Developmental Anomalies Of Oral & Para-oral Structures

Developmental Anomalies Of Oral & Para-oral Structures

Index Introduction Types of anomalies
Developmental anomalies of Oro-facial hard tissues Developmental anomalies of Oro-facial soft tissues Syndromes

Introduction Malformation or defects resulting from disturbance of growth & development are known as Developmental Anomalies Manifestation of defects are evident either at birth or some times after birth

Types of anomalies Congenital developmental anomalies
Hereditary developmental anomalies Familial developmental anomalies Acquired developmental anomalies Hamartomatous developmental anomalies Idiopathic developmental anomalies

Congenital Developmental Anomalies
Defects which are present at birth or before birth during the intra-uterine life as a result of either heredity or environmental influences E.g. - Cleft lip & palate

Hereditary Developmental Anomalies
Defects are genetically transmitted from the parents to the offspring, where definite genetic location is identified E.g. Downs syndrome –Trisomy 21

Familial Developmental Anomalies
Defects are transmitted from the parents to the offspring, where definite genetic location is not identified E.g. – Diabetes

Acquired Developmental Anomalies
Defects develop during intra-uterine life due to some pathological environment condition Can be Prenatal / neonatal / Postnatal E.g.: 1. Congenital Syphilis - Notched incisors - Mulberry molars 2. Fluorides - Enamel hypoplasia

Notched incisors Mulberry molars Fluorosis

Hamartomatous Developmental Anomalies
Defects occuring due to hamartomatous change in the tissues Hamartoma: Excessive focal proliferation of normal tissues which are native to that particular location E.g. – Odontome

Note: Choristoma: Excessive focal proliferation of normal tissues which are not native to that particular location E.g. – Gingival salivary gland choristoma Teratoma: Tumor arising from all the 3 germ layers E.g. – Ovarian teratomas

Idiopathic developmental anomalies
Indicates the developmental anomalies were exact cause is unknown E.g. – Idiopathic enamel hypoplasia

Syndrome The term syndrome derives from the Greek and means literally "run together “ A group of symptoms that collectively indicate or characterize a disease, a psychological disorder, or another abnormal condition Large number of syndromes occur in association with many oral diseases Early diagnosis of a syndrome is important since severity of a disease can be much more when it is occuring in association with a syndrome

Multiple polyposis of large intestine
E.g. Gardner's syndrome Multiple polyposis of large intestine Osteomas of bone Desmoid tumours Multiple epidermoid cysts of skin Multiple impacted supernumerary tooth

Developmental anomalies of Oro-facial hard tissues

Developmental Anomalies affecting the teeth
Developmental Anomalies affecting the jaws

Anomalies of tooth occur either due to genetic / environmental factors
Defects may occur during any of the developmental stages of teeth, which are manifested clinically in the later life once the tooth is fully formed

Developmental Anomalies of Teeth

Initiation - Anodontia/ hyperdontia Proliferation - Microdontia
E.g. Initiation - Anodontia/ hyperdontia Proliferation - Microdontia Histodifferentiation - Cysts / neoplasms Morphodifferentation - teeth with abnormal morphology or Odontome Apposition Hypoplastic tooth Calcification - Hypocalcification Eruption - Embedded tooth Structural diffects

Classification

I. Those affecting the size
Microdontia Macrodontia Rhizomicri Rhizomegaly

II. Those affecting the number
Anodontia Supernumerary teeth Pre-deciduous dentition Post permanent dentition

III. Those affecting the shape
Gemination Fusion Concrescence Talon’s cusp Dens invaginatus Dens evaginatus Taurodontism Dilaceration / Flexion Supernumerary root Extra cusps Enamel pearl Cervical enamel extension

IV. Those affecting the position
Ectopia Rotation Trans-position Inversion Trans-migration

V. Those affecting eruption
Premature eruption Delayed eruption Impacted tooth Embedded tooth Submerged tooth Eruption sequestrum

VI. Those affecting the structure
Enamel Enamel hypoplasia Amelogenesis imperfecta Dentin Dentinogenesis imperfecta Dentin dysplasia Enamel + Dentin Regional odontodysplasia Cementum Hypocementosis Hypercementosis

Microdontia Condition in which one or more teeth are smaller than normal More in females Etiology Genetic factors Environmental factors Types 1. Generalized microdontia (>14) - True - Relative 2. Focal microdontia (<14)

True generalized microdontia
All the teeth in both arches are well formed but, uniformly smaller than normal Associated with - Pituitary dwarfism - Down’s syndrome - Congenital heart disease

