital Grinding of the tubercle & indirect pulp capping with calcium hydroxide. 47
  48. 48. SHOVEL SHAPED INCISOR 48 •Associated with dens evaginatus •Affected incisors demonstrate prominent lateral margins creating a hallowed lingual surface that resembles the scoop of shovel. •Maxillary central incisors most affected •Predominantly in asians, native americans and alaskans
  49. 49. DENS INVAGINATUS 49 • Also called as Dens In Dente, Dilated composite odontome • It is a deep surface invagination of the crown or root by enamel before calcification occurs.. • Causes : – Increased localized external pressure – Focal growth retardation – Focal growth stimulation. • Maxi. Permanent Lateral incisor most commonly involved while central rare. • Condition is frequently bilateral. • Prevalence 0.04%-10%
  50. 50. Oehlers (1957) divided this condition into 2 forms: Coronal: Type 1,2,3. Radicuar Coronal dens invaginatus has been classified into three major types: 50 Type I: An invagination that is confined to the crown. Clinical significance  Predisposition to caries  Pulpal pathology  Periapical pathology (Type III)  Early diagnosis – mandatory
  51. 51. Type II Extends below the CEJ & ends in the blind sac that may or may not communicate with adjacent dental pulp. 51
  52. 52. Type III: Extends through the root & perforates in the apical or lateral radicular area without any immediate communication with pulp. Enamel line often replaced by cementum close to the radicular perforation. Perforation provides communication from oral cavity to the intraosseous periradicular tissue, &often produce inflammatory lesions 52
  53. 53. RADICULAR TYPE: 53 •Radicular invagination results from infolding of hertwig’s sheath and origin is within the root after development is complete
  54. 54. Radiograph: •Affected tooth demonstrate an enlargement of the root. •Dilated invagination lined by enamel • Radiographs reveal a pear shaped invagination of enamel and dentin with a narrow constriction at the opening on the surface of the tooth and closely approximating the pulp in its depth. •  Severe form – an invagination that extends nearly to the apex of the root TYPE II CORONAL DENS INVAGINATUS TYPE III CORONAL DENS INVAGINATUS 54
  55. 55. Treatment: Small type I opening of the invagination is restored to prevent carious involvement. Large type: Contents of the lumen & any carious dentin must be removed & calcium hydroxide base is placed. Pulpal pathosis or pulpal communication then endodontic therapy is recommended 55
  56. 56. MULBERRY MOLARS (MOONS MOLAR) 56 •Molars have multiple poorly developed cusps. •Seen in congenital syphilis. •Mulerry molar shows numerous disorganized globular projection that resembles like mulberry. •Condition occurs due to spirochete infection of enamel organ of teeth during amelogenesis.
  57. 57. HUTCHINSON INCISOR 57  characteristic of congenital syphilis lateral incisors are peg-shaped or screwdriver-shaped  widely spaced  notched on their biting end  with a crescent-shaped defect named after Sir Jonathan Hutchinson  English surgeon + pathologist who 1st described it
  58. 58. SHAPE AND FORM 58 ROOT Concrescence  Union of two adjacent teeth by cementum alone.  May occur before or after eruption  Seen most commonly posterior and maxillary regions  Etiology believed to be trauma or Overcrowding. Usually involves two teeth. But involving three teeth has also been reported.
  59. 59. FACTORS ASSOCIATED: 59 LOCAL FACTORS •Abnormal occlusal trauma •Adjacent inflammation •Unopposd tooth;impacted , ,without antagonist SYSTEMIC FACTORS Acromegaly and pituitary gigantism –Arthritis –Calcinosis –Paget’s disease of bone –Rheumatic fever –Thyroid goiter –Vitamin A deficiency
  60. 60. 60 •Diagnosed by radiographic examination Histopathology •Deposition of excessive cementum over the original layer of primary cementum. •May be hypocellularor exhibit areas of cellular cementum resembling bone called osteocementum . •Polarized light to differentiate dentin and cementum.
