developmental anamomalies

1. PRESENTED BY :
Dr.LOUIS SOLAMAN SIMON
PG 1ST YEAR
DEPARTMENT OF PEDODONTICS & PREVENTIVE DENTISTRY

2. DEVELOPMENT OF TOOTH .......A GLIMPSE TO PREVIOUS SEMINAR
ORIGIN COMPONENTS OF TOOTH GERM COMPONENTS OF
TOOTH GERM
PRODUCTS
ECTODERM OF
FIRST ARCH
TOOTH
GERM
E
C
T
O
MESENCHYME
ENAMEL
ORGAN
DENTAL
PAPILLA
DENTAL
FOLLICLE
CEMENTUM
OUTER ENAMEL
EPITHELIUM
REE
DENTIN
CERVICAL LOOP
STELLATE
RETICULUM
ROOT FORM
PERIODONTAL
LIGAMENT
STRATUM
INTERMEDIUM
INNER ENAMEL
EPITHELIUM
HERS
PULP
CROWN
PATTERN
ENAMEL
P.E.ATTACHMENT
AMELOBLAST
ODONTOBLAST
UNDIFFERENTIATED
MESENCHYMAL CELLS
CEMENTOBLAST
FIBROBLAST

3.  Developmental disturbances means an
abnormality where the pathology starts in the
embryonic stage of human life , before the
formation of the dentition
Frequency of developmental dental anomalies in Indian population
Eur j dent.2010 july;4(3) 263-269

5.  Dental lamina formation stage
 Anodontia
 Initiation and proliferation
 Oligodontia
 Supernumerary teeth
 Geminated / fused teeth
 Histodifferentiation
 Regional odontodysplasia

6. Morphodifferentiation ( defects in size &
shape )
• Macrodontia / Microdontia
• Dens invaginatus / Dens evaginatus
• Hutchinson‟s incisors, mulberry molars
• Talon cusp
• Taurodontism
• Apposition ( defects in structure of enamel &
dentin )
• Amelogenesis imperfecta
• Enamel Hypoplasia
• Dentinogenesis imperfecta
• Dentin dysplasia

7.  Number
 Size
 Shape
 Structure
 Growth or Eruption

8. Developmental Disturbances in
Number of Teeth

9. Basic Principles .
• Butler‟s Field Theory ( 1953 )most distal
members of a class are more asymmetrical
than mesial members
• Int j pediat dent 2004 ; vol 14 ; no 6 ; 446 - 450

10.  Anodontia
 Hyperdontia
 Pre-Decidous Dentition
 Post Permanent Dentition

11.  Congenital absence of teeth
 1)True-Total
-Partial
 2)False-(Extraction)
 3)Pseudo(Multiple Unerupted)

13.  Congenital absence of teeth
 May involve both dentitions
 Associated with Hereditary Ectodermal
Dysplasia

15.  Hypodontia-Missing of 1 or more teeth
 Oligodontia-Missing of 6 or more teeth
 Common condition
 Missing-3rd molar,lateral incisor,maxilary and
mandibular 2nd premolar.
 Congenitally missing primary teeth-
uncommon-lat.incisor
 Etiology-unknown,familial tendency

16.  Increase in no. of teeth - SUPERNUMERARY TEETH
 Closely resemble in size or shape with which
associated
 ETIOLOGY-Supernumerary teeth develop from
splitting of permanent bud
 HYPERACTIVITY THEORY-
 As a result of local , independent , hyperactivity of
dental lamina
 In some cases, hereditary tendency

19. DICHOTOMY THEORY :
Tooth bud splits – 2 equal or different sized
parts – one Eumorphic & other Dysmorphic
tooth
--
Taylor ( 1972 )

