Developmental Anomalies Of Teeth

Developmental anomalies of the tooth, Microdontia, macrodontia,

1. Developmental Anomalies of Teeth Presented by:- Dr. Parikshit Kadam ( JR-I)

2. Content Introduction Developmental defects due to Size Number Shape Form Structure Review of literature Conclusion References

3. Introduction Developmental dental anomalies are marked deviations from the normal color , contour, size, number, and degree of development of teeth Local as well as systemic factors may be responsible for these developmental disturbances Such influences may begin before or after birth, hence deciduous or permanent teeth may be affected

4. DEVELOPMENT AL DISTURBANCES IN SIZE OF TEETH 4

5. MICRODONTIA Smaller than normal Boyle 1955 “ in general microdontia teeth are small, crowns are short and normal contacts between teeth are frequently misssing Ufomata 1988 it can be of whole crown, only crown or only roots Acoording to Shafer et al. Types : (a) True (b) Relative generalized (c) Involving single tooth - is common Shafer’s textbook of oral pathology, 7 th edition

6. All teeth are smaller than normal Occur in some cases of pituitary dwarfism Exceedingly rare Teeth are well formed (1) True Generalized Microdontia Shafer’s textbook of oral pathology, 7 th edition

7. Normal or slightly smaller than normal teeth are present in jaws that are somewhat larger than normal Since it is well recognized that a person may inherit the jaw size from one parent and the tooth size from other parent, there is an obvious role of heredity (2) Relative Generalized Microdontia Shafer’s textbook of oral pathology, 7 th edition

8. Common condition Affects most often maxillary lateral incisior and 3 rd molar I nstead of parallel or diverging mesial and distal surfaces, the sides converges or taper together incisally , forming a peg-shaped or cone shaped crown (3) Focal/Localized Microdontia Shafer’s textbook of oral pathology, 7 th edition

9. HUTCHINSON’S INCISORS Characteristic of congenital syphilis Lateral incisors are peg-shaped or screwdriver-shaped Widely spaced Notched at the end With a crescent-shaped deformity Shafer’s textbook of oral pathology, 7 th edition

10. Occurance in children : Rare (less than 1%) in primary teeth • More common (2.5%) in permanent teeth • Females more frequently affected than males Etiology : Multifactorial Generalized microdontia is rare and may be associated with congenital hypopituitarism or exposure to radiation or chemotherapy during dental development In contrast, localized microdontia is more common and is frequently followed by hypodontia Shafer’s textbook of oral pathology, 7 th edition

11. Clinical Significance Spacing due to microdontia is disturbing cosmetically Midline shift Reduced overjet Mesial movement of upper molars Syndromes in which microdontia may be seen include the trisomy 21 syndrome, the ectodermal dysplasia syndromes, focal dermal hypoplasia , Silver–Russell Shafer’s textbook of oral pathology, 7 th edition

12. Treatment Unerupted microdonts may require surgical removal to prevent the formation of  cysts  Erupted microdonts , peg laterals especially, may cause cosmetic concern. Such teeth may be restored to resemble normal sized teeth, typically with  composite  build ups or  crowns   Orthodontics  may be required in severe cases to close gaps between the teeth

13. MACRODONTIA Teeth which are larger than normal Also known as MEGADONTIA 3 types: True Generalized Relatively Generalized Localized 13 Shafer’s textbook of oral pathology, 7 th edition

14. Occurance in children:- Rare (1.1%) in permanent dentition Etiology : Hereditary klinefelter syndrome Pitutary gigantism Insulin resistant diabetis Hemifacial hypertrophy Shafer’s textbook of oral pathology, 7 th edition

15. A ll teeth are larger than normal Pituitary gigantism E xceedingly rare (1) True Generalized Macrodontia Shafer’s textbook of oral pathology, 7 th edition

16. N ormal or slightly larger than normal teeth in small jaws R esults in crowding of teeth I nsufficient arch space (2) Relative Generalized Macrodontia Shafer’s textbook of oral pathology, 7 th edition

17. Uncommon condition Unknown etiology Usually seen with mandibular 3 rd molars (3) Focal/Localized Macrodontia

18. Localization :- Lower third molars and second premolars Upper central incisors • Frequent bilateral symmetry Management:- Aesthetic restoration Orthodontic treatment of the crowding Extraction Shafer’s textbook of oral pathology, 7 th edition

19. Case report Isolated bilateral macrodontia of mandibular second premolars : A case report Ebru Canoglu , harun Canoglu , Alper Aktas , Zafer C. Cehreli ; European Journal of Dentistry; July 2012 ; vol:6

20. DEVELOPMENTAL DISTURBANCES IN NUMBER OF TEETH 20 Anodontia Supernumerary teeth

21. Anodontia True Induced or false Pseudo anodontia anodontia Total Partial Hypodontia Oligodontia

22. TRUE ANODONTIA Congenital absence of teeth 22 Total Anodontia All teeth are missing Both deciduous & permanent dentition Rare condition Hereditary ectodermal dysplasia Partial Anodontia One or few teeth missing. Relatively common condition

23. PARTIAL ANODONTIA Involves one or more teeth Common condition Maxillary lateral incisors, maxillary or mandibular 2 nd premolars, third molars 23 Hypodontia Lack of development of one or more teeth Oligodontia Lack of development of six or more teeth

24. when teeth are absent clinically because of impaction or delayed eruption when teeth have been Exfoliated or extracted Pseudoanodontia False anodontia

