GROWTH AND DEVELOPMENT OF TEETH AND DENTAL ANOMALIES.pptx

The growth and development of teeth is a complex, well-coordinated biological process that begins early in embryonic life and continues through adolescence. It involves a series of interactions between the oral epithelium and underlying ectomesenchymal tissues, leading to the formation of the enamel, dentin, cementum, and pulp. Each stage—initiation, bud, cap, and bell—plays a crucial role in determining the size, shape, and number of teeth. Any disturbance during these stages, whether genetic, environmental, or systemic, can result in dental anomalies such as alterations in tooth number, size, shape, or structure. Understanding the normal developmental process and its deviations is essential for accurate diagnosis, prevention, and management of these anomalies in clinical practice.

1. PRESENTED BY: DR. VAISHNAVI CHIDRAWAR GROWTH AND DEVELOPMENT OF TEETH AND DENTAL ANOMALIES Dr Vaishnavi Chidrawar

2. CONTENTS INTRODUCTION DENTAL LAMINA TOOTH DEVELOPMENT STAGES OF DEVELOPMENT OF TOOTH BUD STAGE CAP STAGE BELL STAGE ADVANCED BELL STAGE HERTWIGS EPITHELIAL ROOT SHEATH AND ROOT FORMATION DEVELOPMENTAL ANOMALIES Dr Vaishnavi Chidrawar

3. INTRODUCTION Evidence of development of human tooth can be observed as early as the sixth week of embryonic life . At about 7 th week the basal cells in the epithelium proliferate rapidly resulting into the formation of epithelial thickening along the borders of the jaw. This thickening is called as PRIMORDIUM of the ectodermal portion of teeth which is called as DENTAL LAMINA. All the deciduous teeth arise from dental lamina. Later the permanent successors arise from the lingual extension and permanent molars from its distal extension Dr Vaishnavi Chidrawar

4. Dental lamina Two to three weeks after the rupture of buccopharyngeal membrane, certain areas of basal cells of oral ectoderm proliferate rapidly, leading to the formation of primary epithelial band. The band invades the underlying ectomesenchyme along each of the horseshoe shaped future dental arches. Dr Vaishnavi Chidrawar

5. At certain points along the dental lamina each showing the location of one of the 10 mandibular and 10 maxillary teeth, the ectodermal cells ,multiply and form ovoid swellings occur in each jaw. Each of this little down growths from the dental lamina represents the beginning of enamel oragan . First to appear are in the region of anterior mandibular region. As the cells proliferates enamel organ takes the shape of the cap. Dr Vaishnavi Chidrawar

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7. On the inside of the cap , the ectomesenchymal cells increase in number. The tissue appears more dense than surrounding mesenchyme and represents the beginning of the DENTAL PAPILLA. Dr Vaishnavi Chidrawar

8. Surrounding the combined enamel organ or the dental papilla, the third part of the tooth bud forms. It is known as dental sac/follicle and it consists of some ectomesenchymal cells and fibres that surrounds the dental papilla and enamel organ. Dr Vaishnavi Chidrawar

9. Thus the tooth germ consists of ectodermal component that is THE ENAMEL ORGAN and the ectomesenchymal components that are THE DENTAL PAPILLA AND THE THE DENTAL SAC. The enamel is formed from the enamel organ. The dentin and pulp are formed from the dental papilla. All other supporting structures like cementum , periodontal ligament and alveolar bone are formed from dental follicle. Dr Vaishnavi Chidrawar

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12. Developmental stages Dr Vaishnavi Chidrawar

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14. Bud stage / proliferation This is the initial stage of tooth formation the enamel organ resembles its small bud During the stage the enamel organ consists of peripherally located low columnar cells and centrally located polygonal cells The surrounding mesenchymal cells proliferate which results in their condensation in two areas The ectomesenchymal condensation that surrounds the to the bud and the dental papilla is the tooth sac Dr Vaishnavi Chidrawar

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16. CAP STAGe As the tooth bud continues to proliferate it does not expand uniformly into a large sphere Instead unequal growth in different parts of the tooth bud leads to the cap stage which is characterized by a Shallow in invagination on the deep surface of the bud Dr Vaishnavi Chidrawar