  61. 61. TREATMENT 61 often requires no therapy unless union interferes with eruption; then surgical removal may be warranted since with fused teeth, extraction of one may result in extraction of the other
  62. 62. DILACERATION 62 Abnormal angulation or bend in root or less frequently crown of tooth. Majority due to trauma to tooth germ calcified portion. Permanent maxillary incisors are frequently involved, followed by mandibular incisors. Dilaceration in a permanent tooth often follows traumatic injury (avulsion or intrusion) to the deciduous predecessor in which the tooth is driven apically into the jaw. Can also develop secondary to adjacent cyst, tumor or odontogenic hamartoma. kinked tooth ” or “ sickle – tooth
  63. 63. TREATMENT 63 Vary according to severity  Extraction: if it is non vital then surgical removal is suggested.  Can be problematic during extraction sometimes. Deciduous teeth – Extraction Permanent teeth Minor – no treatment
  64. 64. ECTOPIC ENAMEL 64 Thought to arise from localized bulging in the odontoblastic layer with prolonged contact between HERS and dentin leading to enamel formation. Enamel in unusual location Enamel pearlEnamel pearl Common-roots of max. molars followed by mand. Molar. Deciduous molar is not rare. 1.1-9.7% - highest in Asians
  65. 65. ENAMEL PEARLS 65
  66. 66. CERVICAL ENAMEL PROJECTION 66 Represent dipping of enamel from the CEJ toward the bifurcation of molar teeth. Mandibular molars affected more frequent.  prevalence is greater in Asians (8.6%-32.4%) Extensions is correlated with localized loss of periodontal attachment with furcation involvement
  67. 67. TREATMENT 67 Oral hygiene should be maintained. Flattening or removal of enamel pearl or furcation plasty can be done.
  68. 68. SUPERNUMERARY ROOTS 68 Refers to the development of an increased number of roots on a tooth compared with that described in dental anatomy. •May involve any tooth. •Mandibular cuspids and bicuspidsmay have two roots. •Maxillary and mandibular molars may exhibit additional roots. •Significant during extraction
  69. 69. DEVELOPMENTAL DISTURBANCES IN NUMBER OF TEETH 69 Anodontia Hypodontia Hyperdontia Oligodontia Supernumerary teeth
  70. 70. ANODONTIA 70 •Congenital absence of teeth Etiology: Hereditary Autosomal dominent Hereditary ectodermal dysplasia Cleidocranial dysplasia X-ray radiations Types: True Total Partial (hypodontia) False Pseudo
  71. 71. 71 Clinical features: Women Mongoloid Whites True total anodontia: All teeth missing Can be either deciduous or permanent True partial anodontia: Absence of one or more teeth Commonly missing teeth – 3rd molars, max. lateral incisors, max / mand. 2nd premolars
  72. 72. 72 False anodontia: Due to extraction of teeth Pseudoanodontia: Due to multiple unerupted teeth
  73. 73. HYPODONTIA 73 lack of development of one or more teeth. Common dental anomaly Etiology: • Familial tendency – point mutations transmitted in autosomal dominant pattern. • Missing third molars could be an evolutionary trend towards fewer teeth. •It is associated with hereditary ectodermal dysplasia • Xray radiation of face during early age – affecting the sensitive tooth buds .