25. Missing teeth Male (n=571) Female (n=552) Total(1123) Maxillary central incisors 4 (0.70) 2 (0.36) 6 (0.53) Maxillary lateral incisors 9 (1.58) 10 (1.81) 19 (1.69) Mandibular central incisors 5 (0.88) 2 (0.36) 7 (0.62) Maxillary premolars 3 (0.53) 3 (0.54) 6 (0.53) Mandibular premolars 2 (0.35) 3 (0.54) 5 (0.45) Maxillary molars 1 (0.18) 2 (0.36) 3 (0.27) Mandibular molars 1 (0.18) 1 (0.09) Total 24 (4.20) 23 (4.17) 47 (4.19) Saurabh gupta , payal saxena et al. Journal of oral science.vol 53.No 2, 231-238, 2011

26. Management Partial dentures Fixed dental prosthesis Implants Implant age selection Must be carefully selected Implant placement should postponed till permanent dentition period Implants acts as ankylosed teeth and can affect growth of jaws and change position accordingly

27. SUPERNUMERARY TEETH - Supernumerary tooth is one that is addition to the normal series and can be found in almost any region of dental arch Teeth may have: normal morphology rudimentary miniature Supernumerary deciduous teeth- male> female, maxillary anterior> mandibular anterior Supernumerary permanent dentition- male> female,maxilla >mandible

28. Etiology 1) Supernumerary teeth develop from a third tooth bud 2) Hyperactivity theory 3) Hereditary tendency Supernumerary teeth associated with cleft lip and palate result from fragmentation of the dental lamina during cleft formation and commonly seen in the maxillary lateral incisor area

29. CONICAL ( MESIODENS) TUBERCULATE - Often paired - Commonly located on the palatal aspect of central incisors Seema D bagle , shital DP Kiran non- syndromic occurrence of true generalized microdontia with mandibular mesiodens - a name case Head face medicine 2011; 7 ; 19

30. - SUPPLEMENTAL - Duplication of teeth - Maxillary lateral incisors > Premolars & molars - Primary dentition FOURTH MOLAR - Common in maxillary molar area .

31. DISOMOLAR/ DISTODENSE Molar located distal to molar PARAMOLARS

32. ODONTOME 4 th category of supernumerary teeth by Howard Odontoma refers to any tumor of odontogenic origin It represents a hamartomatous malformation rather than a neoplasm The lesion is composed of more than one type of tissue & consequently has been called a composite odontoma 2 types:- 1) complex composite odontoma :- the different type of tissue which is totally disorganized 2) Compound Composite odontoma :- malformation which hears some superficial anatomical similarity to normal tooth

33. Supernumerary teeth may be impacted or erupted. Because of additional tooth bulk, it cause (1) malposition of adjacent teeth (2) prevent their eruption Management - Indication for removal of supernumerary tooth - Altered eruption or displacement of central incisors - Active orthodontic alignment of an incisor in close proximity - Grafting in cleft lip and palate patients. - The tooth is present in bone designated for implant placement

34. Supernumerary Teeth in Indian Children:A survey of 300Cases The aim of this investigation was to study children with supernumerary teeth who visited the Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Rohtak , Haryana, India Only children with supernumerary teeth were included in the study while patients having supernumerary teeth with associated syndromes were excluded Supernumeraries were detected by clinical and radiographic examination A. Sharma and V. P. Singh, International Journal of Dentistry Volume 2012, Article ID 745265, 5 pages

35. The results indicated that males were affected more than females with a sex ratio of 2.9:1. Single supernumerary tooth was seen in 79% of the patients, 20% had double, and 1% had three or more supernumeraries. Premaxillary supernumeraries accounted for 93.8% of the cases. Conical shaped supernumerary teeth were the most common type (59.7%). Majority of supernumeraries remained unerupted (65%). Fusion of supernumerary tooth with a regular tooth was observed in 4% of the patients. Talon cusp, an associated dental anomaly, was seen in 5% of the cases. Simultaneous hypodontia occurred in 2.3% of patients with supernumeraries A. Sharma and V. P. Singh, International Journal of Dentistry Volume 2012, Article ID 745265, 5 pages

36. DEVELOPMENTAL DISTURBANCES IN SHAPE & FORM OF TEETH Crown Fusion Gemination Taurodontism Talon’s Cusp Dens evaginatus 38

37. Dens Invaginatus Peg-shaped Lateral Mulberry Molar

38. FUSION Fused teeth arise from union of two normally separated tooth germs If union occurs before calcification – teeth completely united If union occurs after calcification – roots get fused Primary (2-3%) > Permanent (1-2%) (Graham & Granath ) Can occur between same dentition or primary to permanent dentition ( Caceda 1994)

39. Fusion of primary teeth may lead to congenital absence of permanent teeth Associated syndrome: Solitary median maxillary central incisor syndrome Management : Cause problems with spacing, alignment and function Mesiodistal disking Surgical extraction Shrestha , Ashish ; Marla, Vinay ; Shrestha , Sushmita ; Maharjan , Iccha K Developmental anomalies affecting the morphology of teeth – a review RSBO Revista Sul-Brasileira de Odontologia , vol. 12, núm.1,enero-marzo, 2015, pp. 68-78

40. Solitary median maxillary central incisor syndrome Very rare condition Present as single midline symmetrical maxillary central incisor Due to mutation in SHH gene Shrestha , Ashish ; Marla, Vinay ; Shrestha , Sushmita ; Maharjan , Iccha K Developmental anomalies affecting the morphology of teeth – a review RSBO Revista Sul-Brasileira de Odontologia , vol. 12, núm.1,enero-marzo, 2015, pp. 68-78