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18. Enamel knot- Densely packed cells in the centre of the enamel organ. It determines the shape of crown. Enamel Cord- verticle extension of enamel knot. Enamel septum-Enamel cord extends to meet Outer enamel epithelium (OEE) Enamel Navel- OEE at point of meeting shows small depression. Dr Vaishnavi Chidrawar

19. BELL STAGE HISTODIFFERENTIATION In this stage the epithelium continues to invaginate and deep until the enamel organ takes on the shape of a bell It is during this stage that the cells of the dental papilla differentiate into odontoblasts and those of the inner enamel epithelium differentiate into ameloblasts Histodifferentiation marks the end of the proliferative stage as the cells lose their capacity to multiply this stage is also the forerunner of appositional activity Dr Vaishnavi Chidrawar

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21. Advanced bell stage/ morphodifferentiation This stage is characterized by the commencement of mineralisation and root formation The boundary between the inner enamel epithelium(IEE) and odontoblasts outline the future dentinoenamel Junction Formation of dentin occurs first as a layer along the future dentinoenamel junction in the region of future cusps and proceeds pulpaly and apically After the first layer of dentin is formed the ameloblasts lay down enamel over the Dentin in future incisal and cuspal areas Dr Vaishnavi Chidrawar

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23. HERTWIGS EPITHELIAL ROOT SHEATH AND ROOT FORMATIOn The development of roots begin after the enamel and dentin formation has reached the future cementoenamel junction . Dr Vaishnavi Chidrawar

24. The enamel organ plays and important role in root development by forming Hertwigs epithelial root sheath (HERS), which models the shape of root Hertwigs epithelial root sheath consists of outer and inner enamel epithelium As the first layer of the dentin has been laid down.the epithelial root sheath loses its structural continuity and is in the close relation to the root surface Dr Vaishnavi Chidrawar

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26. Developmental anomalies Dr Vaishnavi Chidrawar

27. Gemination Fusion Concrescence Dilaceration Talon’s cusp Dens in Dente Dens evaginatus Enamel Pearl Taurodontism Supernumerary roots Anodontia Supernumerary teeth Predeciduous dentition Postpermanent dentition Microdontia Macrodontia Amelogenesis imperfecta Environmental Enamel Hypoplasia Dentinogensis imperfecta Regional odontodysplasia Dentin hypocalcification SHAPE NUMBER SIZE STRUCTURE Dr Vaishnavi Chidrawar

28. Gemination Gemination is when two teeth develop from one tooth bud and, as a result, the patient has an extra tooth Dr Vaishnavi Chidrawar

29. The structure is usually one with two completely or incompletely separated crowns that have a single root and root canal. It is seen in deciduous as well as permanent dentition, and, in some reported cases, appears to exhibit a hereditary tendency. Dr Vaishnavi Chidrawar

30. TREATMENT: Oral hygiene Root canal treatment Prosthesis in cases of esthetic requirement Dr Vaishnavi Chidrawar

31. Case report (Journal of conservative dentistry 2014) Preoperative radiograph Working length determination CBCT scanning Post obturation Dr Vaishnavi Chidrawar

32. Fusion The phenomenon of tooth fusion arises through union of two normally separated tooth germs, and depending upon the stage of development of the teeth at the time of union, it may be either complete or incomplete. The fused teeth typically occurred unilaterally (68.75 percent), and mainly located in the anterior region, more frequently in the mandibular (91.25 percent) than that in the maxillary arch. Fusion may occur normal tooth and supernumerary tooth Dr Vaishnavi Chidrawar

33. Seen in both deciduous and permanent tooth but more common in deciduous tooth. Tooth may have separate or fused root canals Treatment Root canal treatment of fused tooth Hemisection and restoration with crown and followed by orthodontic treatment Dr Vaishnavi Chidrawar

34. Case report ( Cureus April 2020) Pre-operative periapical radiographs.(A) Fused 42-43 with separate pulp chambers, (B) Fused 32-33 with merged pulp chambers at the apical third. Dr Vaishnavi Chidrawar

35. Case report (International journal of surgery case reports 2016) Fig. 1.  Panoramic Radiography  (PR) for initial orthodontic treatment, showed  second premolar  agenesis ( mandibular left region—35) and a second molar ( mandibular right) apparently overlaid on the third molar, see that this tooth has more advanced root development than their congeners. Fig. 2. Second radiography, three years later, showed a second molar ( mandibular right) had two separate canals and shared one (second molar mesial root and  first molar  distal root). Dr Vaishnavi Chidrawar