20.  1. CLEFT LIP & PALATE
 2. CLEIDOCRANIAL DYSPLASIA
 3. GARDENER SYNDROME

21.  CONICAL : MESIODENS
 TUBERCULATE – CUSP/TUBERCLE (barrel shaped ; may be
invaginated)
 SUPPLEMENTAL /DUPLICATION
ODONTOME-(hamartomatous malformation rather than a
neoplasm)
 COMPOSITE (composed of >1 type of tissue)
 A)COMPLEX (diffuse mass of dental tissue i.e., totally
disorganized)
 B)COMPOUND (malformation which bears some superficial
anatomic similarity to a normal tooth)

22.  Most common supernumerary tooth
 Situated between maxillary central incisors
 Occurs as : single or paired
;erupted or impacted or inverted

23.  2nd most common supernumerary tooth
 Situated distal to the 3rd molar
 Usually small , rudimentary tooth but may be
of normal size
 Maxillary 4th molar is more common than
mandibular 4th molar
 An accessory 4th molar is called Distomolar
or DISTODENS

25.  The epithelial structures in the mouth of the infant
before the eruption of the primary teeth
 Arising from, – An accessory bud of the dental
lamina ahead of the deciduous tooth bud.
 Described as hornified, epithelial structures
without roots. Occurs in the gingiva over the crest
of the ridge , may be easily removed.
 Some consider it as a misinterpretation of dental
lamina cysts of new born

26.  The rare appearance of supernumerary teeth after loss
of permanent teeth;
 most teeth that appear after extraction of permanent
teeth are due to eruption of previously impacted teeth
particularly after insertion of complete denture.
 Majority is due to delayed eruption of retained or
embedded teeth.
 Some may represent post‐permanent or third dentition.
 But they are actually, multiple supernumerary unerupted
teeth.
 It probably develops from a bud of the dental lamina
beyond the permanent tooth germ.

27. Supernumerary Teeth -An Overview of Classification,
Diagnosis and Management
• M. Thérèse Garvey, B.Dent.Sc, D.Orth., M.Orth., M.Sc.,
FDS •
• Hugh J. Barry, BDS, MA, FDS, FFD •
• Marielle Blake, B.Dent.Sc., MA, D.Orth., M.Orth.,
FDS(Orth.), MRCD(C) •
© J Can Dent Assoc 1999; 65:612-6

28. Developmental disturbances in
size of teeth

29.  MICRODONTIA
 MACRODONTIA

30.  THIS TERM IS USED TO DESCRIBE TEETH WHICH ARE SMALLER
THAN NORMAL i.e. OUTSIDE USUAL LIMITS OF VARIATION
TYPES :
 True generalized microdontia
 Relative generalized microdontia
 Microdontia involving single tooth

31.  ALL TEETH smaller than normal
 Rare
 Well formed teeth, merely small
 Associated with PITUITARY DWARFISM

32.  NORMAL OR SLIGHTLY SMALLER than normal TEETH are
present in JAWS
 Illusion of true microdontia
 Role of HEREDITARY FACTORS

33.  COMMON condition
 SITE : maxillary lateral incisor & 3rd molar

 Supernumerary teeth are frequently small in size
‘PEG LATERAL’:
 in maxillary lateral incisors ,instead of exhibiting parallel or
diverging mesial & distal surfaces ,the sides converge or
taper together incisally ,forming a peg shaped or cone shaped
crown.

35.  Teeth that are LARGER than normal
TYPES :
1. True generalized macrodontia
2. Relative generalized macrodontia
3. Macrodontia of single tooth

36.  ALL TEETH ARE LARGER than normal
 RARE
 Associated with PITUITARY GIGANTISM

37.  More common
 PRESENCE OF NORMAL OR SLIGHTLY LARGER THAN NORMAL
TEETH IN SMALL JAWS
 Illusion of macrodontia
 Role of HEREDITARY FACTORS

38.  Unknown etiology
 TOOTH MAY APPEAR NORMAL IN EVERY
RESPECT EXCEPT FOR ITS SIZE
 Not to be confused with fusion of teeth

