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1. DEVELOPMENTAL DISTURBANCES OF TEETH 1 Presented by: Jalal Katib Abd Junaid Bilal Hazim Omar Qussay Sami Abd-alhameed Salih Humam Marwan Faris Mohammed Buraq Ismail

2. Contents DEVELOPMENTAL DISTURBANCES IN NUMBER OF TEETH DEVELOPMENTAL DISTURBANCES IN SIZE OF TEETH DEVELOPMENTAL DISTURBANCES IN SHAPE OF TEETH 2

3. DEVELOPMENTAL DISTURBANCES IN NUMBER OF TEETH ANODONTIA It refers to a total lack of tooth development. 3

4. TYPES Hypodontia : lack of development of one or more teeth Oligodontia : lack of development of six or more teeth excluding third molars 4

5. Hyperdontia : development of an increased number of teeth and additional teeth are termed supernumerary 5

6. 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. 6

7. 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. 7

8. True partial anodontia ( hypodontia or oligodontia ) involves one or more teeth and is a rather common condition. Although any tooth may be congenitally missing, there is a tendency for certain teeth to be missing more frequently than others. 8

9. Congenitally missing deciduous teeth are uncommon but, when occurring, usually involve the maxillary lateral incisor. Mandibular lateral incisors and mandibular cuspids may also be missing. Although the etiology of a single missing tooth is unknown, a familial tendency for this defect is present in many instances. 9

10. Occasionally one sees children with teeth of one quadrant or both quadrants on the same side missing owing to X-ray radiation of the face at an early age. Tooth buds are extremely sensitive to X-ray radiation and may be destroyed completely by relatively low dosages. Teeth already forming and partially calcified may be stunted by X-ray radiation. 10

11. SUPERNUMERARY TEETH A supernumerary tooth may closely resemble the teeth of the group to which it belongs, i.e. molars, premolars, or anterior possibly from splitting of the permanent bud itself. 11

12. A supernumerary tooth is an additional entity to the normal series and is seen in all the quadrants of the jaw. The etiology of supernumerary teeth is not completely understood. In some cases there appears to be a hereditary tendency for the development of supernumerary teeth. 12

13. The conditions commonly associated with an increased prevalence of supernumerary teeth include cleft lip and palate, cleidocranial dysplasia and Gardner syndrome. The frequency of supernumerary permanent teeth in the cleft area in children with unilateral cleft lip or palate or both was found to be 22.2%. The frequency of supernumeraries in patients with cleidocranial dysplasia ranged from 22% in the maxillary incisor region to 5% in the molar region. 13

14. ODONTOME The term ‘ odontoma ’ refers to any tumor of odontogenic origin. odontoma represents a hamartomatous malformation rather than a neoplasm. 14

15. Types composite odontoma : The lesion is composed of more than one type of tissue complex composite odontoma : the diffuse mass of dental tissue which is totally disorganized compound composite odontoma : malformation which bears some superficial anatomical similarity to a normal tooth. 15

16. MICRODONTIA This term is used to describe teeth which are smaller than normal , i.e. outside the usual limits of variation. It affects most often the maxillary lateral incisor and the third molar . 16 DEVELOPMENTAL DISTURBANCES IN SIZE OF TEETH

17. In true generalized microdontia , all the teeth are smaller than normal. The teeth are reportedly well formed, merely small. In relative generalized microdontia , normal or slightly smaller than normal teeth are present in jaws that are somewhat larger than normal, and there is an illusion of true microdontia . 17

18. One of the common forms of localized microdontia is that which affects the maxillary lateral incisor, a condition that has been called the ‘peg lateral’. Instead of exhibiting parallel or diverging mesial and distal surfaces, the sides converge or taper together incisally , forming a peg-shaped or cone-shaped crown. 18

19. Macrodontia Macrodontia is the opposite of microdontia and refers to teeth that are larger than normal. 19

20. True generalized macrodontia , the condition in which all teeth are larger than normal, has been associated with pituitary gigantism, but is extremely rare. Relative generalized macrodontia is somewhat more common and is a result of the presence of normal or slightly larger than normal teeth in small jaws, the disparity in size giving the illusion of macrodontia . 20

21. Gemination Geminated teeth are anomalies which arise from an attempt at division of a single tooth germ by an invagination , with resultant incomplete formation of two teeth. 21 DEVELOPMENTAL DISTURBANCES IN SHAPE OF TEETH

22. Etiology In some reported cases, appears to exhibit a hereditary tendency. Radiographic appearance 22

23. FUSION Fused teeth arise through union of two normally separated tooth germs. Depending upon the stage of development of the teeth at the time of the union, fusion may be either complete or incomplete. 23

24. Etiology It has been thought that some physical force or pressure produces contact of the developing teeth and their subsequent fusion. If this contact occurs early, at least before calcification begins, the two teeth may be completely united to form a single large tooth. 24

25. If the contact of teeth occurs later, when a portion of the tooth crown has completed its formation, there may be union of the roots only. In some cases the condition has been reported to show a hereditary tendency. 25

26. CONCRESCENCE 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. 26

27. Etiology : traumatic injury or crowding of teeth with resorption of the interdental bone so that the two roots are in approximate contact and become fused by the deposition of cementum between them. The diagnosis can frequently be established by radiographic examination. 27

28. Talon’s cusp appears to be more prevalent in persons with the RUBINSTEIN TAYBI SYNDROME developmental retardation, broad thumbs and great toes, characteristic facial features, delayed or incomplete descent of testes in males, and stature, head circumference, and bone age below the fiftieth percentile. 28

29. Cusp of Carabelli The cusp of Carabelli is an accessory cusp located on the palatal surface of the mesiolingual cusp of a maxillary molar 29

30. DENS IN DENTE (Dens invaginatus , dilated composite odontome ) The ‘dens in dente’ is a developmental variation which is thought to arise as a result of an invagination in the surface of tooth crown before calcification has occurred. 30

31. Etiology increased localized external pressure, focal growth retardation, and focal growth stimulation in certain areas of the tooth bud. 31

32. The permanent maxillary lateral incisors are the teeth most frequently involved In the majority of cases the ‘dens in dente’ appears to represent simply an accentuation in the development of the lingual pit. The maxillary central incisors are sometimes involved, and the condition is frequently bilateral. 32 Clinical presentation

33. DENS EVAGINATUS ( Occlusal tuberculated premolar, Leong’s premolar, evaginated odontome , occlusal enamel pearl) 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 occur rarely on molars, cuspids and incisors. 33

34. It has been thought to develop only in persons of Mongoloid ancestry: Chinese, Japanese, Filipinos, Eskimos, and American Indians. 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. 34

35. 35

36. TAURODONTISM The term ‘ taurodontism ’ was originated 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. 36

37. Thank you 37