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WenChen Wang Dental Anomalies in Radiology Developmental VS. acquired.

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Presentation on theme: "WenChen Wang Dental Anomalies in Radiology Developmental VS. acquired."— Presentation transcript:

1 WenChen Wang Dental Anomalies in Radiology Developmental VS. acquired

2 WenChen Wang Developmental Abnormalities

3 WenChen Wang Supernumerary Teeth (hyperdontia, supplemental teeth) 1~4%, familial tendency Mesiodens, paramolar Distodens, distomolar teeth Peridens Single : premaxilla, maxillary molar Multiple : premolar area, mandibular M : F = 2 : 1 Impaction or delay eruption of normal teeth; dentigerous cyst Syndrome: Cleidocranial dysplasia, Gardners syn.

4 WenChen Wang

5 Cleidocranial dysplasia

6 WenChen Wang

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10 Missing Teeth 3~10%, excluding 3 rd molars Hypodontia Oligodontia Anodontia 8 > 5 > 2 > 1 Ectodermal dysplasia ; orofaciodigital syndrome

11 WenChen Wang Q: X,

12 WenChen Wang ectodermal dysplasia

13 WenChen Wang SIZE OF TEETH True generalized type and relative type Macrodontia Hemangioma, hemihypertrophy of the face, pituitary giantism Microdontia pituitary dwarfism supernumerary teeth, 3 rd molars, lateral incisors

14 WenChen Wang Macrodontia Microdontia

15 WenChen Wang ERUPTION OF TEETH Transposition Two teeth exchanged positions 3 & 4 ; 3 & 2, 657

16 WenChen Wang Altered Morphology of Teeth

17 WenChen Wang Gemination, Fusion, Concrescence

18 WenChen Wang Gemination (twinning) -Division of a single tooth bud primary dentition, esp. incisor region complete twinning increase tooth number pulp chamber is single & enlarged, maybe partial divided

19 WenChen Wang Fusion (synodontia) bifid crown or two recognizable teeth, reduced number of teeth more common in the primary dentition, esp. anterior region -Adjacent tooth germs combined with dentin or enamel

20 WenChen Wang Concresence space restriction during develop., local trauma, excessive occlusal force or local infection after development maxillary molars; 3rd molar & a supernumerary tooth - Roots of two or more teeth united by cementum

21 WenChen Wang Fusion / Gemination A tooth with two separated root canals and with one or two roots…Fusion An enlarged tooth with a bifid crown containing an enlarged or possibly partially divided pulp chamber…Gemination

22 WenChen Wang Taurodontism normal crown size & tooth length, shortened roots not recognizable clinically most in molars Trisomy 21 -Longitudinal enlarged pulp chamber, increased distance between CEJ to the bifurcation

23 WenChen Wang Dilaceration - A sharp bend or curve in the crown or root maxillary premolars

24 WenChen Wang Dens in Dente (dens invaginatus) - Infolding of the outer enamel surface into the interior at the anatomically defined pit cariespulpal disease

25 WenChen Wang coronal type: enamel organ infolding into the dental papilla; 2>1>4,5>3 radicular type: invagination of Hertwigs epithelial root sheath, lined with cementum; 4, 7

26 WenChen Wang radicular type Dilated odontome

27 WenChen Wang Dens Evaginatus - Outfolding of enamel organ a tubercle on occlusal surface, with enamel surface & dentin core, pulp horn often extends into the evagination premolar or molar pulp infection due to fracture

28 WenChen Wang Dens Evaginatus Lingual pits

29 WenChen Wang Amelogenesis Imperfecta -Disturbance in enamel development Normal dentin & root autosomal dominant or recessive, X-linked Four general types

30 WenChen Wang Thin enamel with pitted, rough or smooth & glossy surface; yellowish to brown undersized, squared crown, lack of contact flat occlusal surface & low cusps, attrition 1.Hypoplastic type

31 WenChen Wang 2.Hypomaturation normal thickness of enamel, but mottled surface; cloudy white, yellow or brown, opaque in color softer than normal same density as dentin

32 WenChen Wang normal thickness of enamel, density less than dentin normal size & shape when erupt, abrade or fracture away rapidly permeability increase, darkened & stained 3.Hypocalcified type 4.Hypomaturation-hypocalcified with taurodontism

33 WenChen Wang Amelogenesis Imperfecta

34 WenChen Wang Dentinogenesis Imperfecta (hereditary opalescent dentin) autosomal dominant hereditary Type I : D.I. + osteogenesis imperfecta Type II : D.I., no skeletal defects enamel fractures, attrition severely dark brown to black

35 WenChen Wang Osteogenesis imperfecta Dentinogenesis Imperfecta

36 WenChen Wang bulbous crown, normal size, constriction of the cervical area short & slender roots occlusal attrition partial or complete obliteration of the pulp chambers, root canals absent or threadlike Radiographic Features of D.I.