  74. 74. 74  3.5%-8% (excluding third molars)  Female predominance about 1.5:1  Uncommon in primary dentition (<1%)  About 20-23% of population missing third molars.  After third molars, second premolars and laterals most frequent
  75. 75. 75 Syndromes associated with hypodontia  Ectodermal dysplasia  Chondroectodermal dysplasia (Ellis-van Creveld)  Progeria  Down  Hallermann-Streiff  Rieger  Crouzons  Albright hereditary osteodystrophy
  76. 76. 76  Prevalence of supernumerary teeth is about 1%-3% (higher rate in Asians)  Single tooth hyperdontia represent 75%- 85% of cases  More common in permanent dentition  Almost 90% in maxilla  Maxillary incisor region most common site then 4th molars,premolars and canines  If multiples, usually in mandibular premolar region HYPERDONTIA
  77. 77. 77 Syndromes associated with hyperdontia  Cleidocranial dysplasia  Oral-Facial-Digital  Apert syndrome. cleidocranial dysostosis
  78. 78. 78 Classification of supernumerary teeth Modified Howard s classification‟ Supplemental supernumerary teeth Accessory supernumerary teeth • Classified according to morphology and location, four different types • Conical • Tuberculate • Supplemental • Odontome
  79. 79. 79 Supplemental supernumerary teeth: These teeth duplicate the typical anatomy of anterior and posterior teeth Mesiodens: •Most common Supplemental supernumerary teeth •Small tooth with cone shaped crown and short root •Located near the midline in the incisor region of maxilla between the central incisors •Occurs single / multiple, erupted / impacted •Causes retarded eruption, displacement of adjacent tooth, or resorption of adjacent root and thus improper alignment of teeth
  80. 80. 80 DISTOMOLARS: Found in molar region Located distal to 3rd molars Generally these teeth are smaller than normal 2nd & 3rd molars But crown morphology is abnormal
  81. 81. 81 PARAMOLARS: It is an supernumerary molar Usually small and rudimentary Situated buccally or lingually to one of the maxillary molars Inter–proximally between 1st , 2nd , 3rd maxillary molars
  82. 82. TRANSPOSITION 82 Normal teeth erupting into an inappropriate position. •Usually involves the canine and first premolars. •Canine erupting between two premolars. •Could be confused with supernumerary teeth
  83. 83. 83 Developmental disturbances in the growth/eruption of the teeth Premature eruption. Delayed eruption. Ankylosed teeth. Submerged teeth/ impacted teeth
  84. 84. 84 NATAL TEETH Premature eruption of teeth like structures Present at birth They are hyper mobile because of their limited root development Conical or normal in size and shape Some teeth are so mobile that there is danger of displacement and possible aspiration – removal is indicated other wise not !!
  85. 85. 85 Sharp incisal edges may cause laceration of lingual surface of tongue → RIGA–FEDE DISEASE Associated with Ellis- van creveld syndrome
  86. 86. 86 Neonatal teeth These are the teeth or teeth like structures that erupt prematurely during neonatal period From birth to 30 days
  87. 87. 87 TREATMENT Extraction of teeth (if causing inconvenience) Or Rounding of the sharp angles of the teeth Extraction should be done after 10 days of life If not necessary tooth should not be removed
  88. 88. 88 ERUPTION SEQUESTRUM Anomaly associated with tooth eruption in children.  Described by Starkey and Shafer .  It is a tiny, irregular spicule of bone overlying the crown of an erupting permanent molar, found just prior to or immediately following the emergence of the tip of the cusps through the oral mucosa. Etiology  As the molar teeth erupt through the bone, they can separate a small osseous fragment from the surrounding bone similar to a cork screw.  In most cases, the fragment undergoes complete resorption before eruption.  If the bony spicule is large or the eruption is rapid, complete resorption cannot occur and hence, it is observed
  89. 89. 89 CLINICAL FEATURES  The child may complain of slight soreness in the area during function.  The spicule directly overlies the central occlusal fossa but is within the soft tissue.  It may be seen lying in a tiny depression over the crest of the ridge.  As the tooth erupts, the fragment of bone completely sequesters through the mucosa and is lost’ Radiographic features  It can be recognized even before the tooth eruption.  Seen as a tiny, irregular opacity overlying the central occlusal fossa but separated from the tooth itself.
  90. 90. DELAYED ERUPTION 90 In deciduous and permanent teeth, it is difficult to assess unless a gross variation is present. •Caused by Systemicconditions like rickets, cretinism, cleidocranial dysplasia •Localfactors like fibromatosis gingivae. •Treatment of the primary condition may lead to eruption of teeth
  91. 91. 91 IMPACTED TEETH  occurs due to obstruction from crowding  from some other physical barrier  occasionally, may be due to an abnormal eruption path, presumably because of unusual orientation of tooth germ
  92. 92. 92 Any tooth may be impacted –usually mandibular third molars(22%), maxillary third molars(18%) and maxillary cuspids(0.9%), premolars and supernumerary teeth. Mandibular teeth are more severly impacted.
  93. 93. ANKYLOSIS 93 fusion of a tooth to surrounding bone  with focal loss of periodontal ligament, bone + cementum become inextricably mixed  cause fusion of tooth to alveolar bone
  94. 94. 94 Reported prevalence of clinically detectable ankylosis- 1.5% to 9%  Primary molars are most commonly involved teeth with most cases in mandible Even with extreme root resorption, teeth lack mobility.
