Developmental
disturbances
In
TEETH
08/08/14 1BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Developmental disturbances of
teeth
 Size of teeth
 Shape of teeth
 Number of teeth
 Structure of teeth
 Growth (Erup...
D-D in size of teeth
 Microdontia
 Macrodontia
08/08/14 3BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
D-D in shape of teeth
 Gemination
 Fusion
 Concrescence
 Dilaceration
 Talon cusp
 Dens in dente
 Dens evaginatus
...
D-D in number of teeth
 Anodontia
 Supernumerary teeth
 Pre-deciduous dentition
 Post-permanent dentition
08/08/14 5BY...
D-D in structure of teeth
 Amelogenesis imperfecta
 Environmental enamel
hypoplasia
 Dentinogenesis imperfecta
 Dentin...
D-D of growth (eruption) of teeth
 Premature eruption
 Eruption sequestrum
 Delayed eruption
 Multiple unerupted teeth...
Developmental disturbances
in size of teeth
08/08/14 8BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Microdontia
 It is described as teeth which are smaller than
normal i.e. outside the usual limits of variation.
 Three t...
Microdontia
 True generalized type:
• All the teeth are smaller than normal.
• Exceedingly rare.
• Teeth are well formed ...
Microdontia
08/08/14 11BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Microdontia
 Relative generalized type:
• Normal or slightly smaller than normal teeth.
but the jaws are somewhat larger ...
Microdontia
 Involving a single tooth:
• Also called localized microdontia.
• Rather common.
• Affects mostly the maxilla...
Microdontia
08/08/14 14BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Microdontia
 Common form in lateral incisors – PEG
laterals.
• The mesial and distal surfaces converge or taper
incisally...
Microdontia
08/08/14 16BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Macrodontia
 It refers to teeth that are larger than normal.
 Also called Megalodontia or megadontia.
 Three types:
• T...
Macrodontia
 True generalized type:
• Extremely rare.
• All the teeth are larger than normal.
• Associated with pituitary...
Macrodontia
 Relative generalized type:
• Some what more common.
• Normal or slightly larger sized teeth in smaller
jaws....
Macrodontia
 Involving a single tooth:
• Relatively uncommon.
• Unknown etiology.
• Tooth may appear normal in every aspe...
Macrodontia
08/08/14 21BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Developmental
disturbances
in shape of teeth
08/08/14 22BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Gemination
 These are anomalies which arise from an
attempt at division of single tooth germ by
invagination, with result...
Gemination
 Seen in deciduous and permanent teeth.
 Structure is one tooth with:
• Two completely or incompletely separa...
Gemination
08/08/14 25BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Comparison
 Gemination - Defined as a single enlarged
tooth or joined tooth in which the tooth count
is normal, when the ...
Fusion
 Fused teeth arise through union of two normally
separated tooth germs.
 Could be between two normal teeth or a n...
Fusion
08/08/14 28BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Fusion
08/08/14 29BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Fusion
 Contact occurs before calcification – two teeth
may be completely united to form a single
large tooth.
• Dentin i...
Fusion
08/08/14 31BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Fusion
 Tooth may have separate or fused root canals.
 Common in deciduous as well as permanent
teeth.
 Clinical proble...
Concrescence
 A form of fusion which occurs after root
formation has been completed.
 Teeth are united by cementum only....
Concrescence
08/08/14 34BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Concrescence
 May occur before or after tooth eruption.
 Usually involves two teeth. But a case
involving three teeth ha...
Histopathology
 Deposition of excessive cementum over the
original layer of primary cementum.
 May be hypocellular or ex...
Factors asso.
 Local factors:
• Abnormal occlusal trauma
• Adjacent inflammation
• Unopposed teeth – impacted, embedded, ...
Factors asso.
 Systemic factors:
• Acromegaly and pituitary gigantism
• Arthritis
• Calcinosis
• Paget’s disease of bone
...
Dilaceration
 Refers to an angulation or a sharp bend or
curve, in the root or crown of a formed teeth.
 Due to trauma d...
Dilaceration
08/08/14 40BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Dilaceration
 Dilaceration in a permanent tooth often follows
traumatic injury (avulsion or intrusion) to the
deciduous p...
Dilaceration
 The curve or bend can occur anywhere along the
length of the tooth depending on the amount of tooth
formed ...
Talon cusp
 An anomalous structure resembling an eagle’s
talon, projects lingually from the cingulum areas of
a maxillary...
Clinical features
08/08/14 44BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Radiographic features
08/08/14 45BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Talon cusp
 Clinical problems include esthetics, caries
control and occlusal accomodation.
 Quite uncommon among the gen...
Talon cusp
 More prevalent in Rubinstein – Taybi
syndrome.
• Developmental retardation.
• Broad thumbs and great toes.
• ...
Dens in dente
 Also called Dens invaginatus, Dilated
composite odontome.
 Is a developmental variation thought to arise
...
Dens in dente
 Fairly common and extreme variations in
clinical presentation.
 The term was initially applied to a sever...
Dens in dente
 Caused could be:
• Increased localized external pressure
• Focal growth retardation
• Focal growth stimula...
Dens in dente
 Permanent maxillary lateral incisors are most
frequently involved and sometimes, the maxillary
central inc...
Dens in dente
08/08/14 52BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Radiographic features
08/08/14 53BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Dens in dente
 Mild form – has an accentuation/deep
invagination in the lingual pit area.
 Radiographs reveal a pear sha...
08/08/14 55BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Dens in dente
 Food debris can accumulate leading to
caries and pulpal infection.
 Bizarre radiographic picture with sev...
Dens evaginatus
 Also called Leong’s premolar, Evaginated
odontome.
 It is a developmental condition that appears
clinic...
Dens evaginatus
 Occurs in persons of mongoloid ancestry –
chinese, japanese, filipinos, eskimos and
american-indians.
 ...
Dens evaginatus
 May physically resemble talon cusp.
 Extra cusp can lead to:
• Incomplete eruption
• Displacement of te...
Dens evaginatus
08/08/14 60BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Shovel shaped incisors
 Predominantly in asians, native americans and
alaskans.
 Affects maxillary central and lateral i...
Taurodontism
 Originated by Sir Arthur Keith in 1913 to describe a
dental anomaly in which the body of the tooth is
enlar...
Taurodontism
 Shaw classified it as,
• Hypotaurodont – mildest form
• Mesotaurodont – moderate
• Hypertaurodont – severe ...
Taurodontism
 Causes enumerated by Mangion are:
• Primitive pattern
• Mutation resulting from odontoblastic deficiency du...
Taurodontism
 Associated in Neanderthal man.
 Occur concomitantly with amelogenesis
imperfecta - hypomaturation-hypoplas...
Taurodontism
08/08/14 66BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Taurodontism
 Affect either deciduous or permanent teeth
(more common in permanent teeth).
 Usually molars – single/mult...
Taurodontism
 Affected teeth tend to be rectangular in shape.
 Pulp chamber is extremely large with greater
apico-occlus...
08/08/14 69BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Syndromes asso.
 AI – Type IE, IV
 Ectodermal dysplasia
 Hyper/Hypo phosphatasia
 Klinefelter syndrome
 Oculo-dental-...
Supernumerary roots
 Refers to the development of an increased number of
roots on a tooth compared with that described in...
Supernumerary roots
08/08/14 72BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Ectopic enamel
 Refers to the presence of enamel in unusual
locations, mainly in the roots of teeth.
 Widely known as en...
Ectopic enamel
 Hemispheric structures that consist of,
• Entirely of enamel
• Enamel, dentin and pulp tissue.
 Thought ...
Ectopic enamel
08/08/14 75BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Cervical enamel extensions
 Located on the buccal surface of the root
overlying the bifurcation.
 Affects the mandibular...
Cervical enamel extensions
 Correlated with localized loss of periodontal
attachment with furcation involvement.
 Associ...
08/08/14 78BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Developmental disturbances
in number of teeth
08/08/14 79BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Anodontia
 True anodontia – congenital absence of teeth.
• Total
• Partial
 Induced or false anodontia – as a result of
...
Total anodontia
 It is a rare condition in which all the teeth are
missing.
 May involve both deciduous and permanent
de...
True partial anodontia
 Also called
• Hypodontia – lack of development of one or more
teeth.
• Oligodontia - Lack of deve...
Hypodontia
08/08/14 83BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
True partial anodontia
 Etiology:
• Familial tendency – point mutations transmitted in
autosomal dominant pattern.
• Miss...
True partial anodontia
 Frequently involved teeth are,
• Third molars (all the 4 may be missing)
• Maxillary lateral inci...
Hypodontia
08/08/14 86BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
True partial anodontia
 In severe partial anodontia - there is bilateral
absence of corresponding teeth.
 In hereditary ...
True partial anodontia
 Congenitally missing deciduous teeth is an uncommon
condition.
 Usually involves,
• Maxillary la...
Syndromes asso.
 Ankyloglossia superior
 Crouzon
 Down
 Ectodermal dysplasia
 Ehlers danlos
 Hurlers
 Sturge-weber
...
Hyperdontia
 Development of an increased number of teeth
and the additional teeth are termed as
Supernumerary teeth.
08/0...
Supernumerary teeth
 It may closely resemble the teeth of the
belonging group – molars, premolars or
incisors.
 It may h...
08/08/14 92BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Supernumerary teeth
08/08/14 93BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Supernumerary teeth
 It develops from a third tooth bud arising form
the dental lamina near the permanent tooth
bud.
 Ar...
Supernumerary teeth
 Multiple SN teeth is seen in,
• Cleido-cranial dysplasia
• Gardner’s syndrome – the impacted teeth m...
Supernumerary teeth
 May be found in any location.
 90% of occurrence is in the maxilla.
 May be erupted or impacted.
