Radiographic Interpretation of Dental Anomalies

1. Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2.  Developmental Abnormalities
 Acquired Abnormalities
 References

3.  Congenital abnormalities are typically genetically inherited
anomalies
 Developmental anomalies occur during the formation of a
tooth or teeth.
 Acquired abnormalities result from changes to teeth after
normal formation.
 Teeth that form abnormally short roots may represent
congenital or developmental anomalies.
 The shortening of normal tooth roots by external resorption
represents an acquired change.

5.  Hyperdontia, distodens, mesiodens, peridens, para-teeth, and
supplemental teeth
 Develop in addition to the normal complement as a result of
excess dental lamina in the jaws
 May be morphologically normal or abnormal.
 Usually discovered radiographically; may interfere with normal
tooth eruption
 Supplemental; have normal morphologic features
 Mesiodens; between the maxillary central incisors
 Distodens; Molar Area
 Peridens; Premolar area

6.  Occur in 1% to 4% of the population
 May have a greater incidence in Asians and Native Americans
 Twice as often in males.
 The deciduous or permanent dentitions; more common in the
permanent dentition.
 Single supernumerary teeth are most common in the anterior
maxilla and in the maxillary molar region
 Multiple supernumerary teeth occur most frequently in the
premolar regions, usually in the mandible

7.  They may appear entirely normal in both size and shape
 May also be smaller in size compared with the adjacent normal
dentition or have a conical shape with the appearance of a canine
tooth.
 Counting and identifying all the teeth in the jaws.
 Radiographs may reveal supernumerary teeth in the deciduous
dentition after 3 or 4 years of age when the deciduous teeth have
formed or in the permanent dentition of children older than 9 to 12
years.
 Occlusal radiographs may aid in determining the location and
number of unerupted supernumerary teeth.
 In some cases, the distorted image of a supernumerary tooth lying
outside the focal trough may be easily missed

8.  Differential Diagnosis
 Multiple supernumerary teeth have been associated with a
number of genetically inherited syndromes including
 Cleidocranial dysplasia
 Gardner’s Syndrome
 Pykodysostosis.

9.  Management
 The potential effect on the developing normal dentition, their
position and number, and the potential complications that may
result from surgical intervention.
 If supernumerary teeth erupt, they can cause malalignment of
the normal dentition.
 Those that remain in the jaws may cause root resorption and
their follicles develop into Dentigerous cysts or interfere with
the normal eruption sequence.
 Remove a supernumerary tooth or keep it under observation.

14.  A tooth may be considered to be developmentally missing when it
cannot be discerned clinically or radiographically, and no history
exists of its extraction.
 Hypodontia; Few Teeth (<8 teeth)
 Oligodontia; More than 8 Teeth
 Anodontia; Complete loss of teeth
 Developmentally missing teeth may also be the result of numerous
independent pathologic mechanisms
 Failure of a tooth germ to develop at the optimal time
 Lack of necessary space imposed by a malformed jaw
 Disproportion between tooth mass and jaw size.

15.  Hypodontia in Permanent Dentition - Excluding Third Molars - is
found in 3% to 10% of the population
 Hypodontia is more frequently found in Asians and Native
Americans.
 Although missing primary teeth are relatively uncommon but it is
usually a maxillary incisor.
 The most commonly missing teeth are Third Molars, followed by
Second Premolars and Maxillary Lateral and Mandibular
Central Incisors.
 Unilateral or Bilateral.
 Children who have developmentally missing teeth tend to have
more than one absent and more than one morphologic group
involved.

16.  Radiographic Features
 The development of teeth may vary markedly between
individuals.
 Missing teeth may be recognized by identifying and counting
the teeth present.
 For some individuals, however, the eruption of some teeth may
be delayed by a number of years after the established time
(especially mandibular second premolars)
 Whereas others may erupt as late as a year after the
contralateral tooth.

17.  Differential Diagnosis
 Anodontia or oligodontia; ectodermal dysplasia; AD; absence
of at least two ectodermally derived structures such as sweat
glands, hair, skin, nails, and teeth.
 When the teeth are involved, the condition may present with
multiple missing and/or malformed teeth that often have a
conical or canine shape or a notable decrease in tooth size.
 Management
 Missing teeth, abnormal occlusion, or altered facial
appearance may cause some patients psychologic distress.
 If the extent of hypodontia is mild; manageable by
orthodontics.

