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1
INTRODUCTION
Disorders of development of teeth
2
Disorders of development of teeth may be due to
abnormalities in the differentiation of the dental
lamina and the tooth germs, causing anomalies in
the number, size, and form of teeth (abnormalities
of morphological differentiation)
or to abnormalities in the formation of the dental
hard tissues resulting in disturbances in tooth
structure (abnormalities of histo differentiation).
3
Developmental Anomalies
Hypodontia
Alteration of
number
Hyperdontia
Alteration of
size
Developmental
anomalies
Alteration in
shape
Alteration in
structure
Amelogenesis
imperfecta
Gemination Taurodontism Dilaceration
Dentinogenesis
imperfecta Fusion Talons cuap
Dens
Regional Concresence
evaginatus 4
odontodysplasia
Developmental alteration in number
Hypodontia
Definition
The developmental absence of multiple teeth usually in association with
systemic manifestations
Etilogy
5
Clinical features
Missing tooth:
Primary or permanent.
Other abnormalities
-fusion,ankylosis and short roots.
6
Hyperdontia
Etiology
Clinical features
Types include- mesiodens, supplumental tooth, paramolar and distomolar
Treatment
Surgical removal
Orthodontic alignment if needed.
7
ANOMALIES AFFECTING SIZE OF TEETH
MICRODONTIA:
• Microdontia is a common disease of teeth.
• This is the disease in which all or some teeth of a person are smaller
than the normal size. ,
• Which occurs because of the genetic disorders.
TYPES OF MICRODONTIA
• TRUE GENERALIZED
• RELATIVE GENERALIZED
• LOCALIZED
8
TRUE GENERALIZED
• All the teeth are smaller than normal(fig:1)
• Occurs in pituitary dwarfism, down’s
syndrome and congenital heart disease
Fig : 1
9
RELATIVE GENERALIZED
Fig:2
10
LOCALIZED
• It involves only single tooth.
• It occurs with congenital heart disease, down syndrome
CLINICAL FEATURES:
Maxillary lateral incisors(peg shaped laterals) fig:3
and 3rd molars
11
MACRODONTIA
• Also called as megadontia fig:4
• It is of three types
TRUE MACRODONTIA:(fig :4)
• All the teeth are larger than normal.
• It is commonly associated with pituitary gigantism
RELATIVE GENERALIZED: (fig :5)
Teeth normal or slightly larger than normal teeth, but present
in small jaw
Fig:5
LOCALIZED: one or more large teeth
exits in relation to an normal dentition
12
Clinical features :
Crowding results in malocclusion
• Space is less
• Impaction of teeth
13
ANOMALIES AFFECTING SHAPE OF TEETH
GEMINTION:
Defined as a single enlarged tooth or joined
tooth in which the tooth count is normal when the
anomalous tooth is counted as one.(fig:6&7)
Fig:6 Fig:7
14
CLINICAL FEATURES
• The commonly affected teeth are deciduous mandibular
incisors and permanent incisors.
• Bifid crown on single root (fig:8 &9)
• It does not increase or decrease the number of teeth present
• Enamel or dentin of crown of geminated teeth may be
hypoplastic or hypocalcified fig:9
• fig: 8
15
FUSION
Defined as a single enlarged tooth or joined tooth
in which the tooth count reveals a missing tooth when the
anomalous tooth is counted as one.(fig:10)
fig:10
ETIOLOGY:
• Autosomal dominant trait
• Two separate developing tooth germ being initially close
together as they grow and expand they contact with each
other and the germs fuse to varying degree
16
CLASSIFICATION
COMPLETE:
• If fusion take place before calcification, the two teeth may be
completely united to form a single large tooth
INCOMPLETE:
• When the portion of crown has completed its formation ,
then there is union of root only.
CLINICAL FEATURES:
• Most common in anterior teeth(fig:11 & 12)
• Fig:11 Fig:12
17
• Deciduous dentition(fig:13)
fig:13
Fig:15
Fig:16 Fig:17
19
ETIOLOGY:
Occur due to traumatic injury
Over crowding of teeth with resorption and
interdental bone loss.
Distal inclination of crown of molar,
Space restriction during development
Excessive occlusal trauma and local infection after
development .
