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ABNORMALITIES OF TEETH  Environmental Alterations of Teeth  Developmental Alterations of Teeth 牙齒的異常 - 環境與發育的影響 王文岑 高雄醫學大學 牙醫學系

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Presentation on theme: "ABNORMALITIES OF TEETH  Environmental Alterations of Teeth  Developmental Alterations of Teeth 牙齒的異常 - 環境與發育的影響 王文岑 高雄醫學大學 牙醫學系"— Presentation transcript:

1 ABNORMALITIES OF TEETH  Environmental Alterations of Teeth  Developmental Alterations of Teeth 牙齒的異常 - 環境與發育的影響 王文岑 高雄醫學大學 牙醫學系

2 Wen-Chen Wang ENVIRONMENTAL ALTERATIONS OF TEETH Developmental tooth defects Turner’s tooth Hypoplasia caused by antineoplastic therapy Fluorosis Syphilitic hypoplasia Postdevelopmental structure loss Tooth wear Internal and external resorption Discolorations of teeth Intrinsic stains Extrinsic stains Localized disturbances in eruption Primary impaction Ankylosis

3 Wen-Chen Wang Enamel development  Three stages: 1. Matrix formation: protein laid down 2. Mineralization: minerals deposition, majority of original prot. removed-- diffuse, opaque white, soft enamel 3. Maturation: final mineralization-- translucent, hard enamel  Amelogenesis imperfecta  Enamel hypoplasia

4 Wen-Chen Wang Enamel development  No remodeling after initial formation  Timing of ameloblastic damage has a great impact on location & appearance of the defect  Development of crown : from 14th week of gestation to 12 months of age in deciduous dentition; 6 months to 15 y/o in permanent dentition  Neonatal ring on deciduous enamel and deposition with a rate of 0.023mm/day

5 Wen-Chen Wang Factors associated with enamel defects Systemic- 1. Birth-related trauma: premature birth 2. Chemicals: antineoplastic C/T, fluoride, tetracycline 3. Chromosomal abnormalities: trisomy Infections: chicken pox, CMV, syphilis 5. Inherited diseases: Vit.D-dependent rickets 6. Malnutrition: Vit. A deficiency 7. Metabolic disorders: hypoparathyroidism, maternal diabetes 8. Neurologic disorders: cerebral palsy See Box 2-2

6 Factors associated with enamel defects Local- 1.Local acute mechanical trauma 2. Electric burn 3. Irradiation 4. Local infection: periapical inflammatory disease See Box 2-2

7 Wen-Chen Wang Clinical and Radiographic Features Environmental enamel defects: 1.Hypoplasia: pits, grooves or large area of missing enamel 2. Diffuse opacities: variation in translucency, normal thickness, white opacity without clear boundary 3. Demarcated opacities: increased opacity, a sharp boundary with adjacent normal enamel, normal thickness

8 Wen-Chen Wang Turner ’ s hypoplasia, Turner ’ s tooth  Permanent teeth  Periapical inflammatory disease of the overlying deciduous tooth, less frequently in anterior teeth  Traumatic injury- not rare -45% children sustain injury to their deciduous teeth, 23% permanent teeth development disturbed Turner’s hypoplasia secondary to previous trauma

9 Wen-Chen Wang Turner’s teeth

10 Wen-Chen Wang Hypoplasia caused by antineoplastic therapy  Under 12 y/o, esp. under 5y/o  Age at treatment, forms of therapyChemotherapy-  Less alteration than radiation  Increased number of enamel hypoplasia and discolorations, slight smaller tooth size, radicular hypoplasia

11 Wen-Chen Wang Radiotherapy-  0.72 Gy related to mild defects in enamel, dentin ( 一般成人頭頸癌照射一次約為 2Gy)  Dose, radiation field

12 Wen-Chen Wang  Developmental radicular hypoplasia and microdontia caused by radiotherapy

13 Wen-Chen Wang  Hypodontia, microdontia, radicular hypoplasia, enamel hypoplasia, mandibular hypoplpasia, reduced in vertical development of lower 1/3 of face  Mandibular hypoplpasia may caused by Radiation →impaired root development →reduced alveolar bone growth  Cranial radiation→ altered pituitary gland function→ growth failed

