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WenChen Wang Dental Anomalies in Radiology 王文岑 助理教授 口腔病理影像診斷科

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Presentation on theme: "WenChen Wang Dental Anomalies in Radiology 王文岑 助理教授 口腔病理影像診斷科"— Presentation transcript:

1 WenChen Wang Dental Anomalies in Radiology 王文岑 助理教授 口腔病理影像診斷科

2 WenChen Wang 學習目標  判讀 X 光片上的牙齒異常  Developmental abnormalities v.s. acquired 資料來源  Ref 1: White SC, Pharoah MJ. Oral Radiology: Principles and interpretation 6 th ed  Ref 2: Neville BW, Damm DD, Allen CM and Bouquot JE. Oral & maxillofacial patholgy 3 nd ed  Ref 3: 高醫口腔病理診斷門診病例 2

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, Gardner’s syn. Developmental Abnormalities Ref.1 3

4 WenChen Wang 4 Ref.3

5 WenChen Wang Cleidocranial dysplasia Ref.3

6 WenChen Wang Cleidocranial dysplasia Ref.3

7 WenChen Wang Cleidocranial dysplasia Ref.3

8 WenChen Wang Cleidocranial dysplasia Ref.3 8

9 WenChen Wang Ref.3 Cleidocranial dysplasia

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

11 WenChen Wang Submergence  most affect 8~9y/o children and teeth D & E  PDL absent, ankylosis  Occlusal and periodontal problems 11 Ref.3 Infraocclusion, Secondary retention, Reimpaction, Reinclusion

12 WenChen Wang ectodermal dysplasia Ref.1 12

13 WenChen Wang Ectodermal dysplasia Ref.3

14 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

15 WenChen Wang Macrodontia Microdontia Ref.1 15

16 WenChen Wang ERUPTION OF TEETH Transposition  Two teeth exchanged positions  3 & 4 ; 3 & 2, 657 Ref.1 16

17 WenChen Wang Transposition 17 Ref.3

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 Altered Morphology of Teeth Ref.1 18 Ref.3

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 Ref.1,2 19

20 WenChen Wang Concresence  Fusion after root formation  Traumatic injury or crowding  Pre-extraction x-ray check  maxillary molars; 3rd molar & a supernumerary tooth - Roots of two or more teeth united by cementum Ref.1 20

21 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 Ref.1 21

22 WenChen Wang Dilaceration - A sharp bend or curve in the crown or root  maxillary premolars Ref.1 22

23 WenChen Wang Dens in Dente (dens invaginatus) - Infolding of the outer enamel surface into the interior  at the anatomically defined pit  caries→pulpal disease coronal type: enamel organ infolding into the dental papilla; 2>1>4,5>3 radicular type: invagination of Hertwig’s epithelial root sheath, lined with cementum;  4, 7 Ref.1 23

24 WenChen Wang radicular type Dilated odontome Ref.1 Dens in Dente 24 coronal type

25 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 Ref.1 Ref.2 25

26 WenChen Wang Amelogenesis Imperfecta -Disturbance in enamel development  Normal dentin & root  autosomal dominant or recessive, X-linked 1.Hypoplastic type  Thin enamel with pitted, rough or smooth & glossy surface; yellowish to brown  undersized, squared crown, lack of contact  flat occlusal surface & low cusps, attrition 2.Hypomaturation normal thickness of enamel, but mottled surface; cloudy white, yellow or brown, opaque in color softer than normal same density as dentin 3.Hypocalcified type normal thickness of enamel, density less than dentin normal size & shape when erupt, abrade or fracture away rapidly permeability increase, darkened & stained 4.Hypomaturation-hypocalcified with taurodontism 26

27 WenChen Wang Amelogenesis Imperfecta Ref.1 27 Hypocalcified type Hypoplastic type

28 WenChen Wang Dentinogenesis Imperfecta (hereditary opalescent dentin)  Autosomal dominant hereditary Type I : DI + OI (osteogenesis imperfecta) COL1A1, COL1A2 Type II : Isolated DI. (1/8000) DSPP Type III: DI of the Brandywine type * DSPP A racial isolate in Maryland, DI + multiple pulp exposures in deciduous teeth  enamel fractures, attrition severely  dark brown to black Radiographic Features of D.I. :  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 28

29 WenChen Wang Dentinogenesis Imperfecta Ref.1 29

30 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 filled in before eruption  20 % of teeth with type I disease have apical radiolucencies Ref.1 30

31 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 Ref.1 31 Dentin Dysplasia

32 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 32

33 WenChen Wang Regional Odontodysplasia Ref.1 33

34 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 Ref.1 34

35 WenChen Wang Talon Cusp - Anomalous hyperplasia of the cingulum of a Max. or Mand. incisor →a supernumerary cusp  T shaped in incisal view  Differential diagnosed with supernumerary tooth Ref.1 Ref.2 35

36 WenChen Wang Turner’s Hypoplasia (Turner’s tooth) -a type of enamel hypoplasia - 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 36 Ref.2,3

37 WenChen Wang Turner’s tooth (enamel hypoplasia) 37 Ref.1 Ref.3

38 WenChen Wang Congenital Syphilis  30 % p’t develop dental hypoplasia  Hutchinson’s incisors & mulberry molars  not all p’t with Hutchinson’s teeth or mulberry molars will have congenital syphilis Ref.1 38 Hutchinson’s incisors (screw driver shape)

39 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 Abrasion -Nonphysiologic wearing by contact with foreign substances  Factitious habits or occupational hazards  tooth brushing, flossing, pipe smoking, opening hairpins with teeth Acquired Pathologic Conditions 39

40 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 Ref.1 Ref.3 40

41 WenChen Wang Dental Floss Injury  Cervical portion of proximal surfaces just above gingiva  Narrow semilunar R-L, distal surface often deeper than mesial Ref.1 41

42 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  Radiolucent defect on the crown 42

43 WenChen Wang Resorption -Removal of tooth structure by odontoclast Chronic infection (inflammation), excessive pressure and function, tumors and cysts 43

44 WenChen Wang Internal Resorption - within the pulp chamber or canal, involves resorption of surrounding dentin, results in enlarged pulp space 44 Ref.1

45 WenChen Wang Internal Resorption Ref.1 45

46 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) 46

47 WenChen Wang Apical ER Lateral root surface ER Ref.1 47

48 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 Ref.1 48

49 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 49 Ref.1

50 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 Ref.1 50

51 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.Paget’s disease 5.hyperpituitarism  Smooth or irregular enlargement of root with lamina dura and PDL space Ref.1 51

52 WenChen Wang Summary DEVELOPMENTAL ABNORMALITIES NUMBER OF TEETH SIZE OF TEETH ERUPTION OF TEETH ALTERED MORPHOLOGY OF TEETH  Fusion(synodontia)  Concresence  Gemination(twinning)  Taurodontism  Dilaceration  Dens in dente (dens invaginatus)  Dens evaginatus  Amelogenesis imperfecta  Dentinogenesis imperfecta  Dentin dysplasia  Enamel pearl  Talon cusp  Turner’s hypoplasia (Turner’s tooth)  Congenital syphi lis ACQUIRED PATHOLOGIC CONDITIONS Attrition Abrasion Tooth brushong injury Dental floss injury Erosion Resorption Internal resorption External resorption Secondary dentin Pulp stone Pulpal sclerosis Hypercementosis 52


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