  95. 95. 95 •Diagnosis is suspected clinically and confirmed with radiographs. •There is partial absence of the periodontal ligament with areas of apparent blending between the root of the tooth and alveolar bone. complications Development of malocclusion •Local periodontal disturbance •Dental caries of both the ankylosed tooth and adjacent teeth. TREATMENT Depends on whether tooth are ankylosed or not permanent successor present or not
  96. 96. 96 DEVELOPMENTAL DISTURBANCES IN THE STRUCTURE OF THE TEETH Amelogenesis imperfecta Dentinogenesis imperfecta Regional odontodysplasia Dentin dysplasia Enamel hypoplasia
  97. 97. AMELOGENESIS IMPERFECTA 97  also known as:  Hereditary Enamel Dysplasia  Hereditary Brown Enamel  Hereditary Brown Opalescent Teeth
  98. 98. 98 Group of conditions caused by defects in the genes encoding enamel matrix proteins  genes that encode for enamel proteins:  amelogenin mutated in  enamelin in patients  others with this condition
  99. 99. 99 A heterogeneous group of hereditary disorders that demonstrate developmental alterations in the structure of enamel in the absence of a systemic disorder  Many subtypes  Numerous patterns of inheritance  Wide variety of clinical manifestations  Frequency varies between 1:718 and 1:14,000  Both dentitions involved
  100. 100. 100 Formation of enamel a multistep process Formation of enamel matrix Mineralization of matrix Maturation of matrix Hereditary defects of enamel formation usually classified as:  Hypoplastic  Hypocalcified  Hypomaturative
  101. 101. 101 Amelogenesis imperfecta Witkop classification
  102. 102. 102 Hypoplastic Amelogenesis Imperfecta  Inadequate formation of matrix FEATURES Teeth erupt with insufficient amounts of enamel.  Enamel present is mineralized appropriately and contrasts well with dentin on radiograph.  Teeth may have abnormal shape and open contacts.  Open bite may be present
  103. 103. 103 •Hypoplastic generalized pitted pattern. •Hypoplastic localized patern. •Hypoplastic autosomal dominant smooth pattern •Hypoplastic rough pattern
  104. 104. 104 HYPOPLASTIC GENERALIZED PITTED PATTERN  Pin point to pin head sized pits scattered. Buccal surfaces affected mure severly Pits may arranged in rows and columns.
  105. 105. 105 HYPOPLASTIC LOCALIZED PATTERN  Horizontal rows of pits,a linear depression. Middle third of buccal surfaces of teeth is aeffected.  Both dentition orprimary only may be aeffected
  106. 106. 106 HYPOPLASTIC AUTOSOMAL DOMINANT SMOOTH PATTERN Enamel of all teeth exhibit smooth surface,thin hard glossy surface. Absence of appropriate enamel thickness. Colour varies from opaque white to translucent brown. Radiographically, thin peripheral radiopaque enamel.
  107. 107. SMOOTH PATTERN 107
  108. 108. HYPOPLASTIC ROUGH PATTERN 108 Enamel is thin with hard rough surface Teeth taper towards incisal-occlusal surfaces. open contact points significant attrition and anterior open bite
  109. 109. 109 •ENAMEL AGENESIS •Demonstrate total lack of enamel •Teeth are shape and colour of dentin with yellow brown hue •Open contacts •Crowns taper towards incisally •Dentin is rough •Radiograph demonstrates no peripheral enamel overlying dentin •A lack of eruption of many teeth occurs frequently
  110. 110. HYPOMATURATION TYPE 110 Enamel matrix is laid down properly and begins to mineralize but there is a defect in maturation of enamel’s crystal structure  Affected teeth normal in shape  Mottled appearance-white, brown or yellow  Enamel soft and chips away from dentin  Enamel has similar radiodensity to dentin
  111. 111. 111 AUTOSOMAL DOMINANT HYPOMATURATION TYPE AUTOSOMAL RECESSIVE X LINKED RECESSIVE
  112. 112. HYPOMATURATVE-AUTOSOMAL DOMINANT 112 Commonly in males Both permanent and primary primary teeth-ground glass opaque white. Permanent teeth – mottled yellow white,darkened on absorption of stains
  113. 113. HYPOMATURATIVE-AUTOSOMAL RECESSIVE 113 Both primary and permanent dentition Enamel shows milky to shiny agar brown deeply stained on contact with exogenous agents Chips away around teeth restoration Teeth may resorbs within alveolus
  114. 114. HYPOPLASTIC X-LINKED RECESSIVE 114 Aeffects both dentitions White opaque areas on enamel of incisal and occlusal third of crown – SNOW CAPPED PATTERN
  115. 115. HYPOCALCIFIED –AMELOGENESIS IMPERFECTA 115 Proper amount of enamel matrix is formed but but it doesn’t mineralize properly.  Teeth shaped normally upon eruption but enamel is soft and easily lost  Enamel yellow-brown upon eruption but quickly becomes brown to black  Accumulate calculus.