20.  Larger than normal teeth.
 Rarely affects the entire dentition.
 Often a single tooth, individual contralateral teeth, or a group of
teeth may be involved
 May occur sporadically, and its cause is unknown.
 Vascular abnormalities such as a hemangioma can result in an
increase in the size and accelerate the development of adjacent
teeth.
 Can also occur in hemi-hypertrophy of the face or in pituitary
gigantism.
 Clinical Features; Macrodont teeth appear large and may be
associated with crowding, malocclusion, or impaction

21.  Radiographic Features; Increased size of both unerupted and
erupted macrodont teeth.
 The shape of the tooth is usually normal, but some cases may
exhibit mildly distorted morphology.
 Crowding may cause impaction of adjacent teeth.
 Differential Diagnosis
 Sporadic macrodont tooth; gemination and fusion.
 COUNT!
 The differentiation between these three conditions may not
influence the treatment provided.
 Management; Most cases do not require treatment.
 Orthodontic treatment may be necessary if a malocclusion is
present.

23.  Smaller than normal teeth.
 Often the lateral incisors and third molars may be small.
 Generalized microdontia is extremely rare, although it does
occur in some patients with pituitary dwarfism.
 Supernumerary teeth may also be microdonts.
 Clinical Features; noticeably small and may have altered
morphology.
 Microdont molars may have an altered shape; may have four
cusps rather than five or four cusps rather than three
 Radiographic Features; These small teeth are frequently
malformed.

24.  Differential Diagnosis
 The recognition of small teeth indicates the diagnosis.
 Syndromes (e.g., congenital heart disease, progeria).
 Management
 Restorative or prosthetic treatment.

26.  A condition in which two typically adjacent teeth have exchanged positions
in the dental arch.
 Clinical Features
 The most frequently transposed teeth are the permanent canine and the
first premolar.
 Second premolars infrequently lie between the first and second molars.
 Transposition can occur with hypodontia, supernumerary teeth, or the
persistence of a deciduous predecessor.
 Radiographic Features; may reveal transposition when the teeth are not
in their usual sequence in the dental arch
 Differential Diagnosis; usually easily recognized.
 Management; frequently altered prosthetically for function and/or
esthetics.

28.  Synodontia
 Results from the union of adjacent tooth germs of developing
teeth.
 Some authors think that fusion results when two tooth germs
develop so close together that, as they grow, they contact and
fuse before calcification.
 Others contend that a physical force or pressure produced
during development causes contact of adjacent tooth buds.
 Males and females experience fusion in equal numbers,
 Incidence is higher in Asians and Native Americans.

29.  Reduced number of teeth in the arch.
 More common between deciduous teeth.
 When a deciduous canine and lateral incisor fuse, the
corresponding permanent lateral incisor may be absent.
 Fusion is more common in anterior teeth
 Fusion may be total or partial, depending on the stage of
odontogenesis and the proximity of the developing teeth.
 The result can vary from a single tooth of about normal size to a
tooth of nearly twice the normal size.
 The crowns of fused teeth usually appear to be large and single,
although incisal clefts of varying depth or a bifid crown can
sometimes occur

30.  Radiographic Features; The true nature and extent of the union are
frequently more evident on the radiograph.
 Fused teeth may also show an unusual configuration of the pulp
chamber or root canal.
 Differential Diagnosis Gemination and Macrodontia.
 Management; depends on which teeth are involved, the degree of
fusion, and the morphologic result.
 If the affected teeth are deciduous, they may be retained as they are.
 In the case of fused permanent teeth, reshaped with a restoration
 The morphology of fused teeth require radiographic evaluation
before the teeth are reshaped.
 Endodontic therapy may be necessary and perhaps may be difficult
or impossible if the root canals are of unusual shape.
 In some cases it is most prudent to leave the teeth as they are.

32.  Occurs when the roots of two or more primary or permanent
teeth are fused by cementum.
 Although its cause is unknown, many authorities suspect that
space restriction during development, local trauma, excessive
occlusal force, or local infection after development plays an
important role.
 If the condition occurs during development, it is sometimes
referred to as true concrescence.
 If the condition occurs later, it is acquired concrescence.
 The sexes are equally affected.

33.  Maxillary molars are the teeth most frequently involved, especially a
third molar and a supernumerary tooth.
 Involved teeth may fail to erupt or may erupt incompletely.
 Radiographic Features; May not always distinguish between
concrescence and teeth that are in close contact or that are simply
superimposed
 Additional projections at different angles may be obtained
 Differential Diagnosis
 If the roots are joined, it may not be possible to tell whether the
union is by cementum or by dentin (fusion).
 In this regard, the absence of a periodontal ligament (PDL) space
between the roots may be helpful.

