Developmental
abnormalities
    Islam Kassem


        Level 7




     ikassem@dr.com
• There are many developmental abnormalities
  that can affect the teeth and facial skeleton. In
  most cases, clinicians need little more than to
  be able to recognize these abnormalities




                      ikassem@dr.com
ikassem@dr.com
ikassem@dr.com
Classification of developmental
              abnormalities
1-Anomalies of the teeth
2-Skeletal anomalies.




                    ikassem@dr.com
Anomalies of the teeth
1-Number
2-Structure
3-Size
4-Shape
5-Position.




                ikassem@dr.com
Anomalies of the teeth
1-Number
2-Structure
3-Size
4-Shape
5-Position.




                ikassem@dr.com
1-Abnormalities in number
• Missing teeth
• Additional teeth (hyperdontia)




                    ikassem@dr.com
ikassem@dr.com
Missing teeth

• Localized anodontia or hypodontia — usually
third molars, upper lateral incisors or second
premolars.
• Anodontia or hypodontia associated with
systemic disease — e.g. Down's syndrome,
ectodermal dysplasia.



                    ikassem@dr.com
ikassem@dr.com
ectodermal dysplasia




       ikassem@dr.com
Additional teeth (hyperdontia)

• Localized hyperdontia — Supernumerary teeth
— Supplemental teeth
• Hyperdontia associated with specific
syndromes, e.g. cleidocranial dysplasia,
Gardener's syndrome.




                   ikassem@dr.com
ikassem@dr.com
ikassem@dr.com
ikassem@dr.com
Cleidocranial dysplasia




         ikassem@dr.com
Anomalies of the teeth
1-Number
2-Structure
3-Size
4-Shape
5-Position.




                ikassem@dr.com
2-Abnormalities in structure
• Genetic defects
• Acquired defects




                     ikassem@dr.com
Genetic defects

• Amelogenesis imperfecta — Hypoplastic type
— Hypocalcified type
— Hypomature type
• Dentinogenesis imperfecta
• Shell teeth
• Regional odontodysplasia (ghost teeth)
• Dentinal dysplasia (rootless teeth).

                   ikassem@dr.com
ikassem@dr.com
Shell tooth




   ikassem@dr.com
Acquired defects

• Turner teeth — enamel defects caused by
infection from overlying deciduous predecessor
• Congenital syphilis — enamel hypoplastic and
altered in shape (see below)
• Severe childhood fevers, e.g. measles — linear
enamel defects
Fluorosis — discolouration or pitting of the
enamel
• Discolouration — e.g. tetracycline staining.

                      ikassem@dr.com
Turner tooth




   ikassem@dr.com
Anomalies of the teeth
1-Number
2-Structure
3-Size
4-Shape
5-Position.




                ikassem@dr.com
3-Abnormalities in size

• Macrodontia — large teeth
• Microdontia — small teeth, including
rudimentary teeth.




                    ikassem@dr.com
Macrodontia




   ikassem@dr.com
Microdontia




   ikassem@dr.com
Anomalies of the teeth
1-Number
2-Structure
3-Size
4-Shape
5-Position.




                ikassem@dr.com
4-Abnormalities in shape

• Anomalies affecting -whole teeth
• Anomalies affecting the crowns
• Anomalies affecting roots andlor pulp canals




                    ikassem@dr.com
Anomalies affecting -whole teeth

• Fusion — two teeth joined together from the
fusion of adjacent tooth germs
• Gemination — two teeth joined together but
arising from a single tooth germ
• Concrescence — two teeth joined together by
cementum
• Dens-in-dente (invaginated odontome) — in
folding of the outer surface of a tooth into the
interior usually in the cingulum pit region of
maxillary lateral incisors.

