radiographicassessmentofdevelopmentalanomalies-190829211105.ppt

developmental defects

1. Developmental
Anomalies
of teeth

2. M.Ekram
Chapter 18
White & Pharoh
Page 330
Reference:

3. M.Ekram
Causes of Developmental Anomalies
1. Genetic:inherited or gene mutation.
2. Environmental causes:
Infection, trauma, radiation.
hormonal disturbances.
nutritional deficiencies.
hypoxia
miscellaneous

4. M.Ekram
Classification
Size Shape Number Structure
Disturbance
in eruption
Microdontia
macrodontia
gemination,
fusion.
Concrescence.
Dilaceration.
Talon cusp.
dense-in-dent.
Dens
invaginatus
Taurodontism.
Missing teeth
supernumerary
Amelogenesis
dentinogenisis
imperfecta.
Dentin
dysplasia
Trasposition
premature
delayed
eruption

5. M.Ekram
Anomalies in tooth size
Microdontia
True:
Generalized→ all teeth.
e.g. in dwarfism
Single, group of teeth→ #2 (peg shape )
→ # 8 (fused roots)
Relative Microdontia:as normal sized teeth in
large mandible
Clinically:identified easily

6. Radiographically:
small sized crown androot
Microdontia (cont.)

7. Macrodontia
True
generalized Localized
all teeth in facial hemi-
in Gigantism hypertrophy
clinically:single macrodontis
difficult to be identified from
geminationor fusion
Relative
normal or slightly
large teeth in small
jaw

8. M.Ekram
Developmental Anomalies in
Teeth Number
Increasednumber
supernumerary teeth.
Predeciduous dent.
Post permanent dent.
Decreasednumber
Hypodontia
Oligodontia
Anodontia.
partial-
anodontia

9. M.Ekram
Supernumerary Teeth
Arisefromextra-teethbuds.
Rareindeciduousteeth.
Mayresemblethetoothanatomicallyor
not.

10. M.Ekram
Supernumerary Teeth
Sites
anywhere,Butthemost
commonare:
Mesiodense:between
#1,#1.Small,conical
inverted,impacted,
shortroot.
Paramolars: located
aroundthepremolar-
molars.

11. M.Ekram
Supernumerary Teeth
Distomolar:Distalto#8,
small,rudimentary.

12. M.Ekram
Clinical Picture
Maypreventeruptionordisplacementofnormalteeth
orcausetoothresorption.
MultipleSupernumeraryTeethAremanifestedin:
1.Gardner’sSyndrome:multiplesupernumeraryand
impactedteeth,multiplepolypsoflarge
intestine,multipleosteomas,sebaceouscysts.

13. M.Ekram
Abnormalities
Bifidribsandotherskeletalabnormalities.
Multiplejawcysts.
Multiplenevoidbasalcellcarcinomas.
Characteristic frontal
bossing and broad
nasal root
Bifid ribs Multiple cyst -like radiolucencies
1.Gorlin-Goltz Syndrome:(basal cell nevous-
bifid rib syndrome).

14. M.Ekram
3. Cleido-cranial dysostosis:large skull with
mental retardation, open fontanells, small
maxilla, high arched palate, absent or
hypoplastic clavicles.

15. M.Ekram
Predeciduous Dentition
Hornifiedstructureatbirth
orjustafter.
Duetoextra-teethbuds.
Mostcommoninlower
anteriorarea.
Presentjustabovethe
alveolarridge,soeasily
removed.
NB:weshoulddifferentiate
betweenitanddeciduous
teethbeforeattempting
removal.

16. M.Ekram
Post-permanent Dentition
Third Dentition
After extraction of all teeth and construction of
denture, new teeth begin to erupt.
They may be either impacted.
Or supernumerary uneruptedteeth.

17. M.Ekram

18. M.Ekram

19. M.Ekram
Decrease Number of Teeth
Missing teeth -Anodontia
Total Anodontia:
failure of odontogenesis
rare but may accompany:
H. EctodermalDysplasia:
with dry skin, absence of
sweet glands, scanty hair,
patient can not tolerate
heat.
Partial Anodontia:
few teeth: Hypodontia
Many teeth: Oligodontia.
More common than total A.
Frequency:
#8 > #2 >#5 in permanent.
Upper # B > lower # B

20. M.Ekram
Hereditary
Radiationtotheheadinaveryearlystageof
developmentwitheitheratotaldestructionof
teethbuds,ortheteetharepartiallydeveloped
andhypo-calcifiedwithstuntedgrowth.
Diagnosis:
properhistoryandexclusionofextractionhelp
indiagnosis.Thenradiographicexamination
confirmstheclinicalex.
Etiology (Anodontia)