0...
Mesiodens
 Most common supernumerary tooth.
 It is situated between the maxillary central
incisors.
 It occurs as,
• Si...
Mesiodens
08/08/14 98BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Mesiodens
 It is a small tooth with a cone shaped crown
and a short root.
 High incidence in caucasian population with
2...
Fourth molar
 Second most common supernumerary tooth.
 Situated distal to the third molar.
 Usually small, rudimentary ...
Fourth molar
08/08/14 101BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Supernumerary teeth
 Others include,
• Maxillary paramolars
• Mandibular premolars
• Maxillary lateral incisors
 Rarely ...
Paramolars
 Paramolar is a supernumerary molar,
• Situated buccally or lingually to one of the maxillary
molars.
• Inter-...
Dental transposition
 Normal teeth erupting into an inappropriate
position.
 Usually involves the canine and first
premo...
Syndromes asso.
 Apert
 Cleidocranial dysplasia
 Crouzon
 Down
 Ehler danlos
 Gardner
 Sturge-weber
 fucosidosis
0...
Pre-deciduous dentition
 Infants born with structures appearing to be
erupted teeth in the mandibular incisor region.
 A...
Pre-deciduous dentition
 Described as hornified, epithelial structures
without roots.
 Occurs in the gingiva over the cr...
Pre-deciduous dentition
 Differentiated from true deciduous teeth or natal teeth
described by Massler – which erupts at t...
Post-permanent dentition
 In persons who had all their permanent teeth
extracted and yet had subsequently erupted
several...
Post-permanent dentition
 Some may represent post-permanent or third
dentition.
 But they are actually, multiple supernu...
Developmental disturbances
in structure of teeth
08/08/14 111BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Environmental alterations
 Developmental tooth defects
 Post developmental structure loss
 Discolorations of teeth
 Lo...
Environmental enamel hypoplasia
 Defined as incomplete or defective formation
of the organic enamel matrix of the teeth.
...
Factors associated with enamel
defects
 Systemic factors:
• Birth related trauma – hypoxia, premature birth
• Chemicals –...
Factors associated with enamel
defects
 Local factors:
• Local acute mechanical trauma
• Electric burn
• Irradiation
• Lo...
Environmental enamel hypoplasia
Hereditary Environmental
Both deciduous and
permanent teeth are
affected.
Either dentition...
Amelogenesis imperfecta
 Also called hereditary enamel dysplasia, hereditary
brown enamel, hereditary brown opalescent te...
Amelogenesis imperfecta
 In normal development of enamel, three stages can be
appreciated,
• Formative stage – deposition...
Clinical features
 By Witkop and Sauk,
• Hypoplastic – enamel is not formed to full, normal
thickness on newly erupted, d...
Classification by Witkop and Sauk
 Hypoplastic:
• Pitted, autosomal dominant
• Local, autosomal dominant
• Smooth, autoso...
Classification
 Hypoplastic pattern – IA, IB, IC, ID, IE, IF, IG
 Hypomaturation – IIA, IIB, IIC, IID
 Hypocalcified – ...
Clinical features
 Extremely variable, clinical presentation.
 All teeth of both dentitions affected to some degree.
 C...
Clinical features
 Enamel may be totally lost or have chalky texture
or cheesy consistency or relatively hard.
 Enamel m...
Amelogenesis imperfecta
08/08/14 124BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Amelogenesis imperfecta
08/08/14 125BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Radiographic features
 Overall shape of the tooth may not be normal
depending on the,
• Amount of enamel present
• Amount...
Histologic features
 Disturbance in the differentiation and viability
of ameloblasts in hypoplastic type – seen as
defect...
Hypoplastic/Hypomaturation AI
 Has enamel hypoplasia in combination with
hypomaturation.
 Both the dentition are affecte...
Hypomaturation - Hypoplastic
 Enamel hypomaturation is the dominant
feature.
 Enamel is yellowish-white to yellowish-bro...
Hypoplastic - Hypomaturation
 Enamel hypoplasia is the dominant feature.
 Enamel is thin.
 Other features is similar to...
Tricho-dento-osseous syndrome
 Autosomal dominant disorder.
 Shows hypoplastic-hypomaturation AI with severe
taurodontis...
Environmental enamel hypoplasia
 It occurs only when the injury occurs during the
development or more specifically, forma...
Causes
 Nutritional deficiency – Vitamins A, C, D
 Exanthematous diseases – Measles, Chicken pox,
Scarlet fever
 Congen...
Clinical features
 Mild cases – few small grooves, pits or fissures
on the enamel surface.
 Severe – rows of deep pits a...
Hypoplasia due to nutritional factors
and exanthematous fevers
 Rickets at the time of tooth formation is the
most common...
Hypoplasia due to nutritional factors
and exanthematous fevers
 Most cases involve teeth that form within the first year
...
Hypoplasia due to congenital
syphilis
 Has a characteristic, pathognomonic appearance.
 Involves the maxillary and mandi...
Clinical features
 Upper central incisor is screw-driver shaped.
 Mesial and distal surfaces of the crown tapers and
con...
Hutchinson’s incisors
08/08/14 139BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Clinical features
 Crowns of first molars are irregular.
 Enamel of the occlusal surface and occlusal third
of the tooth...
Mulberry molars
08/08/14 141BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Hypoplasia due to hypocalcemia
 Tetany - due to reduction in blood level of
calcium – due to vitamin D deficiency and
hyp...
Hypoplasia due to birth injuries
 Neonatal line or ring – described by Schour(1936) is
present in deciduous teeth and fir...
Hypoplasia due to local trauma
or infection
 Only a single tooth is involved – permanent
maxillary incisors or maxillary/...
Hypoplasia due to local trauma
or infection
 The periapical infection of a carious deciduous
tooth can disturb the develo...
Hypoplasia due to local trauma
or infection
 Similar hypoplasia can follow trauma to the
deciduous tooth when the tooth i...
Hypoplasia due to trauma
08/08/14 147BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Hypoplasia due to anti-
neoplastic therapy
 Secondary changes due to therapeutic
radiation or chemotherapy.
 Under the a...
Hypoplasia due to fluoride –
Mottled enamel
 Variety of enamel hypoplasia.
 First described by G.V. Black and
Frederick....
Etiology
 Ingestion of fluoride containing drinking water
during the time of tooth formation.
 Severity of hypoplasia in...
Pathogenesis
 Due to disturbance of ameloblasts during the formative
stage of tooth development.
 Exact nature of cell i...
Clinical features
 Questionable changes - white flecks or
spotting of enamel.
 Mild changes – white, opaque areas involv...
Mottled enamel
08/08/14 153BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Mottled enamel
08/08/14 154BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Intrinsic stains
 Congenital erythropoietic porphyria – reddish
brown – red fluorescence under Wood’s light.
 Alkaptonur...
Tetracycline stains
08/08/14 156BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
08/08/14 157BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Dentinogenesis imperfecta
 Called Hereditary opalescent dentin, Capdepont’s
teeth.
 Only the mesodermal portion of the o...
Classification by Shields
 Type I – DI that always occur with OI – autosomal
dominant.
 Type II – DI that never occurs w...
Clinical features
 Varied presentations.
 Deciduous teeth are more severely affected in
Type I.
 Both the dentitions ar...
Dentinogenesis imperfecta
08/08/14 161BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Clinical features
 Enamel may be lost early on incisal and
occlusal surfaces due to the abnormal DEJ.
 DEJ lacks the usu...
Dentinogenesis imperfecta
08/08/14 163BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
08/08/14 164BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Radiographic features
 Total or partial obliteration of the pulp chambers and
root canals by continued formation of denti...
Radiographic features
 Type III shows marked variation.
 Witkop describes it as Shell teeth.
 Originally described by R...
Histologic features
 Type I and II emphasizes a pure mesodermal
disturbance. Type III is not adequately documented.
 The...
Physical and chemical features
 Water content is increased – 60% above
normal.
 Inorganic content is less than that of n...
Histologic features
 Cellular inclusions probably odontoblasts can be seen
in dentin.
 The odontoblasts with limited abi...
Dentin dysplasia
 Called Rootless teeth.
 Rare disturbance in dentin formation characterized by
normal enamel but atypic...
Classification
 Shields:
• Type I – dentin dysplasia
• Type II – anomalous dysplasia of dentin
 Witkops:
• Type I – Radi...
Etiology
 Hereditary disease.
 Autosomal dominant inheritance.
08/08/14 172BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Clinical features
Radicular DD
 Both dentitions are
affected.
 Appear clinically normal
in morphology and color.
 Sligh...
Dentin dysplasia
08/08/14 174BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
08/08/14 175BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Dentin dysplasia
08/08/14 176BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Radiographic features
Radicular DD
 Pulp chambers and root
canals are completely
obliterated in deciduous teeth.
 Cresce...
Histologic features
Radicular DD
 A portion of coronal dentin is
usually normal.
 Pulp is obliterated by calcified,
tubu...
Dentin dysplasia
 Systemic diseases with DD like alterations are
• Calcinosis universalis
• Rheumatoid arthritis
• Vitami...
Fibrous dysplasia of dentin – DD I
 Autosomal dominant disorder
 Clinically normal teeth
 Has a radio-dense, intra-pulp...
Pulpal dysplasia – DD II
 Develops in teeth that are normal clinically.
 Affects both dentitions.
 Radiographs reveal t...
Regional odontodysplasia
 Also called odontodysplsia, odontogenic
dysplasia, Ghost teeth and Odontogenesis
imperfecta.
 ...
Causes
 Somatic mutation
 Latent virus residing in the odontogenic epithelium which
becomes active during tooth developm...
Regional odontodysplasia
 Maxillary teeth are frequently involved –
permanent incisors and cuspids.