41. CASE REPORT Unilateral fusion of primary molars with the presence of a succedenous supernumerary tooth : case report Jorge Caceda ; Curtis creath ; Joe p Thomas; Pediatric dentistry; Jan-Feb 1994; Volume: 16; num :1

42. GEMINATION Arise from attempt at division of single tooth germ by invagination, resulting incomplete formation of two teeth One structure with two completely / incompletely separated crowns having single root or root canal More in primary dentition Shrestha , Ashish ; Marla, Vinay ; Shrestha , Sushmita ; Maharjan , Iccha K Developmental anomalies affecting the morphology of teeth – a review RSBO Revista Sul-Brasileira de Odontologia , vol. 12, núm.1,enero-marzo, 2015, pp. 68-78

43. Twinning Coined by Levitas 1965 Production of equivalent structures by division resulting in one normal & one supernumerary tooth Shrestha , Ashish ; Marla, Vinay ; Shrestha , Sushmita ; Maharjan , Iccha K Developmental anomalies affecting the morphology of teeth – a review RSBO Revista Sul-Brasileira de Odontologia , vol. 12, núm.1,enero-marzo, 2015, pp. 68-78

44. Case Report Twins on either side : A case report of bilateral Gemination Prasanna kumar rao , Veena KM, Laxmikanth Chatra ; Scientific reports; 2012, vo :1;issue : 6

45. TAURODONTISM Originated by Sir Arthur Keith in 1913 Body of the tooth is enlarged at the expense of the roots. ‘Bull- like’ teeth 48 Shafer’s textbook of oral pathology, 7 th edition

46. Causes : (Enumerated by Mangion) Specialized or retrograde character Primitive pattern Mendelian recessive trait Mutation resulting from odontoblastic deficiency during dentinogenesis of roots Failure of hertwig’s epithelial sheath to invaginate at proper horizontal level. (Hammer & his associates ) 50 Shafer’s textbook of oral pathology, 7 th edition

47. Clinical Features : Either deciduous or permanent dentition Molars Unilateral or bilateral Radiographic Features : Involved teeth– rectangular shape Pulp chamber– extremely large– much greater apico-occlusal height Pulp lacks usual constriction at cervical of tooth Roots– exceedingly short Furcation – only few mm above the apices of roots 51

48. Syndrome associated: Klinerfelter’s syndrome Trichodento -osseous syndrome Ectodermal dysplasia Downs syndrome Diagnosis Made only radiographically . Treatment : No specific therapy Shafer’s textbook of oral pathology, 7 th edition

49. TALONS CUSP Anomalous structure Resembles eagle’s talon Projects lingually from the cingulum area Maxillary or Mandibular permanent incisor Composed of normal enamel & dentin & contains a horn of pulp tissue Clinical problems include: esthetics, caries control, occlusion 53 Shafer’s textbook of oral pathology, 7 th edition

50. Three types : Type 1 : Additional cusp from incisal edge to half to CEJ Type 2 : Semi talon, extends from incisal edge to 1mm past half of the CEJ Type 3 : Prominent enlarged cingulum Treatment: * Prophylactically restoring groove– to prevent caries * Occlusal interference–- it should be removed, but exposure of pulp horn— endodontic treatment Shrestha , Ashish ; Marla, Vinay ; Shrestha , Sushmita ; Maharjan , Iccha K Developmental anomalies affecting the morphology of teeth – a review RSBO Revista Sul-Brasileira de Odontologia , vol. 12, núm.1,enero-marzo, 2015, pp. 68-78

51. Case report Talon’s cusp of anterior teeth : A Case report Moksha Nayak,Jitendra kumar,Krishna Prasad; Journal of Endodontology

52. SHOVEL- SHAPED TEETH Characterstic shape on lingual side Lingual side is deeply concave giving tooth appearance of shovel Seen in chinese , japanese , eskimos , north/south american indians Anterior maxilla

53. PARAMOLAR TUBERCLES / BOLK CUSP Genetic basis Seen on buccal surface of mesiobuccal cusp in permanent and deciduous teeth Vary in populations, never seen in negroes Observed in 31% of a group of Pima Indians

54. DENS EVAGINATUS Occlusal Tuberculated Premolar, Leong’s Premolar, Evaginated Odontome , Occlusal Enamel Pearl Prevalence : 2.2 % Yip 1974 Appears clinically as an accessory cusp or a globule of enamel Occlusal surface between buccal & lingual cusps of premolars Unilaterally or bilaterally 58 Shafer’s textbook of oral pathology, 7 th edition

55. Pathogenesis : proliferation & evagination of an area of inner enamel epithelium & subjacent odontogenic mesenchyme into dental organ during early tooth development. Can cause: * I ncomplete eruption * Displacement of teeth * Pulp exposure * Occlusal wear * Fracture 59 Shafer’s textbook of oral pathology, 7 th edition

56. Treatment Vital teeth : Selective grinding followed by fissure sealing [ Hill&Bellis (1984)] Selective pulpotomy Nonvital teeth : endodontic treatment

57. DENS INVAGINATUS Dens In Dente, Dilated Composite Odontome Developmental variation- Invagination in the surface of tooth crown before calcification has occurred Etiology- Increased localized external pressure Focal growth retardation Focal growth stimulation in certain areas of tooth bud 61 Pediatric dentistry, scientific foundation and clinical practice by Stewart and Barber, 1 st edition.