39. Rhizomegaly / Radiculomegaly
RHIZOMICRY
root dwarfism / short root anomaly

40. Macrodontia in association with a contrasting character microdontia
The Journal of clinical pediatric dentistry,vol.23 1(1)
Namdar, FAU - Atasu, M

41. Developmental disturbances in
shape of teeth

42. Developmental disturbances in shape
of teeth
• GEMINATION
• FUSION
• CONCRESCENCE
• DILACERATION
• TALON CUSP
• DENS IN DENTE
• DENS EVAGINATUS
• TAURODONTISM

43. Gemination
• Attempt of DIVISION OF SINGLE TOOTH GERM BY
INVAGINATION
• Incomplete formation of two teeth
• Usually one with two completely or incompletely
separated crowns that have single root and root canal
• Exhibit a hereditary tendency
• Tooth count is normal
• Unknown cause; trauma may be possible cause

44. Fusion
• Fused teeth arise THROUGH UNION OF TWO
NORMALLY SEPARATED TOOTH GERMS
• Physical force or pressure produces contact
Depending upon stage of development of teeth
• fusion may be
• 1. COMPLETE
• 2. INCOMPLETE
• If this contact occurs early, at least before
calcification begins,2 teeth may be completely
united to form a single larger tooth

45. Clinical features
• Seen in deciduous as well as permanent dentition
• Higher frequency in anterior and maxillary region
• It is not always possible to differentiate between
gemination and fusion between a normal tooth &
supernumerary tooth
• The term ‘TWINNING’ is used to designate the
production of equivalent structures by division
resulting in one normal & one supernumerary
teeth

47. CONCRESCENCE
• Fusion which occurs after root formation has
been completed
• Teeth are UNITED BY CEMENTUM ONLY
• Arise as a result of traumatic injury or crowding of teeth with resorption
of interdental bone so that the 2 roots are in approximate contact and
become fused by deposition of cementum between them
• It may occur before/after teeth have erupted

48. Dilaceration
“ kinked tooth ” or “ sickle – tooth ”
• Dilaceration refers to AN ANGULATION,OR A SHARP BEND OR
A CURVE ,IN ROOT OR CROWN OF FORMED TEETH
• Due to trauma in the period in which the tooth is
forming (Van Gool)
• Position of calcified portion of tooth is changed & the
remain of tooth is formed at an angle
• The curve or bend may occur anywhere along length of
tooth depending upon amount of root formed when injury
occurred

50. Talons cusp
• An anomalous structure RESEMBLING AN
EAGLE’S TALON
• Projects lingually from the cingulum of
maxillary /mandibular permanent incisor
• This cusp bends smoothly with tooth except
that there is a deep developmental groove
• It is composed of normal enamel and dentin
& contains a horn of pulp tissue …

51. 3 PATTERNS OF TALON CUSPS
Trace talon
Semi-talon
Talon
Forms: T –form ; Y -shaped

52. Talons cusp
• ASSOCIATED WITH
• RUBINSTEINTAYBI
• STURGE WEBER
• OROFACIAL DIGITAL SYNDROMES
• TREATMENT: PROPHYLACTICALLY RESTORING GROOVE TO
PREVENT CARIES
Bilateral Palatal Talon Cusps on Permanent Maxillary
Lateral Incisors: A Case Report
Bahar Ozcelik and Burcu Atila,Eur j Dent 2011.jan 5(1)
113-116

53. Dens in Dente
• ALSO KNOWN AS ‘DENS INVAGINATUS , DILATED COMPOSITE
ODONTOME’
• Invagination in surface of tooth crown before calcification
has occurred
• CAUSES:
1. increased localized external pressure
2. focal growth retardation/stimulation

54. Dens in dente
• CORONAL 3 types –
• TYPE 1
• TYPE 2
• TYPE 3

55. Oehler’s et al Classification
• TYPE 1: •Confined to the crown
• TYPE 2 : • Extends below CEJ
• • Ends in a blind sac
• • May or may not communicate with
adjacent dental pulp
• TYPE 3 : • Extends through the root
• • Perforates in the apical or lateral radicular area
without any immediate communication with pulp

