Developmental

Developmental Anomalies of Teeth

Presented by: Sima GhimireRoll no:17

BDS 4th year

Contents

• Introduction

• Developmental anomaly in number of tooth

• Developmental anomaly in size of tooth

• Developmental anomaly in shape of tooth

• Developmental anomaly in structure of tooth

• Conclusion

Introduction

Developmental Anomalies:- are the malformation or defects resulting from disturbance of growth & developmental anomalies.

  a)Congenital anomalies:-

b)Hereditary anomalies:

c)Acquired anomalies:-

d)Hamartomatous

e)Idiopathic anomalies:-

• present at birth or during intra uterine life

• inherited from the parents to the offspring

• due to some pathological environment condition

• Hamartamatous change in tissue

• Unknown etiology

Developmental disturbance in the number of teeth:

I. Anodontia:It is the congenital absence of teeth in oral cavity

Classification/types:i. Complete/ Total anodontiaii. Partial anodontia - Hypodontia - Oligodontiaiii. Pseudo anodontiaiv. False anodontia

True Anodontia Hypodontia Oligodontia

Definition • congenital absence of all teeth in oral cavity

• absence of one or few teeth

• lack of development of six or more teeth

Etiology • Hereditary • Hereditary• Ricket or

Syphilis, • German measles

during pregnancy Radiation overdose

• Hereditary• Ass. with Rieger’s

syndrome, Chondroectodermal dysplasia

• High dose radiation

Clinical features • Ass. with Hereditary Ectodermal Dysplasia

• Involve both dentition

• females > male• Rare in

deciduous dentition (<1%)

• drifting

• Rare in primary dentition

• Multiple missing teeth

• drifting

Treatment • Prosthetic rehabilitation

• Prosthetic & orthodontic rehabilitation

• Prosthetic & orthodontic rehabilitation.

Hyperdontia/ Supernumerary

(according to location)

MESIODENS PARAMOLAR DISTOMOLAR

• located at or near the midline

• may occur singly or paired, erupted or impacted or even inverted

• a small tooth with cone shaped crown and short root

• cause retarded eruption, displacement or resorption of adjacent

• supernumerary molar,

• usually small and rudimentary

• situated buccally or lingually to one of the maxillary molars or interproximally

• located distal to third molar

• teeth are smaller than normal second and third molar

• crown morphology is highly abnormal.

According to shapeCONICAL SUPPLEMENTAL TUBERCULATE

• small peg-shaped conical

tooth and is most

common type

• usually present as

mesiodens .

• duplication of teeth in

the normal series & is

found at the end of

tooth series

• common in primary

dentition.

• Possesses more than one

cusp or tubercle

• described as barrel-

shaped.

d. Odontome-

• abnormal proliferation of cells of the enamel organ result in an odontogenic tumor, commonly referred to as an odontoma.

• form as a result of continued budding of the primary or permanent tooth germ in which case an odontoma replaces the normal tooth.

Etiology:-• seen in association with cleft lip & palate , cleidocranial dysplasia

& Gardner syndrome• develop as a consequence of proliferation of epithelial cells from

dental lamina

Clinical features:• Prevalence: 1-3% • male=female (in primary dentition) but male >female (in permanent dentition• cause of crowding type of malocclusion• directly or indirectly responsible for increased caries incidence

& periodontal problems• Dentigerous cyst may sometimes develop from an impacted

supernumerary tooth

Treatment:-• Extraction of supernumerary tooth followed by orthodontic

rehabilitation. 

Developmental disturbance in size of teeth:

The size of teeth depends upon both proliferative and secretary activities of the cell.Variation in the size of teeth are as a result of factors affecting the growth of tooth germ at cap and bell stage.