21. M.Ekram
Anodontia

22. M.Ekram
Ectodermal dysplasia
Fine scanty hairs
Anodontia

23. M.Ekram
Anodontia

24. M.Ekram
Ectodermal dysplasia

25. M.Ekram
Anomalies in eruption of teeth
Transposition
1.Permanent canine and 1
st
premolar.
2.Second premolar (between 6 & 7).
3.Central & lateral incisors.
N.B. Transposition was not reported in Pry teeth but may be
with hypodontiaor supernumerary teeth.
Teeth commonly involved

26. M.Ekram
Anomalies in tooth Shape
Gemination (twinning)
Partial division
tooth with a single root and
a crown that is divided
totally or partially.
Complete division
complete separation with
formation of 2 teeth with
crowns and roots.
N.B. the result is a normal teeth
No + supernumerary tooth.
A single tooth bud divides by an
invagination

27. M.Ekram
Complete
separation
Partial division

28. M.Ekram
Clinical Picture of Gemination
Site:
anterior (deciduous or
permanent).
Structure:
enamel and dentin may
be hypoplastic or
hypocalcified.

29. M.Ekram
RadiographicPicture of Gemination
Largetoothwithwell
defined enamel
separatingthetwo
parts.
One largepulp
chamberorpartially
dividedone.

30. M.Ekram
Gemination
Divided pulp chamber
One pulp chamber

31. M.Ekram
Clinical implications of Gemination
Poor esthetics due to a partially divided tooth.
Hypoplasticenamel and increased caries
susceptibility
Malocclusion and periodontal problems.

32. M.Ekram
Fusion
Unionoftwonormallyseparatedteeth.
Theoriesandtypes
1-fusionoccursearlybefore
calcification:
thetoothformedisonesinglelarge
tooth.
2-fusionoccurs lateafter
calcification:
theremaybeunionintherootsonly
withtwoseparateorsinglerootcanal.

33. M.Ekram
Clinical Picture of Fusion
Decreased number of
teeth by one.
Occurs more in
deciduous teeth.
More in anterior.
The crown may be
bifid

34. M.Ekram
What happens when fusion occurs between
normal tooth andsupernumerary tooth?
it will be very difficult to be differentiated
from gemination !!!!!

35. M.Ekram
Radiographic picture of fusion
Single root with cleft crown
(fusion occurs late after calcification had started)

36. M.Ekram
fusion
Fusion In deciduous teeth
2 separate root canals

37. M.Ekram
Differences between
fusion and gemination
Fusion
Number of teeth is less by
one except if fusion
occurs with extra-tooth.
Tooth with 2 separate
Root Canals with one or
two roots.
Gemination
Number of teeth is
correct or increased by
one.
Tooth with large pulp
chamber with either
clefted or partially
divided crown.
N.B. Also from macrodontia

38. M.Ekram

39. M.Ekram
Concrescence
It is a form of fusion but by cementum
only.
Etiology
traumaandcrowdingofteeth
withresorptionofinterdentalbone
sothatteethareunitedwith
depositionofcementum.
It may occur before or after
development of teeth (true &
acquired).
Significance:during teeth extraction.

40. M.Ekram
Taurodontism
Describestheincreasein
lengthofthecrownonthe
expenseofrootwith
elongatedpulpchamber
so,itshowsincrease
distancebetweenthe
CEJandrootfurcation.
The name derived from similarity of teeth to that of
Cud-chewing animals, so termedBull-liketeeth.

41. M.Ekram
Etiology:mutation resulting from odotoblastic
deficiency during formation of roots.
Clinically :indistinguishable

42. M.Ekram
Radiographic features
1.tooth rectangular in shape.
2. Large elongated pulp chamber.
3. Lack of usual constriction at cervical area.
4. Furcation is few mmsaway from the apex (short root).

43. M.Ekram
Dilaceration
This term refers to an angle or sharp
bend either in the crown or root.
Etiology:Developmental or could be due to
trauma
Trauma of deciduous teeth may cause
dilacerationof the permanents.
Clinically
Site:any where in therootand may be in
the crown.
More in maxillary anterior teeth.

44. M.Ekram
Clinical and Radiographic Picture
(Dilaceration)
Teeth may not erupt.
If in the crown:bad
esthetics.
If in the root:has no
significance except in
endodontics and
extraction.
Radiographically
appearsif dilaceration is to the mesial or distal.
Appears as well defined ROarea with LDin the center
(apical foramen) giving the appearance of “bulls’ eye”

45. M.Ekram
Dilaceration
Buccal or lingual dilaceration
Distal dilaceration
Distal dilaceration
Clear angulation

46. M.Ekram
Differential Diagnosis of Dilaceration
some times it is difficult to be differentiated from
condensing osteitis,
idiopathic osteosclerosis.
fused roots.
N.B. we take radiographs from different angles

47. M.Ekram
Dense-in-Dent
Itisduetoenfoldingofthe
enamelorgantothe
interior during
developmentandbefore
calcification.
Etiology:
1-focalgrowthstimulation
or focal growth
retardationincertain
areas.
2-Externaltrauma.