  116. 116. HYPOMATURATION HYPOPLASTIC TYPE 116 •Enamel hypomaturation is the dominant feature. •Enamel is yellowish white to‐ yellowish brown.‐ •Pits are seen on buccal surface. •Enamel is similar to dentin in density. •Large pulp chambers with varying degrees of taurodontism.
  117. 117. HYPOPLASTIC-HYPOMATURATIVE AD 117 •Enamel hypoplasia is the dominant feature. •Enamel is thin BOTH PATTERNS SEEN IN TRICHODENTO OSSEOUS SYNDROME
  118. 118. TRICHO-DENTO-OSSEOUS SYNDROME 118 •Autosomal dominant disorder. •Shows hypoplastic hypomaturation‐ with severe taurodontism. •Kinky hairat birth which may straighten with age. •Osteosclerosisof the base of skull and mastoid process.
  119. 119. TREATMENT 119 Vary accoring to sub type and severity Main problems associated are esthetics,sensitivity,and loss of vertical dimension. Full coverage restoration recommended in attrition cases Less severe cases can be improved by placements of full crowns and facial veneers
  120. 120. DENTINOGENESIS IMPERFECTA 120 •Called Hereditary opalescent dentin, Capdepont’s teeth. •Only the mesodermal portion of the odontogenic apparatus is affected. •Dentin is defective. •Could be due to hereditary factors •Can be seen in association with osteogenesis imperfecta
  121. 121. CLINICAL FEATURES 121 Deciduous teeth are more severely affected •Gray to brownish violet or yellowish brown with a characteristic translucent or opalescent hue. •Broad crown with constriction of cervical area constriction – TULIP SHAPE
  122. 122. 122 Enamel may be lost earlyon incisal and occlusal surfaces due to the abnormal DEJ . •DEJ lacks the usual scalloping. •Dentin is attrited rapidly. •Occlusal surfaces of affected teeth are severely flattened.
  123. 123. 123
  124. 124. CLASSIFICATION BY SHIELDS 124 Type I –DI that always occur with OI– autosomal dominant. •Type II –DI that never occurs with OI– hereditary opalescent dentin –autosomal dominant . •Type III –DI –Brandy wine type–similar autosomal dominant
  125. 125.  1 in 8000 occurs in families with Osteogenesis Imperfecta  primary teeth are more severely affected than permanent teeth 125 TYPE I DENTINOGENESIS IMPERFECTA
  126. 126.  Radiographically:  partial or total obliteration of pulp chambers + root canals  by continued formation of dentin  roots may be short + blunted  cementum, periodontal membrane + bone appear normal 126 Type I DENTINOGENESIS IMPERFECTA
  127. 127.  never occurs in association with osteogenesis imperfecta unless by chance  most frequently referred to as hereditary opalascent dentin  only have dentin abnormalities and no bone disease 127 Type II DENTINOGENESIS IMPERFECTA
  128. 128.  Radiographically:  partial or total obliteration of pulp chambers + root canals  by continued formation of dentin  roots may be short + blunted  cementum, periodontal membrane + bone appear normal Type II Dentinogenesis Imperfecta 128
  129. 129.  “Bradwine type”  racial isolate in Maryland  multiple pulp exposures in deciduous not seen in type I or II  periapical radiolucencies Type III Dentinogenesis Imperfecta 129
  130. 130.  enamel appears normal  large size of pulp chamber is due not to resorption but rather to insufficient + defective dentin formation Type III Dentinogenesis Imperfecta 130 Witkop describes it as Shell teeth Radiographic features Roots are extremely short
  131. 131. HISTOLOGIC FEATURES 131 •Dentin has irregular tubules with large areas of uncalcified matrix. •Tubules are larger in diameter and lesser in number Cellular inclusions probably odontoblasts can be seen in dentin. •
  132. 132. 132 •The odontoblasts with limited ability to form well organized dentinal matrix,‐ appear to degenerate readily and get entrapped within the matrix. •Pulp chamber is obliterated by continuous dentin deposition
  133. 133.  Treatment: DENTINOGENESIS IMPERFECTA 133 oPreservation of vertical dimension of occlusion o Continued commitment & support to both child & family o Stainless steel crowns to protect against attrition o o Initial composite build – up for anteriors to be replaced by veneers later Overdentures / implants later.