 Mandibular anterior...
Regional odontodysplasia
08/08/14 185BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Radiographic features
 Marked reduction in radiodensity – teeth
assumes a ghost appearance.
 Both enamel and dentin appe...
Radiographic features
08/08/14 187BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Histologic features
 Marked reduction in the amount of dentin.
 Widening of predentin layer.
 Large areas of interglobu...
Other pathologies in asso.
 Ectodermal dysplasia
 Epidermal nevi
 Hypophosphatasia
 Hydrocephalus
 Ipsilateral facial...
Dentin hypocalcification
 Caused by environmental factors affecting
mineralization.
 There is failure in the fusion of c...
Post developmental loss
of tooth structure
08/08/14 191BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Tooth wear
 Termed tooth surface loss – normal
physiologic process that occurs with
aging
 4 causes (inter-related)
• At...
Attrition
 Loss of tooth structure caused by tooth
to tooth contact during occlusion and
mastication.
 More noticeable w...
Attrition
 Tooth destruction can be accelerated by,
• Poor quality or absent enamel
• Fluorosis
• Environmental or heredi...
Attrition
 Can occur in both deci & perm teeth
• Incisal and occlusal surfaces
• Lingual surfaces of maxi antrs
• Labial ...
Attrition
 Pulp exposure and dentin sensitivity are
rare
• Slow loss of tooth structure
• Apposition of reparative dentin...
Abrasion
 Pathologic loss of tooth structure or
restoration secondary to action of an
external agent.
• Tooth brushing – ...
Abrasion
 When tooth wear is accelerated by
chewing an abrasive substance between
opposing teeth, called Demastication.
...
Abrasion
 Has a variety of patterns depending on the
cause.
 Seen as horizontal cervical notches on the
buccal surface o...
08/08/14 200BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Erosion
 Loss of tooth structure caused by a chemical
process beyond that associated with bacterial
interaction with the ...
Erosion
 Tooth loss does not correlate with functional
wear pattern
 Commonly affects facial surfaces of maxi antrs
Shal...
Erosion
 Edges of metallic restorns would be at a higher
level than the tooth structure.
 Concave depression of dentin s...
Erosion
 Facial surfaces of maxi antrs – dietary
sources of acid.
 Incisal portions of antrs in both arches –
external s...
Abfraction
 Loss of tooth structure that results from
repeated tooth flexure caused by occlusal
stresses.
 Dentin is abl...
Abfraction
 Wedge shaped defects limited to the cervical
area of the teeth
 Deep, narrow and V shaped
 Affect a single ...
08/08/14 207BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Internal and external resorption
 Accomplished by cells located in the
dental pulp – internal resorption
 Accomplished b...
Internal and external resorption
Internal resorption
 Relatively rare.
 Follow injury to
pulpal tissues.
 Continues as ...
08/08/14 210BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
08/08/14 211BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
C/F
 Resorption of dentin/cementum can
occur at any site that contacts vital soft
tissue.
 2 main patterns,
• Inflammato...
Inflammatory resorption
 More common in cervical areas.
 Resorption continues as long as vital
pulp remains.
 Coronal p...
Inflammatory resorption
 When it affects the coronal pulp, crown shows
a pink discoloration (Pink tooth of Mummery)
when ...
Replacement resorption
 Mostly involves apical or midportions of the root.
 Portions of pulpal dentinal walls are resorb...
Other clinical entities
 External and internal resorption can
present various forms.
 Cervical pattern of external resor...
Histopathology
Inflammatory resorption
 Vascular pulp tissue with increased
cellularity and collagenization.
 Adjacent t...
Histopathology
Replacement resorption
 Numerous multinucleated dentinoclasts
 Areas of resorption are repaired by deposi...
Disturbances of
Growth (eruption) of teeth
08/08/14 219BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Introduction
 There is a marked variation in biologic eruption
of deciduous and permanent dentition.
 It is difficult to...
Premature eruption
 Deciduous teeth that have erupted into the oral
cavity in infants at birth called Natal teeth.
 If i...
Premature eruption
 Reason is unknown.
 Hormonal influences like hyperthyroidism, adrenal
glands and gonadism, for tooth...
Premature eruption
 Permanent teeth erupt prematurely as a
sequel to the premature loss of deciduous
teeth.
 Seen when o...
Eruption sequestrum
 Anomaly associated with tooth eruption in
children.
 Described by Starkey and Shafer.
 It is a tin...
Etiology
 As the molar teeth erupt through the bone, they can
separate a small osseous fragment from the
surrounding bone...
Clinical features
 The child may complain of slight soreness in the
area during function.
 The spicule directly overlies...
Radiographic features
 It can be recognized even before the tooth
eruption.
 Seen as a tiny, irregular opacity overlying...
Delayed eruption
 In deciduous and permanent teeth, it is difficult to
assess unless a gross variation is present.
 Caus...
Delayed eruption
08/08/14 229BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Multiple unerupted teeth
 Uncommon condition with delayed eruption of teeth.
• Deciduous teeth may be retained or
• Decid...
Embedded and Impacted teeth
 Embedded teeth are individual teeth which are
unerupted usually because of a lack of eruptiv...
Embedded and Impacted teeth
 Any tooth may be impacted – usually
mandibular third molars (22%), maxillary third
molars (1...
Impacted teeth
08/08/14 233BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Impacted mandibular third molars
 Classified based on the position,
• Mesioangular
• Distoangular
• Vertical
• Horizontal...
Impacted mandibular molars
08/08/14 235BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Impacted mandibular third molars
 It is important to determine whether it is a complete or
partial impaction.
 Completel...
Impacted maxillary teeth
 Maxillary third molars can show similar variations of
mandibular third molars.
 Maxillary cusp...
Complications
 Infection
 Resorption of adjacent roots.
 Periodic pain and even trismus.
 Referred pain from impacted ...
08/08/14 239BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Ankylosed deciduous teeth
 Also called Submerged teeth, Infraocclusion,
Secondary retention, Submergence, Reimpaction
and...
Ankylosed deciduous teeth
 This prevents exfoliation and subsequent
replacement by permanent teeth.
 After the eruption ...
Ankylosed deciduous teeth
 The submerged appearance could be due to
• Continued growth of the alveolar process
• Crown he...
Ankylosed teeth
08/08/14 243BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Ankylosed teeth
08/08/14 244BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
Ankylosed deciduous teeth
 Even with extreme root resorption, teeth lack
mobility.
 Diagnosis is suspected clinically an...
Complications
 Development of malocclusion
 Local periodontal disturbance
 Dental caries of both the ankylosed tooth an...
08/08/14 247BY DR. AATISH PAWAR M.D.S
{ORAL PATHOLOGY}
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Developmental disturbances _in_teeth by dr aatish pawar MDS{oral pathology}

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Developmental disturbances _in_teeth by dr aatish pawar MDS{oral pathology}

  1. 1. Developmental disturbances In TEETH 08/08/14 1BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  2. 2. Developmental disturbances of teeth  Size of teeth  Shape of teeth  Number of teeth  Structure of teeth  Growth (Eruption) of teeth 08/08/14 2BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  3. 3. D-D in size of teeth  Microdontia  Macrodontia 08/08/14 3BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  4. 4. D-D in shape of teeth  Gemination  Fusion  Concrescence  Dilaceration  Talon cusp  Dens in dente  Dens evaginatus  Taurodontism  Supernumerary roots 08/08/14 4BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  5. 5. D-D in number of teeth  Anodontia  Supernumerary teeth  Pre-deciduous dentition  Post-permanent dentition 08/08/14 5BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  6. 6. D-D in structure of teeth  Amelogenesis imperfecta  Environmental enamel hypoplasia  Dentinogenesis imperfecta  Dentin dysplasia  Regional odontodysplasia  Dentin hypocalcification 08/08/14 6BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  7. 7. D-D of growth (eruption) of teeth  Premature eruption  Eruption sequestrum  Delayed eruption  Multiple unerupted teeth  Embedded and impacted teeth  Ankylosed deciduous teeth 08/08/14 7BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  8. 8. Developmental disturbances in size of teeth 08/08/14 8BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  9. 9. Microdontia  It is described as teeth which are smaller than normal i.e. outside the usual limits of variation.  Three types: • True generalized • Relative generalized • Involving a single tooth 08/08/14 9BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  10. 10. Microdontia  True generalized type: • All the teeth are smaller than normal. • Exceedingly rare. • Teeth are well formed but small in size. • Seen in Pituitary dwarfism, Down’s syndrome. 08/08/14 10BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  11. 11. Microdontia 08/08/14 11BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  12. 12. Microdontia  Relative generalized type: • Normal or slightly smaller than normal teeth. but the jaws are somewhat larger than normal – impression of microdontia. • Inheritance of jaw size from one parent and tooth size from other parent can lead to this variations. 08/08/14 12BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  13. 13. Microdontia  Involving a single tooth: • Also called localized microdontia. • Rather common. • Affects mostly the maxillary lateral incisor and third molars (Congenitally missing teeth too). • Supernumerary teeth are frequently small in size. • Can be seen in Facial Hemiatrophy. 08/08/14 13BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  14. 14. Microdontia 08/08/14 14BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  15. 15. Microdontia  Common form in lateral incisors – PEG laterals. • The mesial and distal surfaces converge or taper incisally forming a peg-shaped or cone-shaped crown. • The roots are frequently shorter than normal. 08/08/14 15BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  16. 16. Microdontia 08/08/14 16BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  17. 17. Macrodontia  It refers to teeth that are larger than normal.  Also called Megalodontia or megadontia.  Three types: • True generalized macrodontia • Relative generalized macrodontia • Macrodontia of single teeth 08/08/14 17BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  18. 18. Macrodontia  True generalized type: • Extremely rare. • All the teeth are larger than normal. • Associated with pituitary gigantism. 08/08/14 18BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  19. 19. Macrodontia  Relative generalized type: • Some what more common. • Normal or slightly larger sized teeth in smaller jaws. • Hereditary factors. 08/08/14 19BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  20. 20. Macrodontia  Involving a single tooth: • Relatively uncommon. • Unknown etiology. • Tooth may appear normal in every aspect except for its size. • Should not confused with fusion of teeth. • Can be seen in facial hemi-hypertrophy of the face – the teeth of involved side may be larger than unaffected side. 08/08/14 20BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  21. 21. Macrodontia 08/08/14 21BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  22. 22. Developmental disturbances in shape of teeth 08/08/14 22BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  23. 23. Gemination  These are anomalies which arise from an attempt at division of single tooth germ by invagination, with resultant incomplete formation of two teeth.  