20
TYPES
• True concrescence: if roots are bound
during development
• Acquired concrescence: if the condition
occurs after development
21
CLINICAL FEATURES:
22
• The developmental pattern often involves a second
molar tooth in which its roots closely approx the
adjacent impacted third molar
23
• The resultant large pulpal exposure often permits pulpal
drainage, leading to a resolution of a portion of the intra bony
pathosis
• Cemental repair then occurs(fig:19)
Fig:19
24
TALON’S CUSP:
• It project lingually from cingulum area , of maxillary and
mandibular teeth or it is an anomalous hyperplasia of cingulum
on the lingual of maxillary and mandibular incisors, resulting in
the formation of supernumerary cusp (fig:20&21)
Fig:20 Fig:21
25
PATHOGENESIS
• A focal proliferation of tissue during development and
excuberant development of the fourth lobe (cingulum)
leads to development of talon cusp
CLINICAL FEATURES:
• common in both dentition
• Resembles like an eagle’s talon(fig:22)
• Cusp blends with the sloping lingual tooth Surface
• Talon cusp on mandibular lateral incisor
fig:22
26
• It composed of normal enamel, dentin and contains a form of
pulp tissue
• It is usually ‘T’ shaped(fig:23)
• Patient face problem with high incidence of caries.
• It is associated with RUBINSTEIN –TAYBI SYNDROME.
Fig:23
27
• Because many of these cusps contain pulp , rapid
removal often results in pulpal exposure
28
• On eruption , the affected tooth should be inspected for
the presence of a deep fissure at the junction between
the Talon’s cusp and surface of the tooth.
29
DILACERATION
The term dilaceration refers to an angulation or a
sharp bend or curve, in the root or crown of a formed
teeth(fig:24)
Fig:24
ETIOLOGY:
• Injury that displaces the calcified portion of the tooth
germ, and the remainder of the tooth is formed at an
abnormal angle
The damage frequently follows avulsion or intrusion of
the overlying primary predecessor.
30
• Bend develops secondary to the presence of an adjacent
cyst,tumor or odontogenic hamartoma
CLINICAL FEATURES:
• It is commonly formed in maxillary incisors
• The curve or bend may occur anywhere along the length of
the tooth, sometimes at cervical portion or midway along the
root or even just at the apex of root(F ig25&26)
31
DENS IN DENTE
• It is also called as dens invaginatus ,ordilated composite
odontome or gestant odontome
• It is a developmental variation which arises as a result of an
invagination in the surface of tooth crown before
calcification has occurred(Fig :27)
Fig :27
32
DENS EVAGINATUS
Fig35
33
CLINICAL FEATURES:
• It occur on premolar and molar teeth and usually occur
unilaterally and bilaterally
• It consists of all three dental tissue, ie enamel, dentin and pulp
• It appears as a tubercle of enamel on occlusal surface of the
affected tooth
• Polyp like protuberance in central groove, on lingual groove, on
lingual ridge of buccal cusp is seen(Fig36)
Fig36
34
ETIOLOGY:
• Due to an increased localized external pressure.
• Focal growth retardation and focal growth stimulation in certain
areas of the tooth bud(Fig 28)
CLASSIFICATION:
• Coronal dens invaginatus (Fig 28)
• Radicular dens invaginatus
35
CLINICAL FEATURES:
CORONAL DENS INVAGINATUS:
• Commonly affected tooth is permanent maxillary lateral
incisor(Fig:29)
• It is more common in female
• This condition is frequently bilateral
Fig:29
36
• In mild type form there is a deep pit cingulum(fig 31)
fig:31
37
• The crown may or may not be enlarged.
The shape of the crown may be conical or
it may be of irregular shape(Fig32)
Fig 32
Fig 33
39
• It is more common in mandibular 1st premolar, upper lateral
incisor and second molar
• It is usually unilateral
• Crown is small, short and conical with small orifice at the
extreme summit of the convexity(Fig34)
• Lingual marginal ridge is prominent
Fig :34
Fig37
41
CLASSIFICATION BY SHAW(Fig:38)
Fig:38
42
CLINICAL FEATURES:
• It affects permanent teeth more frequently than deciduous
teeth.
• It may be unilateral or bilateral
• The first molars is usually affected least , with increasing
severity noted in the second and third molars.(Fig:39)
• Involved teeth tend to be rectangle shape.
• Increased frequency of taurodontism - cleft lip and cleft palate
patients.
• It may occur as an isolated trait or as a component of a specific
syndrome.
43
•It may associate with certain dermatological
condition like epidermolysis bullosa,and
dyskeratosis congenita.