34.  If the decision is made to remove one or both of the involved
teeth
 Effort to remove one might result in the unintended and
simultaneous removal of the other.

35.  Twinning
 Rare anomaly that arises when a single tooth bud attempts to
divide.
 The result may be an invagination of the crown with partial
division or, in rare cases, complete division through the crown
and root, producing identical structures.
 Complete twinning results in a normal tooth plus a
supernumerary tooth in the arch.
 The cause is unknown, but some evidence suggests that it is
familial.

36.  It more frequently affects the primary teeth, usually in the incisor region.
 It can be detected clinically after the anomalous tooth erupts.
 The occurrence in males and females is about equal.
 The enamel or dentin of geminated teeth may be hypoplastic or
hypocalcified.
 Radiographic Features; altered shape of the hard tissue and pulp
chamber of the geminated tooth.
 Radiopaque enamel outlines the clefts in the crowns and invaginations
and thus accentuates them.
 The pulp chamber is usually single and enlarged and may be partially
divided.
 In the rare case of premolar case, the tooth image suggests a molar with
an enlarged crown and two roots

37.  Management
 Areas of hypoplasia and invagination lines or areas of coronal
separation represent caries-susceptible sites that may in time
result in pulpal inflammation.
 Affected teeth can cause malocclusion and lead to periodontal
disease.
 Extraction, Restoration, or the tooth may be left untreated and
periodically examined.
 Before treatment is initiated on a primary tooth, the status of
the permanent tooth and configuration of its root canals should
be determined radiographically.

40.  The body of taurodont teeth appears elongated and the roots short.
 The pulp chamber has a more apically positioned pulpal floor.
 Permanent or primary dentition
 Usually fully expressed in the molars and less often in the premolars.
 Clinical Features; the distinguishing features of these teeth are not
recognizable clinically.
 Radiographic Features; The peculiar feature is the elongated pulp
chamber and the more apically positioned furcation
 The shortened roots and root canals are a function of the long body
and normal length of the tooth.
 Differential Diagnosis; Taurodontism has been reported with
greater frequency in trisomy 21 syndrome.
 Treatment; No treatment required

42.  Disturbance in tooth formation that produces a sharp bend or
curve in the tooth anywhere in the crown or the root.
 Likely developmental in nature
 Thought to be a result of mechanical trauma to the calcified
portion of a partially formed tooth.
 Clinical Features; If the dilaceration is so pronounced that the
tooth does not erupt
 Only clinical indication of the defect is a missing tooth.
 If the defect is in the crown of an erupted tooth, it may be
readily recognized as an angular distortion

43.  Radiographic Features; best means of detection
 The condition occurs most often in maxillary premolars.
 One or more teeth may be affected.
 If the roots dilacerate mesially or distally, the condition is
clearly apparent on a periapical radiograph.
 When the roots are dilacerated buccally (labially) or lingually,
the central x ray passes approximately parallel with the
deflected portion of the root and the apical end of the root may
have the appearance of a bull’s eye

44.  The PDL space around this dilacerated portion may be seen
as a radiolucent halo encircling the radiopaque area.
 Differential Diagnosis
 Fused roots, sclerosing osteitis, or a dense bone island.
 Management; does not require treatment
 Restoration/ Prosthesis
 Extraction; Difficult

47.  Dens in Dente
 Dilated Odontome
 Gestant odontome
 Tooth within a tooth
 Invagination or enfolding of the enamel surface into the interior
of a tooth.
 The least severe form of this enfolding is dens invaginatus
 The most severe form is the dilated odontome.
 Can occur in the cingulum area (dens invaginatus) or incisal
edge (dens in dente) of the crown or in the root during tooth
development

48.  When the abnormality involves the root, it may be the result of
an invagination of Hertwig’s epithelial root sheath and produce
an accentuation of the normal longitudinal root groove.
 Frequency of occurrence among Caucasian and Asian people,
the condition is found in approximately 5% of these two ethnic
groups.
 Appears to be rare in individuals of African descent.
 No sexual predilection exists.
 High degree of inheritability seems to exist.

49.  May appear as a small pit between the cingulum and the
lingual surface of an incisor tooth
 Occur most frequently in the Permanent maxillary Lateral
incisors, followed by the maxillary central incisors,
premolars, and canines and less often in the posterior teeth.
 The abnormality occurs symmetrically in about half the cases.
 Concomitant involvement of the central and lateral incisors
may occur.
 Pulpal inflammation.