Hereditary factors may play a role.  Difficulty to delineate this from fusion of a normal and supernumerary tooth. 08/08/14 23BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  24. 24. Gemination  Seen in deciduous and permanent teeth.  Structure is one tooth with: • Two completely or incompletely separated crowns. • Roots are single with a root canal.  Twinning – designate the production of equivalent structures by division resulting in one normal and one supernumerary tooth. 08/08/14 24BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  25. 25. Gemination 08/08/14 25BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  26. 26. Comparison  Gemination - Defined as a single enlarged tooth or joined tooth in which the tooth count is normal, when the anomalous tooth is counted as one.  Fusion - defined as a single, enlarged tooth or joined tooth in which the tooth count reveals a missing tooth, when the anomalous tooth is counted as one. 08/08/14 26BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  27. 27. Fusion  Fused teeth arise through union of two normally separated tooth germs.  Could be between two normal teeth or a normal tooth with a supernumerary tooth like mesiodens or distomolar.  Fusion may be complete or incomplete based on the stage of tooth development at the time of fusion.  Physical force or pressure produces contact of developing teeth and their subsequent fusion. 08/08/14 27BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  28. 28. Fusion 08/08/14 28BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  29. 29. Fusion 08/08/14 29BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  30. 30. Fusion  Contact occurs before calcification – two teeth may be completely united to form a single large tooth. • Dentin is confluent in true fusion.  Contact after calcification of the crowns, the roots may be united. 08/08/14 30BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  31. 31. Fusion 08/08/14 31BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  32. 32. Fusion  Tooth may have separate or fused root canals.  Common in deciduous as well as permanent teeth.  Clinical problems include esthetics, spacing and periodontal conditions. 08/08/14 32BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  33. 33. Concrescence  A form of fusion which occurs after root formation has been completed.  Teeth are united by cementum only.  Due to: • Traumatic injury. • Crowding of teeth with resorption of adjacent interdental bone – contact of two roots – fused by cementum deposition. 08/08/14 33BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  34. 34. Concrescence 08/08/14 34BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  35. 35. Concrescence  May occur before or after tooth eruption.  Usually involves two teeth. But a case involving three teeth has been reported.  Diagnosed by radiographic examination.  Should be noted during extraction procedures. 08/08/14 35BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  36. 36. Histopathology  Deposition of excessive cementum over the original layer of primary cementum.  May be hypocellular or exhibit areas of cellular cementum resembling bone called osteocementum.  Polarized light to differentiate dentin and cementum. 08/08/14 36BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  37. 37. Factors asso.  Local factors: • Abnormal occlusal trauma • Adjacent inflammation • Unopposed teeth – impacted, embedded, without an antagonist 08/08/14 37BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  38. 38. Factors asso.  Systemic factors: • Acromegaly and pituitary gigantism • Arthritis • Calcinosis • Paget’s disease of bone • Rheumatic fever • Thyroid goiter • Vitamin A deficiency 08/08/14 38BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  39. 39. Dilaceration  Refers to an angulation or a sharp bend or curve, in the root or crown of a formed teeth.  Due to trauma during tooth formation, the position of calcified portion of the tooth is changed and the remaining tooth develops at an angle. 08/08/14 39BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  40. 40. Dilaceration 08/08/14 40BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  41. 41. Dilaceration  Dilaceration in a permanent tooth often follows traumatic injury (avulsion or intrusion) to the deciduous predecessor in which the tooth is driven apically into the jaw.  Can also develop secondary to adjacent cyst, tumor or odontogenic hamartoma. 08/08/14 41BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  42. 42. Dilaceration  The curve or bend can occur anywhere along the length of the tooth depending on the amount of tooth formed at the time of injury.  Can be problematic during extractions – need for pre-operative radiographs. 08/08/14 42BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  43. 43. Talon cusp  An anomalous structure resembling an eagle’s talon, projects lingually from the cingulum areas of a maxillary or mandibular permanent incisor.  This cusp blends smoothly with the lingual tooth surface except for a deep developmental groove.  Composed of normal enamel, dentin and a horn of pulp tissue. 08/08/14 43BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  44. 44. Clinical features 08/08/14 44BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  45. 45. Radiographic features 08/08/14 45BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  46. 46. Talon cusp  Clinical problems include esthetics, caries control and occlusal accomodation.  Quite uncommon among the general population.  May be seen in other somatic and odontogenic anomalies. 08/08/14 46BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  47. 47. Talon cusp  More prevalent in Rubinstein – Taybi syndrome. • Developmental retardation. • Broad thumbs and great toes. • Characteristic facial features. • Delayed or incomplete descendence of testes in males. • Stature, head circumference and bone age below the 15th percentile. 08/08/14 47BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  48. 48. Dens in dente  Also called Dens invaginatus, Dilated composite odontome.  Is a developmental variation thought to arise as a result of invagination in the surface of a tooth crown before calcification has occurred. 08/08/14 48BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  49. 49. Dens in dente  Fairly common and extreme variations in clinical presentation.  The term was initially applied to a severely invaginated tooth which appeared radiographically as a tooth within a tooth – it is a misnomer but continued to be used. 08/08/14 49BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  50. 50. Dens in dente  Caused could be: • Increased localized external pressure • Focal growth retardation • Focal growth stimulation (in certain areas of the tooth bud) 08/08/14 50BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  51. 51. Dens in dente  Permanent maxillary lateral incisors are most frequently involved and sometimes, the maxillary central incisor and some posterior teeth.  Frequently bilateral.  Radicular variety with a radicular invagination results from infolding of hertwig’s sheath and origin is within the root after development is complete. 08/08/14 51BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  52. 52. Dens in dente 08/08/14 52BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  53. 53. Radiographic features 08/08/14 53BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  54. 54. Dens in dente  Mild form – has an accentuation/deep invagination in the lingual pit area.  Radiographs reveal a pear shaped invagination of enamel and dentin with a narrow constriction at the opening on the surface of the tooth and closely approximating the pulp in its depth.  Severe form – an invagination that extends nearly to the apex of the root. 08/08/14 54BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  55. 55. 08/08/14 55BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  56. 56. Dens in dente  Food debris can accumulate leading to caries and pulpal infection.  Bizarre radiographic picture with severe disturbance in the normal anatomic and morphologic structure of the teeth.  It should be recognized early and restored prophylactically. It could be detected in radiographs even before the tooth erupts. 08/08/14 56BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  57. 57. Dens evaginatus  Also called Leong’s premolar, Evaginated odontome.  It is a developmental condition that appears clinically as an accessory cusp or a globule of enamel on the occlusal surface between the buccal and lingual cusps of premolars, unilaterally or bilaterally. 08/08/14 57BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  58. 58. Dens evaginatus  Occurs in persons of mongoloid ancestry – chinese, japanese, filipinos, eskimos and american-indians.  Evolves by proliferation and evagination of an area of the inner enamel epithelium and subjacent odontogenic mesenchyme into the dental organ during early tooth development. 08/08/14 58BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  59. 59. Dens evaginatus  May physically resemble talon cusp.  Extra cusp can lead to: • Incomplete eruption • Displacement of teeth • Pulp exposure following occlusal wear or fracture. 08/08/14 59BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  60. 60. Dens evaginatus 08/08/14 60BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  61. 61. Shovel shaped incisors  Predominantly in asians, native americans and alaskans.  Affects maxillary central and lateral incisors.  Has prominent lateral margins creating a hollowed lingual surface resembling the scoop of a shovel.  Thickened marginal ridges converge at the cingulum. There is a deep pit, fissure or dens invaginatus at this junction. 08/08/14 61BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  62. 62. Taurodontism  Originated by Sir Arthur Keith in 1913 to describe a dental anomaly in which the body of the tooth is enlarged at the expense of the roots.  Means bull-like tooth as it is similar to teeth in ungulate or cud-chewing animals.  It is an enlargement of the body and pulp chamber of a multi-rooted tooth with apical displacement of the pulpal floor and bifurcation of the roots. 08/08/14 62BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  63. 63. Taurodontism  Shaw classified it as, • Hypotaurodont – mildest form • Mesotaurodont – moderate • Hypertaurodont – severe form with furcation near the apices of the roots. 08/08/14 63BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  64. 64. Taurodontism  Causes enumerated by Mangion are: • Primitive pattern • Mutation resulting from odontoblastic deficiency during dentinogenesis of the roots.  Could be due to failure of Hertwig’s epithelial sheath to invaginate at the proper horizontal level.  Appears to be genetically controlled and familial in nature. 08/08/14 64BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  65. 65. Taurodontism  Associated in Neanderthal man.  Occur concomitantly with amelogenesis imperfecta - hypomaturation-hypoplastic variety.  Reported in Klinefelter’s syndrome. 08/08/14 65BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  66. 66. Taurodontism 08/08/14 66BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  67. 67. Taurodontism  Affect either deciduous or permanent teeth (more common in permanent teeth).  Usually molars – single/multiple.  Unilateral or bilateral involvement.  No unusual morphology. 08/08/14 67BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  68. 68. Taurodontism  Affected teeth tend to be rectangular in shape.  Pulp chamber is extremely large with greater apico-occlusal height.  Pulp lacks the usual cervical constriction.  Roots are extremely short.  Furcation near the apices of the roots. 08/08/14 68BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  69. 69. 08/08/14 69BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  70. 70. Syndromes asso.  