57. Clinical features
• Maxillary lateral incisors
• Bilateral
• Majority represent simply an accentuation on lingual
pit RADICULAR VARIETY
• DISCUSSED BY ‘BHATT & DHOLAKIA’
• Radicular invagination usually results from an infolding of
HERS & takes its origin within the root after development is
complete
• TREATMENT : TOOTH PROPHYLACTICALLY RESTORED
• IN TEETH WITH OPEN APICES,APEXIFICATION WITH Ca(OH)2

58. Dens evaginatus
• ALSO KNOWN AS ‘OCCLUSAL TUBERCULATED PREMOLAR ,
LEONG’S PREMOLAR , EVAGINATED ODONTOME , OCCLUSAL
ENAMEL PEARL’
• Appears as accessory cusp or globule of enamel on
occlusal surface between the buccal and lingual
cusp of premolars
• Proliferation and evagination of an area of inner
enamel epithelium during tooth development
• Unilateral/bilateral
• Rarely on molars , cuspids , laterals
Proliferation & Evagination of IEE (
Tartman )

60. Taurodontism (Bull like tooth)
1913, Keith Tauro - Bull, dont – tooth
• A PECULIAR DENTAL ANOMALY IN WHICH THE BODY OF
TOOTH IS ENLARGED AT EXPENSE OF ROOTS
Shaw Classified into-
• 1. Hypotaurodont
• 2. Mesotaurodont
• 3. Hypertaurodont

62. Taurodontism
CAUSES: 1. A SPECIALIZED OR RETROGRADE CHARACTER
• 2. A PRIMITIVE PATTERN
• 3. A MENDELIAN RECESSIVE TRAIT
• 4. AN ATAVISTIC FEATURE
• 5. A MUTATION RESULTING FROM ODONTOBLASTIC DEFICIENCY
DURING DENTINOGENESIS OF ROOT
• Hammer & his associates believe that the taurodont is caused by
failure of HERS to invaginate at proper horizontal level
• Goldstein & gottlieb stated that condition appears to be
genetically controlled & familial in nature
Unilateral /Bilateral
Permanent > primary teeth
3rd > 2nd > 1st molar
( field effect )

63. RADIOGRAPHIC FEATURES
• 1. RECTANGULAR IN SHAPE
• 2. PULP CHAMBER : LARGE
• 3. LACKS CONSTRICTION
• 4. ROOTS ARE EXCEEDINGLY SHORT
• 5. BIFURCATION OR TRIFURCATION – Few mm
Taurodontism: A dental rarity
CM Jayashankara, Anil Kumar Shivanna, [...],
and Paluvary Sharath Kumar
J oral maxillofac pathol 2013 sep-dec 17(3) 478

64. Ectopic Enamel / Enamel Pearl
• Enamel in unusual location
• DROPLETS OF ECTOPIC ENAMEL
• Hemispheric structure
• Most project from the surface of root
• A localized bulging of odontoblastic layer

65. CLINICAL FEATURES
• 1. Roots of maxillary molar (common)
• 2. Mandibular molar
• 3. Deciduous molar is not rare
• 4. 1.1-9.7% highest in Asians
• SITE- on roots of furcation area
• RADIOGRAPHICALLY-well defined radio
opaque nodule

66. PARAMOLAR
CUSP OF CARABELLI PROTOSTYLID

67. Developmental disturbances of teeth with
respect to shape- a review
Srisha Basappa,Naresh Lingaraju,Suchetha Malleshi,Kumarswamy
International journal of dental update 2011;1(1):73-79

68. To Be Contd..............

69. Developmental Disturbances in
Structure of teeth

70. Developmental Disturbances in
Structure of teeth
• 1. AMELOGENESIS IMPERFECTA
• 2. ENVIRONMENTAL ENAMEL HYPOPLASIA
• 3. DENTINOGENESIS IMPERFECTA
• 4. DENTIN DYSPLASIA
• 5. REGIONAL ODONTODYSPLASIA
• 6. DENTIN HYPOCALCIFICATION

