Dental anomolies /certified fixed orthodontic courses by Indian dental academy

Amelogenesis imperfecta. This is a radiographic view
of amelogenesis imperfecta showing the altered
thickness and shape of the enamel crown that is
characteristic of this disease. In this patient the
condition was inherited as an autosomal dominant
trait..
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• Hypodontia. This radiograph shows a
retained deciduous, mandibular
second molar. Note that the first
premolar is in place, fully erupted, and
apparently functional. There may be
carious involvement of the distal
aspect of the crown of the deciduous
second molar.www.indiandentalacademy.com

• This photograph presents a clinical
view of a nine-year-old boy who has
ectodermal dysplasia, a condition which
affects all ectodermally-derived
structures. It is inherited as both an X-
linked and an autosomal recessive trait.
Note that the hair is sparse and there is
an absence of both the eyebrows and
eyelashes. Fingernails and toenails are
affected as well. What oral findings
might you expect?

• Hypodontia associated with ectodermal dysplasia. This photograph
shows an intraoral view that is characteristic of patients with
ectodermal dysplasia. In this case only the two maxillary canine teeth
have developed. The secondary dentition was also affected in this
patient, and there were no succedaneous replacements, even for
these two primary teeth. Because of the absence of teeth, alveolar
bone also fails to form. Patients with ectodermal dysplasia are best
treated through provision of full upper and full lower dentures, which
must be replaced at regular intervals as growth takes place.

• False anodontia. This frame shows an
interesting clinical phenomenon. This nine-
year-old girl presented clinically with an
"absence of teeth".
Radiographs, however, revealed the presence
of teeth beneath the existing gingiva. This
condition was caused by the overgrowth of
gingiva as a result of a phenomenon called
gingival hyperplasia (increased cellular
proliferation). In this case, the condition was
triggered by the gradual and continual eruption
of the teeth. As the teeth emerge from the
alveolar process, the gingiva overgrows and
keeps pace with the rate of eruption. Patients
with this condition are best treated by regular
gingivoplasty and gingivectomy to allow
normal function and aesthetics. Gingival
overgrowth can also be initiated in patients
taking Dilantin (antiseizure
medication), Cylcosporine
(immunosuppressive drug) or calcium channel
blocker, particularly Nifedipine (treatment of
angina and hypertension). Good oral hygiene
has been shown to reduce the severity of
drug-induced gingival hyperplasia.

• Supernumerary teeth. This clinical view shows a supernumerary
tooth which has erupted in the mid-line between the left and right
maxillary central incisors. The mesiodens, as it is called, is one of the
more common forms of supernumerary teeth. In this case the
supernumerary tooth was acceptable aesthetically, and therefore, no
treatment was provided to the patient. A less esthetically acceptable
example of a mesodens is shown here. Not all supernumerary teeth
resemble a normal tooth in either size or shape. Such teeth are often
called accessory teeth.

• Supernumerary teeth. This is an
example of an impacted supernumerary
tooth (found in the maxilla between the
lateral incisor and canine) that was
found during a routine radiographic
examination. Multiple supernumerary
teeth, many of them impacted, are
characteristically found in cleidocranial
dysostosis. Gardner's Syndrome is
another condition characterized by the
occurence of multiple, impacted
supernumerary teeth. This disease is of
interest to the dental profession,
because the presence of the
supernumerary teeth, and multiple
osteomas in the mandible and maxilla,
may lead to its diagnosis.

• Dens-in-dente (Dens invaginatus). This radiograph show an example of what
happens when there is a distortion of the enamel organ. As a consequence, an
aberrant crown forms in which there is commonly a communication between the
surface of the crown and the pulp chamber. Carious involvement of this usually deep
pit in the crown leads to bacterial invasion of the dental pulp. This radiograph
demonstrates bony tissue breakdown as a consequence of a severe inflammatory
response in the pulp of this tooth. There is a large radiolucency at the apex of this
tooth. Also note that this tooth has a widened pulp canal inconsistent with the
patient's age (compare this canal with that of the adjacent canine tooth). Secondary
dentin formation that would have resulted in normal narrowing of this canal did not
take place because of the death of the pulp.
• Dens-in-dente. This is another example of a "tooth within a tooth", but there is no
evidence of a connection between the surface of the crown and the dental pulp.

•Gemination. This clinical view reveals the
presence of a rather large lateral incisor. Count
the teeth. How many incisors are there? This
oversized tooth is a result of gemination or
twinning of the enamel organ during
development. This partial splitting results in a
larger template for the crown, and the clinical
crown becomes much larger than normal. Such
large teeth, often with clefts in their
surfaces, should be considered twinned teeth if
the proper number of teeth are present
•Gemination. This is a radiograph of another
patient showing that in a "twinned" tooth, the pulp
chamber is often divided into two chambers
within the single partially divided crown of the
tooth. Notice that there is a single pulp canal.