AI – Type IE, IV  Ectodermal dysplasia  Hyper/Hypo phosphatasia  Klinefelter syndrome  Oculo-dental-digital dysplasia  Tricho-dento-osseous syndrome  Down’s syndrome  Sex chromosomal aberrations 08/08/14 70BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  71. 71. Supernumerary roots  Refers to the development of an increased number of roots on a tooth compared with that described in dental anatomy.  May involve any tooth.  Mandibular cuspids and bicuspids may have two roots.  Maxillary and mandibular molars may exhibit additional roots.  Significant during extraction. 08/08/14 71BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  72. 72. Supernumerary roots 08/08/14 72BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  73. 73. Ectopic enamel  Refers to the presence of enamel in unusual locations, mainly in the roots of teeth.  Widely known as enamel pearls.  Project from the surface of the root. 08/08/14 73BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  74. 74. Ectopic enamel  Hemispheric structures that consist of, • Entirely of enamel • Enamel, dentin and pulp tissue.  Thought to arise from localized bulging in the odontoblastic layer with prolonged contact between HERS and dentin leading to enamel formation.  Cervical enamel extensions also occur along the root surface. 08/08/14 74BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  75. 75. Ectopic enamel 08/08/14 75BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  76. 76. Cervical enamel extensions  Located on the buccal surface of the root overlying the bifurcation.  Affects the mandibular molars.  Greater prevalence in asians. 08/08/14 76BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  77. 77. Cervical enamel extensions  Correlated with localized loss of periodontal attachment with furcation involvement.  Associated with development of inflammatory cysts – Buccal bifurcation cysts. 08/08/14 77BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  78. 78. 08/08/14 78BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  79. 79. Developmental disturbances in number of teeth 08/08/14 79BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  80. 80. Anodontia  True anodontia – congenital absence of teeth. • Total • Partial  Induced or false anodontia – as a result of extraction of all teeth.  Pseudo-anodontia – applied to multiple, unerupted teeth. 08/08/14 80BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  81. 81. Total anodontia  It is a rare condition in which all the teeth are missing.  May involve both deciduous and permanent dentition.  Frequently associated with hereditary ectodermal dysplasia. 08/08/14 81BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  82. 82. True partial anodontia  Also called • Hypodontia – lack of development of one or more teeth. • Oligodontia - Lack of development of six or more teeth.  Is a common condition involving one or more teeth.  Any tooth can be congenitally missing. 08/08/14 82BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  83. 83. Hypodontia 08/08/14 83BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  84. 84. True partial anodontia  Etiology: • Familial tendency – point mutations transmitted in autosomal dominant pattern. • Missing third molars could be an evolutionary trend towards fewer teeth. • It is associated with hereditary ectodermal dysplasia. • Xray radiation of face during early age – affecting the sensitive tooth buds. 08/08/14 84BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  85. 85. True partial anodontia  Frequently involved teeth are, • Third molars (all the 4 may be missing) • Maxillary lateral incisors • Maxillary and mandibular second premolars  Bilateral involvement is also seen. 08/08/14 85BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  86. 86. Hypodontia 08/08/14 86BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  87. 87. True partial anodontia  In severe partial anodontia - there is bilateral absence of corresponding teeth.  In hereditary ectodermal dysplasia – few teeth that are present may be deformed or cone shaped. 08/08/14 87BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  88. 88. True partial anodontia  Congenitally missing deciduous teeth is an uncommon condition.  Usually involves, • Maxillary lateral incisors • Mandibular lateral incisors • Mandibular cuspids  The term partial anodontia should be avoided as by Allen. 08/08/14 88BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  89. 89. Syndromes asso.  Ankyloglossia superior  Crouzon  Down  Ectodermal dysplasia  Ehlers danlos  Hurlers  Sturge-weber  Turner  Incontinentia pigmenti  Ellis von creveld 08/08/14 89BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  90. 90. Hyperdontia  Development of an increased number of teeth and the additional teeth are termed as Supernumerary teeth. 08/08/14 90BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  91. 91. Supernumerary teeth  It may closely resemble the teeth of the belonging group – molars, premolars or incisors.  It may have no resemblance in size and shape to the associated tooth. 08/08/14 91BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  92. 92. 08/08/14 92BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  93. 93. Supernumerary teeth 08/08/14 93BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  94. 94. Supernumerary teeth  It develops from a third tooth bud arising form the dental lamina near the permanent tooth bud.  Arises by splitting of the permanent bud itself (unlikely as the associated permanent tooth is normal in all aspects).  Hereditary tendency. 08/08/14 94BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  95. 95. Supernumerary teeth  Multiple SN teeth is seen in, • Cleido-cranial dysplasia • Gardner’s syndrome – the impacted teeth may lead to early diagnosis of entire syndrome (malignant transformation of intestinal polyps).  Most of these SN teeth are frequently impacted. 08/08/14 95BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  96. 96. Supernumerary teeth  May be found in any location.  90% of occurrence is in the maxilla.  May be erupted or impacted. 08/08/14 96BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  97. 97. Mesiodens  Most common supernumerary tooth.  It is situated between the maxillary central incisors.  It occurs as, • Single or paired. • Erupted or impacted or inverted. 08/08/14 97BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  98. 98. Mesiodens 08/08/14 98BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  99. 99. Mesiodens  It is a small tooth with a cone shaped crown and a short root.  High incidence in caucasian population with 2:1 male predilection (Transmitted as an autosomal dominant trait). 08/08/14 99BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  100. 100. Fourth molar  Second most common supernumerary tooth.  Situated distal to the third molar.  Usually small, rudimentary tooth but may be of normal size.  Maxillary 4th molar is more common than mandibular 4th molar.  An accessory fourth molar is called Distomolar or distodens. 08/08/14 100BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  101. 101. Fourth molar 08/08/14 101BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  102. 102. Supernumerary teeth  Others include, • Maxillary paramolars • Mandibular premolars • Maxillary lateral incisors  Rarely – mandibular central incisors and maxillary premolars. 08/08/14 102BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  103. 103. Paramolars  Paramolar is a supernumerary molar, • Situated buccally or lingually to one of the maxillary molars. • Inter-proximally between the first and second molars • Inter-proximally between second and third molars.  Usually small and rudimentary. 08/08/14 103BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  104. 104. Dental transposition  Normal teeth erupting into an inappropriate position.  Usually involves the canine and first premolars.  Canine erupting between two premolars.  Could be confused with supernumerary teeth. 08/08/14 104BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  105. 105. Syndromes asso.  Apert  Cleidocranial dysplasia  Crouzon  Down  Ehler danlos  Gardner  Sturge-weber  fucosidosis 08/08/14 105BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  106. 106. Pre-deciduous dentition  Infants born with structures appearing to be erupted teeth in the mandibular incisor region.  Arising from, • An accessory bud of the dental lamina ahead of the deciduous tooth bud. 08/08/14 106BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  107. 107. Pre-deciduous dentition  Described as hornified, epithelial structures without roots.  Occurs in the gingiva over the crest of the ridge  May be easily removed. 08/08/14 107BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  108. 108. Pre-deciduous dentition  Differentiated from true deciduous teeth or natal teeth described by Massler – which erupts at the time of birth.  Some consider it as a misinterpretation of dental lamina cysts of new born, • Projects above the crest of the ridge. • White in color. • Packed with keratin – hornified appearance. • Easily removed. 08/08/14 108BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  109. 109. Post-permanent dentition  In persons who had all their permanent teeth extracted and yet had subsequently erupted several more teeth particularly after insertion of complete denture.  Majority is due to delayed eruption of retained or embedded teeth. 08/08/14 109BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  110. 110. Post-permanent dentition  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. 08/08/14 110BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  111. 111. Developmental disturbances in structure of teeth 08/08/14 111BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  112. 112. Environmental alterations  Developmental tooth defects  Post developmental structure loss  Discolorations of teeth  Localized disturbances in eruption. 08/08/14 112BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  113. 113. Environmental enamel hypoplasia  Defined as incomplete or defective formation of the organic enamel matrix of the teeth.  Two types: • Hereditary – AI • Caused by environmental factors 08/08/14 113BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  114. 114. Factors associated with enamel defects  Systemic factors: • Birth related trauma – hypoxia, premature birth • Chemicals – Fluoride, anti-cancer drugs • Chromosomal abnormalities – Trisomy 21 • Infections • Inherited diseases • Malnutrition • Metabolic disorders • Neurologic disorders 08/08/14 114BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  115. 115. Factors associated with enamel defects  Local factors: • Local acute mechanical trauma • Electric burn • Irradiation • Local infection 08/08/14 115BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  116. 116. Environmental enamel hypoplasia Hereditary Environmental Both deciduous and permanent teeth are affected. Either dentition may be involved. Sometimes, only a single tooth. Only enamel is affected. Both enamel and dentin are involved. 08/08/14 116BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  117. 117. Amelogenesis imperfecta  Also called hereditary enamel dysplasia, hereditary brown enamel, hereditary brown opalescent teeth.  It represents a group of hereditary defects of enamel unassociated with any other generalized defects.  It is entirely an ectodermal disturbance and the mesodermal components of the teeth are basically normal. 08/08/14 117BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  118. 118. Amelogenesis imperfecta  In normal development of enamel, three stages can be appreciated, • Formative stage – deposition of organic matrix – defective – Hypoplastic AI. • Calcification stage – matrix mineralization – defective – Hypocalcification (Hypomineralization) AI. • Maturation stage – Crystallites mature and enlarge – defective – Hypomaturation AI (immature crystallites). 08/08/14 118BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  119. 