                      ikassem@dr.com
Fusion




ikassem@dr.com
Gemination




   ikassem@dr.com
Concrecence




   ikassem@dr.com
Dens in dente




    ikassem@dr.com
Anomalies affecting the crowns

• Extra cusps
• Congenital syphilis
— Hutchinson 's incisors — crowns small,
screwdriver or barrel-shaped, and often
notched
— Moon's/mulberry molars — dome-shaped or
modular
• Tapering pointed incisors — ectodermal
dysplasia.

                   ikassem@dr.com
Congenital syphilis




       ikassem@dr.com
Tapering pointed incisors —
   ectodermal dysplasia.




           ikassem@dr.com
Anomalies affecting roots and or pulp
               canals
• Number — additional roots, e.g. two-rooted
incisors, three-rooted premolars or four-rooted
molars
• Morphology, including:
— Bifid roots
— Excessively curved roots
— Dilaceration — sharp bend in the root
direction
— Taurodontism — short, stumpy roots and
longitudinally enlarged pulp chambers
Pulp stones — localized or associated with
specific syndromes, e.g. Ehlers-Danlos (floppy
joint syndrome).

                              ikassem@dr.com
Bifid lower Premolar




       ikassem@dr.com
3 root lower molar




      ikassem@dr.com
Dilaceration — sharp bend in the root
              direction




                ikassem@dr.com
Taurodontism — short, stumpy roots and
     longitudinally enlarged pulp chambers




                  ikassem@dr.com
Pulp stones




   ikassem@dr.com
Odontomes

• Enameloma/enamel pearl
• Cementoma (see fibro-cemento-osseousmesions in
— Benign cementoblastoma (true cementoma)
— Periapical cemento-osseous dysplasia
— Focal cemento-osseous dysplasia
— Florid cemento-osseous dysplasia
(gigantiform cementoma)
• Composite
— Compound odontome — made up of one or more small
tooth-like denticles
— Complex odontome — complex mass of disorganized dental
tissue.

                        ikassem@dr.com
Enemeloma




  ikassem@dr.com
Compound odontoma




      ikassem@dr.com
Complex odontoma




      ikassem@dr.com
Anomalies of the teeth
1-Number
2-Structure
3-Size
4-Shape
5-Position.




                ikassem@dr.com
5-Abnormalities in position

• Delayed eruption
• Other positional anomalies




                   ikassem@dr.com
Delayed eruption

• Local causes
— Loss of space
— Abnormal crypt position — especially 8/8 and 3/3
— Overcrowding
— Additional teeth
— Retention of deciduous predecessor
— Dentigerous and eruption cysts
• Systemic causes
— Metabolic diseases, e.g. cretinism and rickets
— Developmental disturbances, e.g. cleidocranial dysplasia
— Hereditary conditions, e.g. gingival fibromatosis and
cherubism.
                          ikassem@dr.com
Other positional anomalies

• Transposition two teeth occupying exchanged positions
• Wandering teeth, movement of unerupted
teeth for no apparent reason (distal drift)
• Submersion, second deciduous molars apparently descend into the
jaws. Since these teeth do not in fact submerge, but rather remain in
their original position while the adjacent Other positional anomalies
• Transposition, two teeth occupying exchanged positions
• Wandering teeth, movement of unerupted teeth for no apparent
reason (distal drift)
• Submersion, second deciduous molars apparently descend into the
jaws. Since these teeth do not in fact submerge, but rather remain
in their original position while the adjacent



                              ikassem@dr.com
Submerged tooth infra occlusion




             ikassem@dr.com
Transposition




    ikassem@dr.com
Wandering 5




   ikassem@dr.com
Skeletal anomalies
• Abnormalities of the mandible and/or maxilla
• Other rare developmental diseases and
syndromes.




                    ikassem@dr.com
Abnormalities of the mandible or
              maxilla
• Micrognathia
• Macrognathia (prognathism)
• Other mandibular anomalies




                   ikassem@dr.com
Micrognathia

• True micrognathia — usually caused by bilateral
hypoplasia of the jaw or agenesis of the condyles

• Acquired micrognathia — usually caused by unilateral
early ankylosis of the temporomandibular joint.