71. Amelogenesis Imperfecta
• SYNONYMS – HEREDITARY ENAMEL DYSPLASIA ; HEREDITARY
BROWN ENAMEL ; HEREDITARY BROWN OPALESCENT TEETH
• A STRUCTURAL DEFECT OF THE TOOTH ENAMEL WITH
COMPLEX INHERITANCE PATTERN (DXS 85 at Xp22-
amelogenin)
• Developmental of normal enamel occurs in 3 stages –
• FORMATIVE
• CALCIFICATION
• MATURATIVE

72. 3 BASIC TYPES ARE-
• Hypoplastic
• Hypocalcification
• Hypomaturation
• CLASSIFICATION :
• CLASSIFICATION OF AMELOGENESIS IMPERFECTA GIVEN BY
– WITKOP (1989)
• TYPE 1
• TYPE 2
• TYPE 3
• TYPE 4

73. CLASSIFICATION(Witkop 1989)
• TYPE 1 HYPOPLASTIC
• • 1A : Hypoplastic , pitted autosomal dominant
• • 1B : Hypoplastic , local autosomal dominant
• • 1C : Hypoplastic , local autosomal recessive
• • 1E : Hypoplastic , smooth X linked dominant
• • 1F : Hypoplastic , rough autosomaldominant
• • 1G : Enamel agenesis , autosomal recessive
• TYPE 2 HYPOMATURATION
• • 2A: hypomaturation,pigmented autosomal recessive
• • 2B: hypomaturation,X linked recessive
• • 2C : snow capped , autosomal dominant

74. ..
TYPE 3 HYPOCALCIFIED
3A : autosomal dominant
3B : autosomal recessive
TYPE 4 HYPOMATURATION-HYPOPLASTIC WITH TAURODONTISM , AD
HYPOPLASTIC-HYPOMATURATION WITH TAURODONTISM,AD

75. Hypoplastic Type
• CLINICAL & RADIOGRAPHIC FEATURES :
• Inadequate deposition of enamel matrix
• Any matrix present will mineralize
appropriately
• Absence of enamel thickness
• Open contact points
• Radiographically, thin peripheral outline of
radio opaque enamel

77. Hypomaturation Type
• CLINICAL & RADIOGRAPHIC FEATURES :
• Enamel matrix is laid appropriately, there is a
defect in maturation of enamel crystal
structure
• Mottled , opaque white brown yellow
discoloration
• Enamel surface tends to chip
• Radiographically , radio density similar to
dentin

79. Hypocalcified Type
• CLINICAL & RADIOGRAPHIC FEATURES :
• No significant mineralization
• Enamel very soft & easily lost
• Occlusal surface more irregular
• Radiographically , radio density of enamel &
dentin are similar
• Yellow to brown in color

81. Treatment
• Main problem is aesthetics , sensitivity & loss of
vertical dimension
• The type which exhibits thin enamel
(hypocalcification-hypomaturation )-full coverage
crown
• Patterns without significant crown length : full
dentures
• Less rapid hypo plastic tooth loss : aesthetics is the
prime consideration – full crown; facial veneers

82. Environmental Enamel Hypoplasia
• Incomplete or defective formation of organic
enamel matrix of teeth by environmental factors
• TYPE I. Hereditary type-both dentition
• Type II. caused by environmental factors-only
single tooth
• CLINICAL FEATURES-
• I. Mild cases few grooves , pits & fissures
• II. Severe rows of deep pits
• III. Most severe forms- considerable portion of enamel may
be absent