14 Wen-Chen Wang *Dental fluorosis  1901, Dr. Frederick S. McKay: Colorado brown stain  1909, Dr. F.L. Robertson in Bauxite, Arkansas  1930, H.V. Churchill: high concentration of fluoride of Bauxite(13.7ppm) and Colorado  1931, Dr. H. Trendley Dean: association between fluoride, dental fluorosis and prevalence of caries among children  1.0 ppm reduced caries by 50~70% and associated with low and mild mottled enamel  0.7~1.2 ppm water fluoridation was recommended after 1962, currently 0.7ppm is recommended due to increased dental fluorosis

15 Wen-Chen Wang Dental fluorosis  Retention of the amelogenin protein in enamel structure → hypomineralized enamel → permanent hypomaturation → increased surface and subsurface porosity → alters light reflection and create white, chalky area

16 Wen-Chen Wang Dental fluorosis  Critical period for clinical dental fluorosis is the 2 nd and 3 rd year of life, dose dependent  Caries resistant

17 Wen-Chen Wang Syphilitic hypoplasia Congenital syphilis Hutchinson’s incisors & mulberry molars

18 Wen-Chen Wang POSTDEVELOPMENTAL LOSS OF TOOTH STRUCTURE  Begin from enamel surface (tooth wear): Attrition, abrasion, erosion, abfraction  Begin from dentin, cemental surface: internal or external resorption

19 Wen-Chen Wang Attrition  Tooth to tooth contact during occlusion and mastication, some are physiologic  Accelerated by: poor quality or absent enamel, premature contact, intraoral abrasives, erosion, grinding habits  Incisal, occlusal and interproximal surfaces

20 Wen-Chen Wang Abrasion  Pathologic loss of tooth structure or restoration secondary to the action of an external agent (ex. Toothbrush, hair grips, toothpicks, chewing tobacco, biting thread, dental flossing…)  Toothbrush abrasion: horizontal buccal cervical notches of exposed radicular cementum and dentin with smooth surface.  Greater on prominent teeth ( canines, premolars, and teeth adjacent to edentulous area) and side of the arch opposite to the dominant hand  Demastication- when tooth wear is accelerated by chewing an abrasive substance between opposing teeth (both attrition and abrasion)

21 Wen-Chen Wang Abrasion

22 Wen-Chen Wang Abrasion Long-term use of tobacco pipe Improper use of hair grips

23 Wen-Chen Wang Erosion  Chemical process, exposure to acidic foods or drinks, medications (chewable Vit. C, aspirin), involuntary regurgitation (ex. esophagitis, pregnancy), voluntary regurgitation (ex. psychologic problems, bulimia)  Perimolysis- dental erosion from gastric secretion  Facial surface of maxillary anteriors affected- dietary source  Posterior teeth extensive loss of occlusal surface, and palatal surface concave dentin surrounded by an elevated enamel rim- regurgitation of gastric secretion

24 Wen-Chen Wang Erosion concave dentin surrounded by an elevated enamel rim

25 Wen-Chen Wang A bulimia patient Erosion

26 Wen-Chen Wang Abfraction  Repeated tooth flexure caused by occlusal stresses (tensile stress) → concentrate at the cervical fulcrum → may produce disruption in the chemical bonds of enamel crystal →cracked enamel can be lost or removed by erosion or abrasion  Wedge-shaped cervical defects, deep, narrow V- shaped, not allow toothbrush to contact base; if the defect, often affect a single tooth  Almost exclusively on facial surface and more often in bruxism, higher in mandibular dentition

27 Wen-Chen Wang Abfraction

28 Wen-Chen Wang Treatment and prognosis of tooth wear  Resolve pain and sensitivity  Identify the cause of tooth structure loss  Protection

29 Wen-Chen Wang INTERNAL & EXTERNAL RESORPTION  Internal resorption- by cells located in pulp, rare  Follows injury to pulp tissues, physical trauma or caries, continue as long as vital pulp remains, may result in communication of the pulp and PDL  External resorption- by cells in PDL, common