                        ikassem@dr.com
Micrognathia




   ikassem@dr.com
Macrognathia (prognathism)

• Genetic
• Relative prognathism — mandibular/maxillary
disparity
• Acquired, e.g. acromegaly owing to excessive
growth hormone from a pituitary tumour.




                       ikassem@dr.com
Macrognathia




    ikassem@dr.com
Other mandibular anomalies

• Condylar hypoplasia
• Condylar hyperplasia
• Bifid condyle
• Coronoid hyperplasia.




                    ikassem@dr.com
Condylar hyperplasia




       ikassem@dr.com
Cleft lip and palate

• Cleft lip
— Unilateral, with or without alveolar ridge
— Bilateral, with or without alveolar ridge
• Cleft palate
— Bifid uvula
— Soft palate only
— Soft and hard palate
• Clefts of lip and palate (combined defects)
— Unilateral (left or right)
— Cleft palate with bilateral cleft lip.

                         ikassem@dr.com
Alveolar cleft




    ikassem@dr.com
Localized bone defects

• Exostoses
— Torus palatinus
— Torus mandibularis
• Idiopathic bone cavities (see Ch. 25)
— Stafne's bone cavity.




                     ikassem@dr.com
Eagle’s syndrome




     ikassem@dr.com
Other rare developmental diseases
            and syndromes
• Cleidocranial dysplasia
 • Gorlin's syndrome (nevoid basal cell
carcinoma syndrome)
• Eagle syndrome
• Crouzon syndrome (craniofacial dysostosis)
• Apert syndrome
• Mandibular facial dysostosis (Treacher Collins
syndrome).