Relative generalized microdontia
Large jaw size relative to the teeth makes the normal teeth seem smaller resulting in spacing between teeth Hereditary condition

True generalized microdontia

Relative generalized microdontia

Focal microdontia One or more teeth are smaller than normal More common than generalized microdontia Frequently involved teeth are maxillary laterals & maxillary 3rd molars E.g. – Peg laterals

Focal microdontia

Macrodontia (Megadontia / Megalodontia)
Condition in which one or more teeth are larger than normal Common in males Teeth are known as megadont / macrodont Types 1. Generalized macrodontia - True - Relative 2. Localized macrodontia

Macrodontia

True generalized macrodontia
All the teeth in both arches are well formed & uniformly larger than normal Associated with - Pituitary gigantism

Relative generalized macrodontia
Small jaw size relative to the teeth makes the normal teeth seem larger resulting in crowding of teeth Hereditary condition

Localized macrodontia
One or more teeth are larger than normal Should not be confused with fusion Associated with - Facial hemi-hypertrophy

Localized macrodontia

Rhizomicri It is a condition where root of the teeth are smaller than normal Teeth most commonly affected are maxillary laterals, maxillary 3rd molars, maxillary & mandibular 1st premolars Clinical significance Involved tooth cannot be used as anchorage & abutment

Rhizomegaly (Radiculomegaly)
Condition where in root of the teeth is larger than normal Most commonly affected teeth are maxillary & mandibular cuspids Clinical significance - Extraction difficulties - Oro-antral fistula

Normal Rhizomegaly Rhizomicri

Anodontia Condition in which there is absence of teeth in the oral cavity Etiology: - Hereditary factor - Familial tendency - Radiation injury to developing tooth germs - Hereditary ectodermal dysplasia - Mutation

Types Pseudo anodontia

Pseudo anodontia Condition in which teeth are present within the jaw bones but are not erupted E.g. - Impacted tooth - Embedded tooth

False anodontia Condition in which the teeth are missing in oral cavity due to extraction or exfoliation

True anodontia Condition which occurs due to failure of development of tooth in the jaw bones Can be total or partial

Complete / Total anodontia
Congenital absence of all teeth Extremely rare condition

Partial anodontia Congenital absence of one or more teeth Commonly seen in third molars, maxillary lateral incisors and the second premolars

Hypodontia Congenital absence of one or more teeth but less than 6

Oligodontia Congenital absence of more than 6 teeth

Conditions & syndromes associated
Hereditary ectodermal dysplasia Ehlers – Danlos syndrome Rieger’s syndrome Down syndrome Book syndrome

Supernumerary teeth (Hyperdontia)
Presence of tooth in excess of the normal number in the dental arch Common in males Etiology: - Accessory tooth bud - Splitting of the regular normal tooth bud - Hereditary - Atavism

Classification I. Based on Number & Shape Conical Complex Single
Compound Tuberculate Supernumerary teeth Supplemental Non-syndrome associated Multiple Syndrome associated

Distomolar / Destodens Paramolar
II. Based on location Mesiodens Distomolar / Destodens Paramolar

Mesiodens Most common type of supernumerary tooth Located between the upper central incisors Small conical in shape Erupted / impacted / inverted

Mesiodens

Distomolar (Distodens)
Small rudimentary tooth Located distal to 3rd molars in the dental arch

Paramolar Small rudimentary tooth Located on buccal / lingual aspect of the normal molars Occurs most commonly in maxilla

Supplemental tooth

Distomolar

Clinical significance
Crowding, malocclusion & aesthetic problems May lead to increased incidence of dental caries & periodontal problems Dentigerous cyst may develop from impacted supernumerary tooth Treatment:- Extraction

Conditions & syndromes associated
Cleido cranial dysplasia Apert syndrome Gardner syndrome (multiple supernumerary teeth) Ehlers Danlos syndrome Down’s syndrome Cleft lip & palate

Predeciduous dentition
Infants occasionally are born with structures which appear to be erupted teeth Earlier thought to arise from accessory bud from accessory dental lamina & the concept is no more in use Now thought as hornified epithelial structures filled with keratin occurring on gingiva on crest of ridge & are termed as ‘dental lamina cyst of new born’

Postpermanent dentition
It is a condition in which several teeth erupt into oral cavity after all permanent teeth are lost particularly after the insertion of full denture Earlier it was thought to be the third dentition Now it is regarded as the delayed eruption of embedded or impacted permanent teeth or it can be eruption of multiple supernumerary unerupted teeth