• Fusion. In this case, how many teeth are present? This is a
clinical example of fusion. Fusion occurs when neighboring
toothbuds fuse, which as in gemination also results in a single
larger-than-normal tooth. Counting the teeth in this mandibular
arch should have revealed the absence of a right lateral
incisor. The lateral incisor and the central incisor have fused to
make a single "macrodont" tooth. Fused teeth commonly have
a clinical crown that is fissured, as you see here. They also
usually have two pulp chambers and two pulp canals, but
these characteristics depend on the time at which fusion took
place. A second example of fusion is shown here.

• Dilaceration. This photograph, and frame #17
show examples of dilaceration, or curving of the
roots. This results from a distortion of Hertwig's
root sheath during development. Such teeth may
present severe problems for either endodontic
treatment or extraction. They are usually vital and
functional. Surprisingly, eruption does not seem to
be affected by the altered shape of the roots.

• Accessory roots. This is an example
of accessory root formation that can
occur as a result of an alteration in
root sheath development.

• Rootless tooth. A 31-year-old male
patient complained of a molar that was
"loose". Radiographs revealed an
absence of roots. Because of the high
mobility of the tooth, it was extracted.
For whatever reason, proliferation of
Hertwig's root sheath abruptly ceased
before much of the roots were formed.
The cervical line of the tooth is clearly
evident.
• Rootless teeth. This is another example
of a patient who complained of "loose"
teeth. Radiographs revealed only short
stubby roots. The cervical line of the
tooth is clearly evident, and the staining
is due to tetracycline. For whatever
reason, proliferation of Hertwig's root
sheath abruptly ceased, but is not
known whether tetracycline was a
factor

• namel pearl. An enamel "pearl" is demonstrated in this photograph of
an extracted tooth. The "pearl" lies in the furca (groove) between the
mesial and distal roots of this maxillary molar. The differentiation of
ameloblasts, and the formation of small amounts of enamel below the
level of the cervical occurs with some regularity. The production of an
actual "enamel pearl" is not as commonly seen. Radiographically, this
would have been recognized as a very bright radiopacity overlying the
furcal area of this tooth. The presence of these ectopic enamel
deposits can have significant consequences for the periodontal health
of these teeth. Notice that the palatal root of this tooth is affected by
dilaceration. www.indiandentalacademy.com

• Hutchinson's or "Screwdriver-shaped" incisors. This clinical
photograph presents an example of peg-shaped and misshapen
incisors in both the maxilla and the mandible that occur in
patients with congenital syphilis. Another anomaly, "mulberry
molars," is shown in frame #22. There is narrowing of the incisal
third of the maxillary and mandibular incisors, a form which has
been described as screwdriver-shaped. The Treponemes (T.
pallidum) that cause syphilis cross the placenta, and the fate of
the infected fetus depends on the duration and the stage of the
mother's disease.

• Mulberry molars. This clinical photograph presents a
second example of the effects of congenital syphilis
on the developing dentition. The first
anomaly, "screw-driver shaped" incisors is shown in
the previous frame. The blebbed surface of the
mulberry molar wears away rather quickly, and
carious involvement of the multiple pits is not an
uncommon feature of these teeth.

• Enamel Hypoplasia. Hypoplasia commonly leads to an altered
tooth form as a result of a reduction in the quantity of the organic
matrix produced. Not uncommonly there is also a defect in the
mineralization process. Hypoplastic and hypomineralization
defects usually occur as a consequence of disease states.
Because of the pitting, and other structural defects, hypoplastic
enamel is often more susceptible to dental caries. This clinical
photograph shows severe hypoplasia in the incisal third of the
crowns with loss of some of the enamel.

• Enamel Hypoplasia. In this
patient, hypoplasia resulted in enamel
pitting that predisposed these teeth to
carious attack.

• Enamel Hypomineralization. This clinical view presents an
example of "snow-capped" teeth. This phenomenon is a form
of hypomineralization. Notice that all four incisor teeth are
affected with the central incisors showing the greatest defect.
Only the maxillary teeth were involved in this patient. This
condition may be due to a dietary deficiency, a systemic
disease, or to an inherited defect in mineralization.

• Enamel hypoplasia associated with rickets. This is a case of
avitaminosis D that results in the clinical condition of Vitamin D-
dependent rickets. Severe hypoplastic defects are present in all
eight maxillary and mandibular permanent incisors. This gives
some idea of the time in which the nutritional deficiency took
place. In some cases, vitamin C and vitamin A deficiencies can
lead to similar hypoplastic defects in enamel.