36. Radiography presented a tooth with three roots, two crowns sharing a pulp chamber and one root canal (the other third molars are with open apex). Dr Vaishnavi Chidrawar

37. How to differentiate between Gemination and fusion Gemination – Number of tooth increases Fusion – Number of tooth remains same Dr Vaishnavi Chidrawar

38. Concrescense Concrescence of teeth is actually a form of fusion, which occurs after root formation has been completed. In this condition, teeth are united by cementum only. Dr Vaishnavi Chidrawar

39. Dilaceration The term “ dilaceration ” refers to an angulation , or a sharp bend or curve, in the root or crown of a formed tooth . The condition is thought to be due to trauma during the period in which the tooth is forming, with the result that the position of the calcified portion of the tooth is changed and the remainder of the tooth is formed at an angle. Dr Vaishnavi Chidrawar

40. TREATMENT: A dilacerated root generally does not require treatment, because it provides adequate support. If the tooth is to be extracted for some other reason, the removal can be complicated, especially if the surgeon is not prepared with a preoperative image. In contrast, dilacerated crowns are frequently restored with a prosthetic crown to improve esthetics and function. Endodontic treatment if carious lesion present. Dr Vaishnavi Chidrawar

41. Case report (journal of clinical and diagnostic research 2014) Preoperative radiograph showing dilacerated canal in relation to 15 and Bayonet or S-shaped root canals in relation to 14. Working length radiograph Master cone radiograph Post obturation radiograph Sequential filing of the curved canals was done using nickel titanium ( NiTi ) hand files No. 15, 20, and 25 (Mani, Inc, Japan) to the working length. Final cleaning and shaping was carried out using Hyflex CM rotary files up to 4% 40 size of the instrument. Dr Vaishnavi Chidrawar

42. Talon cusp The talon cusp, an anomalous structure resembling an eagle’s talon, projects lingually from the cingulum areas of a maxillary or mandibular permanent incisor. This cusp blends smoothly with the tooth except that there is a deep developmental groove where the cusp blends with the sloping lingual tooth surface It appears to be more prevalent in persons with the Rubinstein– Taybi syndrome. Dr Vaishnavi Chidrawar

43. TREATMENT: The developmental grooves present between the Talons cusp and the palatal surface of the tooth can harbor microorganisms and lead to future caries. This anomaly demands early and preventive intervention especially where orthodontic movement of the tooth is anticipated. Reduction of the cusp and management of the developmental grooves associated with it.  Gradual grinding of the cusp and use of air abrasion allow us to follow the principles of minimally invasive dentistry in treating this anomaly.  Dr Vaishnavi Chidrawar

44. Dens-in-dente [dens invaginatus ] Represents a defect of tooth in which a focal area on the tooth surface is folded or invaginated pulpaly to a variable extent This Defect in generally localized to a single tooth & interestingly maxillary lateral incisors are more commonly affected Bilateral involvement is often seen & sometimes defect can involve multiple teeth involving the supernumeraries Dr Vaishnavi Chidrawar

45. OEHLER’S Classification Type І : Minimal invagination (confined to crown) Type ІІ : Moderate invagination (extends below CEJ) Type III : Severe invagination (extends through the root) A:communicates laterally through pseudoforamen . B: Communicates apically through pseudoforamen . Radiographic features: Tooth within tooth appearance. More orifices can be present so endodontic treatment is difficult. MANAGEMENT: If no caries- no treatment required. Deep pits- pit & fissure sealants If caries sets in: open apex : Apexification closed apex: Endodontic treatment Dr Vaishnavi Chidrawar

46. Dens evaginatus The dens evaginatus is a developmental condition that appears clinically as an accessory cusp or a globule of enamel on the occlusal surface between the buccal and lingual cusps of premolars, unilaterally or bilaterally. The pathogenesis of the lesion is thought to be the proliferation and evagination of an area of the inner enamel epithelium and subjacent odontogenic mesenchyme into the dental organ during early tooth development. Thus, it has been considered to be the antithesis of the mechanism of development of the dens invaginatus . Dr Vaishnavi Chidrawar

47. TREATMENT: Treatment can be either conservative or radical, depending on the size and shape of evagination . Pit and fissure sealants are recommended as preventive measures. Root canal therapy is often required and may be followed by either an aesthetic restoration or a full crown coverage. Dr Vaishnavi Chidrawar

