This document discusses various morphological alterations that can occur in tooth structure, including: - Supernumerary roots, which are developmental extra roots that most commonly occur in third molars, mandibular canines, and mandibular premolars. - Ectopic enamel formations like enamel pearls and cervical enamel extensions, which are small pearl-like deposits of enamel that can occur in unusual locations. - Other conditions like dilaceration (sudden changes in root angulation), bulbous roots, hypercementosis (excessive cementum deposition), taurodontism (enlarged pulp chambers), and shovel-shaped incisors. Several case examples are provided to illustrate some

1. Alterations In Tooth
Morphology
Presented By Sajjad Haghi

2. Supernumerary Roots
Developmental Extra Roots
Can Affect AnyTooth
More Frequent InThird Molars, Mandibular Canines ,
Mandibular Premolars
May Be Fully Developed Or Rudimentary
Radiographic Diagnosis:
• Root Canal Space Abruptly Diminishes In Size
• Root Canal Space Bifurcates IntoTwo Separate Canals

3. Supernumerary Root Is Result Of:
• Metabolic Dysfunction During Root Development After Birth
• Supernumerary Roots May Be DueToThe Disturbances OfThe
Hertwig's Epithelial Root Sheath FormingThe Root.
• Turner Syndrome

4. Case:
A 16-year old male patient presented with a chief complaint of pain in his lower right
posterior region of mouth for one week.
The patient revealed a history of mild intermittent pain for the past 2 months, which
had increased in intensity since one week ago.
The patient reported subjective symptoms of prolonged sensitivity to hot and cold
food and drinks.The pain was spontaneous and aggravated particularly at night and
required analgesic to get relief from pain.
Clinical examination revealed a deep carious lesion on the proximal surface of right
mandibular second molar (tooth #47).
Palpation and percussion test of the involved tooth did not reveal any tenderness.
The tooth was not mobile and periodontal probing around the tooth was within
physiological limits.
The preoperative diagnostic radiograph showed carious lesion closely approximating
the pulp with no signs of periapical changes.
From the clinical tests and radiographic findings, a diagnosis of symptomatic
irreversible pulpitis was made and endodontic treatment was initiated.
Radiographic evaluation of the involved tooth revealed an unusual anatomical
configuration suggesting the possibility of the presence of two mesial roots.
To confirm this rare and unusual morphology, dental imaging of the tooth with the
help of CBCT was planned.

8. Ectopic Enamel
Enamel Pearl
also known as enamelous, enamel droplets, enamel globules, enamel
nodules, enamel knots and enamel exostoses
Small Pearl Like , Dome Shaped Deposits Of Enamel At Unusual Locations
More Common In Maxillary Molars
AssociatedWith Chronic Periodontal Infection
prevalence of enamel pearls is 2.69%
The diameter can vary between 0.3 and 4 mm (mean 1.7 mm)

9. Types:
• enamel pearls (formed entirely of enamel)
• composite enamel pearls or enamel dentin pearls (formed by enamel and
dentin)
• enamel-dentin-pulp pearls (formed by enamel, dentin and pulpal tissue)

10. Case:
A 30-year-old man systemically healthy presented with chief complaint of
bleeding gums.
Periapical radiograph revealed severe bone loss around the mandibular
first molar ,The presence of one enamel pearl on the first right molar on
mesial root surface.
Periodontal probing showed local bleeding on interproximal areas.
A diagnosis of chronic localized severe periodontitis was established.

15. Ectopic Enamel
Cervical Enamel Extension
• Flat Ectopic Deposits Of EnamelThat AreTriangular In Shape AndTapering In
Form, Extending Apically IntoThe FurcationArea.
• More CommonOn Asian Race
• Mostly Seen On Mandibular Molars
• Can Affect Plaque Removal, Complicate Scaling And Root Planning, And May
Be A Local Factor InThe Development Of Gingivitis And Periodontitis.
• Can Cause Buccal Bifurcation Cyst

16. Classification
Grade I -The enamel projection extends from the cementoenamel junction of
the tooth toward the furcation entrance.
Grade II -The enamel projection approaches the entrance to the furcation. It
does not enter the furcation, and therefore, no horizontal component is present.
Grade III -The enamel projection extends horizontally into the furcation.

