Developmental Anomalies Of Teeth

Developmental Anomalies of
Teeth
Presented by:- Dr. Parikshit Kadam
(JR-I)

Content
• Introduction
• Developmental defects due to
 Size
 Number
 Shape
 Form
 Structure
• Review of literature
• Conclusion
• References

Introduction
• Developmental dental anomalies are marked deviations from
the normal color, contour, size, number, and degree of
development of teeth
• Local as well as systemic factors may be responsible for these
developmental disturbances
• Such influences may begin before or after birth, hence
deciduous or permanent teeth may be affected

DEVELOPMENT AL DISTURBANCES IN
SIZE OF TEETH
MacrodontiaMicrodontia
4

MICRODONTIA
 Smaller than normal
 Boyle 1955 “ in general microdontia teeth are small,
crowns are short and normal contacts between teeth are
frequently misssing
 Ufomata 1988 it can be of whole crown, only crown or only roots
• Acoording to Shafer et al. Types:
(a) True
(b) Relative generalized
(c) Involving single tooth - is common
Shafer’s textbook of oral pathology, 7th edition

 All teeth are smaller than
normal
 Occur in some cases of
pituitary dwarfism
 Exceedingly rare
 Teeth are well formed
(1) True Generalized
Microdontia

 Normal or slightly smaller than
normal teeth are present in jaws that are
somewhat larger than normal
 Since it is well recognized that a
person may inherit the jaw size from one
parent and the tooth size from other
parent, there is an obvious role of
heredity
(2) Relative Generalized
Microdontia

 Common condition
 Affects most often maxillary
lateral incisior and 3rd molar
 Instead of parallel or diverging mesial
and distal surfaces, the sides converges
or taper together incisally, forming a peg-
shaped or cone shaped crown
(3) Focal/Localized
Microdontia

HUTCHINSON’S INCISORS
• Characteristic of congenital
syphilis
• Lateral incisors are peg-shaped or
screwdriver-shaped
• Widely spaced
• Notched at the end
• With a crescent-shaped deformity

 Occurance in children : Rare (less than 1%) in primary teeth
• More common (2.5%) in permanent teeth
• Females more frequently affected than males
 Etiology :Multifactorial
 Generalized microdontia is rare and may be associated with
congenital hypopituitarism or exposure to radiation or
chemotherapy during dental development
 In contrast, localized microdontia is more common and is
frequently followed by hypodontia

Clinical Significance
1) Spacing due to microdontia is disturbing cosmetically
2) Midline shift
3) Reduced overjet
4) Mesial movement of upper molars
• Syndromes in which microdontia may be seen include the
trisomy 21 syndrome, the ectodermal dysplasia syndromes,
focal dermal hypoplasia, Silver–Russell

Treatment
• Unerupted microdonts may require surgical removal to prevent
the formation of cysts
• Erupted microdonts, peg laterals especially, may cause
cosmetic concern. Such teeth may be restored to resemble
normal sized teeth, typically with composite build ups
or crowns
• Orthodontics may be required in severe cases to close gaps
between the teeth

MACRODONTIA
o Teeth which are larger than normal
o Also known as MEGADONTIA
o 3 types:
1. True Generalized
2. Relatively Generalized
3. Localized
13

 Occurance in children:- Rare (1.1%) in permanent dentition
 Etiology : Hereditary
klinefelter syndrome
Pitutary gigantism
Insulin resistant diabetis
Hemifacial hypertrophy

 All teeth are larger than normal
 Pituitary gigantism
 Exceedingly rare
(1) True Generalized
Macrodontia

 Normal or slightly larger than
normal teeth in small jaws
 Results in crowding of teeth
 Insufficient arch space
(2) Relative Generalized
Macrodontia

 Uncommon condition
 Unknown etiology
 Usually seen with
mandibular 3rd molars
(3) Focal/Localized
Macrodontia

• Localization:- Lower third molars and second premolars
• Upper central incisors
• Frequent bilateral symmetry
Management:- Aesthetic restoration
Orthodontic treatment of the crowding
Extraction

Case report
Isolated bilateral macrodontia of mandibular second
premolars : A case report
Ebru Canoglu,harun Canoglu,Alper Aktas,Zafer C. Cehreli
; European Journal of Dentistry; July 2012 ; vol:6

DEVELOPMENTAL DISTURBANCES
IN NUMBER OF TEETH
20
Anodontia
Supernumerary
teeth

Anodontia
True Induced or false Pseudo
anodontia anodontia
Total Partial
Hypodontia Oligodontia

TRUE ANODONTIA
o Congenital absence of teeth
22
Total Anodontia
 All teeth are missing
 Both deciduous &
permanent dentition
 Rare condition
 Hereditary ectodermal
dysplasia
Partial Anodontia
 One or few teeth missing.
 Relatively common
condition