48. Case Report (International journal of pediatric dentistry 2010) Age 9 yr Clinically, the tooth was asymptomatic and responded normally to pulp vitality tests. The grooves at the junction of the cusp and palatal surface were stained and contained dental plaque. Maxillary right lateral incisor displayed a deep lingual pit suggesting type I invagination . Dr Vaishnavi Chidrawar

49. Treatment oral hygiene instructions, restoration of carious teeth, and prophylactic restorative procedures in the maxillary central incisors and lateral incisors. The prophylactic treatment consisted of selective grinding of extra cusp with flare-shaped diamond bur under water coolant using high-speed hand piece at 3-month intervals. Each grinding session was followed by the application of a desensitizing/ remineralizing agent with 0.2% fluoride (GC Tooth mousse plus, Recaldent , GC Co. Japan), to the surfaces of reduced cusp, after polishing, to reduce dentin sensitivity. Dr Vaishnavi Chidrawar

50. Enamel pearl( enameloma , enamel drop) Heterotopic presence of enamel in the form of a globule is called enamel pearl. It is usually found on the root surface. It has been variously referred to as enameloma , enamel pearl, enamel drop, enamel nodule, enamel globule. and is usually located in the cementoenamel junction or in the cervical third of the root surface Dr Vaishnavi Chidrawar

51. TREATMENT: It is of no clinical significance except that, clinically and radiographically , it may mistaken for calculus. Odontoplasty is indicated when it causes periodontal problem. Dr Vaishnavi Chidrawar

52. Taurodontism The term “ taurodontism ” was first used by Sir Arthur Keith in 1913 to describe a peculiar dental anomaly in which the body of the tooth is enlarged at the expense of the roots . The term means “bull-like” teeth Taurodontism is caused by failure of Hertwigs epithelial root sheath to invaginate at the proper horizontal level. Dr Vaishnavi Chidrawar

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54. The clinical implication of taurodontism has potentially increased risk of pulp exposure because of decay and dental procedures. Taurodontism may complicate orthodontic and/or prosthetic treatment planning. A taurodont tooth shows wide dissimilarity in the size and shape of the pulp chamber, varying degrees of obliteration and canal configuration, apically positioned canal orifices, and the potential for additional root canal systems. Taurodontism presents a challenge during negotiation, instrumentation and obturation in root canal treatment. Because of the difficulty of the root canal, anatomy and proximity of buccal orifices complete filling of the root canal system in taurodont teeth are challenging. Dr Vaishnavi Chidrawar

55. Case report (Iranian Endodontic Journal 2006) The patient was a 17 years old boy with severe pain on the right maxillary first molar A modified obturation technique was used because of the complexity of the inner root canal anatomy and the proximity of the buccal orifices. This consisted of combined cold lateral compaction in the apical part with warm vertical compaction in the elongated pulp chamber with an obturator unit (Endo-Twin2, VDW, GmbH, Munich, Germany). Dr Vaishnavi Chidrawar

56. Supernumerary roots This developmental condition is not uncommon and may involve any tooth Teeth that are normally single-rooted; particularly, the mandibular bicuspids and cuspids , often have two roots. Both maxillary and mandibular molars, particularly third molars, also may exhibit one or more supernumerary roots. This phenomenon is of considerable significance in endodontics and exodontias Dr Vaishnavi Chidrawar

57. Case report (Journal of Taibah University Medical Sciences 2014) A 22 yr old male patients presented with pain with 46. Diagnostic X-ray with horizontal angulation revealed presence of extra root. Endodontic treatment was planned according to that. Dr Vaishnavi Chidrawar

58. ANODONTIA True anodontia is the failure of development of tooth. It may be of two types, total and partial. Total anodontia , in which all teeth are missing, may involve both deciduous and permanent dentition This is a rare condition; when it occurs, it is frequently associated with a more generalized disturbance, hereditary ectodermal dysplasia Induced or false anodontia occurs as a result of extraction of all teeth, while the term pseudo- anodontia is sometimes applied to multiple unerupted teeth. Dr Vaishnavi Chidrawar