Those affecting the shape

Gemination It’s a developmental anomaly which refers to the incomplete formation of 2 teeth resulting from an attempt at division single tooth germ by an invagination. The result is formation of two completely or incompletely separated crown that have single root and root canal. Affects both deciduous & permanent dentition Commonly affects deciduous mandibular incisors & permanent maxillary incisors

Clinically the tooth reveals extremely widened crown with indentation / groove as a mark of attempted division Gemination consist of same number of teeth (32) in oral cavity

Twinning It’s a developmental anomaly in which there is complete & equal division of single tooth germ resulting in one normal & one supernumerary tooth Twinning consist of one extra tooth (may be 33) in the oral cavity

Fusion It is defined as the union of 2 adjacent normally separated tooth germs It results in one anomalous large crown in place of two normal teeth. The teeth are fused at the level of dentin If fusion occurs before the calcification begins complete fusion with single crown and root develops If it happens after crown completion resuting tooth will have union of roots only

Affects both deciduous & permanent dentition
Incisor teeth are frequently affected Fusion may be complete or incomplete. Physical force or pressure produces the contact between the adjacent tooth germs

Types Fusion Fusion consist of one teeth less (31) in the oral cavity
Complete Incomplete Fusion takes place before calcification of tooth has occurred Fusion begins at later stages of tooth development & may be limited to roots only Fusion consist of one teeth less (31) in the oral cavity

Concrescence Developmental anomaly where the roots of 2 or more adjoining teeth have been united by cementum It occurs after root formation of involved teeth are completed Causes: - Traumatic injury - Crowding of teeth - Hypercementosis associated with chronic inflammation

Occurs frequently between maxillary 2nd & 3rd molars
Clinical significance:- Difficulty in extraction

Dilaceration (Flexion)
Refers to a sharp bend / curve / angulation in root or crown of tooth Etiology:- - Trauma - Injury to deciduous tooth - Idiopathic

Pathogenesis Trauma Partially calcified tooth germ
Displacement of hard calcified crown portion of tooth Uncalcified root portion develops by forming an angle

More common in maxillary incisors
Curve may be present at apical / middle / cervical portion of root depending on the portion which is forming at the time of trauma Clinical significance:- Difficulties in extraction & RCT

Talon cusp Anomalous projection or additional cusp arising lingually from cingulum area & extends to the incisal edge as a prominent “T” shaped projection Common in permanent dentition & rare in deciduous dentition Seen commonly on permanent maxillary incisors (more in laterals) and less frequently on mandibular incisors Forms a stucture resembles an eagle’s talon Causes:- - Local environmental factors - Genetic factors

Talon cusp consist of normally appearing enamel & dentin. In few cases there can be presence of vital pulp tissue Usually asymptomatic May interfere with occlusion Susceptibility to caries (lingual pits)

Syndromes associated:-
Treatment:- - Restoration of lingual pits to prevent dental caries - Reduction of cusp if it interferes with occlusion Syndromes associated:- 1. Rubinstein – Taybi syndrome 2. Sturge – Weber syndrome 3. Mohr syndrome

Dens invaginatus Dens – in – Dente Tooth – with in – Tooth
Pregnant tooth Dilated composite odontome

Developmental morphologic variation characterized by deep surface invagination of the crown / root
Presence of enamel lined cavity within tooth led the early investigators to believe that a tooth with in a tooth & hence the name “Dens – in – Dente” The condition is most probably caused by an invagination of enamel organ before calcification

Types Based on occurrence Dens invaginatus Coronal Radicular
Invagination / infolding occurs on crown portion of the tooth Invagination / infolding occurs on root portion of the tooth

Coronal dens invaginatus
Type I / Mild form Invagination confined to crown within the CEJ Type II / Intermediate form Invagination extends below CEJ; may or may not communicate with pulp Type III / Extreme form Invagination extend beyond the pulp through the root & perforate the apical / lateral radicular area without any communication with the pulp

Type I Type II Type III

More common is coronal type
Common in permanent maxillary teeth Commonly affected teeth are maxillary laterals, central incisors & premolars Before eruption the invagination is filled with soft tissue which is similar to dental follicle, which on eruption becomes necrotic

Radicular dens invaginatus
Rare condition Thought to arise secondary to a proliferation of HERS, with the formation of a strip of enamel that extends along the root surface The root reveals an invagination with the opening on the lateral aspect of the root

Radiographic feature Affected tooth demonstrates an enlargement with deep pear shaped invagination lined by enamel

The invagination is extremely prone to caries Type III form of Dens invaginatus provides direct communication between oral cavity & periapical tissues leading to inflammatory lesions Treatment:- Early detection & prophylactic restoration