119. Clinical features  By Witkop and Sauk, • Hypoplastic – enamel is not formed to full, normal thickness on newly erupted, developing teeth. • Hypocalcified – enamel is so soft that it can be removed by prophylaxis instrument. • Hypomaturation – enamel can be pierced by an explorer point under firm pressure and can be lost by chipping off from the underlying normal dentin. 08/08/14 119BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  120. 120. Classification by Witkop and Sauk  Hypoplastic: • Pitted, autosomal dominant • Local, autosomal dominant • Smooth, autosomal dominant • Rough, autosomal dominant • Rough, autosomal recessive • Smooth, X-linked dominant  Hypocalcified: • Autosomal dominant • Autosomal recessive  Hypomaturation: • Hypomaturation - hypoplastic with taurodontism, autosomal dominant. • X-linked recessive. • Pigmented, autosomal recessive • Snow capped teeth. 08/08/14 120BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  121. 121. Classification  Hypoplastic pattern – IA, IB, IC, ID, IE, IF, IG  Hypomaturation – IIA, IIB, IIC, IID  Hypocalcified – IIIA, IIIB  Hypomaturation – Hypoplastic – IVA  Hypoplastic – Hypomaturation - IVB 08/08/14 121BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  122. 122. Clinical features  Extremely variable, clinical presentation.  All teeth of both dentitions affected to some degree.  Crowns may show discoloration varying from yellow to dark brown. 08/08/14 122BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  123. 123. Clinical features  Enamel may be totally lost or have chalky texture or cheesy consistency or relatively hard.  Enamel may be smooth or show vertical wrinkles or grooves.  May be chipped or show depressions with exposed dentin at its base.  Contact points are open  Occlusal and incisal edges are severely abraded. 08/08/14 123BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  124. 124. Amelogenesis imperfecta 08/08/14 124BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  125. 125. Amelogenesis imperfecta 08/08/14 125BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  126. 126. Radiographic features  Overall shape of the tooth may not be normal depending on the, • Amount of enamel present • Amount of occlusal and incisal wear  Enamel may be totally absent or seen only on the cusp tips and inter-proximal surfaces.  It may have similar radiodensity to dentin. 08/08/14 126BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  127. 127. Histologic features  Disturbance in the differentiation and viability of ameloblasts in hypoplastic type – seen as defective matrix formation – even total absence of matrix.  Hypocalcification type shows defects in matrix structure and mineral deposition.  Hypomaturation type shows alterations in enamel rods and rod sheath structures. 08/08/14 127BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  128. 128. Hypoplastic/Hypomaturation AI  Has enamel hypoplasia in combination with hypomaturation.  Both the dentition are affected.  Two patterns based on thickness of enamel and overall tooth size. 08/08/14 128BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  129. 129. Hypomaturation - Hypoplastic  Enamel hypomaturation is the dominant feature.  Enamel is yellowish-white to yellowish-brown.  Pits are seen on buccal surface.  Enamel is similar to dentin in density.  Large pulp chambers with varying degrees of taurodontism. 08/08/14 129BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  130. 130. Hypoplastic - Hypomaturation  Enamel hypoplasia is the dominant feature.  Enamel is thin.  Other features is similar to the forementioned type. 08/08/14 130BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  131. 131. Tricho-dento-osseous syndrome  Autosomal dominant disorder.  Shows hypoplastic-hypomaturation AI with severe taurodontism.  Kinky hair at birth which may straighten with age.  Osteosclerosis of the base of skull and mastoid process.  Mandible exhibits shortened ramus and an obtuse angle.  Brittle nails. 08/08/14 131BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  132. 132. Environmental enamel hypoplasia  It occurs only when the injury occurs during the development or more specifically, formative stage of enamel.  Once the enamel is calcified, no such defect can be produced.  By correlating the chronology and location of the defect, the approximate time of injury could be predicted. 08/08/14 132BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  133. 133. Causes  Nutritional deficiency – Vitamins A, C, D  Exanthematous diseases – Measles, Chicken pox, Scarlet fever  Congenital syphilis  Hypocalcemia  Birth injury, prematurity, Rh hemolytic disease  Local infection or trauma  Ingestion of chemicals – fluoride  Idiopathic causes. 08/08/14 133BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  134. 134. Clinical features  Mild cases – few small grooves, pits or fissures on the enamel surface.  Severe – rows of deep pits arranged horizontally across the surface of the tooth.  Several rows indicate series of injuries.  Most severe – enamel may be absent. 08/08/14 134BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  135. 135. Hypoplasia due to nutritional factors and exanthematous fevers  Rickets at the time of tooth formation is the most common cause.  Serious nutritional deficiency or systemic disease is potentially capable of producing enamel hypoplasia as the ameloblasts are one of the most sensitive groups in terms of metabolic function. 08/08/14 135BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  136. 136. Hypoplasia due to nutritional factors and exanthematous fevers  Most cases involve teeth that form within the first year after birth.  Maxillary central and lateral incisors, cuspids (tip of cuspids forms before the lateral incisor) and first molars are frequently affected.  Premolars, 2nd and 3rd molars are seldom affected – formation is 3 years or later.  Decay progresses rapidly in hypoplastic teeth. 08/08/14 136BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  137. 137. Hypoplasia due to congenital syphilis  Has a characteristic, pathognomonic appearance.  Involves the maxillary and mandibular permanent incisors and first molars.  Anteriors – “Hutchinson’s teeth”  Posteriors – “Mulberry molars, Moon’s molars, Fournier’s molars”. 08/08/14 137BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  138. 138. Clinical features  Upper central incisor is screw-driver shaped.  Mesial and distal surfaces of the crown tapers and converges towards the incisal edge of the tooth.  Incisal edge is usually notched – could be due to the absence of central tubercle or calcification center. 08/08/14 138BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  139. 139. Hutchinson’s incisors 08/08/14 139BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  140. 140. Clinical features  Crowns of first molars are irregular.  Enamel of the occlusal surface and occlusal third of the tooth appears to be an agglomerate mass of globules.  Crown is narrower on the occlusal surface than at the cervical margins.  All the patients do not exhibit dental findings. 08/08/14 140BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  141. 141. Mulberry molars 08/08/14 141BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  142. 142. Hypoplasia due to hypocalcemia  Tetany - due to reduction in blood level of calcium – due to vitamin D deficiency and hypo-parathyroidism.  Calcium level falls to 6-8mg/dl and can affect the devloping tooth.  Hypoplasia is of the pitting variety. 08/08/14 142BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  143. 143. Hypoplasia due to birth injuries  Neonatal line or ring – described by Schour(1936) is present in deciduous teeth and first permanent molars.  Considered as a hypoplastic defect in enamel and dentin due to trauma or environmental change at the time of birth.  More common in premature infants and in Rh hemolytic diseases.  Can even involve prenatal enamel – due to GI disturbances or other illnesses in the mother. 08/08/14 143BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  144. 144. Hypoplasia due to local trauma or infection  Only a single tooth is involved – permanent maxillary incisors or maxillary/mandibular premolar.  Single teeth are frequently referred as Turner’s teeth and the condition is called as Turner’s hypoplasia.  Mild, brownish discoloration to severe pitting. 08/08/14 144BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  145. 145. Hypoplasia due to local trauma or infection  The periapical infection of a carious deciduous tooth can disturb the developing ameloblastic layer of the succeeding permanent tooth producing hypoplastic crown.  Severity of the hypoplasia depends on the, • Severity of the infection • Degree of tissue involvement • Stage of permanent tooth development at the time of infection. 08/08/14 145BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  146. 146. Hypoplasia due to local trauma or infection  Similar hypoplasia can follow trauma to the deciduous tooth when the tooth is driven into the alveolus and damages the developing permanent successor.  Usually affects the labial surface of maxillary anteriors.  Seen as yellowish or brownish stain or pigmentation of enamel on the labial surface or as a pitted hypoplasia.  Could be due to disturbance in matrix formation or calcification. 08/08/14 146BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  147. 147. Hypoplasia due to trauma 08/08/14 147BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  148. 148. Hypoplasia due to anti- neoplastic therapy  Secondary changes due to therapeutic radiation or chemotherapy.  Under the age of 5 years.  Hypodontia, microdontia, radicular hypoplasia and enamel hypoplasia.  Reduced alveolar bone development. 08/08/14 148BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  149. 149. Hypoplasia due to fluoride – Mottled enamel  Variety of enamel hypoplasia.  First described by G.V. Black and Frederick.S.Mckay in 1916 – Colarado brown stain.  Exhibited a geographic distribution and due to the water supply.  Later, the causative agent was found to be flourine. 08/08/14 149BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  150. 150. Etiology  Ingestion of fluoride containing drinking water during the time of tooth formation.  Severity of hypoplasia increases with concentration of fluoride in water.  Little mottling at 0.9 to 1.0 ppm of Fluoride. 08/08/14 150BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  151. 151. Pathogenesis  Due to disturbance of ameloblasts during the formative stage of tooth development.  Exact nature of cell injury is not known but the enamel matrix is defective or deficient.  Findings may be related to individual variations to fluoride intake.  High levels of fluoride interferes with calcification of the matrix. 08/08/14 151BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  152. 152. Clinical features  Questionable changes - white flecks or spotting of enamel.  Mild changes – white, opaque areas involving more of tooth surface.  Moderate and severe changes – pitting and brownish staining of the surface. Tendency of enamel to wear or fracture.  Corroded surface of the affected teeth. 08/08/14 152BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  153. 153. Mottled enamel 08/08/14 153BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  154. 154. Mottled enamel 08/08/14 154BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  155. 155. Intrinsic stains  Congenital erythropoietic porphyria – reddish brown – red fluorescence under Wood’s light.  Alkaptonuria – bluish black – asso. with Ochronosis  Hyperbilirubinemia in erythroblastosis fetalis, biliary atresia – green discoloration – cholorodontia.  Tetracycline – bright yellow to dark brown – bright yellow fluorescence in uv light. 08/08/14 155BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  156. 156. Tetracycline stains 08/08/14 156BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  157. 