83. CAUSES
• LOCAL INFECTION OR TRAUMA – TURNERS TEETH-
• condition is called TURNERS HYPOPLASIA any infection to
1º teeth that leads to periapical area where ameloblasts of 2º teeth
(tooth buds are present)
• CONGENITAL SYPHILIS – non pitting type maxillary & mandibular
2º incisors & 1st molars
• HUTCHINSON’S INCISORS
• MOON’S MOLAR/FOURNIER MOLAR/MULBERRY MOLAR
• NUTRITIONAL DEFICIENCY-Incisors, canines & 1st molar
• BIRTH INJURIES
• ERYTHROBLASTOSIS FOETALIS
• NEONATAL LINES OR RINGS MULBERRY

84. MULBERRY MOLARS
ERYTHROBLASTOSIS FOETALIS

85. CHEMICALS
• Eg.Tetracycline Mechanism – a chelate of calcium &
tetracycline forms. at high concentration, in both
ameloblast & odontoblast , protein synthesis is
impaired ,this results in hypoplasia of enamel & dentin
matrix
• CRITICAL PERIOD – TEETH IU (months)
Deciduous incisors 4
Deciduous canines 5
Permanent incisors
& canines 3-5

87. FLUOROSIS
• PATHOGENESIS – disturbance of ameloblasts
during the formative stage of tooth development
resulting in defective or deficient enamel matrix
• GRADE CLINICAL APPEARANCE
Very mild, questionable white, opaque,<25%
Mild white , opaque,</=50%
Moderate white , opaque, brownish
Severe opaque,pitted,brown,brittle

90. Dentinogenesis Imperfecta
• Affected teeth are gray to yellowish
brown & have ‘TULIP SHAPE’
• Radiographically,the teeth appear solid,
lacking pulp chamber & root canals

92. CLASSIFICATION
TYPE 1 I.
DENTINOGENESIS IMPERFECTA 1 – D.I. Without osteogenesis imperfecta
• (opalescent dentin, Shields type II,Capdepont teeth)
• DSPP at Gene map locus 4q21.3
• D.I. TYPE 1: FREQUENCY -1 in 6000-8000 children, BLUE
GRAY OR AMBER BROWN & OPALESCENT
• RADIOGRAPHICALLY ; teeth have bulbous crowns &
obliterated pulp chambers

93. ..
TYPE II. DENTINOGENESIS IMPERFECTA 2 -
Shieldstype III,Brandywine type D.I. (Shell tooth)
• D.I. TYPE 2 : brandywine triracial isolate in southern
Maryland Multiple pulp exposures may occur Dentin is
amber colored & smooth
• Radio graphically , deciduous- large pulp chambers &
root canals Permanent – completely obliterated

95. HISTOLOGICAL FEATURES
• Irregular tubules , with large areas of uncalcified matrix
• Tubules are larger in diameter
• Dentinal tubules in D.I. are disoriented
• PHYSICAL AND CHEMICAL FEATURES :
water content increased 60 %
hardness - low
TREATMENT :
• Full coverage : crowns & roots close to normal shape
• Overlay dentures placed on teeth covered with fluoride releasing GIC
Vertical dimension rebuilt-metal castings
• Newer composite combined with dentin bonding agent – occlusal wear

96. ATYPICAL DENTIN FORMATION WITH
ABNORMAL PULP MORPHOLOGY
• SHIELDS & HIS ASSOCIATES classified it into –
• TYPE 1 – DENTIN DYSPLASIA
• TYPE 2 – ANOMALOUS DYSPLASIA OF DENTIN
• WITKOP referred as – RADICULAR – TYPE 1
• CORONAL - TYPE 2

97. TYPE 1 (RADICULAR),
• Slight amber translucency, Exfoliated prematurely or after
only minor trauma
• Radio graphically ; Deciduous – pulp completely obliterated
• Permanent – crescent shaped
• TYPE 2 (CORONAL)
• Yellow brown or bluish gray opalescent
• Clinical appearance of permanent dentition is normal
• Radio graphically , Deciduous – pulp chamber obliterated
• Permanent – thistle tube shaped