Dens Evaginatus Leong’s premolar Evaginated odontome
Occlusal tuberculated premolar Occlusal enamel pearl Central tubercle

Developmental anomaly of the tooth in which a focal area of the crown shows a ‘globe’ or ‘nipple’ shaped outward projection on the occlusal surface Clinically appears as an extra cusp Common in individuals of Mongolian origin & rare in whites

Pathogenesis Develops as a result of localized elongation & proliferation of inner enamel epithelium as well as the dental papilla into the dental organ

Clinical features Primarily affects the premolars (Molars also) Usually bilateral with mandibular predominance Presents as an extra cusp located on the occlusal surface between buccal & lingual cusps Can interfere with tooth eruption Causes occlusal disharmony Sometimes, the extra cusp may contain vital pulp and its attrition / facture may result in pulp exposure leading to associated complications & pain

Note Shovel shaped incisors Variant of Dens Evaginatus
Prominent marginal ridges which creates a hollowed lingual surface resembling a scoop of a shovel

Treatment Asymptomatic – No treatment needed Occlusal disharmony – Minor reduction Pulp exposure – RCT

Taurodontism (Bull teeth)
Developmental anomaly in which the crown portion of the tooth is enlarged at the expense of the roots. Term coined by Sir Arthur Keith Was found commonly in ancient neanderthal man The overall shape resembles that of the molar teeth of cud-chewing animals (Tauro = Bull, Dont = tooth) There is altered crown-to-root ratio

Causes Failure of hertwig’s epithelial root sheath to invaginate at proper horizontal level during development of teeth Primitive pattern Atavism Mendelian recessive trait Mutation resulting from odontoblastic deficiency during dentinigenesis of roots The reappearance of a biological characteristic in an organism after it has not appeared for several generations.

Clinical & radiographic features
Affects permanent teeth more frequently than deciduous teeth Unilateral or bilateral Molars are frequently involved Teeth are usually rectangular in shape Minimal constriction at cervical area Elongated crown & enlarged pulp chamber Apically placed furcation area Exceedingly short roots

Types Based on degree of apical displacement of pulpal floor / furcation area (by Shaw) 1. Hypotaurodont (Mild) Furcation area placed below normal but within cervical 1/3rd of root 2. Mesotaurodont (Moderate) Furcation area placed at middle 1/3rd of root 3. Hypertaurodont (Severe) Furcation area placed at apical 1/3rd of root

Normal Mild moderate severe

Klinefelter’s syndrome Down syndrome Poly X syndrome
Syndromes associated Klinefelter’s syndrome Down syndrome Poly X syndrome Ectodermal dysplasia

OTHERS Cervical enamel extensions Globodontia Enamel pearl
Conical incisors ( peg shaped laterals) Hutchinsons incisors, Moon’s Molar, Mulberry molars e Accessory roots Accessory cusps & ridges ( Cusp of carabelli) Paramolar tubercle/ Bolk cusp/ Protostylids

Supernumerary root Refers to the presence of one or more extra roots than normal Roots may be curved / straight / divergent Affects both deciduous & permanent dentition Commonly involved teeth are permanent molars, mandibular cuspids & premolars Clinical significance:- Difficulties in extraction & RCT

Enamel pearl Enameloma Enamel drops / nodule Enamel exostoses

These are white dome shaped calcified projections of enamel located at the furcation areas of molar teeth They may consist entirely of enamel or contain underlying dentin & pulp

Causes The epithelial component of the hertwigs root sheath may sometimes retain its ameloblastic potential and may synthesize enamel in some focal areas on root surface Localized bulging of odontoblastic layer From small group of misplaced ameloblasts

Clinical features Affects both deciduous & permanent dentition
Occur single / multiples Commonly seen on roots of maxillary molars followed by mandibular molars Highest incidence in Asians Types:- 1. Extradental (on root surface) 2. Intradental (included in dentin)

Exophytic nature of the pearl is conducive to inadequate cleaning & plaque retention

Cervical enamel extensions
These are triangular extensions of enamel from CEJ towards furcation area of molar teeth Common in mandibular molars Frequently involve bifurcation area on buccal surface of roots

Classification Type I Coronal enamel projecting just below CEJ Type II
Coronal enamel projecting below CEJ but not involving the furcation area Type III Coronal enamel extending to involve the furcation area

Enamel extensions lead to loss of PDL attachment and may predispose to development of: 1. Periodontal pocket 2. Buccal bifurcation cyst