59. TREATMENT: Prosthodontic crown Removable dentures Implant placement. Dr Vaishnavi Chidrawar

60. supernumerary tooth A supernumerary tooth is an additional tooth to the normal set of teeth. It may closely resemble the teeth of the group to which it belongs, i.e., molars, premolars or anterior teeth, or it may bear little resemblance in size or shape to the teeth with which it is associated Dr Vaishnavi Chidrawar

61. Morphological classification Supplemental Tuberculate Odontome Conical Dr Vaishnavi Chidrawar

62. According to location Parapremolar Mesiodens Paramolar Distomolar Dr Vaishnavi Chidrawar

63. Predeciduous dentition Infants occasionally are born with structures which appear to be erupted teeth, usually in the mandibular incisor area. These structures must be distinguished from true deciduous teeth, or the so-called natal teeth, which is present at the time of birth The predeciduous teeth have been described as hornified epithelial structures without roots, occurring on the gingiva over the crest of the ridge, which may be easily removed. Prematurely erupted true deciduous teeth, of course, are not to be extracted. These predeciduous teeth have been thought to arise either from an accessory bud of the dental lamina ahead of the deciduous bud or from the bud of an accessory dental lamina Dr Vaishnavi Chidrawar

64. Enamel hypoplasia Enamel hypoplasia is the defect of the teeth in which the tooth enamel is hard but thin and deficient in amount cause- defective enamel matrix formation Clinically- a roughened surface with discrete pitting or circumferential band – like irregularities which post- eruptively acquire yellow brown stain. Dr Vaishnavi Chidrawar

65. Causes: Hereditary- Amelogenesis imperfecta Environmental Nutritional Def ( Vit A,C,D) Congenital syphilis Birth injury, prematurity, Rh hemolytic disease Local infection or trauma-turners teeth Chemical ingestion-like fluoride-mottling Dr Vaishnavi Chidrawar

66. ENAMEL HYPOPLASIA DUE TO LOCAL INFECTION OR TRAUMA Referred as ‘ Turner’s teeth and the condition is called Turner’s hypoplasia due to local infection. Most commonly seen in maxillary incisors, maxillary or mandibular premolar. Degree -mild, brownish discoloration of the enamel severe pitting and irregularity of the tooth crown. Dr Vaishnavi Chidrawar

67. CONGENITAL SYPHILIS Presence of pathognomonic appearance, not of the pitting variety Involves- maxillary and mandibular incisors & first molars. Anterior teeth affected are called ‘Hutchinson’s teeth Affected molars referred to as ‘mulberry molars’ (Moon’s molars, Fournier’s molars). Dr Vaishnavi Chidrawar

68. Maxillary central incisor is ‘screw-driver’ shaped, the mesial and distal surfaces of crown tapering and converging toward the incisal edge of the tooth rather than toward the cervical margin. Due to absence of the central tubercle or calcification center. First molars are irregular. Crown is narrower on the occlusal surface than at the cervical margin. Dr Vaishnavi Chidrawar

69. CHEMICAL INGESTON-FLOURIDE MOTTLING Mottling at a level 0.9–1.0 part per million of fluoride in the water Range of severity in the appearance of mottled teeth: (1) occasional white flecking or spotting of the enamel (2) mild changes by white opaque areas involving more of the tooth surface area (3)moderate and severe changes showing pitting and brownish staining of the surface, shows tendency for wear and even fracture of the enamel (4) Corroded appearance of the teeth. Dr Vaishnavi Chidrawar

70. GRADING OF MOTTLED ENAMEL VERY MILD -Small paper-white areas involve less than 25% of surface MILD -Opaque areas involve up to 50% of surface MODERATE - The whole of the enamel surface may be affected with paper-white or brownish areas or both SEVERE - The enamel is grossly defective, opaque, pitted, stained brown and brittle Dr Vaishnavi Chidrawar

71. In mild cases – Special care is adviced to avoid tooth decay Some cases may require cosmetic adjustments such as composite restorations. For cosmetic reasons, bleach the affected teeth with an agent such as hydrogen peroxide. For more serious cases crown is recommended. Dr Vaishnavi Chidrawar

72. AMELOGENESIS IMPERFECTA Amelogenesis imperfecta (AI) presents with abnormal formation of the enamel or external layer of teeth. Enamel is composed mostly of mineral, that is formed and regulated by the proteins in it. Amelogenesis imperfecta is due to the malfunction of the proteins in the enamel: ameloblastin , enamelin , tuftelin , amelogenins People affected with amelogenesis imperfecta have teeth with abnormal color: yellow, brown or grey. Dr Vaishnavi Chidrawar