30 Wen-Chen Wang Factors associated with external resorption

31 Wen-Chen Wang Clinical and Radiographic Features Internal resorption-  Inflammatory resorption- dentin replaced by inflamed granulation tissue  Pink tooth of Mummery: internal resorption involved coronal pulp Balloonlike enlargement of the canal  Replacement, or metaplastic absorption- pulpal dentinal walls are replaced by bone or cementum-like bone

32 Wen-Chen Wang Clinical and Radiographic Features External resorption-  Moth-eaten loss of tooth structure, less well-defined and variation in density in radiography  Most involved apical or midportions of root, occasionally, begin from cervical (invasive cervical resorption)

33 Wen-Chen Wang Histopathologic Feature Increased cellularity, vascularity and collagenization Numerous multinucleated dentinoclasts Inflammatory cells infiltration

34 Wen-Chen Wang Treatment and prognosis  Internal resorption-  Removal of all soft tissue from site of resorption  Endodontic treatment before perforation in internal resorption  Placement of calcium hydroxide paste for remineralization  Surgical exposure and restoration  Extraction  External resorption-  Identification and elimination the accelerating factor

35 Wen-Chen Wang ENVIRONMENTAL DISCOLORATION OF TEETH  Extrinsic- surface accumulation of exogenous pigment  Intrinsic-secondary to endogenous factors that result in discoloration of underlying dentin

36 Wen-Chen Wang Extrinsic stains  Bacterial- Chromogenic bacteria, green, black-brown, orange coloration Frequently in children, labial surface of maxillary ant. in gingival third  Iron- formation of ferric sulfide  Tobacco  Food and beverage- chlorophyll  Gingival hemorrhage- Hb. breakdown to biliverdin  Restorative material – ex. Amalgam  Medications- iron, iodine, silver nitrate, chlorhexidine, stannous fluoride

37 Wen-Chen Wang Intrinsic stains  Amelogenesis imperfecta  Dentinogenesis imperfecta  Dental fluorosis  Erythropoietic porphyria –  autosomatic recessive disorder of porphyrin metabolism, increased synthesis and excretion of porphyrins and their related precursors  Porphyrin deposition in teeth, reddish-brown coloration, red fluorescence when exposed to a Wood’s UV light  Present both in dentin and enamel in deciduous teeth, but only dentin affected in permanent teeth

38 Wen-Chen Wang Erythropoietic porphyria Hyperbilirubinemia

39 Wen-Chen Wang Intrinsic stains  Hyperbilirubinemia- bilirubin, breakdown product of RBC, jaundance (yellow-green discoloration), erythroblastosis fetalis, biliary atresia  Biliverdin deposition, green discoloration of teeth (chlorodontia)  Ochronosis-alkaptonuria, blue-black discoloration  Trauma- coronal discoloration, pulp necrosis  Localized RBC breakdown

40 Wen-Chen Wang Intrinsic stains  Medications- Tetracycline (bright yellow to dark brown), chlortetracycline (gray-brown), oxytetracycline (yellow), minocycline hydrochloride  Time of administration dose, duration  Avoid from pregnancy up to 8 yrs of age

41 Wen-Chen Wang Minocycline hydrochloride  Tx for Acne  Blue-gray from incisal 3/4, to dark green or black in roots, also affect developed teeth  Skin, nail, sclera, conjunctiva, thyroid, bone discoloration in susceptible individuals Stained alveolar bone

42 Wen-Chen Wang Treatment and prognosis  Extrinsic stains- polishing  Intrinsic stains- bleaching, bonded restoration, crowns

43 Wen-Chen Wang LOCALIZED DISTURBANCES IN ERUPTION  PRIMARY IMPACTION- Teeth cease to eruption before emergence  ANKYLOSIS -Cease of eruption after emergence and anatomic fusion of tooth cementum or dentin with alveolar bone

44 Wen-Chen Wang Impaction  3rd molars, maxillary canines, mandibular premolars, mandibular canines, maxillary premolars, maxillary central incisors, maxillary lateral incisors, and mandibular second molars; usually angulated or diverted Factors associated with impaction:  Crowding and deficient maxillofacial development  Overlying cysts or tumors  Trauma  Reconstructive surgery  Thickened overlying bone or soft tissue  A host of systemic disorders, diseases or syndromes