44
SUPERNUMERARY ROOTS
Fig40
45
• The most frequently affected teeth are permanent
molars(especially third molars) from either arch and
mandibular cuspids and premolars
• In some instance the supernumerary roots are divergent
• In some cases additional root is small(Fig41)
Fig41
46
Ectopic enamel:
It is also called as enameloma
• Ectopic enamel refers to the presence of enamel in
unusual locations, mainly the tooth root, known as
enamel pearls.
47
• Usually 1mm or 2mm in diameter,
that form on the root, or at bifurcation or trifurcation
of multi rooted teeth (fig42)
Fig:42
48
ETIOLOGY:
• It arises from local activity of remnants of Hertwig’s
epithelium, before it reduces to rests of malassez
49
CERVICAL ENAMEL EXTENSION:
• Occurs along the surface of dental roots,
these extensions represent a dipping of the
enamel from the cemento - enamel junction
toward the bifurcation of molar teeth.
50
• The base of the triangle is continuous with the inferior
portion of the coronal enamel, these areas of ectopic
enamel have been called cervical enamel
projections.(Fig43)
• Tiny nodule may be sufficiently close to gingival
margin to become involved in the periodontal problems
Fig43
51
• Involvement of deciduous molars is not rare
52
GLOBODONTIA
• It is common in crown of premolar and molar teeth.(Fig46)
Teeth have a round globular or clove leaf appearance.(Fig47)
Fig 46 Fig 47
53
MULBERRY MOLAR/ MOON’S MOLAR /
FOURNIER MOLAR’S
(Fig48)
54
• 1st molar is commonly involved.
• Cusp of teeth show exaggerated rounded or nodular
shapes.(Fig49)
Fig49
55
HUTCHINSON’S INCISOR
• Exhibit crowns that are shaped like straight-edge screw
drivers, with the greatest circumference present in the middle
one third of the crown and a constricted incisal edge often
demonstrates a central hypoplastic notch.(Fig50)
Fig 50
56
SHOVEL SHAPED INCISOR
• It is morphologically an anomally of the crowns of incisor teeth.
• It is more common in the maxillary lateral and central incisors most
frequently affected(Fig51)
Fig51
58
SYNOPSIS
AMELOGENESIS IMPERFECTA.
ENAMEL HYPOPLASIA
DENTINOGENESIS IMPERFECTA
DENTINE DYSPLASIA
REGIONAL ODONTODYSPLASIA
DENTINE HYPOCALCIFICATION
59
AMELOGENESIS IMPERFECTA (AI) :
Hereditary brown opalescent teeth, hereditary enamel dysplasia).
SUBGROUPS:
• Hypoplastic (HP)
• Hypocalcified (HC)
• Hypomaturation (HM)
PREVALENCE:
1 in 718 to 1 in 14,000- depending upon the population studied.
o Hypoplastic type- 60-73% of all cases.
o Hypomaturation type- 20-40%
o Hypocalcificatin type- 7%. 60
CLASSIFICATION OF AMELOGENESIS IMPERFECTA: (witkop-1989)
Type I Hypoplastic:
Type11: Hypomaturation:
62
Type 1V Hypomaturation-hypoplastic with taurodontism:
RADIOGRAPHIC FEATURES:
Enamel appears totally absent or sometimes when present may appear as a
very thin layer- tips of cusps & interproximal surfaces.
Hypoplastic type:
65
Hypocalcification type:
showing enamel which s soft and easily chips away and is caries prone
66
X-LINKED AMELOGENESIS IMPERFECTA.( hypoplastic , hypomaturation and smooth)
67
Hypomaturation: Alteration in enamel rod and rod sheath structures.
TREATMENT:
No treatment except for improvement of cosmetic appearance ( prosthetic
rehabilitation) 68
ENAMEL HYPOPLASIA:
TYPES:
HEREDITARY TYPE: As previously discussed under amelogenesis imperfecta.
They are:
•Nutritional deficiency (vit A , C& A)
•Exanthematous disease ( measels, chicken pox)
•Congenital syphilis.
•Hypocalcemia
•Birth injury, prematurity, rh hemolytic disease.
•Local infection or trauma.
•Ingestion of chemicals ( fluoride)
•Idiopathic.
69
Deep grooves arranged horizontally across the tooth surface.
70
Localized enamel hypoplasia of the mandibular central incisors.
71
CLINICAL FEATURES:
Since the pits tend to stain, clinical appearance of the teeth may be unsightly.
Clinical studies indicate that most cases of enamel hypoplasia involve those
teeth that form within first year after birth.