Disturbance in position
Ectopia Trans position Trans migration Rotation

Ectopia Remote location of a tooth away from its normal position E.g:-
1. Maxillary canine erupting in nasal cavity / maxillary sinus / at the inner canthus of eye 2. Mandibular 3rd molar erupting at angle of mandible / lower border of mandible / through the skin of cheek

Transposition Condition where in 2 teeth exchange position E.g:-
Exchange of position between maxillary canine & premolar Exchange of position between mandibular canine & lateral incisors

Rotation Developmental anomaly where in a tooth turns partially / completely Commonly seen in, Maxillary 2nd premolar (Complete rotation) Maxillary central & 1st premolar (Partial rotation)

Disturbance in eruption and exfoliation
Premature eruption Delayed eruption Unerupted teeth Embedded or impacted teeth Ankylosed teeth Eruption cyst, eruption hematoma, & eruption sequestrum Premature exfoliation

Delayed eruption Tooth erupts into oral cavity much later than normal time of eruption Affects both deciduous & permanent dentition

Premature eruption Tooth erupts into oral cavity much earlier than normal time of eruption Frequently involved tooth are deciduous mandibular central incisors

Types Natal teeth Erupted deciduous teeth present at the time of birth
Neonatal teeth Deciduous teeth which erupt within first 30 days of life

Causes Endocrinal disturbances - Adreno-cortical syndrome - Hyperthyroidism Premature loss of deciduous teeth causes premature eruption of permanent teeth

Causes Systemic factors - Rickets - Cleidocranial dysplasia - Cretinism Local factors - Fibromatosis gingivae - Cleft lip & palate - Retained deciduous tooth Idiopathic

Impacted teeth Teeth which are prevented from eruption into oral cavity by some physical barrier in eruptive path or non availability of space Causes - Micrognathia - Retained deciduous teeth - Supernumerary teeth - Odontogenic cyst & tumors - Cleft palate - Syndrome associated

Classification Completely impacted tooth Partially impacted tooth
Impacted tooth is totally surrounded by bone Partially impacted tooth Impacted tooth is partly surrounded by bone & partly by soft tissue

Mesioangular : Impacted tooth mesially inclined
Distoangular : Impacted tooth distally inclined Vertical : Impacted tooth lies vertical Horizontal : Impacted tooth lies horizontal

Complications Crowding Malocclusion Pericoronitis Radiating pain
Root resorption of adjacent erupted teeth Caries Food impaction & halitosis Dentigerous cyst Treatment:- - Removal of cause - Surgical removal

Embedded teeth It refers to those teeth that are unerrupted due to lack of eruptive forces

Submerged teeth It refers to ankylosed deciduous teeth
Frequently involved teeth are deciduous molars Occlusal table of the ankylosed deciduous tooth is located below the occlusal plane of the rest of the permanent teeth in the arch giving an submerged appearance In such cases the underlying permanent tooth may become impacted or may erupt either buccally / lingually

Disturbance in structure of teeth

ENAMEL HYPOPLASIA Defect of enamel due to disturbance during its formative process During the formative stages of enamel, the ameloblast cells are susceptible to various factors which can disturb the process and the effect of which are reflected on the surface enamel after the eruption of tooth

Types Based on causative factors: Enamel hypoplasia Hereditary
(Amelogenesis Imperfecta) Environmental Focal (Turners hypoplasia) Generalized

Differences between hereditary & environmental enamel hypoplasia
Both dentition affected Only enamel is affected Affected tooth shows diffuse or vertical orientation of defects Environmental Either one dentition affected Affects enamel and other calcified structures Affected tooth shows defects, which are horizontally arranged

Hereditary enamel hypoplasia

Amelogenesis imperfecta
Hereditary enamel dysplasia Hereditary brown enamel Hereditary brown opalescent tooth

Genetic defect – with Enamelin gene ( ENAM)
- Gene coding amelogenin protein (AMELX) Location of defective gene Autosomal form is less understood in X – linked AI defective gene is closely linked to locus DXS85 at Xp 22 ( general location of gene for amelogenin)

It is a heterogenous group of hereditary disorders of enamel formation
Entirely an ectodermal disturbance. The condition involves only the enamel while dentin, cementum & pulp remain normal

Types Amelogenesis imperfecta may set in during any stage of enamel formation . Based on that there are 4 types Hypoplastic type - Defective matrix deposition Hypocalcification type – Defective calcification Hypomaturation type- Defective maturation Hypomaturation-hypoplastic with taurodontism