                     ikassem@dr.com
Curzon's syndrome




      ikassem@dr.com
Thank you
• You can get it form

• http://www.slideshare.net/islamkassem




                        ikassem@dr.com

Developmental abnormalities

  • 1.
    Developmental abnormalities Islam Kassem Level 7 ikassem@dr.com
  • 2.
    • There aremany developmental abnormalities that can affect the teeth and facial skeleton. In most cases, clinicians need little more than to be able to recognize these abnormalities ikassem@dr.com
  • 3.
  • 4.
  • 5.
    Classification of developmental abnormalities 1-Anomalies of the teeth 2-Skeletal anomalies. ikassem@dr.com
  • 6.
    Anomalies of theteeth 1-Number 2-Structure 3-Size 4-Shape 5-Position. ikassem@dr.com
  • 7.
    Anomalies of theteeth 1-Number 2-Structure 3-Size 4-Shape 5-Position. ikassem@dr.com
  • 8.
    1-Abnormalities in number •Missing teeth • Additional teeth (hyperdontia) ikassem@dr.com
  • 9.
  • 10.
    Missing teeth • Localizedanodontia or hypodontia — usually third molars, upper lateral incisors or second premolars. • Anodontia or hypodontia associated with systemic disease — e.g. Down's syndrome, ectodermal dysplasia. ikassem@dr.com
  • 11.
  • 12.
    ectodermal dysplasia ikassem@dr.com
  • 13.
    Additional teeth (hyperdontia) •Localized hyperdontia — Supernumerary teeth — Supplemental teeth • Hyperdontia associated with specific syndromes, e.g. cleidocranial dysplasia, Gardener's syndrome. ikassem@dr.com
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
    Anomalies of theteeth 1-Number 2-Structure 3-Size 4-Shape 5-Position. ikassem@dr.com
  • 19.
    2-Abnormalities in structure •Genetic defects • Acquired defects ikassem@dr.com
  • 20.
    Genetic defects • Amelogenesisimperfecta — Hypoplastic type — Hypocalcified type — Hypomature type • Dentinogenesis imperfecta • Shell teeth • Regional odontodysplasia (ghost teeth) • Dentinal dysplasia (rootless teeth). ikassem@dr.com
  • 21.
  • 22.
    Shell tooth ikassem@dr.com
  • 23.
    Acquired defects • Turnerteeth — enamel defects caused by infection from overlying deciduous predecessor • Congenital syphilis — enamel hypoplastic and altered in shape (see below) • Severe childhood fevers, e.g. measles — linear enamel defects Fluorosis — discolouration or pitting of the enamel • Discolouration — e.g. tetracycline staining. ikassem@dr.com
  • 24.
    Turner tooth ikassem@dr.com
  • 25.
    Anomalies of theteeth 1-Number 2-Structure 3-Size 4-Shape 5-Position. ikassem@dr.com
  • 26.
    3-Abnormalities in size •Macrodontia — large teeth • Microdontia — small teeth, including rudimentary teeth. ikassem@dr.com
  • 27.
    Macrodontia ikassem@dr.com
  • 28.
    Microdontia ikassem@dr.com
  • 29.
    Anomalies of theteeth 1-Number 2-Structure 3-Size 4-Shape 5-Position. ikassem@dr.com
  • 30.
    4-Abnormalities in shape •Anomalies affecting -whole teeth • Anomalies affecting the crowns • Anomalies affecting roots andlor pulp canals ikassem@dr.com
  • 31.
    Anomalies affecting -wholeteeth • Fusion — two teeth joined together from the fusion of adjacent tooth germs • Gemination — two teeth joined together but arising from a single tooth germ • Concrescence — two teeth joined together by cementum • Dens-in-dente (invaginated odontome) — in folding of the outer surface of a tooth into the interior usually in the cingulum pit region of maxillary lateral incisors. ikassem@dr.com
  • 32.
  • 33.
    Gemination ikassem@dr.com
  • 34.
    Concrecence ikassem@dr.com
  • 35.
    Dens in dente ikassem@dr.com
  • 36.
    Anomalies affecting thecrowns • Extra cusps • Congenital syphilis — Hutchinson 's incisors — crowns small, screwdriver or barrel-shaped, and often notched — Moon's/mulberry molars — dome-shaped or modular • Tapering pointed incisors — ectodermal dysplasia. ikassem@dr.com
  • 37.
    Congenital syphilis ikassem@dr.com
  • 38.
    Tapering pointed incisors— ectodermal dysplasia. ikassem@dr.com
  • 39.
    Anomalies affecting rootsand or pulp canals • Number — additional roots, e.g. two-rooted incisors, three-rooted premolars or four-rooted molars • Morphology, including: — Bifid roots — Excessively curved roots — Dilaceration — sharp bend in the root direction — Taurodontism — short, stumpy roots and longitudinally enlarged pulp chambers Pulp stones — localized or associated with specific syndromes, e.g. Ehlers-Danlos (floppy joint syndrome). ikassem@dr.com