17. Case:
A 24 year-old boy reported with the chief complaint of bleeding
gums.
A diagnosis of localized chronic periodontitis was made on the
basis of history and clinical and radiological examination results.
Clinical examination showed deep periodontal pockets on the
lingual surface with Grade II furcation involvement in the right
and left mandibular first molars.
Radiographic examination showed cervical enamel projection.

21. Dilaceration
• sudden change in the axial inclination of root or between the crown
and the root of a tooth.
• CommonCauses: Crowding,Trauma,Adjacent Bony Lesions ,
OrthodonticTraction
• More Common In 3rd Molars & Lateral Incisors

23. Bull’s Eye:
When bend IsToward
Buccal Or Lingual

25. Bulbous Root
• Normal ApicalTaper of root replaced by widening of
the root
• Genetic Condition
• Result Of Increased amount of dentin

27. Hypercementosis
• Deposition Of excessive amount of secondary cementum on the root
surface (mostly Apical third)
• Mostly seen in mandibular molars and pre molars
• The aetiopathogenesis of hypercementosis is ambiguous. Although
most of the cases are idiopathic, several local and systemic factors are
also linked to this condition, such as Paget's disease,Thyroid Goiter,
acromegaly, vitamin A deficiency, Apical Periodontal infection, occlusal
trauma, etc.

28. Radiographic Features
• Thickening and Apparent Blunting Of Root with rounding of apex
• Bulbous apex
• Irregular accumulation of cementum by related area of bone
resorption

29. Types:
1- Generalized
A 33-year-old woman, diagnosed with SLE, pain in the right maxillary second premolar,
which was extensively decayed. A panoramic radiograph was taken to evaluate the
roots of other teeth. Most of them showed increased thickness of roots due to excessive
deposition of cementum depicting a generalized thickening and mild interdental bone
loss

30. 2- localized
A 29-year-old woman diagnosed with SLE joint pains, fatigue, weight loss and rashes over her skin.
IOPA's of first and third quadrants and a panoramic radiograph were advised to evaluate the status of the
remaining teeth. Incidentally, these radiographs showed increased thickness of roots with respect to 15, 17,
27, 34 and 35, with mild periodontal bone loss

31. Taurdontism
• change in tooth shape caused by the failure of Hertwig's
epithelial sheath diaphragm to invaginate at the proper
horizontal level.
• characteristic features :
a) An enlarged pulp chamber
b) apical displacement of the pulpal floor
c) no constriction at the level of the cemento-enamel
junction
• Permanent molar is Mostly affected teeth

32. Related Syndromes:

33. Types:
(Mild) (Moderate) (Severe)

37. Shovel-Shaped Incisor Syndrome
• prominent marginal (shovel-shaped) ridges especially in
the anterior teeth, accentuated lingual pits in maxillary
incisors, and markedly shortened roots
• seen in Native Americans, Eskimos, and Hispanics
• Patients are prone to class III and lingual pit caries in
maxillary incisors.

38. (B–D)Variation in shoveling, which refers to the development of marginal ridges on the lingual surfaces of UI1. (B)
shows grade 1, (C) shows grade 3, and (D) shows grade 5.
(E–G)Variation in double shoveling, which refers to the development of marginal ridges on the labial surfaces of
UI1 (E) grade 1, (F) grade 3, and (G) grade 5. Arrows indicate pronounced mesial marginal ridges.

41. 1. Common oral disease 2017- page : 52-53
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916505/
3. https://www.researchgate.net/publication/11044800_Supernumerary_roots-PMID_12420579
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3981278/
5. https://www.ncbi.nlm.nih.gov/pubmed/25427926
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756549/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248133/
8. http://www.slideshare.net/nehal288/21hypercementosis
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157250/
References:

42. THE END!