37 WenChen Wang Dentinogenesis Imperfecta

38 WenChen Wang Dentin Dysplasia - autosomal dominant disturbance rare (1:100,000) Type I (radicular) _ normal color & shaped in both dentition _ malaligned arch, drifting and exfoliate with little or no trauma short or abnormal root shaped, pulp chamber & root canals completely fill in before eruption 20 % of teeth with type I disease have apical radiolucencies

39 WenChen Wang Dentin Dysplasia

40 WenChen Wang TypeII (coronal) primary dentition appears as D.I., but permanent dentition is normal obliterated of the pulp chamber & reduced root canals after eruption roots are normal in shape & proportion

41 WenChen Wang Dentin Dysplasia

42 WenChen Wang Regional Odontodysplasia (odontogenesis imperfecta) - hypoplastic & hypocalcified of both dentin & enamel only a few adjacent teeth in a quadrant affected either primary or permanent teeth central incisors > lateral incisors >canines (maxillary) delayed eruption ghostlike appearance in image large pulp chamber & wide root canals, roots are short & poorly outlined thin enamel, less dense as usual

43 WenChen Wang Regional Odontodysplasia

44 WenChen Wang Enamel Pearl (enameloma, enamel drop, enamel nodule) - small globule of enamel on the roots furcation area of molars prevalence : 3 % mesial or distal aspect in Max. molar and buccal or lingual in Mand. molars

45 WenChen Wang

46 Talon Cusp - Anomalous hyperplasia of the cingulum of a Max. or Mand. incisora supernumerary cusp T shaped in incisal view Differential diagnosed with supernumerary tooth

47 WenChen Wang Turners Hypoplasia (Turners tooth) -a local hypoplastic or hypomineralized defect in crown of a permanent tooth extension of a periapical infection or mechanical trauma from deciduous predecessor most common in lower premolars

48 WenChen Wang Turner tooth

49 WenChen Wang Congenital Syphilis 30 % pt develop dental hypoplasia Hutchinsons incisors & mulberry molars not all pt with Hutchinsons teeth or mulberry molars will have congenital syphilis

50 WenChen Wang Congenital syphilis Hutchinsons incisors & mulberry molars

51 WenChen Wang Acquired Pathologic Conditions

52 WenChen Wang Attrition - Physiologic wearing from occlusal contacts Incisal, occlusal and interproximal surfaces(contact points) Depends on the abrasiveness of diet, salivary factors, mineralization, emotional tension Bruxism--pathologic condition Crown shorten, reduction of pulp chamber & canals

53 WenChen Wang Abrasion -Nonphysiologic wearing by contact with foreign substances Factitious habits or occupational hazards tooth brushing, flossing, pipe smoking, opening hairpins with teeth

54 WenChen Wang Tooth Brushing Injury V-shaped groove in cervical area Sensitive Maxillary premolars >canines > incisors R-L defect at cervical level, well-defined semilunar shapes

55 WenChen Wang Attrition Tooth Brushing Injury

56 WenChen Wang Dental Floss Injury Cervical portion of proximal surfaces just above gingiva Narrow semilunar R-L, distal surface often deeper than mesial

57 WenChen Wang Erosion - Chemical action not involving bacteria Contact acid with teeth: 1. chronic vomiting or acid reflux from GI disorders 2. consumes large amounts of acid foods 3. occupational exposure Regurgitated acids attack lingual surfaces; diet--labial; industrial–all surfaces R-L defect on the crown

58 WenChen Wang Resorption -Removal of tooth structure by odontoclast _ Chronic infection (inflammation), excessive pressure and function, tumors and cysts

59 WenChen Wang Internal Resorption - within the pulp chamber or canal, involves resorption of surrounding dentin, results in enlarged pulp space Maybe related to inflammation of pulp tissues--acute trauma to tooth, pulp capping, pulpotomy… 1>6>7; M>F, commonly begins during 30-50y/o Pink spots

60 WenChen Wang Radigraphs reveal symptomless early lesions of IR R-L, round, oval, or elongated within root or crown and continuous with pulp chamber or canal Sharply defined and smooth or slightly scalloped …irregular widening of the pulp chamber or canal

61 WenChen Wang Internal Resorption

62 WenChen Wang External Resorption -outer surface of tooth resorbed, most commonly in root surface Localized inflammatory lesions, reimplanted teeth, tumor & cyst, excessive mechanical(orthodontic) and occlusal forces, impactions Common sites : apical & cervical (lateral root surface)

63 WenChen Wang Apical ER: -blunting with normal bone and lamina dura -root shortening, except due to periapical inflammatory lesions *canal is visible and abnormal wide at apex Lateral root surface ER: -presence of an unerupted adjacent tooth

64 WenChen Wang Apical ER Lateral root surface ER

65 WenChen Wang Secondary Dentin - Dentin deposited in pulp chamber after primary dentin formatted completely Normal aging process tertiary dentin: pathologic condition after chronic trauma Reduction in size of pulp chamber and canals Begins in the region adjacent to source of stimuli and alters normal shape of chamber

66 WenChen Wang Pulp Stone -- Foci of calcification in the pulp R-O within pulp chambers or root canals or extending from pulp chamber into root canals, most common in molars No uniform shape or number

67 WenChen Wang Pulpal Sclerosis - Diffuse calcification in pulp chamber and canals Correlation strongly with age Generalized, ill defined collection of fine RO throughout pulp chamber and canals

68 WenChen Wang Hypercementosis - Excessive deposition of cementum on roots 1.supraerupated tooth after opposing tooth loss 2.periapical inflammatory lesions 3.hyperocclusion or fractured 4.Pagets disease 5.hyperpituitarism Smooth or irregular enlargement of root with lamina dura and PDL space

69 WenChen Wang Hypercementosis


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