157. 08/08/14 157BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  158. 158. Dentinogenesis imperfecta  Called Hereditary opalescent dentin, Capdepont’s teeth.  Only the mesodermal portion of the odontogenic apparatus is affected.  Dentin is defective.  Could be due to hereditary factors  Can be seen in association with osteogenesis imperfecta. 08/08/14 158BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  159. 159. Classification by Shields  Type I – DI that always occur with OI – autosomal dominant.  Type II – DI that never occurs with OI – hereditary opalescent dentin – autosomal dominant – 1 in 8000.  Type III – DI – Brandy wine type – similar to I and II along with multiple pulp exposures in deciduous teeth – autosomal dominant. 08/08/14 159BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  160. 160. Clinical features  Varied presentations.  Deciduous teeth are more severely affected in Type I.  Both the dentitions are equally affected in Type II and III.  Gray to brownish violet or yellowish brown with a characteristic translucent or opalescent hue. 08/08/14 160BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  161. 161. Dentinogenesis imperfecta 08/08/14 161BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  162. 162. Clinical features  Enamel may be lost early on incisal and occlusal surfaces due to the abnormal DEJ.  DEJ lacks the usual scalloping.  Dentin is attrited rapidly.  Occlusal surfaces of affected teeth are severely flattened. 08/08/14 162BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  163. 163. Dentinogenesis imperfecta 08/08/14 163BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  164. 164. 08/08/14 164BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  165. 165. Radiographic features  Total or partial obliteration of the pulp chambers and root canals by continued formation of dentin in Type I and II.  Seen in both dentitions.  Roots may be short and blunted.  The cementum, alveolar bone and periodontal bone appear normal. 08/08/14 165BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  166. 166. Radiographic features  Type III shows marked variation.  Witkop describes it as Shell teeth.  Originally described by Rushton as a dentinal disturbance with normal enamel, extremely thin dentin and enormous pulp chambers.  Roots are extremely short. 08/08/14 166BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  167. 167. Histologic features  Type I and II emphasizes a pure mesodermal disturbance. Type III is not adequately documented.  The enamel is normal in appearance.  Dentin has irregular tubules with large areas of uncalcified matrix.  Tubules are larger in diameter and lesser in number. 08/08/14 167BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  168. 168. Physical and chemical features  Water content is increased – 60% above normal.  Inorganic content is less than that of normal dentin.  Density, Xray absorption and hardness of dentin is low.  Micro-hardness of dentin is close to cementum – rapid attrition. 08/08/14 168BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  169. 169. Histologic features  Cellular inclusions probably odontoblasts can be seen in dentin.  The odontoblasts with limited ability to form well- organized dentinal matrix, appear to degenerate readily and get entrapped within the matrix.  Pulp chamber is obliterated by continuous dentin deposition. 08/08/14 169BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  170. 170. Dentin dysplasia  Called Rootless teeth.  Rare disturbance in dentin formation characterized by normal enamel but atypical dentin formation with abnormal pulp morphology.  First described by Ballschmiede (1920) – spontaneous exfoliation of multiple teeth.  Rushton (1939) designated it as dentin dysplasia. 08/08/14 170BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  171. 171. Classification  Shields: • Type I – dentin dysplasia • Type II – anomalous dysplasia of dentin  Witkops: • Type I – Radicular dentin dysplasia – More common. • Type II – Coronal dentin dysplasia 08/08/14 171BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  172. 172. Etiology  Hereditary disease.  Autosomal dominant inheritance. 08/08/14 172BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  173. 173. Clinical features Radicular DD  Both dentitions are affected.  Appear clinically normal in morphology and color.  Slight amber translucency.  Normal eruption pattern.  Extreme mobility of teeth and premature exfoliation due to abnormally short roots. Coronal DD  Both dentitions are affected.  Deciduous teeth are yellow, brown or bluish- grey opalescent appearance as DI.  Permanent dentition is normal. In both dentitions, roots are short, blunt, conical or similarly malformed. 08/08/14 173BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  174. 174. Dentin dysplasia 08/08/14 174BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  175. 175. 08/08/14 175BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  176. 176. Dentin dysplasia 08/08/14 176BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  177. 177. Radiographic features Radicular DD  Pulp chambers and root canals are completely obliterated in deciduous teeth.  Crescent shaped pulpal remnant in the pulp chamber of permanent teeth.  Obliteration of permanent teeth occurs pre-eruptively.  Periapical radiolucencies of apparently, intact teeth. Coronal DD  Pulp chambers of deciduous teeth are obliterated.  Permanent teeth shows abnormally, large pulp chamber in the coronal portion of the tooth – thistle tube in shape. Radio-opaque foci resembling pulp stones may be found.  Obliteration does not occur before eruption.  Periapical radiolucencies do not occur. 08/08/14 177BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  178. 178. Histologic features Radicular DD  A portion of coronal dentin is usually normal.  Pulp is obliterated by calcified, tubular dentin, ostodentin and fused denticles.  Normal dentinal tubule formation appears to be blocked and dentin forms around obstacles – Lava flowing around boulders.  EM – cascades of dentin due to repeated attempts of root formation. Coronal DD  Coronal dentin is relatively normal.  Deciduous teeth shows amorphous and atubular dentin in the radicular portion.  Permanent teeth has multiple pulp stones or denticles. 08/08/14 178BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  179. 179. Dentin dysplasia  Systemic diseases with DD like alterations are • Calcinosis universalis • Rheumatoid arthritis • Vitaminosis D • Sclerotic bone • Skeletal anomalies • Tumoral calcinosis 08/08/14 179BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  180. 180. Fibrous dysplasia of dentin – DD I  Autosomal dominant disorder  Clinically normal teeth  Has a radio-dense, intra-pulpal material (fibrotic dentin) filling the pulp chambers and canals.  Small foci of radiolucency can be seen in the pulp (D/D – DI)  No crescent pulp chambers and no decrease in root length (D/D – DD) 08/08/14 180BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  181. 181. Pulpal dysplasia – DD II  Develops in teeth that are normal clinically.  Affects both dentitions.  Radiographs reveal thistle-tube shaped pulp chambers and multiple pulp stones. 08/08/14 181BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  182. 182. Regional odontodysplasia  Also called odontodysplsia, odontogenic dysplasia, Ghost teeth and Odontogenesis imperfecta.  Unusual dental anomaly in which one or several teeth in a localized area are affected. 08/08/14 182BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  183. 183. Causes  Somatic mutation  Latent virus residing in the odontogenic epithelium which becomes active during tooth development.  Local vascular defects.  Abnormal migration of neural crest cells  Local trauma or infection  Hyperpyrexia  Malnutrition  Medications during pregnancy  Radiation therapy  Somatic mutation 08/08/14 183BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  184. 184. Regional odontodysplasia  Maxillary teeth are frequently involved – permanent incisors and cuspids.  Mandibular anteriors may be affected.  Both the dentitions are affected.  Show a delayed or total failure of eruption.  Irregular in shape with defective mineralization. 08/08/14 184BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  185. 185. Regional odontodysplasia 08/08/14 185BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  186. 186. Radiographic features  Marked reduction in radiodensity – teeth assumes a ghost appearance.  Both enamel and dentin appear very thin.  Pulp chamber is extremely large. 08/08/14 186BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  187. 187. Radiographic features 08/08/14 187BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  188. 188. Histologic features  Marked reduction in the amount of dentin.  Widening of predentin layer.  Large areas of interglobular dentin.  Irregular trabecular pattern of dentin.  Reduced enamel epithelium around non-erupted teeth show many irregular, calcified bodies – focal collections of basophilic enamel like calcifications called Enameloid conglomerates. 08/08/14 188BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  189. 189. Other pathologies in asso.  Ectodermal dysplasia  Epidermal nevi  Hypophosphatasia  Hydrocephalus  Ipsilateral facial hypoplasia  Neurofibromatosis  Orbital coloboma  Rhesus incompatibility  Vascular nevi 08/08/14 189BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  190. 190. 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 and decalcifed sections.  Hypocalcified dentin is softer. 08/08/14 190BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  191. 191. Post developmental loss of tooth structure 08/08/14 191BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  192. 192. Tooth wear  Termed tooth surface loss – normal physiologic process that occurs with aging  4 causes (inter-related) • Attrition • Abrasion • Erosion • Abfraction 08/08/14 192BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  193. 193. Attrition  Loss of tooth structure caused by tooth to tooth contact during occlusion and mastication.  More noticeable with age  If it affects esthetics or function, it must be considered pathologic. 08/08/14 193BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  194. 194. Attrition  Tooth destruction can be accelerated by, • Poor quality or absent enamel • Fluorosis • Environmental or hereditary enamel hypoplasia • Dentinogenesis imperfecta • Premature contacts (Edge to edge conclusion) • Intra oral abrasives, erosion and grinding habits. 08/08/14 194BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  195. 195. Attrition  Can occur in both deci & perm teeth • Incisal and occlusal surfaces • Lingual surfaces of maxi antrs • Labial surfaces of mandi antrs  Seen as large, flat, smooth and shiny wear facets.  Inter-proximal loss – shortening of arch length 08/08/14 195BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  196. 196. Attrition  Pulp exposure and dentin sensitivity are rare • Slow loss of tooth structure • Apposition of reparative dentin within the pulp chamber. 08/08/14 196BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  197. 197. Abrasion  Pathologic loss of tooth structure or restoration secondary to action of an external agent. • Tooth brushing – abrasive paste with horizontal brushing stroke. • Pencils, tooth picks, pipe stems, bobby pins, 08/08/14 197BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  198. 198. Abrasion  When tooth wear is accelerated by chewing an abrasive substance between opposing teeth, called Demastication.  Has features of both attrition and abrasion  Caused by chewing tobacco, biting thread.. 08/08/14 198BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  199. 199. Abrasion  Has a variety of patterns depending on the cause.  Seen as horizontal cervical notches on the buccal surface of exposed radicular cementum and dentin  Sharply defined margins with a hard, smooth surface.  