Teeth involved- maxillary & mandibular permanent incisors & first molars.
Upper central incisor is screw driver shaped, mesial & distal surfaces of crown
tapering & converging towards the incisal edge of tooth, in addition the incisal edge is
notched.
74
Mulberry molars/moon’s molars/ Fournier's molars:
Crowns of first molars are irregular & enamel of the occlusal surface & occlusal
third of tooth appears to be arranged in agglomerate mass of globules rather than
in well formed cusps.
MULBERY MOLARS
In tetany, the calcium serum level may fall as low as 6-8 mg/100 ml & vit D
deficiency, parathyroid deficiency may result in hypoplasia of teeth which is
of pitting variety.
Neonatal line or ring in deciduous teeth & first permanent molars may be
thought as a type of hypoplasia because there is a disturbance produced in
the enamel & dentine, which is indicative of trauma or change of environment
at time of birth.
Etiology:
Ingestion of fluoride containing drinking water during the time of tooth
formation.
Little mottling of any clinical significance at a level below 0.9-1.0 part per
million of fluoride in water & above which it becomes progressively evident.
Pathogenesis:
Mild- white opaque areas involving most of the tooth surface areas.
Mild fluorosis
Clinical features:
Affected teeth are gray to yellowish brown & have broad crowns with
constriction of cervical area. (”tulip shape”).
Radiographic features:
Tooth appears solid, lacking pulp chambers & root canals.
Classification:
DI type I : dentinogenesis imperfecta without osteogenesis
imperfecta.(opalescent dentine)
Teeth have bulbous crowns, roots are narrower than normal and pulp
chambers, root canals are smaller than normal or completely obliterated.
Clinical features:
Crowns of deciduous & permanent teeth wear rapidly after
eruption & multiple pulp exposures may appear.
87
Fig - showing dentinogenesis imperfecta with osteogenesis imperfecta with blue
sclera.
88
Radiographic features:
Deciduous dentition: shows very large pulp chambers & root canals
atleast during first few years, although it becomes reduced in size with
age.
Permanent teeth: have pulpal spaces that are either smaller than
normal or completely obliterated.
Histopathological features:
90
Fig -showing large sized and widely placed dentinal tubules and the
lack of normal density of intertubular collagen deposits.
91
Large pulp
chambers
Treatment:
Etiology:
Transmitted as autosomal dominant characteristic.
93
Clinical features:
Type 1 –
Both dentitions are affected.
Clinically normal in morphologic appearance and color, occasionally with slight amber
translucency & exhibit a normal eruption pattern, although may be delayed in few cases.
They exhibit extreme mobility and exfoliate prematurely due to abnormally short
roots.
Affected deciduous
dentition
Radiographic image of dentine dysplasia with short , blunt and conical teeth 95
Fig - Dentine dysplasia type 1 showing obliteration of the pulp except for the
occasional chevron radiolucency with periapical radiolucency.
96
Fig –dentine dysplasia type 11 periapical radiographs indicating teeth with relatively
normal roots and pulp chambers that contain large pulp stones.
97
Fig -showing teeth with obliterated pulp chamber and thistle tube
appearance.
Type 11: pulp chambers of deciduous teeth are obliterated & does
not occur before eruption.
Type 1:
A portion of coronal dentine is normal, apical to this may be areas of tubular dentine ,
osteodentin & fused denticles. “Lava flowing around boulders”- normal dentinal tubule
formation appears to have been blocked ,so that new dentine forms around obstacles
results from repetitive attempts to form root structure.
Tooth with gnarled and rippling formation of dysplastic dentine and lava flowing around
boulders appearance 99
Type 11:
Treatment:
Prognosis is poor & no treatment needed.
Requires extraction followed by prosthetic rehabilitation.
100
REGIONAL ODONTODYSPLASIA: (Ghost teeth, Odontodysplasia)
Unusual dental anomaly in which one or several teeth in a localized area are affected
in an unusual manner.
fig - showing localized area of mandible in which abnormal teeth are present surrounded
by increased soft tissue.
Enamel & dentine appear very thin & pulp chamber is exceedingly large. Enamel
layer most often not evident.
Treatment :
Extraction of tooth followed by prosthetic rehabilitation.
104
DENTINE HYPOCALCIFICATION:
Clinical features:
Gemination
Fusion
a)Complete
b)Incomplete
Concrescence
a)True
b)Acquired
• Talon’s cusp
• Dilaceration 107
• Dens in dente
108