Developmental disturbances of the Teeth

1. DEVELOPMENTA
L
DISTURBANCES
OF THE TEETH
Prepared by:
Dr. Rea Corpuz

2.  (1) Size
 (2) Number and Eruption
 (3) Shape/Form
 (4) Defects of Enamel and Dentin
Developmental
Disturbances

3.  Microdontia
 Macrodontia
Size

4.  Microdontia
 (1) True Generalized
Microdontia
 (2) Relative Generalized
Microdontia
 (3) Focal or Localized
Microdontia
Size

5.  all teeth are smaller than
normal
 occur in some cases of
pituitary dawrfism
 exceedingly rare
 teeth are well formed
(1) True Generalized

Microdontia

6.  normal or slightly smaller than
normal teeth
 are present in jaws that are
somewhat larger than normal
(2) Relative Generalized

Microdontia

7.  common condition
 affects most often maxillary
lateral incisior + 3
rd
molar
 these 2 teeth are most often
congenitally missing
(3) Focal/Localized
Microdontia

8.  common forms of localized
microdontia is that which
affects maxillary lateral
incisior
 peg lateral
 instead of parallel or
diverging mesial + distal
surfaces
(3) Focal/Localized
Microdontia

9.  sides converge or taper
together incisally
 forms cone-shaped crown
 root is frequently shorter
than usual
(3) Focal/Localized
Microdontia

10.  Microdontia
 Macrodontia
Size

11.  Macrodontia
 (1) True Generalized
Macrodontia
 (2) Relative Generalized
Macrodontia
 (3) Focal or Localized
Macrodontia
Size

12.  all teeth are larger than
normal
 associated with
pituitary gigantism
 exceedingly rare
(1) True Generalized

Macrodontia

13.  normal or slightly larger than
normal teeth in small jaws
 results in crowding of teeth
 insufficient arch space
(2) Relative Generalized

Macrodontia

14.  uncommon condition
 unknown etiology
 usually seen with
mandibular 3
rd
molars
(3) Focal/Localized
Macrodontia

15.  (1) Size
 (2) Number and Eruption
 (3) Shape/Form
 (4) Defects of Enamel and Dentin
Developmental
Disturbances

16.  Supernumerary
 Anodontia
 Impaction
Number and Eruption

17.  Supernumerary
 results from continued
proliferation of permanent
or primary dental lamina
to form third tooth germ
 teeth may have:
• normal morphology
• rudimentary
• miniature

Number and Eruption

18.  Supernumerary
 more often in permanent
dentition than primary
dentition
 more in the maxilla than in
mandible

Number and Eruption

19.  Supernumerary
 may be impacted erupted
or impacted
 because of additional tooth
bulk, it causes:
• malposition of adjacent
teeth
• prevent their eruption

Number and Eruption

20.  Supernumerary
 many are impacted
• characteristically found
in cleidocranial dysostosis

Number and Eruption

21.  Supernumerary
 Mesiodens
 Fourth molar
•Maxillary Paramolar
• Distomolar or Distodens
 Mandibular Premolar
 Maxillary lateral incisors

Number and Eruption

22.  Supernumerary
 Mandibular central incisors
 Maxillary Premolars

Number and Eruption

23.  most common
supernumerary tooth
 tooth situated between
maxillary central incisors
 singly
 paired
 erupted or impacted
 inverted
Mesiodens

24.  small tooth
 cone-shaped crown
 short root
Mesiodens

25.  2
nd
most common
 situated distal to 3
rd
molar
 small rudimentary tooth,
but may be of normal size
 mandibular 4
th
molar also is
seen occasionally, but less
common than maxillary molar
Fourth Molar

26.  small + rudimentary
 situated bucally or lingually
to one of the maxillary
molars
 interproximally between 1
st
+ 2
nd
or 2
nd
+ 3
rd
maxillary
molars
Paramolar

27.  molar located distal to molar
Distomolar/Distodens

28.  Supernumerary
 Anodontia
 Impaction
Number and Eruption

29.  Anodontia
 lack of tooth development
 absence of teeth

Number and Eruption

30.  Anodontia
 Complete Anodontia
 Partial Anodontia
• Hypodontia
• Oligodontia
 Pseudoanodontia
 False Anodontia

Number and Eruption

31.  when all teeth are missing
 rare
 often associated with a
syndrome known as hereditary
ectodermal dysplasia