73. Hypoplastic AI Hypomaturation AI Defect in the mineralization process with normal matrix formation Enamel is hypomineralized and prone to attrition Mottled appearance to yellow-brown or red- brown discoloration Reduction in the thickness of enamel matrix with normal mineralization Enamel appears normal and less prone to attrition color: appears normal with translucency to a yellow to dark brown color depending on the thickness Reduction in tooth size Rough, irregular or pitted enamel Dr Vaishnavi Chidrawar

74. Hypocalcified AI Defect in the quality of the mineralization process with normal quantity of matrix formation Normal thickness of enamel with loss of translucency Enamel is hypomineralized and exhibits a soft cheesy consistency. Easily broken down. Teeth appear more dark Dr Vaishnavi Chidrawar

75. Although AI primarily affects enamel formation, a variety of clinical implications may also be present, such as low caries susceptibility, rapid attrition, excessive calculus deposition, and gingival hyperplasia.  AI patients may experience compromised chewing function due to tooth sensitivity and the short clinical crowns caused by attrition and/or incomplete eruption Dr Vaishnavi Chidrawar

76. Radiographic Features Enamel may appear totally absent on the radiograph, when present, may appear as a very thin layer, over the tips of cusps and interproximal surfaces. Dr Vaishnavi Chidrawar

77. TREATMENT: Glass ionomer cements, composite resin veneers, porcelain veneers, stainless steel crowns and/or over dentures can restore the affected teeth. Composite veneers and composite resin restorations have been advocated to mask discoloration and improve dental esthetics.  Dr Vaishnavi Chidrawar

78. Dentinogenesis imperfecta (Hereditary Opalescent Dentin) is a genetic disorder of tooth development. This condition causes teeth to be discolored (most often a blue-gray or yellow-brown color) and translucent. Teeth are also weaker than normal, making them prone to rapid wear, breakage, and loss. These problems can affect both primary (baby) teeth and permanent teeth. Dr Vaishnavi Chidrawar

79. CLASSIFICATION Shields Classification Type І With osteogenesis imperfecta Type ІІ without osteogenesis imperfecta Type III Brandywine Type (shell teeth) Revised Classification Type І : DI without OI (corresponds to Type ІІ ) Type ІІ : corresponds to Type III Dr Vaishnavi Chidrawar

80. Type І Associated with osteogenesis imperfecta Affects deciduous teeth more than permanent Blue Sclera Squarish incisor crowns Flat posterior crowns No DEJ scalloping Type ІІ Not associated with Osteogenesis Imperfecta Affects both dentition Features are same as Type І but more severe Type III Brandywine type Affects both dentitions Opalascent bell shaped crown Multiple pulpal exposure Common in Maryland race of people Dr Vaishnavi Chidrawar

81. TREATMENT: In primary dentition: In the restorative treatment of pediatric patients, GIC or composite restoration Polycarbonate crowns may offer an alternative for the restoration of the anterior primary teeth. In mixed and permanent dentition: Jacket crown- anterior teeth Cast metal crown- posterior teeth Dr Vaishnavi Chidrawar

82. How to differentiate amelogenesis imperfecta from dentinogenesis imperfecta ? Amelogenesis Imperfecta Dentinogenesis Imperfecta Affects enamel Affects dentin Delayed eruption Normal eruption Very thin layer of enamel Fractured enamel with enamel pits Square-shaped crown Bulbous crown because of cervical constriction of neck Less severe attrition Marked attrition Normal roots Short and slender roots No obliteration of pulp chamber Obliteration of pulp chamber Dr Vaishnavi Chidrawar

83. DENTIN DYSPLASIA (ROOTLESS TOOTH) Rare disturbance of dentin formation characterized by normal enamel and atypical dentin formation Abnormal pulpal morphology Autosomal dominant CLASSIFICATION: Witkop Radicular Dentin Dysplasia Coronal Dentin Dysplasia Shields Type І (dentin dysplasia) Type ІІ (anomalous dysplasia of dentin) Dr Vaishnavi Chidrawar