48. M.Ekram
Clinical Picture of Dens-in-Dent
Incidence:tooth #2> #1
Site:most common in crowns, but may be in the roots
due to folding of epithelial root sheath of Hertwing.
It Appears as a palatal pit.
N.B.the most extreme form of this anomaly is referred to
as Dilated odontome.

49. M.Ekram
Clinical Picture of Dens-in-Dent
Clinicalsignificance:
Thepalatalpitisdifficultto
clean.
verythinenamelseparate
thedefectfromthepulp
chamber.
Thereisariskofcaries
andpulpnecrosis.

50. M.Ekram
Coronally
pear-shaped area of enamel and
dentin.
Narrow constriction at the
opening .
Closely approximated to the pulp
in depth.
RadiographicPicture of Dens-in-Dent

51. M.Ekram
Radicular
lined with cementum,
may reach to the apical
foramen (not as defined
as the coronally).
RadiographicPicture of Dens-in-Dent

52. M.Ekram
Dense-in-Dent
Reported Case

53. M.Ekram
Dense evaginatus
Leong’s premolar
Clinically:
Occursinpremolars,as
atubercleofenamelin
themiddleofthe
occlusalsurface.
coveredwithenamel
andcomposed of
dentinandacoreof
pulp.
Itisduetooutfolding
oftheenamelorgan.

54. M.Ekram
Dense evaginatus
Radiographically:extension of pulp covered by
E & D.
Significance:
occlusalinterference.
prevention of complete eruption of the
opposing tooth.
wearing with subsequently pulp exposure.

55. M.Ekram
Talon Cusp
Itisprojectingfromthecingulumof
upperorloweranteriorteeth.
ClinicalPicture
Surroundedby2grooves.
Blendstothesurfaceofthe
tooth.
Significance
*MayInterferewithocclusion.
*Cariessusceptibility

56. M.Ekram
Radiographic picture of Talon Cusp
Differential diagnosis : Supernumerary teeth (buccal
object rule).

57. M.Ekram
Enamel Pearl
Is a small globule of enamel1-3 mm
in diameter that occurs on the roots
of molars (furcation area).
DD
1. Isolated piece of calculus
2. Pulp stone (buccal object rule –
vertically).

58. Anomalies in Tooth
Structure

59. M.Ekram
Developmental anomaly that affects enamel
formation.
Marked changes in E in either part or all the
teeth in both dentitions.
Dentin and roots are usually normal.
Causes delayed eruption of the affected teeth.
Increases tendency for impaction.
Amelogenesis Imperfecta (AI)

60. M.Ekram
AI: Types
E. Hypoplastictype. in matrix formation.
E. Hypocalcification in mineralization.
E. Hypomaturation.
Hypomaturation. Hypocalcifidtype. (mottled E).

61. M.Ekram
Clinical Picture (AI)
Hypoplastic type
Thin enamel & dentin is
shown, so the teeth are
dark or brown in color.
Loss of normal tooth
contour and teeth become
undersized.
Lack of proximal contact.
Occlusal surfaces are
usually flat (attrition).

62. M.Ekram
E Hypomaturation type
Clinical features
Enamel is of normal thickness but mottled.
Enamel can be pierced by probe.
Patient may be affected by different degrees.
Teeth may show vertical grooves.
Teeth may be chalky or dark in color.
radiographically.
Enamel is of normal thickness but with density
similar to D.

63. M.Ekram
Clinical picture (AI)
E Hypocalcification type
Clinical features
Staining of the tooth
occurs due to increased
permeability.
Associated with deposition of secondary
dentine in the pulp. Therefore ,
resembles DI
Staining of the tooth
occurs due to increased permeability.

64. M.Ekram
E Hypocalcification
Normal enamel thickness with lessdensity than D.
Radiographically.

65. M.Ekram
Radiographically
The diagnosis depends mainly
on the clinical examination.
TheteethareNormalorSquare-
shapedwiththinopaquemottledE.
(accordingtothethicknessofenamel).
Enamel may be lost and very difficult
to differentiate it from DI.

66. M.Ekram
DD of AI
FromDIwhy?
Ifformationofsecondarydentinwith
obliterationofthepulpisassociatedwith
Enamelabrasion,thiswillresembleDI.
Howeverbulboustooth+obliteratedshort
rootsruleoutAI.