Complete Anodontia

32.  lack of development of
one or more teeth

Hypodontia

33.  lack of development of
six or more teeth

Oligodontia

34.  when teeth are absent
clinically because of
impaction or delayed
eruption

Pseudoanodontia

35.  when teeth have been
exfoliated or extracted

False Anodontia

36.  Supernumerary
 Anodontia
 Impaction
Number and Eruption

37.  Impaction
 most often affects the
mandibular 3
rd
molars +
maxillary canines
 less commonly:
• premolars
• mandibular canines
• second molars


Number and Eruption

38.  Impaction
 occurs due to obstruction
from crowding
 from some other physical
barrier
 occasionally, may be due
to an abnormal eruption
path, presumably because
of unusual orientation of
tooth germ

Number and Eruption

39.  Impaction
 Ankylosis

Number and Eruption

40.  fusion of a tooth to surrounding
bone
 with focal loss of periodontal
ligament, bone + cementum
become inextricably mixed
 cause fusion of tooth to
alveolar bone

Ankylosis

41.  (1) Size
 (2) Number and Eruption
 (3) Shape/Form
 (4) Defects of Enamel and Dentin
Developmental
Disturbances

42.  Crown
 Root
Shape and Form

43.  Crown
 Fusion
 Gemination
 Taurodontism
 Talon’s Cusp
 Leong’s Cusp
Shape and Form

44.  Crown
 Dens Invaginatus
 Peg-shaped Lateral
 Hutchinson Incisor
 Mulberry Molar
Shape and Form

45.  Root
 Concresence
 Enamel Pearl
 Dilaceration
 Flexion
 Ankylosis
Shape and Form

46.  joining of 2 developing
tooth germs
 resulting in a single
large tooth structure
 may involve entire length
of teeth
 or may involve roots only,
in which case cementum +
dentin are SHARED
Fusion

47. Fusion

48.  fusion of 2 teeth from a
single enamel organ
 partial cleavage
 appearance of 2 crowns
that share same root canal
 trauma has been suggested
as possible cause, the cause is
still unknown
Gemination

49.  variation in tooth form:
 elongated crowns
 apically displaced furcations
• resulting in pulp
chambers that have
apical occlusal height
Taurodontism

50.  may bee seen as isolated
incident in families
 associated with syndromes
such as
 Down syndrome
 Klinefelter’s syndrome
Taurodontism

51.  little clinical significance
 No treatment is required
Taurodontism

52.  Talon’s Cusp
 Leung’s Premolar
Dens Evaginatus

53.  well-delineated additional
cusp
 located on the surface of
an anterior tooth
 extends at least half the
distance from CEJ to
incisal edge
Talon’s Cusp

54.  developmental condition
 clinically as an accessory cusp
or a globule
 located on occlusal
surface between buccal +
lingual cusps of premolars
 unilaterally or bilaterally
Leung’s Cusp

55.  deep surface invagination
of crown or root that is lined
by enamel
 2 forms:
 coronal
 radicular
Dens Invaginatus
(Dens in Dente)

56.  depth varies from slight
enlargement of cingulum
to a deep infolding that
extends to apex
 historically, it has been
classified into 3 major types:
 Type I
 Type II
 Type III
Dens Invaginatus
(Dens in Dente)

57.  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
Dens Invaginatus
(Dens in Dente)

58.  Type III
• extends through the root
• perforates in the apical or
lateral radicular area
without any immediate
communication with pulp
Dens Invaginatus
(Dens in Dente)

59.  undersized lateral incisor
 smaller than normal
 occurs when permanent lateral
incisors do not fully develop
Peg-Shaped
Lateral

60. Peg-Shaped
Lateral

61.  characteristic of congenital
syphilis
 lateral incisors are peg-shaped
or screwdriver-shaped
 widely spaced
 notched at the end
 with a crescent-shaped
deformity
Hutchinson’s Incisor

62.  notches on their biting
surfaces
 named after Sir Jonathan
Hutchinson
 English surgeon +
pathologist who 1
st

described it
Hutchinson’s Incisor

63.  dental condition usually
associated with congenital
syphilis
 characterized by multiple
rounded rudimentary enamel
cusps on permanent 1
st
molars
Mulberry Molar