98. HISTOLOGICAL FEATURES
• TYPE 1 (RADICULAR) - lava flowing around boulders
• TYPE 2 (CORONAL) –
• DECIDUOUS : amorphous & atubular dentin in radicular portion
PERMANENT : multiple pulp stones or denticles
TREATMENT
• Preventive care
• Meticulous oral hygiene
• Shallow restorations – pulpal necrosis
• Periapical inflammatory lesions : therapeutic choice guided by root
lengths

100. SYSTEMIC DISEASES ASSOCIATED
WITH DENTIN DYSPLASIA
• CALCINOSIS UNIVERSALIS
• RHEUMATOID ARTHRITIS & VITAMINOSIS
• SCLEROTIC BONE & SKELETAL ABNORMALITIES
• TUMOR CALCINOSIS

101. REGIONAL ODONTODYSPLASIA
• Also known as :Odontogenic Dysplasia
• Odontogenesis Imperfecta
• Ghost Teeth
• ETIOLOGY :
• 1. Abnormal migration of neural crest cells
• 2. Latent virus
• 3. Local circulatory deficiency
• 4. Local trauma or infection
• 5. Hyperpyrexia
• 6. Malnutrition
• 7. Medication
• 8. Radiation therapy
• 9. Somatic mutation
• 10. Alteration in vascular supply

102. CLINICAL FEATURES
• a. BIMODAL PEAK
• b. FOCAL AREA
• c. MAXILLARY PREDOMINANCE
• d. SURROUNDING BONE – LOWER DENSITY
• e. ERUPTED TEETH – IRREGULAR, ROUGH, YELLOW TO BROWN IN COLOR
SIGNS & SYMPTOMS :
a. DELAYED/FAILURE OF ERUPTION
b. EARLY EXFOLIATION
c. ABSCESS FORMATION
d. MALFORMED TEETH
e. NON INFLAMMATORY GINGIVAL ENLARGEMENT
RADIOGRAPHIC FEATURES : a. THIN ENAMEL & DENTIN,large Pulp chamber – GHOST TEETH
b. LACK OF CONTRAST
c. PULP STONES

103. HISTOLOGIC FEATURES
• ENAMEL : PRISM STRUCTURE – IRREGULAR
• DENTIN : GLOBULAR AREAS –POORLY ORGANIZED TUBULAR
DENTIN
• PULP : PULP STONES
• TREATMENT :
• RETENTION
• NON VITAL – ENDODONTIC THERAPY
• TOOTH PREPARATION CONTRAINDICATED
• SEVERELY INFECTED / AFFECTED TEETH
EXTRACTION

104. DENTIN HYPOCALCIFICATION
• Caused by environmental factors affecting
mineralization
• There is failure in the fusion of calcium globules ,
during mineralization , leaving interglobular areas
of uncalcified matrix
• Globular dentin can be easily detected in ground &
decalcified sections
• Hypocalcified dentin is softer

105. [Frequency of the developmental disturbances of tooth structure].
Shoni shikaquaku zaashi,ncbi pubmed 1990;28(2):466-85.

106. DEVELOPMENTAL
DISTURBANCES IN
GROWTH(ERUPTION) OF TEETH

107. DEVELOPMENTAL DISTURBANCES IN
GROWTH(ERUPTION) OF TEETH
• PREMATURE ERUPTION
• DELAYED ERUPTION
• ERUPTION SEQUESTRUM
• MULTIPLE UNERUPTED TEETH
• EMBEDDED AND IMPACTED TEETH
• ANKYLOSED & DECIDUOUS TEETH

108. PREMATURE ERUPTION
• Natal tooth,Neonatal tooth
• Polychlorinated biphenyls (PCBs), polychlorinated
dibenzo- -dioxins (PCDDs), and dibenzofurans (PCDFs)
• Hormonal influences like hyperthyroidism ADRENOGENITAL
SYNDROME

109. DELAYED ERUPTION
• In deciduous and permanent teeth, it is
difficult to assess unless a gross variation is
present.
Caused by
• Systemic conditions like rickets, cretinism, cleidocranial
dysplasia.
• Local factors like fibromatosis gingivae
• Treatment of the primary condition may lead to eruption of
the teeth.