58. Type I Confined to the crown Type II Extends below cemento enamel junction Ends in a blind sac May or may not communicate with adjacent dental pulp Type III Extends through the root Perforates in the apical or lateral radicular area without any immediate communication with pulp

59. It is a condition resulting from invagination of inner enamel epithelium in enamel organ producing the appearance of tooth within a tooth ( pinkham ) Radicular invagination results from infolding of Hertwig”s sheath and takes its origin from the root after development is complete ( Bhatt and Dholakia ) Permanent maxillary lateral incisor Bilateral Mild form: deep invagination in the lingual pit area–- not evident clinically.

60. Radiographically- pear shaped invagination of enamel & dentin Severe form: invagination extends nearly to the apex of the root Can cause: caries, pulp infection, premature loss of tooth Treatment: prophylactic restoration . 64

61. Undersized lateral incisor Smaller than normal Occurs when permanent lateral incisors do not fully develop PEG SHAPED LATERALS

62. Dental condition usually associated with congenital syphilis Characterized by multiple rounded rudimentary enamel cusps on permanent 1 st molars MULBERRY MOLARS

63. Dwarfed molars with cusps covered with globular enamel growths Giving the appearance of a mulberry

64. Root Concresence Enamel Pearl Dilaceration Flexion Ankylosis Supernumerary roots Shape and Form

65. 2 fully formed teeth Joined along the root surfaces by cementum Noted more frequently in posterior and maxillary regions CONCRESCENCE

66. Case report Concrescence in primary dentition: A case report Zakirulla Meer, N Rakesh;International journal of clinical dental science;May 2011;2(2)

67. Dilaceration Angulation or a sharp bend or curve in root or crown of a formed tooth Trauma to a developing tooth can cause root to form at an angle to normal axis of tooth Rare deformity Usually seen in deciduous dentition

68. Three main etiologic theories for dilacerations Acute trauma Before 4-5yrs of age Scar formation Trauma to primary tooth causes a wound – scar prevents normal eruption, root adheres to scar & rotate around this fixed point Primary tooth germ developmental anomaly Treatment: Deciduous teeth – Extraction Permanent teeth Minor – no treatment Delayed / abnormal eruption – surgical exposure and extraction Nonvital teeth – Endodontic treatment /extraction Extensive --- Extraction

69. D roplets of ectopic enamel so called enamel pearls May occasionally be found on roots of teeth Uncommon , minor abnormalities, which are formed on normal teeth ENAMEL PEARLS

70. Occur most commonly in bifurcation or trifurcation of teeth May occur on single-rooted premolar as well Maxillary molars are commonly affected than mandibular molars

71. also known as “submerged teeth” F usion of a tooth to surrounding bone Deciduous teeth most commonly mandibular 2 nd molars Undergone variable degree of root resorption ANKYLOSIS

72. This process prevents their exfoliation + subsequent replacement by permanent teeth After adjacent permanent teeth have erupted, ankylosed tooth appears to have submerged below level of occlusion

73. SUPERNUMERARY ROOTS Development of an increased number of roots in a tooth compared with normal May involve any tooth Mandibular bicuspids & cuspids Both maxillary & mandibular molars–-particularly 3 rd molars. 78

74. Deviation or bend restricted just to the root portion Usually bend is less than 90 degrees May be a result of trauma to the developing tooth FLEXION

75. DEVELOPMENTAL DISTURBANCES IN STRUCTURE OF TEETH Amelogenesis Imperfecta Environmental Enamel Hypoplasia Dentinogenesis Imperfecta Dentin Dysplasia Regional Odontodysplasia 80

76. AMELOGENESIS IMPERFECTA Amelogenesis = enamel formation Imperfecta = imperfect Also known as * Hereditary Enamel Dysplasia * Hereditary Brown Enamel * Hereditary Brown Opalescent Teeth It is a heterogeneous group of hereditary disorders of enamel formation 81

77. The first definition of AI – as a disease caused by a primary defect in enamel – has been attributed to Weinmann et al (1945) Subsequently, Witkop and Rao (1971) defined AI as “ A group of disfiguring hereditary conditions’ which affect the clinical appearance of enamel of all or nearly all the teeth, which occur in kindreds such that all the individuals in the kindred show essentially the same defect and which are unassociated with known morphologic or biochemical changes elsewhere in the body” 82

78. Mutations in following genes: AMELX (associated with enamel protein amelogenin , X-linked and linked with all 14 types) ENAM (associated with enamelin , associated with autosomal dominant and recessive patterns of HP AI) MMP-20 (encodes for proteinase named enamelysin , correlated with autosomal recessive, HM AI) KLK-4 (Protease kallikrein-4, associated with HM AI) DLX-3 (associated with various group of proteins that code for craniofacial, tooth, hair, brain and neural development. Correlated with HP-HM with taurodontism AI)

79. CLASSIFICATION – WITKOP’S (1988) Type I Hypoplastic (60-73%) IA – hypoplastic, pitted autosomal dominant lB – hypoplastic, local autosomal dominant (ENAM) IC – hypoplastic, local autosomal recessive ID – hypoplastic, smooth autosomal dominant (ENAM) IE – hypoplastic, smooth X-linked dominant (AMELX) IF – hypoplastic, rough autosomal dominant IG – enamel agenesis, autosomal recessive Type II Hypomaturation (20-40%) IIA – hypomaturation , pigmented autosomal recessive IIB – hypomaturation , (AMELX) IIC – snow-capped teeth, X-linked lID – autosomal dominant