  • 40.
    Bifid lower Premolar ikassem@dr.com
  • 41.
    3 root lowermolar ikassem@dr.com
  • 42.
    Dilaceration — sharpbend in the root direction ikassem@dr.com
  • 43.
    Taurodontism — short,stumpy roots and longitudinally enlarged pulp chambers ikassem@dr.com
  • 44.
    Pulp stones ikassem@dr.com
  • 45.
    Odontomes • Enameloma/enamel pearl •Cementoma (see fibro-cemento-osseousmesions in — Benign cementoblastoma (true cementoma) — Periapical cemento-osseous dysplasia — Focal cemento-osseous dysplasia — Florid cemento-osseous dysplasia (gigantiform cementoma) • Composite — Compound odontome — made up of one or more small tooth-like denticles — Complex odontome — complex mass of disorganized dental tissue. ikassem@dr.com
  • 46.
  • 47.
    Compound odontoma ikassem@dr.com
  • 48.
    Complex odontoma ikassem@dr.com
  • 49.
    Anomalies of theteeth 1-Number 2-Structure 3-Size 4-Shape 5-Position. ikassem@dr.com
  • 50.
    5-Abnormalities in position •Delayed eruption • Other positional anomalies ikassem@dr.com
  • 51.
    Delayed eruption • Localcauses — Loss of space — Abnormal crypt position — especially 8/8 and 3/3 — Overcrowding — Additional teeth — Retention of deciduous predecessor — Dentigerous and eruption cysts • Systemic causes — Metabolic diseases, e.g. cretinism and rickets — Developmental disturbances, e.g. cleidocranial dysplasia — Hereditary conditions, e.g. gingival fibromatosis and cherubism. ikassem@dr.com
  • 52.
    Other positional anomalies •Transposition two teeth occupying exchanged positions • Wandering teeth, movement of unerupted teeth for no apparent reason (distal drift) • Submersion, second deciduous molars apparently descend into the jaws. Since these teeth do not in fact submerge, but rather remain in their original position while the adjacent Other positional anomalies • Transposition, two teeth occupying exchanged positions • Wandering teeth, movement of unerupted teeth for no apparent reason (distal drift) • Submersion, second deciduous molars apparently descend into the jaws. Since these teeth do not in fact submerge, but rather remain in their original position while the adjacent ikassem@dr.com
  • 53.
    Submerged tooth infraocclusion ikassem@dr.com
  • 54.
    Transposition ikassem@dr.com
  • 55.
    Wandering 5 ikassem@dr.com
  • 56.
    Skeletal anomalies • Abnormalitiesof the mandible and/or maxilla • Other rare developmental diseases and syndromes. ikassem@dr.com
  • 57.
    Abnormalities of themandible or maxilla • Micrognathia • Macrognathia (prognathism) • Other mandibular anomalies ikassem@dr.com
  • 58.
    Micrognathia • True micrognathia— usually caused by bilateral hypoplasia of the jaw or agenesis of the condyles • Acquired micrognathia — usually caused by unilateral early ankylosis of the temporomandibular joint. ikassem@dr.com
  • 59.
    Micrognathia ikassem@dr.com
  • 60.
    Macrognathia (prognathism) • Genetic •Relative prognathism — mandibular/maxillary disparity • Acquired, e.g. acromegaly owing to excessive growth hormone from a pituitary tumour. ikassem@dr.com
  • 61.
    Macrognathia ikassem@dr.com
  • 62.
    Other mandibular anomalies •Condylar hypoplasia • Condylar hyperplasia • Bifid condyle • Coronoid hyperplasia. ikassem@dr.com
  • 63.
    Condylar hyperplasia ikassem@dr.com
  • 64.
    Cleft lip andpalate • Cleft lip — Unilateral, with or without alveolar ridge — Bilateral, with or without alveolar ridge • Cleft palate — Bifid uvula — Soft palate only — Soft and hard palate • Clefts of lip and palate (combined defects) — Unilateral (left or right) — Cleft palate with bilateral cleft lip. ikassem@dr.com
  • 65.
    Alveolar cleft ikassem@dr.com
  • 66.
    Localized bone defects •Exostoses — Torus palatinus — Torus mandibularis • Idiopathic bone cavities (see Ch. 25) — Stafne's bone cavity. ikassem@dr.com
  • 67.
    Eagle’s syndrome ikassem@dr.com
  • 68.
    Other rare developmentaldiseases and syndromes • Cleidocranial dysplasia • Gorlin's syndrome (nevoid basal cell carcinoma syndrome) • Eagle syndrome • Crouzon syndrome (craniofacial dysostosis) • Apert syndrome • Mandibular facial dysostosis (Treacher Collins syndrome). ikassem@dr.com
  • 69.
    Curzon's syndrome ikassem@dr.com
  • 70.
    Thank you • Youcan get it form • http://www.slideshare.net/islamkassem ikassem@dr.com