  134. 134.  also known as “Rootless Teeth”  rare disturbance of dentin formation atypical dentin formation DENTIN DYSPLASIA 134 First described by Ballschmiede(1920) –spontaneous exfoliation of multiple teeth. •Rushton(1939) designated it as dentin dysplasia.
  135. 135. 135 Rare autosomal-dominant condition that affects dentin  Prevalence about 1:100,000  abnormal pulpal morphology
  136. 136. CLASSIFICATION 136 Shields: Type I –dentin dysplasia Type II –anomalous dysplasia of dentin •Witkops: Type I –Radicular dentin dysplasia –More common. Type II –Coronal dentin dysplasia
  137. 137.  Classification:  Type I (Radicular Type)  Type II (Coronal Type) DENTIN DYSPLASIA 137
  138. 138.  both dentitions are of normal color Most common type  prevalence 1:100000 Type I (Radicular Type) 138 (Rootless teeth) Wide variation in root formation because dentinal disorganization may occur at different stages of tooth development
  139. 139.  Radiographically:  roots are extremely short  pulps almost completely obliterated  periapical radiolucencies: • granulomas • cysts • chronic abscesses Type I (Radicular Type) 139
  140. 140.  autosomal dominant Root length is normal. Colour blue -amber to brown translucency  coronal pulps are usually large (thistle tube appearance)  filled with globules of abnormal dentin Type II (Coronal Type) 140
  141. 141.  Radiographically: (Deciduous)  roots are extremely short  pulps almost completely obliterated (Permanent)  abnormally large pulp chambers in coronal portion of tooth Type II (Coronal Type) 141
  142. 142.  also known as:  Odontogenic Dysplasia  Odontogenesis Imperfecta  Ghost Teeth 142 REGIONAL ODONTODYSPLASIA
  143. 143.  one or several teeth in a localized area are affected  maxillary teeth are involved more frequently than mandibular area  etiology is unknown 143
  144. 144.  teeth affected may exhibit a delay or total failure in eruption  shape is altered, irregular in appearance 144
  145. 145.  Radiographically:  marked reduction in radiodensity  teeth assume a “ghost” appearance  both enamel + dentin appear very thin  pulp chamber is exceedingly large 145
  146. 146.  Treatment:  poor cosmetic appearance of teeth  extraction with restoration by prosthetic appliance 146
  147. 147. ENAMEL HYPOPLASIA 147 An incomplete or defective formation of the organic enamel matrix of teeth. •It occurs only when the injury occurs during the development or more specifically, formative stage of enamel. TYPES: I.Hereditary type enamel hypoplasia II.Environmental type hypoplasia
  148. 148. Hereditary type enamel hypoplasia 148 •This is an ectodermal disturbance that occurs during the embryonic development of the enamel. • The mesodermal components are normal. Both the deciduous and permanent teeth are involved and only the enamel is affected. The three types of hereditary type of enamel hypoplasia are the: •Hypoplastic type, where there is a defective formation of organic matrix. •Hypocalcification type, in which there is a defective mineralization of the matrix. •Hypomaturation type, where there is a defective maturation of the matrix
  149. 149. Environmental type enamel hypoplasia- 149 This is caused by the environmental factors that causes damage to the enamel cells. Either deciduous or permanent teeth are involved and sometimes a single tooth is involved Hypoplasia results only if the injury occurs during the time the teeth are developing or more specifically during the formative stage of enamel development. The environmental factors which produce enamel hypoplasia can include
  150. 150. 150
  151. 151. CLINICAL FEATURES 151 Mild: Few small grooves, pits or fissures on enamel surface Moderate: Enamel may exhibit rows of deep pits arranged horizontally across tooth surface. Severe: pitting and brownish staining of the surface. Tendency of enamel to wear or fracture
  152. 152. TREATMENT 152 Treatment of enamel hypoplasia is always individualized and depends on the location and severity of then condition. The location of enamel hypoplasia also affects treatment options : > Anterior teeth - For sensitive teeth with no wear, desensitizing agent (such as potassium nitrate) as needed can be used. If there are esthetic concerns, composite or porcelain veneers may be bonded to afected tooth.