Greatest on prominent teeth – cuspids, bicuspids and teeth adjacent to edentulous areas. 08/08/14 199BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  200. 200. 08/08/14 200BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  201. 201. Erosion  Loss of tooth structure caused by a chemical process beyond that associated with bacterial interaction with the tooth.  Exposure to excessive acid – • foods/drinks, • chewable vit.C/aspirin • Chronic involuntary/voluntary regurgitation • Industrial environment exposure  Erosion from dental exposure to gastric secretions is termed perimolysis. 08/08/14 201BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  202. 202. Erosion  Tooth loss does not correlate with functional wear pattern  Commonly affects facial surfaces of maxi antrs Shallow, spoon shaped depressions in cervical portion of the crown  Active erosion reveals a clean, unstained surface  Inactive sites become stained and discolored. 08/08/14 202BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  203. 203. Erosion  Edges of metallic restorns would be at a higher level than the tooth structure.  Concave depression of dentin surrounded by an elevated rim of enamel.  Buccal cusps are replaced by ski-slope like depressions.  Can proceed rapidly and result in dentinal sensitivity or pulp exposure. 08/08/14 203BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  204. 204. Erosion  Facial surfaces of maxi antrs – dietary sources of acid.  Incisal portions of antrs in both arches – external source.  Palatal surface of antrs, occ surface of postrs – gastric regurgitation 08/08/14 204BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  205. 205. Abfraction  Loss of tooth structure that results from repeated tooth flexure caused by occlusal stresses.  Dentin is able to withstand greater tensile stress than enamel.  Eccentric occlusal forces – tensile stress concentrated at cervical fulcrum – flexure can disrupt the chemical bonds of enamel crystals – can lose by erosion or abrasion. 08/08/14 205BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  206. 206. Abfraction  Wedge shaped defects limited to the cervical area of the teeth  Deep, narrow and V shaped  Affect a single tooth with adjacent unaffected teeth  Almost exclusively on the facial surface  More prevalent in bruxism  Higher freq in mandibular dentition – ling orientation – more susceptible to tensile stresses. 08/08/14 206BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  207. 207. 08/08/14 207BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  208. 208. Internal and external resorption  Accomplished by cells located in the dental pulp – internal resorption  Accomplished by cells located in the periodontal ligament – external resorption 08/08/14 208BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  209. 209. Internal and external resorption Internal resorption  Relatively rare.  Follow injury to pulpal tissues.  Continues as long as vital pulp tissue remains.  Usually asymptomatic. External resorption  Extremely common  Mostly root resorption – mild  Susceptibility to resorption is inherent for each patient. 08/08/14 209BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  210. 210. 08/08/14 210BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  211. 211. 08/08/14 211BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  212. 212. C/F  Resorption of dentin/cementum can occur at any site that contacts vital soft tissue.  2 main patterns, • Inflammatory – resorbed dentin replaced by inflamed granulation tissue, • Replacement or metaplastic - resorbed dentin replaced by bone or cementum-like bone. 08/08/14 212BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  213. 213. Inflammatory resorption  More common in cervical areas.  Resorption continues as long as vital pulp remains.  Coronal pulp is necrotic.  Apical portion remaining vital.  Area of destruction – uniform, well circumscribed, symmetric radiolucent enlargement of pulp chamber or canal. 08/08/14 213BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  214. 214. Inflammatory resorption  When it affects the coronal pulp, crown shows a pink discoloration (Pink tooth of Mummery) when vascular resorption approaches the surface.  When it occurs in the canal, original outline of the canal is lost and a balloon-like radiographic dilation of canal.  Transient changes occur in traumatized teeth, recently undergone orthodontic or periodontal therapy. 08/08/14 214BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  215. 215. Replacement resorption  Mostly involves apical or midportions of the root.  Portions of pulpal dentinal walls are resorbed.  Enlargement of canal is filled with a material that is less radio-dense than the surrounding dentin.  Partial obliteration of the canal.  Outline of destruction is less defined – moth eaten loss of tooth structure  If it overlies the pulp canal, retention of unaltered canal through the area of the defect. 08/08/14 215BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  216. 216. Other clinical entities  External and internal resorption can present various forms.  Cervical pattern of external resorption id rapid and called Invasive Cervical resorption.  Several teeth are involved in Multiple Idiopathic root resorption. 08/08/14 216BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  217. 217. Histopathology Inflammatory resorption  Vascular pulp tissue with increased cellularity and collagenization.  Adjacent to dentin, numerous multinucleated dentinoclasts  Infl infiltrate has lymphocytes, histiocytes and PMNs 08/08/14 217BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  218. 218. Histopathology Replacement resorption  Numerous multinucleated dentinoclasts  Areas of resorption are repaired by deposition of osteodentin.  Deposits of inflamed granulation tissue and areas of replacement with woven bone.  Extensive bone replacement can lead to ankylosis. 08/08/14 218BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  219. 219. Disturbances of Growth (eruption) of teeth 08/08/14 219BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  220. 220. Introduction  There is a marked variation in biologic eruption of deciduous and permanent dentition.  It is difficult to assess when the eruption date of the given person is outside the limits of the normal range.  Some cases have extremities of normality and can be considered as a pathology. 08/08/14 220BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  221. 221. Premature eruption  Deciduous teeth that have erupted into the oral cavity in infants at birth called Natal teeth.  If it erupts prematurely within the first 30 days of life, it is Neonatal teeth.  Usually one or two teeth erupt early – often mandibular deciduous incisors. 08/08/14 221BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  222. 222. Premature eruption  Reason is unknown.  Hormonal influences like hyperthyroidism, adrenal glands and gonadism, for tooth eruption are also considered.  These teeth are often well formed, normal in all aspects but may exhibit mobility.  It should be retained though nursing difficulties may be experienced. 08/08/14 222BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  223. 223. Premature eruption  Permanent teeth erupt prematurely as a sequel to the premature loss of deciduous teeth.  Seen when only a single deciduous teeth is lost with subsequent eruption of the succedaneous tooth. 08/08/14 223BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  224. 224. 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. 08/08/14 224BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  225. 225. 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. 08/08/14 225BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  226. 226. 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. 08/08/14 226BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  227. 227. 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. 08/08/14 227BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  228. 228. 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. 08/08/14 228BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  229. 229. Delayed eruption 08/08/14 229BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  230. 230. 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. 08/08/14 230BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  231. 231. Embedded and Impacted teeth  Embedded teeth are individual teeth which are 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. 08/08/14 231BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  232. 232. Embedded and Impacted teeth  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. 08/08/14 232BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  233. 233. Impacted teeth 08/08/14 233BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  234. 234. Impacted mandibular third molars  Classified based on the position, • Mesioangular • Distoangular • Vertical • Horizontal • Inverted • Deflected buccally or lingually • Even seen in the lower border of ramus. 08/08/14 234BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  235. 235. Impacted mandibular molars 08/08/14 235BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  236. 236. Impacted mandibular third molars  It is important to determine whether it is a complete or partial impaction.  Completely impacted tooth is one which lies completely within the bone and has no communication with the oral cavity. It cannot become infected or carious.  Partially impacted tooth is not completely encased in bone but lies partially in soft tissue. Oral communication could be through a periodontal pocket leading to infection or carious involvement. 08/08/14 236BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  237. 237. Impacted maxillary teeth  Maxillary third molars can show similar variations of mandibular third molars.  Maxillary cuspids can be impacted from horizontal to vertical directions.  Horizontally impacted teeth may impinge on the roots of anteriors or premolars.  It can be placed labially or palatally. 08/08/14 237BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  238. 238. Complications  Infection  Resorption of adjacent roots.  Periodic pain and even trismus.  Referred pain from impacted tooth.  Dentigerous cyst and ameloblastomatous change.  May undergo resorption from the crown and gets replaced by bone. 08/08/14 238BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  239. 239. 08/08/14 239BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  240. 240. Ankylosed deciduous 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. 08/08/14 240BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  241. 241. Ankylosed deciduous teeth  This prevents exfoliation and subsequent replacement by permanent teeth.  After the eruption of adjacent teeth, these ankylosed teeth appears to be submerged from the level of occlusion. 08/08/14 241BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  242. 242. Ankylosed deciduous 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. 08/08/14 242BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  243. 243. Ankylosed teeth 08/08/14 243BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  244. 244. Ankylosed teeth 08/08/14 244BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  245. 245. Ankylosed deciduous teeth  Even with extreme root resorption, teeth lack mobility.  Diagnosis is suspected clinically and confirmed with radiographs.  There is partial absence of the periodontal ligament with areas of apparent blending between the root of the tooth and alveolar bone. 08/08/14 245BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  246. 246. Complications  Development of malocclusion  Local periodontal disturbance  Dental caries of both the ankylosed tooth and adjacent teeth. 08/08/14 246BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}
  247. 247. 08/08/14 247BY DR. AATISH PAWAR M.D.S {ORAL PATHOLOGY}

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