45 Wen-Chen Wang  Classification :  Partially erupted or full bony impaction  according to angulation: Mesioangular, distoangular, vertical, horizontal or inverted  Eruption sequestrum

46 Wen-Chen Wang Treatment and Prognosis Choice of treatment:  Long-term observation  Orthodontically assisted eruption  Transplantation  Surgical removal The risks associated with nonintervention:  Crowding dentition  Resorption and worsening of the periodontal status of adjacent teeth  Development of pathologic conditions, ex infections, cysts or tumors

47 Wen-Chen Wang The risks associated with intervention:  Transient or permanent sensory loss  Alveolitis  Trismus  Infection  Fracture  TMJ injury  Periodontal injury  Injury to adjacent teeth

48 Wen-Chen Wang ANKYLOSIS Infraocclusion, secondary retention, submergence, reimpaction, reinclusion

49 Wen-Chen Wang ANKYLOSIS Clinical And Radiographic Features  Pathogenesis is unknown, may be secondary to many factors and result in PDL barrier deficiency.  May occur at any age, any tooth  Most affect 8~9yr-old children and D, E, D, E  PDL absent  Occlusal, periodontal problems, impaction of the underlying teeth Treatment and Prognosis  Variable : extraction, orthodontics, segmental osteotomy

50 Wen-Chen Wang DEVELOPMENTAL ALTERATIONS OF TEETH SHAPE Gemination, Fusion, Concrescence Accessary cusps Dense in dente Ectopic Enamel Taurodontism Dilaceration Hypercementosis Supernumerary roots NUMBER Hypodontia Hyperdontia SIZE Microdontia Macrodontia STRUCTURE Amelogenesis imperfecta Dentinogenesis imperfecta Dentin dysplasia I & II Regional odontodysplasia

51 Wen-Chen Wang Missing teeth  %, excluding 3 rd molars, female predominance  Hypodontia: missing one or more teeth  Oligodontia: missing 6 or more teeth  Anodontia: total missing  8 > 5 > 2 > 1  Deciduous mandibular incisors  Gene mutation, ex: PAX9, MSX1, AXIN2 gene, He- Zhao deficiency, maps to chromosome 10q11.2  AXIN2 mutation: associated with the development of adenomatous polyps of colon, and colorectal carcinoma Ectodermal dysplasia orofaciodigital syndrome

52 Wen-Chen Wang Hypodontia

53 Wen-Chen Wang Ectodermal dysplasia Kaohsiung Medical University, Oral Pathology and image Diagnosis Dept.

54 Wen-Chen Wang Supernumerary teeth, hyperdontia  Mesiodens  4th molar  Paramolar  Distomolar, distodens  deciduous - lat. incisors  86% single supernumerary  multiple & impaction  cleidocranial dysostosis  Gardner’s syndrome

55 Wen-Chen Wang Mesiodens  The most common in supernumerary.  Premaxillary area, usually between upper central incisors  Cone-shaped crown & short root  One or two in number

56 Wen-Chen Wang Kaohsiung Medical University, Oral Pathology and image Diagnosis Dept.

57 Wen-Chen Wang Cleidocranial dysostosis 1. Skull: flat appearance, sutures remain open 2. Jaws: underdeveloped, high narrow palate 3. Teeth: prolonged retained deciduous teeth, delayed eruption of permanent teeth 4.Clavicles: complete or partial absent

58 Wen-Chen Wang Kaohsiung Medical University, Oral Pathology and image Diagnosis Dept.

59 Wen-Chen Wang Kaohsiung Medical University, Oral Pathology and image Diagnosis Dept.

60 Wen-Chen Wang Kaohsiung Medical University, Oral Pathology and image Diagnosis Dept.

61 Wen-Chen Wang Kaohsiung Medical University, Oral Pathology and image Diagnosis Dept.

62 Wen-Chen Wang

63 Gardner ’ s syndrome 1. multiple polyposis of the large intestine 2.osteoma of the bone 3.multiple epidermoid cysts or sebaceous cysts of the skin 4.desmoid tumors 5.impacted supernumerary & permanent teeth

64 Wen-Chen Wang Predeciduous dentition  Neonatal teeth: within 30 days  Natal teeth: newborns  Most are prematurely erupted deciduous teeth  Removal only if mobile and at risk of aspiration