110. ERUPTION SEQUESTRUM
• Anomaly associated with tooth eruption in children. Described by
Starkey and Shafer.
• It is a tiny, irregular spicule of bone overlying the crown of an
erupting permanent molar, found just prior to or immediately
following the emergence of the tip of the cusps through the oral
mucosa.
Etiology :
As the molar teeth erupt through the bone, they can separate a
small osseous fragment from the surrounding bone similar to a
cork screw.
• In most cases, the fragment undergoes complete resorption
before eruption.
• If the bony spicule is large or the eruption is rapid, complete
resorption cannot occur and hence, it is observed.

112. Clinical features
• The child may complain of slight soreness in the
area during function.
• The spicule directly overlies the central occlusal
fossa but is within the soft tissue.
• It may be seen lying in a tiny depression over the
crest of the ridge.
• As the tooth erupts, the fragment of bone
completely sequesters through the mucosa and is
lost.

113. Radiographic features
• It can be recognized even before the tooth
eruption.
• Seen as a tiny, irregular opacity overlying the
central occlusal fossa but separated from the tooth
itself.

114. MULTIPLE UNERUPTED TEETH
• Uncommon condition with delayed eruption of teeth. –
Deciduous teeth may be retained or – Deciduous teeth
would be shed but the permanent teeth would have failed
to erupt (Pseudo‐anodontia).
• Radiographs may be normal but the eruptive forces
would be lacking.
• In association with cleidocranial dysplasia

115. EMBEDDED AND IMPACTED TEETH
• unerupted usually because of a lack of eruptive force.
• Impacted teeth are prevented from eruption by some
physical barrier in the eruption path like,
• Lack of space – crowding, premature loss of deciduous
teeth. – Rotation of tooth buds.
• Any tooth may be impacted – usually mandibular third
molars (22%), maxillary third molars (18%) and maxillary
cuspids (0.9%), premolars and supernumerary teeth.
• Mandibular teeth are more severely impacted than maxillary
teeth.

117. ANKYLOSED TEETH
• Also called Submerged teeth, Infraocclusion, Secondary retention, Submergence,
Reimpaction and Reinclusion.
• Usually deciduous mandibular second molars with variable degree of root
resorption can become ankylosed to bone.
• This prevents exfoliation and subsequent replacement by permanent teeth.
• The submerged appearance could be due to – Continued growth of the alveolar
process – Crown height of deciduous tooth is less than that of adjacent
permanent teeth.
• It has a solid sound on percussion when compared to the dull, cushioned sound
of normal teeth.
• Radio graphically , partial absence of PDL , with areas of apparent bending
between tooth root & bone

119. Overall management of dental anomalies –
pediatric dentists
Informing & supporting child & parent
Establishing a diagnosis
Genetic counselling
Inter – disciplinary formulation of definitive
treatment plan
Elimination of pain
Restoration of aesthetics
Provision for adequate function
Maintenance of occlusal vertical dimension
Intermediate restorations through childhood &
adolescence
Planning definitive treatment at optimum age

120. Mechanism of Human Tooth Eruption: Review Article Including a New Theory for
Future Studies on the Eruption Process,
Inger kjaer,ScientificaVolume 2014 (2014), Article ID 341905, 13 pages

121. REFERENCES
• Books
• Cawson, R.A: Cawson’s Essentials of Oral › Oral Pathology
and Oral Medicine, › 8th Edition • (pages 18-36)
• Shafer, et al: A textbook of Oral Pathology, › 5TH Edition
• (pages 52-87)
• Developmental disorders of the dentition:an update
Ophir D klein,Snehalata oberoi,ann huysene,maria
hovarokova,miroslav peterka,renata peterkova. Am J
Med Genet C Semin Med Genet 2013
November;163(4),doi 10.1002/ajmg.c.31382