Anomalies

DEVELOPMENTAL
DISTURBANCES OF
TEETH
CONTENTS
Developmental disturbances of teeth o Talon’s cusp
 Structure o Dens invaginatus
o Amelogenesis imperfecta o Dens evaginatus
 Taurodontism
o Enamel hypoplasia
 Number
o Dentinogenesis imperfecta
o Anodontia
o Dentin dysplasia
o Supernumerary teeth
o Regional odontodysplasia  Predeciduous dentition
 Shape  Size
o Gemination o Microdontia
o Fusion o Macrodontia
o Concrescence  Conclusion
o Dilaceration  References
INTRODUCTION
 Developmental dental anomalies are marked deviations from the
normal colour, contour, size, number, and degree of development of
teeth.
 Local as well as systemic factors may be responsible for these

developmental disturbances.
 Manifestation of defects are evident either at birth or some time after

birth.
DEVELOPMENTAL DEFECTS
OF TEETH
STRUCT
SHAPE NUMBER SIZE
URE
Shafer’s Textbook of Oral Pathology Ninth Edition

AMELOGENESIS
IMPERFECTA
ENAMEL
HYPOPLASIA
DENTINOGENESIS
STRUCTURE IMPERFECTA
DENTIN DYSPLASIA
REGIONAL
ODONTODYSPLASIA

AMELOGENESIS IMPERFECTA
 Also known as Hereditary enamel dysplasia, hereditary brown enamel, hereditary brown
opalescent teeth.
 Mutations in AMELX, ENAM, MMP20, and FAM83H genes causes amelogenesis
imperfecta.
 These genes provide instructions for making proteins that are essential for normal tooth
development.
CLASSIFICATION
Depending on Clinical presentation of defects and stage of enamel formation that is primarily
affected:
 Hypoplastic (HP)
 Hypocalcified (HC)
 Hypomature (HM)
Hypoplastic Amelogenesis Imperfecta
 Inadequate deposition of enamel matrix.
 Generalized pattern : Pinpoint-to-pinhead–sized pits are scattered across the surface of teeth.
 Buccal surfaces are affected more severely, Staining of pits may occur
 Localized pattern: Affected teeth show horizontal rows of pits, linear depression, or one large area of
hypoplastic enamel.
 Typically, located in middle third
of buccal surfaces.

Hypomaturation
 Defects in mineralization
 Classically, hypomaturation pattern is associated
with Enamel that chips and fractures easily but does
not demonstrate massive loss upon eruption.
 Snow-capped hypomaturation patterns

Exhibit a zone of white opaque enamel on the incisal
or occlusal to one-third of crown.

Hypocalcification
 Hypocalcification pattern associated with “cheesy” enamel that is lost
rapidly and diffusely except for a residual band in cervical portion of
teeth.
 Teethdemonstrating lack of enamel protein with more severe enamel
abnormalities.

Main problems associate with amelogenesis imperfecta:-
 Aesthetics
 Dental sensitivity
 Loss of vertical dimension
 Increased prevalence of caries
 Anterior open bite
 Delayed eruption
 Tooth impaction
 Gingival inflammation
Neville Oral and Maxillofacial Pathology Third Edition

Preoperative clinical photographs showing teeth with well-defined pitted surfaces along with yellowish brown
discoloration and normal healthy periodontium.
11
Roma M et.al, Management guidelines for amelogenesis imperfecta. J Med Case
Preoperative OPG showing root canal treated tooth with
respect to 36 and endodontic treatments to be performed on
#37, 47,47,16,26
Definitive treatment plan:

• Patient motivation for the treatment and maintenance
of oral hygiene.
• Endodontic treatments of #37, 47, 47, 16, 26, 3.
• Providing temporary bridges on all posterior teeth for
reconstruction of the lost occlusal vertical dimension,
• Trial of fixed partial dentures,
• Periodic follow-ups at 1 year and 2 year intervals
followed by augmentation of oral hygiene measures.
12
3% sodium hypochlorite (Vishal
Dentocare Pvt Ltd, India) used as Cleaning and shaping of all
Endodontic treatment was irrigant in all teeth. WL obtained canals performed with hand K
performed with respect to #37, by hand K file (Dentsply Inc, files and Protaper rotary files
47, 16, 26 under rubber dam Maillefer, Dentsply India), Root (Dentsply Inc, Maillefer,
and local anesthesia. ZX II Apex locator (Morita, Dentsply India) and enlarged
Irvine, CA), confirmed using upto F2 file size.
IOPA.
All the obturation was All access cavities were given