  153. 153. 153 Posterior teeth – 1. For sensitive teeth with minimal wear, desensitizing agent (such as potassium nitrate) can be used. 2. For mildly hypoplastic molars, place pit and fissure sealant on the occlusal surface. - at 6 month re-evaluation 3. Remove demineralized enamel and restore with composite. - at 6 month re-evaluation, if composite is lost, either replace using good isolation techniques or go to step 4 4. Perform minimal reduction of tooth and cement a stainless steel crown - evaluate clinically and radiographically as indicated
  154. 154. CASE REPORTS 154
  155. 155. 155 A CASE REPORT OF A PATIENT AFFECTED BY AMELOGENESIS IMPERFECTASHOWING A POSSIBLE MINIMAL AND CONSERVATIVE ADHESIVE TREATMENT APPROACH. A 14 years old boy with amelogenesis imperfecta consulted a dentist for full mouth rehabilitation After examination ,step by step minimum conservative approach planned. S Ardu O Duc I Krejci R Perroud Clinical views at the patient’s first appointment
  156. 156. 156 In the posterior area conservative resin composite onlays were realized , whereas in the anterior area freehand bonded composite restorations were performed according to the natural layering technique proposed. Intraoral view of the conservative preparations for resin composite onlays and clinical view after posterior onlays placement
  157. 157. 157 Intraoral view of the preparations for freehand bonded composite restorations and clinical view after teeth rehydration. Last image shows the clinical view after the placement of a cantilever bonded bridge 23
  158. 158. 158 Clinical views at the end of the treatment, together with the final treatment status at the 3-month recall. Except for the lithium disilicate bridge from 21–23, all other teeth are single-unit lithium disilicate bonded crowns.
  159. 159. 159 •case report describes a possible application of a minimally invasive approach for treating amelogenesis imperfecta in a young adolescent. •This conservative adhesive treatment allows a two-stage intervention that accompanies the patient during his adolescence until the complete formation of hard and soft tissues. •This will allow acceptable esthetics and lack of pain during eating and will allow the patient to have a more normal social life.
  160. 160. 160 Dan Emil GEORGESCU, Rodica LUCA and Elisa Mădălina CHIRCA Conducted study to assess the frequency of development anomalies of teeth and soft tissue in the anterior region, of a school children from Bucharest. cross sectional study is conducted Material and methods: 226 children from two secondary schools, aged between 5-8years •Children were examined in the school dental office. • The presence of dental development anomalies or of other types was recorded. • The frequency of developmental anomalies was determined. •4.87% of the examined school children had oral developmental anomalies: . Fused teeth
  161. 161. 161 Dental size anomalies (0.44%) - one fusion and one gemination and 9 abnormal maxillary frenum attachment (3.98%). Dental anomalies were found in front teeth, in both dentition. Diastema was found in permanent dentition, between the two upper central incisors. The evaluated age group had a low frequency for front teeth dental development anomalies. Follow up of all children is necessary until the eruption of all permanent teeth Gemination Diastema between the two upper permanent central incisors
  162. 162. 162 Endodontic treatment of developmental anomalies in posterior teeth: Treatment of geminated/fused teeth Nelly Steinbock Two cases of complex endodontic treatment of fused/geminated teeth are presented. The first is an 11-year-old girl with an anomalous ‘double’ first mandibular molar and premolar diagnosed as having necrotic pulp with chronic apical abscess of endodontic origin; . Fused crowns of the mandibular right first molar and second premolar
  163. 163. 163  Two separate endodontic access cavities were prepared in the fused crown in the molar and the premolar area •Five canal orifices were found – two leading to the distal root canals (emerging from the molar pulp chamber) and the other three leading to the mesial roots and emerging from the floor of the premolar pulp chamber •The canals were instrumented manually using K-files and irrigated with 3% sodium hypochlorite solution. • Working length was determined with an electronic apex locator Working length radiograph of the fused mandibular right first molar and second premolar •Follow-up 6 months later showed that the tooth was restored with composite filling
  164. 164. 164 The second is a 16-year-old boy with ‘double’ second and supernumerary mandibular molars, who was diagnosed with irreversible pulpitis. Preoperative radiograph of the geminated second molar tooth (fusion of molar with supernumerary). Clinical examination revealed an anomalous second molar that could have been a fusion of the mandibular right second molar with a supernumerary tooth in its mesiobuccal aspect •Radiographic examination •Two separate access cavities were prepared •Five canal orifices were found on the mesial side of the pulp chamber floor – two leading to the supernumerary tooth and three leading to the mesial root of the molar.