• Enamel fluorosis (mottled enamel). Low-grade pitting, followed by
pigmentation of the pitted areas can be seen in teeth when exposure
levels of fluoride exceed 1-2 parts per million in the drinking water, or if
inappropriate fluoride supplementation is carried out during early infancy
and childhood. The degree of fluorosis seen in this patient suggests that
fluoride levels in the drinking water exceeded 5 parts per million. The high
levels of fluoride incorporated into the hydroxyapatite crystals of the
enamel renders these teeth extremely resistant to carious attack. In fact,
the beneficial effects of fluoride were recognized after epidemiological
studies of communities in which fluorosis was endemic revealed a
significant reduction in the prevalence of dental caries. A second example
of fluorosis is shown here.

• Amelogenesis imperfecta. This patient demonstrates an inherited
form of enamel hypomineralization in which tooth form is reasonably
good. Any genetically inherited form of hypomineralization or
hypoplasia is called amelogenesis imperfecta, and there are at least
13 distinct inheritance patterns that have been
characterized, including both autosomal and sex-linked recessive
and dominant forms.. The thinness of the enamel and its poor
attachment to the underlying dentin lead to the rapid loss of the
enamel from the surface of the crown. The brown areas seen in this
photograph represent discolored areas of exposed dentin. A second
patient is shown here.

• Amelogenesis imperfecta. This is
different patient presenting a more
severe type of amelogenesis imperfecta.
In this case there is both a hypoplasia
and a hypomineralization of the enamel.

• Amelogenesis imperfecta. This is a
radiographic view of amelogenesis
imperfecta showing the altered thickness
and shape of the enamel crown that is
characteristic of this disease. In this patient
the condition was inherited as an autosomal
dominant trait..

• Dentinogenesis imperfecta. Dentinogenesis imperfecta is often associated with
a systemic condition known as osteogenesis imperfecta in which bone is
affected, as well as teeth. In the latter condition, a peculiar blue coloration of
the sclera of the eye may sometimes be seen. Dentinogenesis imperfecta is
characterized by the presence of a pearl-gray coloration of the teeth and an
early loss of the enamel, particularly from incisal and occlusal surfaces. The
loss of the enamel is the result of an abnormal dentinoenamel junction. In
addition, the dentin is excessively "soft" due to the high amount of interglobular
dentin, which is hypomineralized, and thus support for the enamel is poor. The
peculiar coloration of the tooth is a result of the obliteration the pulp
chamber, which normally gives a pinkish coloration to the dentin. A second
view is shown in Frame #34 presents a radiograph of these teeth showing
several distinctive features.

• Dentinogenesis imperfecta. Dentinogenesis imperfecta is
characterized by the presence of a pearl-gray coloration of the teeth
and an early loss of the enamel, particularly from incisal and occlusal
surfaces. The loss of the enamel is the result of an abnormal
dentinoenamel junction. In addition, the dentin is excessively "soft" due
to the high amount of interglobular dentin, which is hypomineralized,
and thus support for the enamel is poor. The premature loss of enamel
exposes the dentin to occlusal forces that can lead to severe attrition.
As in this patient, full crown coverage is often used to preserve
occlusal height. A another view is shown in frame #33. Frame #35
presents a radiograph of these teeth showing several distinctive
features.

• Dentinogenesis imperfecta. This is a radiograph of the previous patient
showing several distinctive features of dentinogenesis imperfecta. Clinical
photographs are shown in frame #33 and frame #34. The teeth have a
"lollipop" look, i.e. a bulbous crown that appears to be attached to a narrow
root. There is a marked reduction in the size of the pulp chambers and pulp
canals, with an absence of the canals in at least one of these teeth. It is not
uncommon for these teeth to be painful, but the cause of the pain is not
fully understood. In contrast, it is uncommon for patients who have
amelogenesis imperfecta to experience pain, even in teeth that have been
denuded of their enamel. A closer look is shown in this radiograph.

• Dentinal dysplasia. This is a rare phenomenon in
which there is abnormal dentin development and
aberrant root formation. The dentin is poorly formed
with large amounts of interglobular dentin
present, and pulp chambers and pulp canals are
virtually nonexistent. These teeth quickly become
mobile, and are commonly extracted because they
cannot withstand the forces of occlusion.

• Hypercementosis. This radiograph reveals
an excessive radiopacity surrounding the
root. However, careful inspection will
reveal the presence of a radiolucency (the
periodontal ligament space) and a
radiodense line (the lamina dura).

• Concrescence. This frames shows the clinical features of the
condition known as concrescence wherein hypercementosis
has resulted in the union of two or more teeth. The
histological appearance is shown in frame #38. The cause of
this condition is not understood, but it presents significant
problems for extraction of these teeth. Normal
function, however, seems to be unaffected.

• Concrescence. This frames
shows the histological
features of the condition
known as concrescence
wherein hypercementosis
has resulted in the union of
two or more teeth. The
clinical appearance is
shown in frame #37. Note
that there is an absence of
the intervening alveolar
bone.

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