Types:i. Microdontia

ii. Macrodontia

MICRODONTIA MACRODONTIA

TYPES True generalized: occurs in pituitary dwarfism, Down's syndrome and congenital heart disease.Relative generalized: are present in jaws that are somewhat larger than normal. exhibits spacing between the teeth.Localized: involves only single toothoccurs with congenital heart diseases, Down's syndrome and progeria.

True generalized all the teeth are larger than normal associated with pituitary gigantism

Relative generalized: teeth are normal or slightly larger than normalbut present in smaller jaw

Localized: one or more large teeth exist

TREATMENT Crown & bridge prosthetic can be provided for esthetic rehabilitation of such teeth.Orthodontic rehabilitation can be required as there is space present.

Orthodontic Rehabilitation

Developmental disturbance in Shape of teeth

• Gemination

• Fusion

• Concrescence

• Dilaceration

• Taurodontism 

• Dens-in-dente (Dens Invaginatus)

• Dens Evaginatus

• Talon cusp

• Supernumerary roots:

Gemination Fusion

Definition • Counting the bifid crown as one tooth, normal no of teeth are present & anomalous tooth has only one root canal

• Incomplete attempt of two tooth buds to fuse into one

Etiology • tooth bud dividesresults in formation of tooth with bifid crown &• common root and root

canal.

• Pressure produced by physical force Hereditary tendency

Clinical features

• normal no. of teeth present• tooth has two crown one

root

• two crowns joined by enamel or dentin• complete/ incomplete

Clinical complication

• Spacing or diastema• Crowding of teeth• Esthetic problems• Periodontal complication

Treatment • Crown and bridge • Surgical division• Crowns or bridges fabrication for

esthetic purpose

Concresence Dilaceration

Definition Union of two or more adjoining teeth by cementum alone without confluence of dentin

abnormal angulation or bend in the root or less frequently the crown of a tooth.

Etiology •Traumatic injury•Crowding of the teeth•Hypercementosis associated with Chronic inflammation

• Trauma to calcified portion

• Secondary to an adjacent cyst, tumor, or odontogenic hamartoma.

Clinical features • Not much significant clinicallyRadiograph needed for diagnosis

•Maxillary lateral incisor mostly affectedangulation may be present anywhere

Clinical significance

• Radiograph before extractionattempted extraction may cause removal of 2 teeth 

• care should be taken during extraction of such teeth

Treatment • No treatment if patient is asymptomatic

Extraction if interferes with eruption of succeeding tooth 

•Small deviation no treatment•Larger deviation may need hemisection or extraction

Taurodontism Talons Cusp

Definition • Abnormally large crown in expense of root

• cusp like structure projecting from the cingulum area or cementoenamel junction of anterior teeth

Etiology • Heriditary , Error in

Hertwig’s epithelial root

sheath

• outward folding of inner enamel epithelial cells

• Ass. With Rubunstein- Taybi Syndrome

Type • Hypotaurodontism

• Mesotaurodontism

• Hypertaurodontism

Clinical Features • Commanly affects permanent molars

• unilateral/bilateral

• Commanly affect max. lateral incisors

• Pulp horn may project from the cusp

Radiographic features • pulp chamber is large• Lacking cervical

constricton• Furcation more apically

Treatment • No special treatmnet • Sealant application in the dental groove & occlusal ineterference- removal

Dens in Dente(Dens invaginatus)

Dens Evaginatus(Occlusal enamel pearl)

Definition an invagination in the surface of crown before calcification

Appears clinically as an accessory cusp or globules of enamel on occlusal surface, between buccal and lingual cusps of premolar

Etiology • increased localized external pressure, focal growth retardation & focal growth stimulation the tooth bud

• Proliferation & envagination of an area of inner enamel epithelium

Clinical Feature • max. parmanent lateral incisor mostly affected

Types:i.Coronal: invagination in coronal portionii. Radicular: invagination on the root portionDepending upon the extent to the invagination towards the pulp:-Mild: confined to crown-Intermediate: below CEJ (tooth within tooth)-Extreme: Extend till rootKnown as “dilated odontomes”

• premolar and molar teeth

• consists of all three

dental tissues, i.e. enamel, dentine and cementum

• appears as a tubercle of enamel on occlusal surface of the affected tooth.