65 Wen-Chen Wang

66 Microdontia  True: 1.General -pituitary dwarfism 2. Single -peg lat., 3rd molar  Relative microdontia

67 Wen-Chen Wang Macrodontia  True macrodontia : 1. Generalized-pituitary gigantism 2. Localized- single, hemifacial hypertrophy  Relative macrodontia: small jaw, child

68 Wen-Chen Wang

69 Gemination, Fusion, Concrescence

70 Wen-Chen Wang Gemination  single tooth germ division  single root & root canal + 2 complete or incomplete separated crowns  tooth no.: normal  twinning

71 Wen-Chen Wang Fusion  Union of 2 separate tooth germs  Contact of tooth germ before calcified  Confluent of the dentin  Complete- form a single tooth  Incomplete- after calcified begins  Tooth no. : less one

72 Wen-Chen Wang Concrescence  Fusion after root formation  Cementun united  Traumatic injury or crowding  Pre-extraction x-ray check

73 Wen-Chen Wang Talon cusp  Eagle’s talon  Lingual projection from the cingulum area of ant. teeth  Most contain a pulp horn  Both in deciduous & permanent dentition

74 Wen-Chen Wang Dens evaginatus ( central tubercle, occlusal tuberculated premolar; Leong’s premolar; evaginated odontome; occlusal enamel pearl )  An accessory cusp or a globule of enamel on central groove or buccal cusp of premolars or molars; unilateral or bilateral.  15% in Asians, rare in whites

75 Wen-Chen Wang Dens evaginatus Kaohsiung Medical University, Oral Pathology and image Diagnosis Dept.

76 Wen-Chen Wang  Shovel-shaped incisors

77 Wen-Chen Wang Dens in dente (Dens invaginatus; Dilated composite odontome)  Tooth within a tooth, incidence 5%  Invagination of the enamel organ into dental papilla before calcification Coronal type: 3 types  maxillary lateral incisors are common

78 Wen-Chen Wang Dens invaginatus, coronal type II

79 Wen-Chen Wang Dens invaginatus  Radicular type Hertwig’s sheath invagination Food deposition→ caries → pulp infection  Restorated as soon as possible

80 Wen-Chen Wang Taurodontism  “Bull-like “ teeth  Bi- or trifurcation near the apex  Pulp chamber : greater apico-occlusal height and no constriction at the cervical of the tooth

81 Wen-Chen Wang Syndromes associated with taurodontism

82 Wen-Chen Wang Hypercementosis

83 Wen-Chen Wang Supernumerary roots  Any tooth may develop accessary roots  No tx required, but critical important in endodontic procedure

84 Wen-Chen Wang Dilaceration  Angulation, sharp bend of root or crown  Trauma during tooth is forming  Pre-extraction x-ray check

85 Wen-Chen Wang Amelogenesis imperfecta (Hereditary enamel dysplasia; Hereditary brown enamel; Hereditary brown opalescent teeth) Defects in--  Formative stage→hypoplastic type → defective formation of matrix  Calcification stage →hypocalified → defective mineralization of formed matrix  Maturation stage → hypomaturation → enamel crystallites remain immature  Genes mutation : AMELX, ENAM, MMP-20, KLK4, DLX3

86 Wen-Chen Wang Amelogenesis imperfecta

87 Wen-Chen 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

88 Wen-Chen Wang Hypoplastic type Kaohsiung Medical University, Oral Pathology and image Diagnosis Dept.

89 Wen-Chen Wang Hypoplastic type

90 Wen-Chen 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

91 Wen-Chen Wang Hypomaturation type Kaohsiung Medical University, Oral Pathology and image Diagnosis Dept.

92 Wen-Chen 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

93 Wen-Chen Wang Hypocalcified type

94 Wen-Chen Wang Tricho-dento-osseous syndrome Hypoplastic-Hypomaturation type

95 Wen-Chen Wang Dentinogenesis imperfecta (Hereditary opalescent dentin)  Classification of DI : (Shields) 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

96 Wen-Chen Wang Osteosclerosis imperfecta Blue sclera M Greenwood, J G Meechan,:General medicine and surgery for dental practitioners Part 8: Musculoskeletal system. British Dental Journal 2003 (195) ,

97 Wen-Chen Wang Clinical features  type I : deciduous severe than permanent teeth; type II: equally affected; type III: both dentitions affected.  Gray to brownish violet or yellowish brown color, with translucent or opalescent hue.  Enamel lost early through fracture, esp. on the incisal & occlusal surface, and dentin attrition rapidly.  Caries rate is not increased.