50.  Radiographic Features
 The enfolding of the enamel lining is more radiopaque than the
surrounding tooth structure and can easily be identified as an
inverted teardrop-shaped radiolucency with a radiopaque border
 Less frequently the radicular invaginations appear as poorly defined,
slightly radiolucent structures running longitudinally within the root.
 The defects, especially the coronal variety, may vary in size and
shape from small and superficial to large and deep.
 If a coronal invagination is extensive, the crown is almost invariably
malformed and the apical foramen is usually wide
 In the most severe form (dilated odontome) the tooth is severely
deformed, having a circular or oval shape with a radiolucent interior
 Management; Restoration, Root Canal Therapy

53.  Leong’s premolar
 The result of an outpouching of the enamel organ.
 Enamel-covered tubercle
 Occurs in or near the middle of the occlusal surface of a premolar or occasionally a
molar
 Lateral incisors are most commonly involved
 Canines are rarely affected.
 The frequency of occurrence of dens evaginatus is highest in Asians and Native
Americans.
 Clinically, dens evaginatus appears as a tubercle of enamel on the occlusal surface
of the affected tooth.
 Hard, polyp-like protuberance predominantly exists in the central groove or lingual
ridge of a buccal cusp of posterior teeth and in the cingulum fossa of anterior teeth.
 Dens evaginatus may occur bilaterally and usually in the mandible.

54.  Radiographic Features
 Shows an extension of a dentin tubercle on the occlusal surface unless the tubercle
is already worn down.
 The dentin core is usually covered with opaque enamel.
 A fine pulp horn may extend into the tubercle, but this may not be visible
radiographically.
 If the tubercle has been worn to the point of pulpal exposure or has fractured, pulpal
necrosis may result
 This is indicated by an open apical foramen and periapical radiolucency.
 Multiple root formation is often associated with dens evaginatus, especially in
mandibular premolars.
 Differential Diagnosis
 The clinical and radiographic appearance may be characteristic
 May be difficult to visualize if the tubercle has been worn down to the occlusal
surface.
 Managemnet; Removal with caution

57.  Genetic anomaly arising from mutations that may have
occurred in one of four different genes that play some role in
enamel formation.
 May be inherited in an autosomal dominant or recessive
manner, or it may be inherited in an X-linked pattern.
 The mutation leads to marked changes in the enamel of all or
nearly all the teeth in both dentitions and is not related to any
time or period of enamel development or any clinically
demonstrable alteration (disease or dietary abnormality) in
other tissues.
 The enamel may lack the normal prismatic structure and be
laminated throughout its thickness or at the periphery.
 As a result, these teeth are more resistant to decay.

58.  The dentin and root form are usually normal.
 Eruption of the affected teeth is often delayed, and a tendency
for tooth impaction exists.
 Four general types have been delineated on the basis of their
clinical or radiographic appearances:
 Hypoplastic, Hypo-maturation, Hypo-calcified and a
hypomaturation/ hypoplastic type associated with taurodontism

59.  Hypoplastic Type.
 The enamel of the affected teeth fails to develop to its normal
thickness.
 The color of the underlying dentin imparts a yellowish-brown
color to the tooth.
 Enamel may be abnormal: rough, pitted, smooth, or glossy.
 The crowns of the teeth may appear undersized with a roughly
square shape.
 The reduced enamel thickness also causes a loss of contact
between adjacent teeth
 The occlusal surfaces of the posterior teeth are relatively flat with
low cusps.

60.  Hypomaturation; The enamel has a mottled appearance but is
of normal thickness.
 The enamel is softer than normal, its density comparable to
dentin, and it may break away from the crown.
 Its color may range from clear to cloudy white, yellow, or brown.
 In one form, the teeth may be capped with white, opaque
enamel, “Snow-capped” teeth.

61.  Hypocalcification. more common than the hypoplastic
variety.
 The crowns of the teeth are normal in size and shape when
they erupt because the enamel is of regular thickness
 Enamel is poorly mineralized (it is less dense than dentin), it
starts to fracture away shortly after it comes into function.
 The soft enamel abrades rapidly and the softer dentin also
wears down rapidly, resulting in a grossly worn tooth,
sometimes to the level of the gingiva.
 Has increased permeability and becomes stained and
darkened.

62.  Hypomaturation/ Hypo-calcification.
 If the dominant defect is hypomaturation, then hypomaturation-
hypocalcification is used.
 The enamel is usually mottled and discolored to a yellow or
brown color.
 The enamel has the same radiopacity as the dentin.
 When the dominant defect is hypo-calcification, hypo-
calcification-hypomaturation is used.
 The appearance of the teeth is similar, but the enamel is thin.