80. Type III Hypocalcified (7%) IIA – autosomal dominant IIB – autosomal recessive Type IV - Hypomaturation –hypoplastic with taurodontism IVA – Hypomaturation –hypoplastic with taurodontism , autosomal dominant IVB – Hypoplastic– hypomaturation with taurodontism , autosomal dominant

81. Inadequate formation of matrix Enamel is randomly: pitted grooved or very thin hard + translucent Defects become stained but teeth are not especially susceptible to caries unless enamel is scanty and easily damaged Hypoplastic Amelogenesis Imperfecta

82. R educed enamel thickness abnormal contour absent interproximal contact points Radiographically: Enamel reduced in bulk Shows thin layer over occlusal interproximal surfaces Dentin + pulp chambers appear normal

83. Enamel is normal in form on eruption but: Opaque White to brownish-yellow Softer than normal Tends to chip from underlying dentin Hypomaturation Amelogenesis Imperfecta

84. Radiographic Features : Enamel may appear totally absent. When present-- appear as very thin layer mainly over tips of the cusps & interproximal surfaces Enamel & dentin–- same radiodensity

85. Enamel matrix is formed in normal quantity Poorly calcified When newly erupted: enamel is normal in thickness normal form but weak opaque or chalky in appearance Hypocalcified Amelogenesis Imperfecta

86. Radiographically: density of enamel + dentin are similar

87. hypomaturation-hypoplastic amelogenesis imperfecta with taurodontism Distinct from trichodentoosseous (TDO) syndrome Teeth meet at contact points, normal contour Softer than normal, ground glass opaque white appearance Shows alternate vertical bands of white opaque and normal translucent enamel Seen commonly in boys

88. Histologic features: There is disturbance in the differentiation or viability of ameloblast in the hypoplastic type , and this is reflected in defect in matrix formation ,including total absence in matrix formation In the hypocalcification types there are defect of matrix structure and of mineral deposition. In hypomaturation types there are alterations in enamel rods and rod sheath structure.

89. Radiographic features: Overall shape of the tooth may or may not be normal, depending on the amount of enamel present on the tooth and the amount of occlusal and incisal wear. Enamel may be totally absent on the radiographs or when present may appear as a thin layer, chiefly over the tip of the cusps and on interproximal surface. In some cases calcification of the enamel may be so affected that it appears to have the same approximate radiodensity as the dentin, making differentiation between the two difficult .

90. Diagnostic methods The family history Clinical observation Extraoral radiographs may reveal the presence of unerupted and sometimes spontaneously resorbing teeth Intra-oral radiographs will reveal the relative contrast between enamel and dentine in cases where mineralisation may have been affected . 95

91. Differential diagnosis Extrinsic disorders of tooth formation Chronological disorders of tooth formation Localised disorders of tooth formation 96

92. Treatment: Cases with rapid attrition Proper crown length : full coverage restorations Insufficient length: full dentures; overdentures Esthetics as prime concern : Full crowns composite resin veneers for anterior Lack of good enamel bonding may occur Overcome by - Using GIC with dentinal adhesives

93. ENAMEL HYPOPLASIA Amelogenesis occurs in two stages . In the 1 st stage enamel matrix forms, In the 2 nd stage matrix undergoes calcification . Defination : It may be defined as an incomplete or defective formation of the organic enamel matrix of teeth. - SHAFER - Factors that interfere with calcification and maturation of the enamel produce a condition termed ENAMEL HYPOCALCIFICATION .

94. Types of enamel hypoplasia Hereditary type ( amelogenesis imperfecta ) A type caused by environmental factors : a)Nutritional deficiency & Exanthematous fever b) Congenital Syphilis c)Hypocalcemia d)Birth Injuries e)Local infection, trauma f) Flouride g)Idiopathic Factors

95. Treatment (AAPD 2013) General considerations and principles of management : A primary goal for treatment is to address each concern as it presents but with an overall comprehensive plan that outlines anticipated future treatment needs. Preventive care : Meticulous oral hygiene, calculus removal, and oral rinses can improve periodontal health. Fluoride applications and desensitizing agents may diminish tooth sensitivity. 100

96. Restorative care : When the enamel is intact but discolored, bleaching and/or microabrasion may be used to enhance the appearance. If the enamel is hypocalcified , composite resin or porcelain veneers may be able to be retained with bonding. Primary teeth may require composite or veneered anterior crowns with posterior full coverage steel or veneered crowns. Permanent teeth require veneers, full coverage crowns, implants, and fixed or removable prostheses . 101

97. Amelogenesis imperfecta -lifelong management..Restorative management of the adult patient m. Patel,*1 s. T. Mcdonnell,2 s. Iram1 and m. F. W-y. Chan1 B ritish dental journal volume 215 no. 9 nov 9 2013 A mild case of AI which has been treated with microabrasion initially followed by placement of direct composite veneers. Microabrasion has significantly improved the discolouration making it easier to restore aesthetics with minimal intervention using composite resin

98. Case report Dental rehabilitation of amelogenesis imperfecta using thermoformed templates ; sockalingam snmp ; journal of indian society of pedodontics and preventive dentistry | jan - mar 2011 | issue 1 | vol 29 |

99. Also known as “Hereditary Opalascent Dentin”( Skillen , Finn & Hodges) - Due to clinical discoloration of teeth Incidence : 1in 6,000 to 1 in 8,000 ( witkop 1957) Follows autosomal dominant trait Chromosome 4 (DSPP )– Dentin sialophosphoprotein Affects both primary and permanent dentition Dentinogenesis Imperfecta