PARTIAL ANODONTIA
o Involves one or more teeth
o Common condition
o Maxillary lateral incisors, maxillary or mandibular 2nd premolars,
third molars
23
Hypodontia
Lack of development of
one or more teeth
Oligodontia
Lack of development of
six or more teeth

 when teeth are absent clinically because of impaction or delayed
eruption
when teeth have been
Exfoliated or extracted
Pseudoanodontia
False anodontia

Missing teeth Male (n=571) Female (n=552) Total(1123)
Maxillary central
incisors
4 (0.70) 2(0.36) 6(0.53)
Maxillary lateral
incisors
9 (1.58) 10(1.81) 19(1.69)
Mandibular
central incisors
5 (0.88) 2(0.36) 7(0.62)
Maxillary
premolars
3 (0.53) 3(0.54) 6(0.53)
Mandibular
premolars
2 (0.35) 3(0.54) 5(0.45)
Maxillary molars 1 (0.18) 2(0.36) 3(0.27)
Mandibular
molars
1(0.18) 1(0.09)
Total 24 (4.20) 23(4.17) 47(4.19)
Saurabh gupta, payal saxena et al. Journal of oral science.vol 53.No 2, 231-
238, 2011

Management
- Partial dentures
- Fixed dental prosthesis
- Implants
Implant age selection
- Must be carefully selected
- Implant placement should postponed till permanent dentition
period
- Implants acts as ankylosed teeth and can affect growth of jaws and
change position accordingly

SUPERNUMERARY TEETH
- Supernumerary tooth is one that is addition to the normal series and
can be found in almost any region of dental arch
• Teeth may have:
1. normal morphology
2. rudimentary
3. miniature
Supernumerary deciduous teeth- male> female, maxillary anterior>
mandibular anterior
Supernumerary permanent dentition- male> female,maxilla>mandible

Etiology
1) Supernumerary teeth develop from a third tooth bud
2) Hyperactivity theory
3) Hereditary tendency
• Supernumerary teeth associated with cleft lip and palate
result from fragmentation of the dental lamina during cleft
formation and commonly seen in the maxillary lateral incisor
area

CONICAL ( MESIODENS)
TUBERCULATE
- Often paired
- Commonly located on the palatal aspect of central incisors
Seema D bagle, shital DP Kiran non-syndromic occurrence of true generalized microdontia
with mandibular mesiodens- a name case Head face medicine 2011; 7 ; 19

-
SUPPLEMENTAL
- Duplication of teeth
- Maxillary lateral incisors >
Premolars & molars
- Primary dentition
FOURTH MOLAR
- Common in maxillary molar area.
-

DISOMOLAR/ DISTODENSE
Molar located distal to molar
PARAMOLARS

ODONTOME
- 4th category of supernumerary teeth by Howard
- Odontoma refers to any tumor of odontogenic origin
- It represents a hamartomatous malformation rather than a
neoplasm
- The lesion is composed of more than one type of tissue &
consequently has been called a composite odontoma
- 2 types:- 1) complex composite odontoma:- the different type
of tissue which is totally disorganized
2) Compound Composite odontoma:- malformation
which hears some superficial anatomical similarity
to normal tooth

- Supernumerary teeth may be impacted or erupted.
- Because of additional tooth bulk, it cause
- (1) malposition of adjacent teeth
(2) prevent their eruption
Management
- Indication for removal of supernumerary tooth
- Altered eruption or displacement of central incisors
- Active orthodontic alignment of an incisor in close proximity
- Grafting in cleft lip and palate patients.
- The tooth is present in bone designated for implant placement

Supernumerary Teeth in Indian Children:A
survey of 300Cases
• The aim of this investigation was to study children with
supernumerary teeth who visited the Department of
Pedodontics and Preventive Dentistry, Government Dental
College and Hospital, Rohtak, Haryana, India
• Only children with supernumerary teeth were included in the
study while patients having supernumerary teeth with
associated syndromes were excluded
• Supernumeraries were detected by clinical and radiographic
examination
A. Sharma and V. P. Singh, International Journal of Dentistry Volume 2012, Article
ID 745265, 5 pages

• The results indicated that males were aﬀected more than
females with a sex ratio of 2.9:1.
• Single supernumerary tooth was seen in 79% of the patients,
20% had double, and 1% had three or more supernumeraries.
• Premaxillary supernumeraries accounted for 93.8% of the
cases. Conical shaped supernumerary teeth were the most
common type (59.7%).
• Majority of supernumeraries remained unerupted (65%).
• Fusion of supernumerary tooth with a regular tooth was
observed in 4% of the patients.
• Talon cusp, an associated dental anomaly, was seen in 5% of
the cases. Simultaneous hypodontia occurred in 2.3% of
patients with supernumeraries
A. Sharma and V. P. Singh, International Journal of Dentistry Volume 2012, Article
ID 745265, 5 pages