Dens in Dente Dens Evaginatus

Clinical significance • vulnerable to caries soon after the tooth erupts

• may develop pulpitis, pulp necrosis, periapical cysts or abscesses etc.

• Displacement of teeth with pulp exposure and subsequent infection may present, following occlusal wear or fracture.

Radiographic feature • Pear shaped invagination of enamel and dentin

• Tuberculated appearance of occlusal surface.

Treatment • Early detection & restoration.

• Endodontic treatment Extraction if severely involved

• No treatment unless symptomatic.

• minor occlusal reduction• Endodontic treatment if

pulp exposed

Supernumerary roots ( Radix entomolaris)

• Development of increased number of roots compared to normal.

Clinical features:-

• Common in permanent dentition

• Commonly affects molars particularly 3rd molars

• Appears as slender outgrowths at the center of furcation area of

molar teeth.

Clinical significance:-

• During endodontic therapy due consideration has to be given

to the presence of such tooth

• During extraction if one of these roots may be broken off & if

unrecognized & allowed to remain in the alveolus, may be the

source of future infection.

Treatment:-

• No treatment is required

Developmental Disturbances In Structure of teeth:

I. Amelogenesis Imperfecta

II. Dentinogenesis Imperfecta

I. Amelogenesis imperfecta

Amelogenesis imperfecta is a group of hereditary disorders characterized by alteration of the quantity and quality of enamel in humans and is frequently associated with a significant dental disease .

Classification of Amelogenesis Imperfecta According to Witkop (1989)TYPE I

Hypoplastic

IA Hypoplastic, pitted autosomal dominant

IB Hypoplastic , local autosomal dominant

IC Hypoplastic, local autosomal recessive

ID Hypoplastic, smooth, autosomal dominant

IE Hypoplastic, smooth X-linked dominant

IF Hypoplastic, rough autosomal dominant

IG enamel agenesis, autosomal resessive

Type II Hypomaturation

IIA Hypomaturation,pigmented autosomal recessive

IIB Hypomaturation, X-linked recessive

IIC Snow-capped teeth, autosomal dominant

TypeIII Hypocalcified

IIIA Autosomal dominant

IIIB IIIB

Type IV Hypomaturation- hypoplastic with taurodontism

IVA Hypomaturation – hypoplastic with taurodontism, autosomal dominant

IVB Hypoplastic- hypomaturation with taurodontism, autosomal dominant

Etiology:

• Alteration of gene DXS85 at Xp22 gene.

Clinical features:

i. Hypoplastic:

ii. Hypomaturation:

iii. Hypoclacified:

iv. Hypomaturation hypoplastic with taurodontism: 

Radiographic Features:

 Treatment:For poor esthetics:• Primary teeth restored with glass inomer cement and composite

veneer.Dentinal sensitivity: • Full coverage with stainless steel crownsDental caries:• Dietary advice, fluoride therapy, glass ionomer and composite

restorations, stainless steel crownsGingival inflammation: • Increased preventive oral health care practices

II. Dentinogenesis Imperfecta

Dentinogenesis Imperfecta is a hereditary developmental disturbance of the dentin that may be seen alone or in conjunction with the systemic hereditary disorder of the bone, osteogenesis imperfecta. Classification1. Dentinogenesis imperfecta 12. Dentinogenesis imperfecta 2 

i. Dentinogenesis imperfect 1:(dentinogenesis imperfecta without osteogenensis imperfect)

Etiology: mutation in DSPP gene encoding dentin phosphoprotein and dentin sialoprotein

ii. Dentinogenesis imperfecta 2:(Shields type III, Brandywine type dentinogenesis imperfect)The crown of deciduous and permanent teeth wear rapidly after eruption and multiple root exposure may occur.• Dentin is amber and smooth.