100. Have blue to brown discoloration With distinctive translucence Enamel frequently separates easily from underlying defective dentin

101. DI has been classified by Shields and co-workers [1974] into three types: Type I DI associated with osteogenesis imperfecta (OI). Both are mesodermal defects, (although OI may occur without DI). Type II DI without OI. Type III Brandywine type. It is a rare variety characterized by shell teeth, with very little dentin and multiple pulp exposures in the primary teeth. 107

102. Revised Classification 108 Dentinogenesis Imperfecta type 1 (Shield’s type 2) : opalescent dentin. DI without OI Dentinogenesis Imperfecta type 2(shield’s type 3) : Brandywine type DI (Shell teeth)

103. Type I : Dentinogenesis Imperfecta N ever occurs in association with osteogenesis imperfecta unless by chance M ost frequently referred to as hereditary opalascent dentin Clinical features: Blue gray or amber brown teeth. Bulbous crowns Narrow root canals or completely obliterated. Brittle enamel

104. 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 Increased Glycosaminoglycans seen

105. Type II : Dentinogenesis Imperfecta “Brandywine type ” M ultiple pulp exposures in deciduous not seen in type I or II P eriapical radiolucencies E namel appears normal L arge size of pulp chamber is not due to resorption but rather to insufficient + defective dentin formation

106. HISTOLOGICAL : enamel formation seems normal. Tubules seem to be larger in diameter and not evenly distributed. TREATMENT : primarily toward preventing loss of enamel. Cast metal crowns, and jacket crowns

107. MacDougall et al in 1999 stated: DGI – 1 can be differentiated from DGI – 2 by :- Presence of multiple pulp exposures. Normal nonmineralized pulp chamber and canals. Shell teeth

108. Normal thickness enamel Extremely thin dentin Enlarged pulps Thin dentin may involve entire tooth or be isolated to the root Most frequently in deciduous Shell Tooth

109. AAPD guidelines 2013 Preventive care : Meticulous oral hygiene, calculus removal, and oral rinses can improve periodontal health. Fluoride applications and desensitizing agents may diminish tooth sensitivity. Restorative care : the treatment of choice is full coverage restorations in both the primary and permanent dentitions. Overlay dentures placed on teeth that are covered with fluoride-releasing glass ionomer cement 115

110. Endodontic considerations : multiple periapical abscesses are common and routine radiographic check ups required. Because of pulpal obliteration, apical surgery may be to maintain the abscessed teeth. Occlusion : Class III malocclussion with high incidences of posterior cross bites and anterior open bites occur in DI Type I. 116

111. Case report Subramaniam p., Mathew s., Sugnani s. N. Dentinogenesis imperfecta : a case report ; j indian soc pedod prevent dent - June 2008 117

112. DENTIN DYSPLASIA Originally termed “rootless teeth” Autosomal dominant inherited disorder characterized by abnormal dentin formation and abnormal pulpal morphology. Incidence 1 in 100,000 ( witkop 1957) 118 A hereditary defect in dentin formation in which the coronal dentin and tooth color are normal; the root dentin is abnormal with a gnarled pattern and associated shortened and tapered roots.

113. Also known as “Rootless Teeth” Rare disturbance of dentin formation Normal enamel Atypical dentin formation Abnormal pulpal morphology Hereditary disease Classification: Type I ( Radicular Type) Type II (Coronal Type)

114. Dentin Dysplasia : Type I ( Radicular Type) B oth dentitions are of normal color , periapical lesion P remature tooth loss may occur because of short roots or periapical inflammatory lesions Radiographically: roots are extremely short pulps almost completely obliterated periapical radiolucencies : granulomas cysts chronic abscesses

115. 121 Histological feature : Dentinal tubules formation appear to be blocked so new dentin forms around obstacles. Characteristic appearance – lava flowing around boulders . Forms due to repetitive attempts to form root.

116. Dentin Dysplasia : Type II (Coronal Type) C olor of primary dentition is opalescent P ermanent dentition is normal C oronal pulps are usually large (thistle tube appearance) filled with globules of abnormal dentin Radiographically: (Deciduous) roots are extremely short pulps almost completely obliterated (Permanent) abnormally large pulp chambers in coronal portion of tooth

117. Treatment and Prognosis General considerations and principles of management : Due to shortened roots and periapical lesions, the prognosis for prolonged tooth retention is poor. Prosthetic replacement including dentures, overdentures, partial dentures, and/or dental implants may be required Preventive care : Meticulous oral hygiene must be established and maintained. As a result of shortened roots with DD Type I, early tooth loss from periodontitis is frequent. 123

118. Restorative care : Teeth with DD Type I have such poor crown to root ratios that prosthetic replacement including dentures, overdentures, partial dentures, and/or dental implants are the only practical courses for dental rehabilitation. Teeth with DD Type II that are of normal shape, size, and support can be restored with full coverage restorations if necessary. For esthetics, discolored anterior teeth can be improved with resin bonding, veneering, or full coverage esthetic restorations . 124

119. Endodontic considerations : Endodontic therapy, negotiating around pulp stones and through whorls of tubular dentin, has been successful in teeth without extremely short roots. (AAPD 2013) 125

120. Dentin dysplasia - A case report Hegde M and Hegde ND Endodontology , Vol. 16, 2004 Intra oral periapical radiograph showing lower central incisors, lateral incisors and canines with no roots Intra oral periapical radiograph of the upper anterior teeth showing short malformed roots .