Classification by Witkop (1989)
TYPE I Hypoplastic type IA Pitted, autosomal dominant IB Local, autosomal dominant IC Local, autosomal recessive ID Smooth, autosomal dominant IE Smooth, X- linked dominant IF Rough, autosomal dominant IG Enamel agenesis, autosomal recessive

TYPE II Hypomaturation type
IIA - Pigmented autosomal recessive IIB - X- linked recessive IIC - Snow capped tooth, Autosomal dominant TYPE III Hypocalcification type IIIA - Autosomal dominant IIIA - Autosomal recessive

TYPE IV Hypomaturation-hypoplastic with taurodontism
IVA - Hypomaturation-hypoplastic with taurodontism, Autosomal Dominant IVB - Hypoplastic-Hypomaturation with taurodontism, Autosomal Dominant

Clinical features

Hypoplastic type The disease affects the stage of matrix formation Teeth exhibit complete absence of enamel or there may be presence of enamel on some focal areas Enamel thickness is usually below normal Quantity is affected, but quality of formed enamel is normal Tooth appears as though prepared for receiving a prosthetic crown

Hypocalcification type
The disease affects the stage of early mineralization Enamel is of normal thickness (quantity not affected) Tooth is normal in shape on eruption, but the enamel is lost very easily Enamel is soft & can be easily removed with a blunt instrument Enamel is yellowish brown on eruption

Hypomaturation type The disease affects the stage of maturation Enamel is of normal thickness (quantity not affected) Teeth are normal in shape but enamel is opaque white or brownish in colour Enamel does not have normal hardness & translucency and tend to chip off easily It can be pierced with an explorer tip with firm pressure

Snow capped teeth It is the mildest form of hypomaturation type of amelogenesis imperfecta. Affects both 10 & 20 dentitions. Most cases demonstrate an X linked pattern of inheritance The enamel is of near normal hardness & has a zone of white opaque enamel on the incisal or occlusal one quarter to one third of crown. Demonstrates an anterior to posterior distribution and have been compared to a denture dipped in white paint

Radiological features
The thickness & radio density of enamel varies greatly Hypoplastic type Enamel may appear totally absent or as a thin line Radiodensity of affected enamel is similar to that of normal enamel (greater than dentin) Hypocalcification type Radiodensity of affected enamel is much lesser than that of normal enamel Hypomaturation type Radiodensity of affected enamel is lesser than that of normal enamel and is equivalent to normal dentin

Histopathology Hypoplastic type
Lack of differentiation of ameloblast cells with little or no matrix formation Hypocalcification type Abnormal matrix structure & mineral deposition Hypomaturation type Alteration in the enamel rod & rod sheath structures

Treatment No definitive treatment
Veneering or capping of teeth to improve esthetics

Environmental enamel hypoplasia

Focal enamel hypoplasia
Also known as Turner’s hypoplasia Most common form of enamel hypoplasia Occurs due to trauma or infection to deciduous teeth affecting the developing permanent tooth Usually affects single tooth & is called as Turners tooth

Hypoplasia ranges from a mild, brownish discolouration to a severe pitting of enamel surface on the labial aspect Frequently involved teeth are permanent maxillary/mandibular bicuspids & maxillary incisors Severity of hypoplasia depends on severity of infection, degree of tissue involvement and stage of tooth formation

Pathogenesis Trauma Periapical Infection Deciduous teeth
Affect the ameloblastic layer of permanent tooth Disturb the enamel formation Enamel defects

Clinical features Affected area of tooth appear as a zone of white or yellow brown discoloration & pitted areas

Generalized enamel hypoplasia
The ameloblasts in the developing tooth germ are sensitive to external stimuli Any systemic or environmental disturbance can result in abnormalities in enamel formation which manifests as defects on the surface of tooth It affects numerous teeth which are being formed at the time of disturbance

Clinically the defects can manifests as
1. Hypoplasia 2. Diffuse opacities 3. Demarcated opacities Most often it manifests as a horizontal line of enamel hypoplasia with pits & grooves

The line on the tooth surface indicates the zone of enamel hypoplasia
The location of the line corresponds with the developmental stage of affected tooth & width indicates the duration of the disturbances

Causes Prenatal Infections (Rubella, Syphilis)
Malnutrition, Metabolic & Neurological disorders during pregnancy Chromosomal abnormalities Excess chemical intake (Tetracycline, Fluoride) Natal Birth injury Premature delivery Prolonged labor Postnatal Severe childhood infections Congenital heart diseases Nutritional deficiencies (Vit-B, Vit-D) Endocrinal disorders