completed using F2 protaper temporary seal dressing (cotton
Next stage of treatment was gutta percha cone (Dentsply, pellet and intermediary
restorative and prosthetic Maillefer, Dentsply India) with restorative material, Cavit G,
phase. Fixed partial dentures AH Plus sealer (Dentsply, 3M ESPE GmbH, Neuss,
Sirona, Dentsply India) Germany).
13
Clinical photographs showing facebow transfer, and clinical
procedures for prosthetic rehabilitation and following Full-mouth porcelain fused to metal restorations preferred for
postoperative OPG view enhanced stability, mechanical durability, satisfactory esthetics
and protection of the remaining dentin.
14
ENAMEL HYPOPLASIA
 It is defined as an Incomplete or defective formation of the organic enamel

matrix of teeth.
 Hypoplasia results only if the injury occurs during the time the teeth are
developing specifically, during the formative stage of enamel development

CHARACTERISTIC APPERANCE
 In mild environmental hypoplasia, few small
grooves, pits, or fissures on the enamel surface
 Ifcondition is severe, enamel exhibit rows of deep
pits arranged horizontally across the surface of
tooth .
 In most severe cases, considerable portion of
enamel may be absent, suggesting a prolonged
disturbance in function of the ameloblasts.

FACTORS AFFECTING ENVIRONMENTAL ENAMEL
HYPOPLASIA
 Nutritional deficiency (vitamins A, C, and D) :-

Pitting variety is seen. Mostly frequently central, lateral incisors, cuspids and
first molars are involved.
 Exanthematous diseases (e.g. measles, chickenpox, scarlet fever)
 Congenital syphilis:- Hypoplasia involves Maxillary and Mandibular
permanent incisors, First molars.
Anterior teeth affected are called ‘Hutchinson’s teeth,’ while the molars
referred to as ‘mulberry molars’ (Moon’s molars, Fournier’s molars).

Hutchinson’s teeth Mulberry molars
 Characteristically, Upper central  Occlusal 3rd of tooth appears to be
incisor is ‘screw-driver’ shaped, arranged in agglomerate mass of
Mesial and Distal surfaces globules rather than in well-
tapering and converging towards formed cusps
incisal edge.  Crown is narrower on occlusal
 Incisal edge is usually notched. surface than at the cervical margin

 Hypocalcemia
 Birth injury (Neonatal lines), Rh hemolytic disease
 Local infection or trauma :- TURNER’S HYPOPLASIA
 Single tooth is involved
 Most commonly one of the permanent maxillary incisors or maxillary or
mandibular premolar.
 Hypoplasia, ranging from a mild, brownish discoloration of the enamel to a
sever pitting and irregularity of tooth crown .
These single teeth are
frequently referred to
as ‘Turner’s teeth,’ and
condition is called
‘Turner’s hypoplasia. Shafer’s Textbook of Oral Pathology Ninth Edition
Ingestion of chemicals (chiefly
fluoride) :- MOTTLED ENAMEL
 Etiology: Ingestion of fluoride
containing drinking water during time of
tooth formation may result in mottled
enamel.
 Severity increases with higher amount of
fluoride in Water. ( >6ppm)
 Based on severity they can be classified
as:

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DEVELOPMENTAL

 Local as well as systemic factors may be responsible for these

 Manifestation of defects are evident either at birth or some time after

Shafer’s Textbook of Oral Pathology Ninth Edition

Shafer’s Textbook of Oral Pathology Ninth Edition

 Typically, located in middle third

Shafer’s Textbook of Oral Pathology Ninth Edition

 Snow-capped hypomaturation patterns

Shafer’s Textbook of Oral Pathology Ninth Edition

Shafer’s Textbook of Oral Pathology Ninth Edition

Neville Oral and Maxillofacial Pathology Third Edition

Definitive treatment plan:

All the obturation was All access cavities were given

 It is defined as an Incomplete or defective formation of the organic enamel

Shafer’s Textbook of Oral Pathology Ninth Edition

Shafer’s Textbook of Oral Pathology Ninth Edition

 Nutritional deficiency (vitamins A, C, and D) :-

Shafer’s Textbook of Oral Pathology Ninth Edition

Shafer’s Textbook of Oral Pathology Ninth Edition

Shafer’s Textbook of Oral Pathology Ninth Edition

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