121. - Given by Pindborg 1970 - A lso known as: Odontogenic Dysplasia Odontogenesis Imperfecta Ghost Teeth ( Rushton 1965) Regional Odontodysplasia

122. one or several teeth in a localized area are affected maxillary teeth are involved more frequently than mandibular area (2:1) ( Lutsman 1975) Etiology : local circulation disorders, viral infections, local trauma , metabolic disturbances , somatic and neural mutations ( Crawford and Aldred 1989)

123. Teeth affected may exhibit a delay or total failure in eruption Shape is altered, irregular in appearance

124. Radiographically: Marked reduction in radiodensity Teeth assume a “ghost appearance Both enamel + dentin appears very thin Pulp chamber is exceedingly large

125. Treatment: Poor cosmetic appearance of teeth Extraction with restoration by prosthetic appliance

126. Case report Abel Cahuana, Yndira González, Camila Palma, Clinical Management of Regional Odontodysplasia Pediatric Dentistry – 27:1, 2005 132

127. DENTIN HYPOCALCIFICATION Normal dentin is calcified in the form of globules which increase in size and coalesce with each other. Here, there is a failure of union of these globules. Presence of uncalcified interglobular areas. Although on the outside, tooth structure remains normal. Could be because of environmental factors similar to enamel hypoplasia Example: parathyroid deficiency, rickets.

128. NATAL AND NEO-NATAL TEETH MYTHS AND MISCONCEPTIONS

129. ERUPTION SEQUESTRUM It’s a tiny irregular spicule of bone overlying the crown of an erupting permanent molar. ETIOLOGY : as the molar teeth erupt through the bone, they will occasionally separate a small osseous fragment from the surrounding bone. In most cases, the fragment resorbs unless its too large for it to get resorbed completely

130. Supernumerary teeth: A case report A boy, aged 14 years reported to our dental clinic with complaints of many teeth in the mouth. He gave a history that three teeth were already extracted in the upper anterior region as they were ‘extra’ ARATHI R., ASHWINI R., J Indian Soc Pedod Prev Dent - June 2005,103 -105.

131. Dens evaginatus of anterior teeth (talon cusp) associated with other odontogenic anomalies An eight year old female patient reported to the department with the complaint of malalignment of upper anterior teeth. Intraoral examination showed the maxillary permanent lateral incisors exhibited pronounced cusp like structure projecting from the cingulum area ( semitalon ). The other dental abnormality recorded was bilaterally, palatally erupting two supernumerary teeth in the maxillary incisors region SHARMA A. J Indian Soc Pedod Prev Dent - Special issue 2006,41-46 .

132. A nine year old boy reported with the chief complaint of odd looking upper front teeth. Oral examination revealed both the maxillary permanent lateral incisors with enlarged or prominent cingula (trace talon). Other odontogenic variations detected were shovel shaped central incisors with bifid cingula and a palatally erupted, conical supernumerary tooth between the maxillary central incisors SHARMA A. J Indian Soc Pedod Prev Dent - Special issue 2006,41-46 .

133. Authors and year Aim Study design Results Conclusion Kruthika S , Puneet Bhargava , Renuka in july 2010 To evaluate the frequency of developmental dental anomalies in the Indian population This prospective study was conducted over a period of 1 year and comprised both clinical and radiographic examinations in oral medicine and radiology outpatient department. Adult patients were screened for the presence of dental anomalies with appropriate radiographs. A comprehensive clinical examination was performed to detect hyperdontia , talon cusp, fused teeth, gemination , concrescence, hypodontia , dens invaginatus , dens evaginatus , macro- and microdontia and taurodontism . Of the 20,182 patients screened, 350 had dental anomalies. Of these, 57.43% of anomalies occurred in male patients and 42.57% occurred in females. Hyperdontia , root dilaceration , pegshaped laterals ( microdontia ), and hypodontia were more frequent compared to other dental anomalies of size and shape. Dental anomalies are clinically evident abnormalities. They may be the cause of various dental problems. Careful observation and appropriate investigations are required to diagnose the condition and institute treatment

134. Authors and year Aim Study design Results Conclusion Rachana V Prabhu , Prasanna Kumar Rao , Veena KM, Prathima Shetty , Laxmikanth Chatra , Prashanth Shenai in 2012 prevalence of the talon cusps in a sample of Indian dental patients and their distribution among different types of teeth. presence of other dental anomalies associated with the talon cusps . 2740 out patients (1523 males and 1217 females) attending Oral Medicine department from November 2010 to January 2011 were screened for the presence of talon cusps and were subjected to Intra Oral Peri -apical (IOPA) radiograph to rule out any associated anomalies or peri -apical changes. Talon cusps were detected in 16 out of 2740 patients (person prevalence 0.58%). Thirty one teeth were found to have talon cusp. Maxillary lateral incisors were the most commonly affected teeth (54.8%, 17 teeth), followed by maxillary central incisors and canines (16.12%, 5 teeth).Talon cusp was found in two mandibular central incisors (6.45%) and one each in mandibular second and third molar (3.22% each). Seventeen teeth in 7 patients (54.83%) were found to be associated with anomalies like dens invagination (6 teeth, 19.35%), impacted 13, 23 (6 teeth, 19.35%), partial anodontia (3 teeth, 9.67%), geographic and fissured tongue (2 teeth, 6.45%). Peri -apical granuloma was found in one tooth with talon cusp associated with dens invaginatus . None of the patients were found to be associated with any syndromes. Attention should be paid to the presence of the talon cusp and the associated anomalies. Early diagnosis of the talon cusp can help the clinician in preventing the further complications