Enamel hypoplasia due to nutritional deficiency and exanthematous fevers
Serious nutritional deficiency is potentially capable of producing enamel hypoplasia The teeth that form within the first year after birth are affected. Teeth most frequently affected are central & lateral incisors, cuspids and first molars. Premolars, 2nd & 3rd molars are rarely affected, since their formation does not begin until the age of 3 or later Presents as pitting of the tooth surface

Enamel hypoplasia due to congenital syphilis
Hypoplasia is not of pitted variety Involves the permanent maxillary & mandibular incisors and 1st molars Anterior teeth are referred to as hutchinson’s incisors and posterior teeth are referred to as mulberry molars. Characteristically, the upper central is screw driver shaped, the mesial and distal surfaces tapering and converging towards the incisal edge. Incisal edge is usually notched. Middle lobe of tooth is affected

The crowns of first molars are irregular & constricted, and the enamel of the occlusal surface and occlusal third of tooth appears to be arranged in an agglomerate mass of globules rather that well formed cusps. Resembles a mulberry, hence the name mulberry molars

Enamel hypoplasia due to fluoride
Excess amounts of fluoride can result in enamel defect known as dental fluorosis./ mottled enamel First described by GV Black & Federick S McKay in 1916 The severity increases with an increase in amount of fluoride in the water. The optimum range of fluoride in drinking water is ppm

Pathogenesis Increased levels of fluoride interferes with calcification process of the enamel matrix leading to the formation of hypomineralized enamel These alterations results in an increased surface and subsurface porosity of the enamel which alters the light reflection and creates the appearance of white chalky areas which later gets stained

Affected teeth are caries resistant
Clinical features Affected teeth are caries resistant Wide range of manifestations depending on fluoride levels Grading Questionable changes White flecking or spotting of enamel Mild changes White opaque areas involving more of tooth surface areas Moderate and severe changes Pitting and brownish staining of surface Corroded appearance

Mild cases- Bleaching of teeth Severe cases- Prosthetic crowns
Treatment Mild cases- Bleaching of teeth Severe cases- Prosthetic crowns

Dentinogenesis Imperfecta
A hereditary defect of dentin in the absence of any systemic disorder, consisting of opalescent teeth, composed of irregularly formed and undermineralized dentin that obliterates the coronal and root portion of pulp chamber. Autosomal dominant mode of transmission Also known as “Hereditary opalescent dentin” & “Capdepont’s teeth”

Classification Clinical presentation By Shields By Witkop
Osteogenesis imperfecta with opalescent teeth DI - I Dentinogenesis imperfecta Isolated opalescent teeth DI - II Hereditary opalescent teeth DI - III Brandywine type

Clinical features Type I Associated with osteogenesis imperfecta
Type II Not associated with osteogenesis imperfecta unless by chance This type is most frequently referred to as Hereditary opalescent dentin Most common type Type III Brandywine type, racial isolate in Maryland state Same clinical presentation of Type I or II with multiple pulpal exposures in deciduous dentition

Severely affects the deciduous teeth than permanent teeth (Incisors & 1st molars; Least involved teeth- 2nd & 3rd molars) Teeth exhibits a gray to brownish violet or yellowish brown appearance Involved teeth exhibits a characteristic unusual translucent or opalescent hue. Enamel is normal but fractures and chips away easily, leads to exposed dentin and functional attrition presumably because of defective DEJ Teeth are not particularly sensitive & are not caries prone

Type I Type II Type III Deciduous teeth more severely affected.
Both dentition affected Type III Multiple pulpal exposures in deciduous dentition

Radiologically type I & II are similar Exhibit bulb-shaped or bell shaped crowns with constricted CEJ Thin & blunted roots Early obliteration of root canals and pulp chamber Cementum, PDL & bone appears normal

Type III exhibits great variability in deciduous teeth, ranging from normal to those changes of type I & II. Shell teeth Apparently normal enamel Extremely thin dentin (may involve entire tooth or isolated to the root) Enormous pulp chambers (not as a result of resorption, but due to insufficient dentin) Appear as shells of enamel & dentin surrounding enormous pulp chambers and root canals.