Treatment:• Cast metal crown on the posterior teeth and jacket crowns on the

anterior teeth.

Dentin dysplasia

• Dentin dysplasia is an autosomal dominant inherited disorder characterised by defective dentin formation and abnormal pulpal morphology. The condition is also known as root-less teeth.

• Types-Type IRadicular dentin dysplasia.-Type IICoronal dentin dysplasia.

Type I :Radicular dentine dysplasia

• In Type I , the roots of teeth are shorter than normal and the affected teeth often exhibit severe mobility and they may exfoliate prematurely.

• Radiographic Features:Type 1 : Roots are short, blunt and conicalIn deciduous teeth, pulp chambers and root canals are completely obliterated in permanent they may be crescent shaped.

Type II : coronal dentin displasia

• In Type II , the deciduous dentition exhibit an “amber- grey” color with some translucent or opalescent appearance.

• Radiographic Features:• Type II: The pulp chamber of the deciduous teeth becomes

obliterated. While in permanent teeth, large pulp chamber is seen in coronal portion. Pulp stones may be found.

Treatment

• Aimed at preventive care• Oral hygiene must be established and maintained for the

retention of teeth • Oral rehabilitation of prematurely exfoliated teeth

Regional odontodysplasia (ghost teeth)

localized disorder of the tissue of dental origin resulting in characteristically bizarre clinical and radiographic appearances.

Etiology • A somatic mutation affecting dental lamina in the area• activation of latent viruses• local circulatory disorders• Pharmacotherapy during pregnancy• Neural disorder• Rh incompatibility or failure of migration and differentiation

of neural crest cells

Clinical features• Typically yellow discoloured.• Enamel and dentin soft on probing.• Rough surface texture.• Permanent anterior commonly affected.• predominant in maxilla.• Drifting and over eruption of adjacent or opposing teeth.

Treatment • laminated veneer can be given.• Stainless steel crown or ceramic crown can be given.

Fluorosis

• It can be defined as hypoplasia or hypomaturation of tooth enamel or dentin produced by chronic ingestion of excessive amount of fluoride during the period when teeth are developing.

Etiology• Mainly is water consumption containing high level of

fluoride during the first six years of life.

• Clinical feature

Treatment

• The method of acidic microabrasion, followed by remineralisation procedures using amorphous calcium phosphate

• Bleaching, composite restoration, veneers or complete crown restorations can be given.

Difference between enamel hypoplasia and fluorosis

Area affected

Lesion shape

Demarcation, colour

Teeth affected

• Enamel hypoplasia• Centered, smooth,

limited extent.• Round or oval.

• Clearly differentiated opaque white, cream yellow to dark reddish.

• Common on the labial surface of single or homologous teeth. Any teeth can be affected.

• Entire surface.

• Follow incremental line.• Diffuse, Opaque,

white/brownish white.

• Homologous teeth, early erupting teeth are least affected. Premolar and second molar are severely affected.

• Dental fluorosis

Conclusion• Developmental anomalies are the malformations of body

structures resulting due to trauma, infection or unfavorable conditions to the developing structures during intrauterine and early postnatal life.

• Those anomalies of teeth could be congenital, hereditary or acquired.

• These may result into significant discomfort to the patient functionally, esthetically as well as psychologically.

• Deciduous tooth with anomalies may not require any treatment until it is not hampering growth and development of permanent tooth germ.

• Permanent tooth with anomalies requires prosthetic, restorative or orthodontic rehabilitation.

Reference

• Shafer’s Textbook of Oral Pathology 6th edition - R Rajendran - B Sivapathasundharam• Shobha Tandan Textbook of Pedodontics 2nd edition• Textbook of Oral Medicene Oral Diagnosis And Oral

Radiology 2nd edition - Ravikiran Ongole - Praveen B N

Thank you