63.  Radiographic Features
 The radiographic signs of hypoplastic Amelogenesis
imperfecta include a square crown, a relative thin layer of
enamel, low or absent cusps, and multiple open contacts
between the teeth.
 The appearance of the anterior teeth on radiographs is
said to have a “ picket fence ”
 Pitted enamel appears as sharply localized areas of
mottled density, quite different from the image cast by a
tooth that is normal in shape and density.

64.  Differential Diagnosis
 If advanced abrasion is present and secondary dentin obliterates the
pulp chambers; similar to that of dentinogenesis imperfecta.
 Management; Restoration of the esthetics and function of the affected
teeth.

66.  Hereditary opalescent dentin
 Genetic anomaly involving primarily the dentin, although the
enamel may be thinner than normal.
 Three types of dentinogenesis imperfecta exist;
 Type I is associated with osteogenesis imperfecta and is caused
by mutations of one of two genes involved in synthesis of collagen
type I.
 The tooth roots and pulp chambers are generally small and
underdeveloped, and the primary dentition may be more severely
affected than the permanent dentition.
 Type II dentinogenesis imperfecta only affects the dentin without
any skeletal

67.  Type III dentinogenesis imperfecta, Brandywine isolate
 There is some controversy regarding the differentiation between
types II and III; however, type III teeth are said to exhibit enlarged
pulp chambers, making them more susceptible to pulp exposure.
 Type II and III dentinogenesis imperfecta are associated with
mutations of the (DSPP) gene located among a cluster of four other
genes involved in bone and/or dentin formation on chromosome 4.
 The incidence pattern of dentinogenesis imperfecta occurs with
equal frequency in both sexes.
 Both the deciduous and permanent dentition may show this defect.

68.  They show a high degree of amber-like translucency and a
variety of colors from yellow to blue-gray.
 The colors change according to whether the teeth are
observed by transmitted light or reflected light.
 The enamel easily fractures from the teeth and the crowns
wear readily.
 In adults the teeth may frequently wear down to the gingiva.
 The exposed dentin becomes stained.
 The color of the abraded teeth may change to dark brown or
even black.
 Some patients demonstrate an anterior open bite.

69.  Radiographic Features
 Bulbous appearance of crowns.
 The roots are usually short and slender.
 There may be partial or complete obliteration of the pulp chambers.
 Early in development, the teeth may appear to have large pulp
chambers, but these are quickly obliterated by the formation of
dentin.
 Ultimately the root canals may be absent or threadlike
 Occasionally, areas of rarefying osteitis may be seen in association
with what appears to be a sound tooth
 These lesions do not occur as frequently as in dentin dysplasia.
 The architecture of the bone in the maxilla and mandible is normal.

72.  Genetically inherited autosomal-dominant abnormality that
resembles dentinogenesis imperfecta.
 Type I Radicular; most marked changes are found in the
appearances of the roots
 Type II Coronal; changes in the crown are most clearly seen in
the altered shape of the pulp chambers.
 Dentin dysplasia is rarer than dentinogenesis imperfecta (1 :
100,000 compared with 1 : 8,000).

73.  Type I (the radicular form) teeth have mostly normal color and shape
in both dentitions.
 Occasionally a slight bluish-brown translucency is apparent.
 The teeth are often misaligned in the arch, and patients may
describe drifting and spontaneous exfoliation with little or no trauma.
 In type II, the crowns of the primary teeth appear to be of the same
color, size, and contour as those in dentinogenesis imperfecta.
 This is interesting evidence in light of the purported close genetic
linkage between the two dentin abnormalities.
 Although not universally accepted, reports exist that primary teeth
rapidly abrade.
 The permanent teeth have clinically normal-appearing crowns

74.  In type I dentin dysplasia, the roots of both the primary and permanent
teeth are either short or abnormally shaped.
 The molar roots have been described as having a shallow “ W ”
shape.
 The extent of obliteration of the pulp chambers and canals is variable.
 About 20% of type I dentin dysplasia teeth are associated with
rarefying osteitis.
 In type II dentin dysplasia, obliteration of the pulp chamber and
reduction in the caliber of the root canals occurs after eruption (at
least by 5 or 6 years).
 As the chambers of the molars are being filled with hypertrophic
dentin, the pulp chambers may become flame or thistle shaped and
may have multiple pulp stones.