Shell teeth

Histopathological features
Enamel & mantle dentin are normal Remaining dentin is severely dysplastic & exhibits vast areas of inter-globular dentin Dentinal tubules are short, disoriented, irregular & widely spaced Scanty odontoblasts line the pulp and they can be seen in the defective dentin The DEJ is Smooth

Treatment Treatment is aimed at preventing excessive tooth attrition & improving esthetics Metal / Ceramic crowns & over dentures can be given

Dentin dysplasia A hereditary defect characterized by defective dentin formation & abnormal pulpal morphology Autosomal dominant disorder

Type I – Radicular dentin dysplasia Also known as “Rootless teeth”
Types Type I – Radicular dentin dysplasia Also known as “Rootless teeth” Type II – Coronal dentin dysplasia Mild Severe

Clinical features Type I Type II
Disturbance in development of radicular dentin Disturbance in development of coronal dentin Normal crowns, both structurally & morphologically Semi-transparent opalescent 10 teeth Normal appearance in the permanent teeth Color of teeth normal with slight bluish translucency in cervical region Amber – grey color Early loss of dentin organization results in extremely short roots Later disorganization results in minimal root changes Affected teeth exhibits short roots, delayed eruption , severe mobility & premature exfoliation

Type I Type II Deciduous teeth affected severely with little or no detectable pulp Deciduous teeth shows bulbous crowns, cervical constriction and early obliteration of pulp (Resembles DI) Permanent teeth: Features vary on the proportion of organized versus disorganized dentin Early disorganization - extremely short roots with little or no pulp Somewhat Later disorganization - crescent or chevron shaped pulp chambers overlying shortened roots that exhibit no pulp canals Late disorganization – normal pulp chamber with large pulp stone Permanent teeth: Exhibits abnormally large pulp chambers and apical extension described as flame shaped or thistle-tube in shape. Pulp stones present Periapical radiolucencies around the defective roots Absence of periapical radiolucencies

Type I Type II Normal enamel Normal enamel and radicular dentin with partial obliteration of root canals Portion of coronal dentin is usually normal and may show tubular dentin apical to it Pulp is obliterated by calcified tubular dentin, osteodentin & fused denticles Near normal coronal dentin with numerous areas of interglobular dentin near the pulp Normal dentinal tubule formation appears to be blocked so that new dentin forms around obstacles and takes on characteristic appearance described as lava / stream flowing around boulders Abnormally large pulp chambers with pulp stones

Treatment No treatment Prognosis depends on presence / absence of periapical lesions

Regional odontodysplasia
It is an uncommon non-hereditary developmental disturbances of tooth characterized by defective formation of enamel & dentin with abnormal calcifications of pulp & follicle Also known as Ghost teeth / odontogenesis imperfecta Cause somatic mutation Slow virus residing in odontogenic epithelium Local ischemic change during odontogenesis

Clinical features More common in permanent dentition More common in maxilla Affects several teeth in a single quadrant Maxillary anterior teeth affected more Failure of eruption or delayed eruption of affected teeth Teeth are deformed, yellowish – brown in color with a soft leathery surface

Marked decrease in radiodensity of teeth Enamel & dentin are very thin & radiological distinction not possible Extremely large & open pulp chamber with pulp stones Ghostly appearance of affected teeth

Abnormal enamel & dentin Marked reduction in amount of dentin, widening of predentin layer, large areas of interglobular dentin and an irregular pattern of dentin Large pulp chamber with pulp stones Calcification in follicular connective

Treatment Extraction & artificial prosthesis

Developmental Anomalies affecting the jaws

Agnathia Micrognathia Macrognathia Facial hemihypertrophy Facial hemiatrophy

Agnathia Congenital absence of maxilla or mandible
Commonly, only a portion of one jaw is missing In maxilla Maxillary process Premaxilla In mandible Entire mandible Condyle Entire ramus

Micrognathia A smaller jaw than normal
Involve either maxilla or mandible Types Apparent [Abnormal positioning/ relation of one jaw to the other or skull] True Congenital Acquired

Congenital micrognathia
Etiology unknown Associated with other congenital abnormalities like congenital heart disease and pierre robin syndrome Micrognathia of maxilla is due to a deficiency of the premaxillary area Micrognathia of mandible may be due to Small jaw Posterior positioning of mandible in relation to skull Steep mandibular angle Agenesis of condyles

Acquired micrognathia
Post natal in origin Causes Ankylosis of joint as result of trauma/infection

Macrognathia Condition of abnormally large jaws Seen in
Pagets disease of bone Enlarged maxilla Acromegaly Enlarged mandible Leontiasis ossea

Developmental Anomalies Of Oral & Para-oral Structures

Similar presentations

Presentation on theme: "Developmental Anomalies Of Oral & Para-oral Structures"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Developmental Anomalies Of Oral & Para-oral Structures

Similar presentations

Presentation on theme: "Developmental Anomalies Of Oral & Para-oral Structures"— Presentation transcript:

Similar presentations

About project

Feedback