67. M.Ekram
Dentinogenesis imperfecta (DI)
It is a developmental anomaly affecting dentin in both
sexes and both dentitions.
Hereditary opalescent dentin

68. M.Ekram
Type I Type II
usually + O I Never with O I
Unless by chance
Types of Dentinogenesisimperfecta
(DI)

69. M.Ekram
General clinical picture (D I)
Type I:more in deciduous teeth > permanent
Type II:equal in both
Tooth Color:
Teeth vary in color from
brownish, yellowish brown
or to even violet with
unusual translucency.
Enamel:
May be lost due to
abnormal DEJ, so dentin
undergo discoloration and
rapid attrition.
opalescent dentin

70. M.Ekram
Radiographic Picture (DI)
Bulbous teethwith variable degrees
of attrition.
In the early stage of development, the
pulp appears more wide then quickly
shows calcification.
Partial or total obliteration of pulpdue
to deposition of dentin in both
deciduous and permanent teeth.
Short blunted roots.
Occasionally associated with
multiple periapicalR L. without
actual pulp exposure but not as
frequent as in D dysplasia.

71. M.Ekram
Radiographic Picture (DI)

72. M.Ekram
Osteogenesis imperfecta
Hereditary disorder
Clinical features
Skeletal deformities
Blue sclera
Progressive osteopenia
Class III malocclusion
Impacted 1
st
& 2
nd
molars.
Dentinogenesis imperfecta
(25% of cases)

73. M.Ekram
Dentin Dysplasia
(Rootless teeth)
Veryrare,characterizedbynormalE,
defectiveD,abnormal pulp
morphology.
Veryshortconicalrootswith
obliterationofpulp.
AssociatedwithperiapicalRL.

74. M.Ekram
Rootless Teeth

75. M.Ekram
Dentin Dysplasia: Types
Type I (Radicular)
Roots are either short or of
abnormal shape (specules).
Obliteration of pulp before
eruption.
Associated with periapical
radiolucencies.
Teeth of normal color
Teeth malalignment
Tooth exfoliation
Type II (Coronal)
Crowns as in DI
Obliteration of pulp after
eruption
Pulp chambers may
become flame-like shaped.
Anterior teeth and
premolars may develop
thistle-tube shaped pulp
chamber.

76. M.Ekram
Rootless Teeth Type I

77. M.Ekram
Rootless Teeth Type II
Flame-like pulp chamber Thistle-like pulp

78. M.Ekram
DD of Dentin Dysplasia
D Imperfecta
Crown:bulbous bell-
shaped
Root:short
Obliterated pulp chamber
D Dysplasia
Crown:Normal size and
shape.
Root:short or normal
Type II shows obliteration
after eruption
Pulp chamberis thistle-
tube-shaped or flame-like.
Rarifying osteitisis more
frequent.
Both causes discoloration of teeth and obliteration
of pulp chamber.

79. M.Ekram
Regional Odontodysplasia
(Ghost teeth)
It is a relatively rare disorder of unknown
etiologyaffecting both E & Dof both
dentitions.
E and D are both hypoplasticand
hypocalcified.
Results in arresting developmentof the
involved teeth.
One or several teethin a localized area are
affected.

80. M.Ekram
Ghost tooth
Clinically:
It affects maxillary anterior
teeth more than mandibular.
Central > lateral > canine.
Teeth have irregular shape
with defective mineralization.
Teeth show delayed eruption.
Increase incidence of caries,
pulp infectionand tooth
fracture.

81. M.Ekram
Ghost tooth
Radiographically
thinE&Dwithlarge
pulp.
SometimesEisvery
hypo-denssothatitmay
notbeevidenton
radiographs.

82. M.Ekram
DD of Odontodysplasia
D Imperfecta
Family history
E is normal
Involves all teeth
Odontodysplasia
No family history
E is hypoplastic
Few or group of teeth
in the arch are only
affected.
It may resemble DI But:

83. M.Ekram
Turner’s Hypoplasia
Usually involve single tooth.
Permanent > deciduous.
Ranges from mild discoloration or pitting of E,
to severe defects and abnormal anatomy.
Due toinfection or trauma to deciduous.

84. M.Ekram
Congenital Syphilis
Affects permanent
dentitionmore than
deciduous.
Deciduousteethare
usuallynormal as
abortionwouldoccurif
treponeamalspirocheats
getaccessthroughthe
placentatothefetus.

85. M.Ekram
Clinical features
Anterior teeth : Hutchinson’s
teeth.
#1 >#2 >#6
Screw driver with rounding of
the mesial and distal incisal
angles.
Notching of the incisaledge.
Molars: Mulberry molars or
Moon's molars
narrow crown with globular
shaped cusps.
E. hypoplasia due to syphilis has a very
pathognomonic features.

86. M.Ekram
Thank you
Questions ?