64.  dwarfed molars with cusps
covered with globular enamel
growths
 giving the appearance of a
mulberry
Mulberry Molar

65.  Root
 Concresence
 Enamel Pearl
 Dilaceration
 Flexion
 Ankylosis
Shape and Form

66.  2 fully formed teeth
 joined along the root surfaces
by cementum
 noted more frequently in
posterior and maxillary regions
Concrescence

67.  often involves a 2
nd
molar
tooth in which its roots
closely approximate the
adjacent impacted 3
rd
molar
 may occur before or after the
teeth have erupted
 usually involves only 2 teeth
Concrescence

68.  diagnosis can frequently be
established by
roentgenographic examination
 often requires no therapy
unless union interferes with
eruption; then surgical
removal may be warranted
since with fused teeth,
extraction of one may result in
extraction of the other
Concrescence

69.  droplets of ectopic enamel
 or 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
Enamel Pearls

71.  consist of only a nodule
of enamel attached to dentin
 may have a core of dentin
containing pulp horn
 may be detected on
radiographic examination
Enamel Pearls

72.  may cause stagnation at
gingival margin but, if they
contain pulp, this will
be exposed when pearl is
removed
Enamel Pearls

73.  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
Dilaceration

74.  movement of crown or
of the crown and part of root
from remaining developing
root may result in sharp
angulation after tooth
completes development
Dilaceration

75.  hereditary factors are
believed to be involved
in small number of cases
 eruption generally continues
without problems
Dilaceration

76.  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

77.  also known as
“submerged teeth”
 fusion of a tooth to surrounding
bone
 deciduous teeth most commonly
mandibular 2
nd
molars
 undergone variable
degree of root resorption
Ankylosis

78.  have become ankylosed
to bone
 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
Ankylosis

79.  (1) Size
 (2) Number and Eruption
 (3) Shape/Form
 (4) Defects of Enamel and Dentin
Developmental
Disturbances

80.  also known as:
 Hereditary Enamel
Dysplasia
 Hereditary Brown Enamel
 Hereditary Brow Opalescent
Teeth
Amelogenesis
Imperfecta

81.  group of conditions caused by
defects in the genes encoding
enamel matrix proteins
 genes that encode for enamel
proteins:
 amelogenin mutated in
 enamelin in patients
 others with this
condition
Amelogenesis
Imperfecta

82.  affects both dentition
 deciduous
 permanent
 classified based on pattern of
inheritance:
 hypoplasia
 hypomaturation
 hypocalcified
Amelogenesis
Imperfecta

83.  No treatment except for
improvement of cosmetic
appearance
Amelogenesis
Imperfecta

84.  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

85.  reduced enamel thickness
 abnormal contour
 absent interproximal
contact points
 Radiographically:
 enamel reduced in bulk
 shows thin layer over
occlusal
+ interproximal surfaces
Hypoplastic
Amelogenesis Imperfecta

86.  dentin + pulp chambers
appear normal
 no treatment is necessary
Hypoplastic
Amelogenesis Imperfecta

87.  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

88.  Radiographically:
 affected enamel exhibits
radiodensity similar to
dentin
Hypomaturation
Amelogenesis Imperfecta

89.  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

90.  with years of function:
 coronal enamel is removed
 except for cervical portion
that is occasionally calcified
better
 Radiographically:
 density of enamel + dentin are
similar
Hypocalcified
Amelogenesis Imperfecta

91.  also known as “Hereditary
Opalascent Dentin”
 due to clinical discoloration
of teeth
 mutation in the dentin
sialophosphoprotein
 affects both primary + permanent
dentition
Dentinogenesis Imperfecta

92.  have blue to brown
discoloration
 with distinctive translucence
 enamel frequently separates
easily from underlying defective
dentin
Dentinogenesis Imperfecta

93.  Radiographically:
 bulbous crowns
 cervical constriction
 thin roots
 early obliteration of roots
canals + pulp chambers
Dentinogenesis Imperfecta

94.  Treatment:
 prevent loss of enamel +
subsequent loss of dentin
through attrition
 cast metal crowns on posterior
 jacket crowns on anterior
teeth
Dentinogenesis Imperfecta