  165. 165. 165 Working length determination radiograph demonstrating five of the six canals. •Irrigated with 3% sodium hypochlorite solution •The tooth was obturated using the lateral condensation technique with AH-26 as a sealer DISCUSSION •Fusion and gemination are developmental anomalies with inherently unusual and bizarre anatomy. •A prerequisite for endodontic treatment of anomalous teeth is a careful examination of radiographs from various angles In both the cases, there was a communication between two parts of the pulp chambers and root canal systems. Thus, endodontic treatment was performed on both parts of these teeth.
  166. 166. 166 Dental Anomalies in Chinese Children with Cleft Lip and Palate Hai Ming Wong1*, Moon Cheung Lai2 and Nigel Martyn King3 • The prevalence of anomalies in children with CLP and to ascertain if there were any differences between the prevalence figures for CLP and non-CLP children • The sample consisted of 231 pairs of age and gender matched CLP and non-CLP southern Chinese aged between 12 and 16 years. • The dental records of the subjects were examined to gather data on anomalies of tooth number, size and shape. : Missing permanent maxillary lateral incisor and canines. Number of types of dental anomalies per individual Hypodontia (57.6%) Microdontia (42.4%), The cleft type associated with the highest percentage of supernumerary teeth was CL (25.0%),
  167. 167. 167 •Approximately 10% of BCLP, UCLP and CP children were found to have taurodontism Taurodontism of permanent maxillary first molars. •This group of Chinese CLP children exhibited the various types of dental anomalies. • Statistically higher prevalences of hypodontia, supernumerary teeth and microdontia were demonstrated in the CLP children than in the non- CLP children. A conical shaped supernumerary tooth in relation to permanent maxillary right canine
  168. 168. CONCLUSION 168 Anomalies on tooth have aesthtic,functional,psychological impact on the individual.so any abnormalities or pathologies on hard or soft tissues in oral cavity must prompt clinician to think beyond the local factors for proper diagnosis and treatment
  169. 169. References:References:  BooksBooks  Neville, et al: Oral and Maxillofacial PathologyNeville, et al: Oral and Maxillofacial Pathology 33rdrd EditionEdition Shafer, et al: A textbook of Oral Pathology,Shafer, et al: A textbook of Oral Pathology, 33rdrd EditionEdition Anil govindrao ghom:textbook of oral medicine.Anil govindrao ghom:textbook of oral medicine. 44thth editionedition Cawson, R.A: Cawson’s Essentials of OralCawson, R.A: Cawson’s Essentials of Oral Oral Pathology and Oral Medicine,Oral Pathology and Oral Medicine, 88thth EditionEdition 169
  170. 170.  Burkits textbook of oral medicine.11th edition.  DentalAnomalies inChineseChildrenwithCleft LipandPalate HaiMingWong1*, MoonCheungLai2andNigelMartynKing3  Endontic treatment of developmentalanomalies inposteriorteeth:treatment of fusionandgeminationteeth(endodontic journal2003) 170 Amelogenesis Imperfecta: A Conservative and Progressive Adhesive Treatment Concept S Ardu O Duc I KrejciR Perroud (operative dentistry 2013)
  171. 171. 171

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