135. Authors and year Aim Study design Results Conclusion Santosh Patil , Bharati Doni , Sumita Kaswan , Farzan Rahman in 2013. to determine the prevalence of dental anomalies in the Indian population . A retrospective study of 4133 panoramic radiographs of patients, who attended the Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital between September 2008 to December 2012 was done. The ages of the patients ranged from 13 to 38 years with a mean age of 21.8 years. The orthopantomographs (OPGs) and dental records were examined for any unusual finding such as congenitally missing teeth, impactions, ectopic eruption, supernumerary teeth, odontoma , dilacerations, taurodontism , dens in dente, germination and fusion, among others. 1519 (36.7%) patients had at least one dental anomaly. The congenitally missing teeth 673 (16.3%) had the highest prevalence, followed by impacted teeth 641 (15.5%), supernumerary teeth 51 (1.2%) and microdontia 41 (1.0%). Other anomalies were found at lower prevalence ranging from transposition 7 (0.1%) to ectopic eruption 30 (0.7%). The most prevalent anomaly in the Indian population was congenitally missing teeth (16.3%), and the second frequent anomaly was impacted teeth (15.5%), whereas, macrodontia , odontoma and transposition were the least frequent anomalies, with a prevalence of 0.2%, 0.2% and 0.1% respectively.

136. Authors and year Aim Study design Results Conclusion Mitesh D Kathariy , Atul Pralhad Nikam , Kirti Chopra, Namrata N Patil , Hitesh Raheja , Renuka Kathariy in 2013 to investigate the prevalence of dental anomalies according to gender among children. This cross-sectional study was conducted a group of 600 children, of them 293 (48.8%) were males and 275 (45.8%) females which were taken with proper sampling technique. Type III clinical examination was done to know the prevalence of dental anomalies. The Statistical software namely SPSS version 16.0 was used for data analysis. Impactions (39.2%) were the most common anomaly in this study and most of the impacted teeth were related to maxilla. A significant difference was seen in case of hypodontia , microdontia and talons cusp according to gender in which first two anomalies were more among females and last one among males. Children with one dental anomaly were 25.8%, and 13.4% were having more than one The percentage of dental anomalies were high specially impaction and rotated teeth. So these anomalies should be treated earlier to avoid further complications.

137. Authors and year Aim Study design Results Conclusion Rajesh T Anegundi , Veeresh S Tegginmani1, Prashant Battepati , Anand Tavargeri , Shruthi Patil , Vijay Trasad , Garima Jain in 2014 To describe the distribution and characteristics of the supernumerary teeth in South Indian population of paediatric patients. In a 12 year retrospective study, a total of 63,569 patients up to the age of 14 years who visited our department between June 2003 and May 2013 were revised.790 cases of supernumerary teeth were found. Patients were evaluated for age, sex, site, status of dentition, number, position, orientation and type of supernumerary teeth. Statistical analysis was carried out using chi square test 790 subjects with supernumerary teeth (481 males and 309 females) were detected, revealing male-female ratio of 1.55:1.The most common supernumerary teeth were mesiodens (82.28%), the most common site was the anterior maxilla (92.53%)region. Majority of patients had a single erupted supernumerary oriented straight in the arch. Patients in mixed dentition stage reported with maximum number of supernumerary teeth. The prevalence of supernumerary teeth in non syndromicSouth Indian paediatric population is 1.24% with slight male predilection and conical mesiodens being the commonest.

138. CONCLUSION Since development of tooth forms the base of dentistry, a thorough understanding and a sound knowledge is required by a dentist regarding the development stages of tooth & the anomalies related to it, so as to identify & treat them in a proper fashion.

139. References Pediatric dentistry, scientific foundation and clinical practice by Stewart and Barber, 1 st edition. Shafer’s textbook of oral pathology, 7 th edition Orban’s Oral Histology and Embryology : 12 th edition Ten Cate’s Oral Histology Development, Structure, and Function Antonio Nanci : 7 th edition Seema D bagle , shital DP Kiran non- syndromic occurrence of true generalized microdontia with mandibular mesiodens - a name case Head face medicine 2011; 7 ; 19

140. ARATHI R., ASHWINI R., J Indian Soc Pedod Prev Dent - June 2005,103 -105. SHARMA A. J Indian Soc Pedod Prev Dent - Special issue 2006,41-46 . Patil S, Doni B, Kaswan S, Rahman F. Prevalence of dental anomalies in Indian population. J Clin Exp Dent. 2013;5(4):e183-6. Anegundi RT, Tegginmani VS, Battepati P, Tavargeri A, Patil S, Trasad V, Jain G. Prevalence and characteristics of supernumerary teeth in a nonsyndromic South Indian pediatric population. J Indian Soc Pedod Prev Dent 2014;32:9-12.

141. Kruthika S Guttala Venkatesh G Naikmasurb Puneet Bhargavac Renuka J Bathid , Eur J Dent 2010;4:263-269. Kathariya MD, Nikam AP, Chopra K, Patil NN, Raheja H, Kathariya R. Prevalence of Dental Anomalies among School Going Children in India. J Int Oral Health 2013; 5(5):10-14. Prabhu RV, Rao PK, Veena KM, Shetty P, Chatra L, Prashanth Shenai . Prevalence of Talon cusp in Indian population. J Clin Exp Dent. 2012;4(1):e23-27.