95.  Classification:
 Type I
 Type II
 Type III
Dentinogenesis Imperfecta

96.  occurs in families with
Osteogenesis Imperfecta
 primary teeth are more severely
affected than permanent teeth
Type I Dentinogenesis
Imperfecta

97.  Radiographically:
 partial or total obliteration
of pulp chambers + root canals
 by continued formation
of dentin
 roots may be short + blunted
 cementum, periodontal
membrane + bone appear
normal
Type I Dentinogenesis
Imperfecta

98.  never occurs in association
with osteogenesis imperfecta
unless by chance
 most frequently referred to as
hereditary opalascent dentin
 only have dentin abnormalities
and no bone disease
Type II Dentinogenesis
Imperfecta

99.  Radiographically:
 partial or total obliteration
of pulp chambers + root canals
 by continued formation
of dentin
 roots may be short + blunted
 cementum, periodontal
membrane + bone appear
normal
Type II Dentinogenesis
Imperfecta

100.  “Bradwine type”
 racial isolate in Maryland
 multiple pulp exposures in
deciduous not seen in type
I or II
 periapical radiolucencies
Type III Dentinogenesis
Imperfecta

101.  enamel appears normal
 large size of pulp chamber
is due not to resorption but
rather to insufficient + defective
dentin formation
Type III Dentinogenesis
Imperfecta

102.  also known as “Rootless Teeth”
 rare disturbance of dentin
formation
 normal enamel
 atypical dentin formation
 abnormal pulpal morphology
 hereditary disease
Dentin Dysplasia

103.  Classification:
 Type I (Radicular Type)
 Type II (Coronal Type)
Dentin Dysplasia

104.  both dentitions are of
normal color
 periapical lesion
 premature tooth loss may occur
because of short roots or
periapical inflammatory lesions
Type I (Radicular Type)

105.  Radiographically:
 roots are extremely short
 pulps almost completely
obliterated
 periapical radiolucencies:
• granulomas
• cysts
• chronic abscesses
Type I (Radicular Type)

106.  color of primary dentition
is opalescent
 permanent dentition is normal
 coronal pulps are usually large
(thistle tube appearance)
 filled with globules of abnormal
dentin
Type II (Coronal Type)

107.  Radiographically:
(Deciduous)
 roots are extremely short
 pulps almost completely
obliterated
(Permanent)
 abnormally large pulp
chambers in coronal portion of
tooth
Type II (Coronal Type)

108.  also known as:
 Odontogenic Dysplasia
 Odontogenesis Imperfecta
 Ghost Teeth
Regional
Odontodysplasia

109.  one or several teeth in a
localized area are affected
 maxillary teeth are involved
more frequently than
mandibular area
 etiology is unknown
Regional
Odontodysplasia

110.  teeth affected may exhibit
a delay or total failure in
eruption
 shape is altered, irregular
in appearance
Regional
Odontodysplasia

111.  Radiographically:
 marked reduction in
radiodensity
 teeth assume a “ghost”
appearance
 both enamel + dentin appear
very thin
 pulp chamber is exceedingly
large
Regional
Odontodysplasia

112.  Treatment:
 poor cosmetic appearance
of teeth
 extraction with restoration
by prosthetic appliance
Regional
Odontodysplasia

113.  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

114. References:References:
 BooksBooks
 Cawson, R.A: Cawson’s Essentials of OralCawson, R.A: Cawson’s Essentials of Oral
Oral Pathology and Oral Medicine,Oral Pathology and Oral Medicine,
88
thth
Edition Edition
• (pages 24-36)(pages 24-36)
 Neville, et al: Oral and Maxillofacial PathologyNeville, et al: Oral and Maxillofacial Pathology
33
rdrd
Edition Edition
• (pages 77-113)(pages 77-113)
 Regezi, Joseph et al: Oral Pathology, Clinical Regezi, Joseph et al: Oral Pathology, Clinical
Pathological CorrelationsPathological Correlations
55
thth
Edition Edition
• (pages 361-373)(pages 361-373)
 Shafer, et al: A textbook of Oral Pathology,Shafer, et al: A textbook of Oral Pathology,
33
rdrd
Edition Edition
• (pages 37-69)(pages 37-69)