75.  Differential Diagnosis
 Dentinogenesis imperfecta, because the appearances can appear
clinically similar.
 Both entities can produce crowns with altered color and occluded
pulp chambers.
 The finding of a thistle-tube – shaped pulp chamber in a single-
rooted tooth strengthens the probability of dentin dysplasia.
 In type II dentin dysplasia, however, the pulp chambers become
obliterated after eruption.
 The teeth in dentinogenesis imperfecta typically have bulbous
shaped crowns with a constriction in the cervical region, whereas
the crowns in dentin dysplasia are usually normal

76.  If the roots are short and narrow, the condition is likely to be
dentinogenesis imperfecta.
 On the other hand, normal-appearing roots or practically no roots at
all should suggest dentin dysplasia.
 Management
 Teeth with type I dentin dysplasia have such poor root support that
prosthetic replacement is about the only practical treatment.
 On the other hand, teeth that are of normal shape, size, and
support (type II) can be crowned if they seem to be rapidly
abrading.
 At the same time the esthetics of discolored anterior teeth can be
improved by prosthetic treatment.

79.  Enameloma
 Small globule of enamel 1 to 3 mm in diameter that occurs on
the roots of molars
 3% of the population
 Radiographs; smooth, round, and comparable in degree of
radiopacity to the enamel covering the crown
 Pulp Stone
 Calculus
 Removal in case of Periodontal Disease

83.  A permanent tooth with a local hypoplastic defect in its
crown.
 This defect may have been caused by the extension of a
periapical infection from its deciduous predecessor or by
mechanical trauma transmitted through the deciduous tooth.
 Clinical Features; Most often affects the mandibular
premolars, Caries
 The severity of the defect depends on the severity of the
infection or mechanical trauma and on the stage of
development of the permanent tooth.
 Brownish Spot on Tooth

84.  Radiographic Features; Alteration the normal contours of the
affected tooth and are often apparent on a radiograph.
 The involved region of the crown may appear as an ill-defined
radiolucent region.
 A stained hypomineralized spot may not be apparent because
a insufficient difference in the degree of radiopacity between
the spot and the crown of the tooth.
 The hypo-mineralized areas may become re-mineralized by
continued contact with saliva.
 Differential Diagnosis
 High doses of therapeutic radiation,
 Management; the esthetics and function of the deformed
crown can be restore

86.  Odontoclasts resorb the outer surface of the tooth.
 This most commonly involves the root surface but may also
involve the crown of an unerupted tooth
 Radiographs; Common sites for are the apical and cervical
regions.
 When the lesion begins at the apex, it generally causes a
smooth resorption of the tooth structure.
 Management; Remove the etiologic factors

91.  Pulp stones are foci of calcification in the dental pulp.
 They are probably apparent microscopically in more than half the teeth from
young people and in almost all the teeth from people older than 50 years.
 Only these larger concretions are radiographically apparent.
 Although the larger masses represent only 15% to 25% of pulpal calcification
 They are associated with any systemic or pulpal disturbance.
 Radiographic Features; may be seen as radiopaque structures within pulp
chambers or root canals or they may extend from the pulp chamber into the
root canals
 They may occur as a single dense mass or as several small radiopacities.
 They occur in all tooth types but most commonly in molars.
 Differential Diagnosis; pulpal sclerosis
 Management; None

93.  Calcification in the pulp chamber and canals of teeth.
 Diffuse process.
 Appearance correlates strongly with age.
 About 66% of all teeth in individuals between the ages of 10
and 20 years and
 90% of all teeth in individuals between the ages of 50 and
70 years show histologic evidence of pulpal sclerosis.
 Histologically the pattern is amorphous and unorganized
 Clinically silent
 Early pulpal sclerosis is not radiographically demonstrable.
 Diffuse pulpal sclerosis produces a generalized, ill- defined
collection of fine radiopacities throughout large areas of the
pulp chamber and pulp canals

95.  Excessive deposition of cementum on the tooth roots.
 Occasionally it appears on a supra-erupted tooth after the loss
of an opposing tooth.
 Usually resulting from rarefying or sclerosing osteitis.
 Occasionally Hypercementosis has been associated with teeth
that are in hyper-occlusion or that have been fractured.
 Hypercementosis occurs in patients with Paget ’ s disease of
bone
 Hypercementosis is evident radiographically as an excessive
buildup of cementum around all or part of a root
 Dense bone island or mature Cemento-osseous dysplasia.

98.  Chapter 19: Dental Anomalies