98 Wen-Chen Wang Dentinogenesis imperfecta

99 Wen-Chen Wang Dentinogenesis imperfecta Histology: 1.pulp chamber obliterated with dentin 2.flatten D-E junction 3.atypical granular dentin, enlarged tubles, poor calcification  water contents: 50% above normal

100 Wen-Chen Wang Radiographic features  Partial or total obliteration of the pulp chamber & root canal by continued formation of dentin, in both dentitions.  Short and blunted roots  Normal cementum, PDL & supporting bone

101 Wen-Chen Wang Shell teeth  Initial reported in the Brandywine population  Normal thickness of enamel associated with extremely thin dentin and dramatically enlarged pulps (due to insufficent and deffective dentin formation)  Short roots.

102 Wen-Chen Wang Kaohsiung Medical University, Oral Pathology and image Diagnosis Dept.

103 Wen-Chen Wang Dentin dysplasia  Hereditary, autosomal dominant. Normal enamel but atypical dentin formation with abnormal pulp morphology Type I (radicular type): “Rootless teeth” Type II (coronal) DSPP (dentin sialophosphoprotein) gene mutation

104 Wen-Chen Wang Type I (radicular type) Radiographically:  deciduous teeth affected more severely, little or no pulp, short or absent roots.  If disorganization late---normal pulp chambers, with a large pulp stone.  periapical lesions (R-L) no obvious cause. Histologic features  Normal coronal enamel& dentin.  In root: tubular dentin and atypical osteodentin surrounded with normal dentin --- appearance of “ Lava flowing around boulders”.

105 Wen-Chen Wang Dentin dysplasia, type I

106 Wen-Chen Wang Type II (coronal)  Normal root length in both dentitions.  Primary dentition similar to DI: bulbous crowns, cervical constriction thin roots, early obliterated pulp.  Permanent teeth : normal coloration, thistle tube-shaped or flame-shaped pulp chamber with pulp stones.

107 Wen-Chen Wang Dentin dysplasia, type II (coronal)

108 Wen-Chen Wang Dentin dysplasia “Lava flowing around boulders”. Large pulp stones

109 Wen-Chen Wang Regional odontodysplasia (odontodysplasia; odontogenic dysplasia; odontogenesis imperfecta; ghost teeth)  One or several teeth in a localized area  Maxi. > Mand.; both dentitions  most in ant. area  Delayed or total failure eruption  Irregular appearance  Defective mineralization

110 Wen-Chen Wang  Radiographic features 1. Radiodensity ↓, “ghost appearance” 2. Large pulp, thin enamel & dentin  Histologic features 1. Dentin↓ 2.Widening of the predentin layer, 3. Interglobular dentin and an irregular tubular pattern of dentin ↑ 4.Calcification of the reduced enamel epi.

111 Wen-Chen Wang Regional odontodysplasia Enameloid conglomerates Odontogenic epithelium

112 Wen-Chen Wang ENVIRONMENTAL ALTERATIONS OF TEETH Developmental tooth defects Turner’s tooth Hypoplasia caused by antineoplastic therapy Fluorosis Syphilitic hypoplasia Postdevelopmental structure loss Tooth wear Internal and external resorption Discolorations of teeth Intrinsic stains Extrinsic stains Localized disturbances in eruption Primary impaction Ankylosis Summary

113 Wen-Chen Wang DEVELOPMENTAL ALTERATIONS OF TEETH SHAPE Gemination, Fusion, Concrescence Accessary cusps Dense in dente Ectopic Enamel Taurodontism Dilaceration Hypercementosis Supernumerary roots NUMBER Hypodontia Hyperdontia SIZE Microdontia Macrodontia STRUCTURE Amelogenesis imperfecta Dentinogenesis imperfecta Dentin dysplasia I & II Regional odontodysplasia Summary


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