84. Type І (Radicular) Clinical Features Both dentitions affected Morphologically teeth appear normal Normal eruption pattern Extreme mobility Exfoliated prematurely slight amber translucency Radiographic Features Roots are short, conical and blunt Deciduous teeth ( pulp chamber and root canal completely obliterated) Permanent teeth (crescent shaped pulpal remnant seen in canal) Histologic Features Lava flowing around boulders (normal dentinal tubule formation blocked, hence new dentin formed around obstacle) Dr Vaishnavi Chidrawar

85. Type ІІ (Coronal) Clinical Features Both dentitions affected Deciduous teeth: yellow, brown or bluish opalescence Permanent teeth: appears normal Radiographic Features Deciduous teeth : obliterated pulp chamber Permanent teeth: abnormally large pulp chamber- thistle tube appearance Histologic features Deciduous teeth: coronal dentin- normal radicular dentin- amorphous, atubular Permanent teeth: coronal dentin- relatively normal radicular dentin-multiple pulp stones or denticles Dr Vaishnavi Chidrawar

86. Meticulous oral hygiene Endodontic therapy considered in cases with periapical lesion where pulp chamber is not completely obliterated. Prosthetic replacement MANAGEMENT Dr Vaishnavi Chidrawar

87. Case report (Journal of head face and medicine 2020) Dr Vaishnavi Chidrawar

88.  Apical radiolucency in seven teeth (12, 15, 26, 31, 32, 36 and 46). Dr Vaishnavi Chidrawar

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91. REGIONAL ODONTODYSPLASIA It is an unusual developemental anomaly in which ectodermal and mesodermal tooth components are affected. Also known as ghost teeth. Clinical Features Affects both dentitions Maxillary teeth more frequently involved Aetiology unknown Delay or total failure of eruption of teeth Shape of teeth- altered (irregular mineralization) Dr Vaishnavi Chidrawar

92. Radiographic features Reduction in radiodensity : Ghost teeth appearance Enamel and dentin appear thin Exceedingly large pulp chamber Histologic features Marked reduction in amount of dentin Widening of predentin layer Large areas of interglobular dentin Irregular tubular pattern Endodontic therapy on vital teeth having sufficient hard tissue to allow restoration Severely affected and infected teeth removed Management: Dr Vaishnavi Chidrawar

93. Case report (Journal of European oral research 2018) a 6-year-old girl was referred to Department of Pedodontics with the chief complaint of a missing or unerupted permanent maxillary left central incisor, lateral incisor and both canines. Dr Vaishnavi Chidrawar

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95. references Orban’s Oral histology and Embryology 14 th edition Ten Cate’s Oral histology 8 th edition Shafer’ Oral pathology 8 th edition James EP, Johns DA, Johnson K, Maroli RK. Management of geminated maxillary lateral incisor using cone beam computed tomography as a diagnostic tool. J Conserv Dent. 2014 May;17(3):293-6. Angela Jordão Camargo , Emiko Saito Arita , Plauto Christopher Aranha Watanabe, Fusion or gemination ? An unusual mandibular second molar, International Journal of Surgery Case Reports, Volume 21, 2016,Pages 73-77 Sakkir N, Thaha KA, Nair MG, Joseph S, Christalin R. Management of Dilacerated and S-shaped Root Canals - An Endodontist's Challenge. J Clin Diagn Res. 2014 Jun;8(6):ZD22-4. Shekhar MG, Vijaykumar S, Tenny J, Ravi GR. Conservative Management of Dens Evaginatus : Report of Two Unusual Cases. Int J Clin Pediatr Dent. 2010 May-Aug;3(2):121-4 Dr Vaishnavi Chidrawar

96. Nazari S, Mirmotalebi F. Endodontic treatment of a taurodontism tooth: report of a case. Iran Endod J. 2006 Fall;1(3):114-6. Epub 2006 Oct 1. Dankner E, Harari D, Rotstein I. Conservative treatment of dens evaginatus of anterior teeth.  Endod Dent Traumatol . 1996;12(4):206-208. Mothanna Alrahabi , Clinical management of a mandibular first molar with supernumerary distal root (radix entomolaris ), Journal of Taibah University Medical Sciences, Volume 9, Issue 1, 2014, Pages 81-84, Krug, R., Volland , J., Reich, S.  et al.  Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report.  Head Face Med   16 , 27 (2020). https://doi.org/10.1186/s13005-020-00240-4 Dr Vaishnavi Chidrawar

97. T H A N K Y O U ! ! ! Dr Vaishnavi Chidrawar