DEVELOPMENTAL DISTURBANCES IN
SHAPE & FORM OF TEETH
 Crown
 Fusion
 Gemination
 Taurodontism
 Talon’s Cusp
 Dens evaginatus
38

 Dens Invaginatus
 Peg-shaped Lateral
 Mulberry Molar

FUSION
• Fused teeth arise from union of two
normally separated tooth germs
• If union occurs before calcification –
teeth completely united
• If union occurs after calcification – roots
get fused
• Primary (2-3%) > Permanent (1-2%)
(Graham & Granath)
Can occur between same dentition or
primary to permanent dentition ( Caceda
1994)

• Fusion of primary teeth may lead to congenital absence of
permanent teeth
• Associated syndrome:
Solitary median maxillary central incisor syndrome
Management :
- Cause problems with spacing, alignment and function
- Mesiodistal disking
- Surgical extraction
Shrestha, Ashish; Marla, Vinay; Shrestha, Sushmita; Maharjan, Iccha K Developmental
anomalies affecting the morphology of teeth – a review RSBO Revista Sul-Brasileira de
Odontologia, vol. 12, núm.1,enero-marzo, 2015, pp. 68-78

Solitary median maxillary central incisor
syndrome
• Very rare condition
• Present as single midline symmetrical maxillary central incisor
• Due to mutation in SHH gene
Shrestha, Ashish; Marla, Vinay; Shrestha, Sushmita; Maharjan, Iccha K
Developmental anomalies affecting the morphology of teeth – a review RSBO
Revista Sul-Brasileira de Odontologia, vol. 12, núm.1,enero-marzo, 2015, pp. 68-78

CASE REPORT
Unilateral fusion of primary molars with the presence
of a succedenous supernumerary tooth : case report
Jorge Caceda; Curtis creath; Joe p Thomas; Pediatric
dentistry; Jan-Feb 1994; Volume: 16; num :1

GEMINATION
• Arise from attempt at division of single
tooth germ by invagination, resulting
incomplete formation of two teeth
• One structure with two completely /
incompletely separated crowns having
single root or root canal
• More in primary dentition
Shrestha, Ashish; Marla, Vinay; Shrestha, Sushmita; Maharjan, Iccha K Developmental
anomalies affecting the morphology of teeth – a review RSBO Revista Sul-Brasileira de
Odontologia, vol. 12, núm.1,enero-marzo, 2015, pp. 68-78

Twinning
• Coined by Levitas 1965
• Production of equivalent structures by division resulting in one
normal & one supernumerary tooth
Shrestha, Ashish; Marla, Vinay; Shrestha, Sushmita; Maharjan, Iccha K Developmental anomalies
affecting the morphology of teeth – a review RSBO Revista Sul-Brasileira de Odontologia, vol. 12,
núm.1,enero-marzo, 2015, pp. 68-78

Case Report
Twins on either side : A case report of bilateral Gemination
Prasanna kumar rao, Veena KM, Laxmikanth Chatra;
Scientific reports; 2012, vo :1;issue : 6

TAURODONTISM
o Originated by Sir Arthur Keith in 1913
o Body of the tooth is enlarged at the expense of the roots.
o ‘Bull- like’ teeth
48

o Causes: (Enumerated by Mangion)
a) Specialized or retrograde character
b) Primitive pattern
c) Mendelian recessive trait
d) Mutation resulting from odontoblastic deficiency during
dentinogenesis of roots
• Failure of hertwig’s epithelial sheath to invaginate at proper
horizontal level. (Hammer & his associates)
50

o Clinical Features:
a) Either deciduous or permanent dentition
b) Molars
c) Unilateral or bilateral
o Radiographic Features:
a) Involved teeth– rectangular shape
b) Pulp chamber– extremely large– much
greater apico-occlusal height
c) Pulp lacks usual constriction
at cervical of tooth
a) Roots– exceedingly short
b) Furcation– only few mm above the apices
of roots
51

• Syndrome associated:
1. Klinerfelter’s syndrome
2. Trichodento-osseous syndrome
3. Ectodermal dysplasia
4. Downs syndrome
• Diagnosis
Made only radiographically.
• Treatment : No specific therapy

TALONS CUSP
o Anomalous structure
o Resembles eagle’s talon
o Projects lingually from the cingulum area
o Maxillary or Mandibular permanent incisor
o Composed of normal enamel & dentin &
contains a horn of pulp tissue
o Clinical problems include: esthetics, caries
control, occlusion
53

Three types :
Type 1 : Additional cusp from incisal edge to half
to CEJ
Type 2 : Semi talon, extends from incisal edge to
1mm past half of the CEJ
Type 3 : Prominent enlarged cingulum
o Treatment:
* Prophylactically restoring groove– to prevent caries
* Occlusal interference–- it should be removed, but
exposure of pulp horn— endodontic treatment
Shrestha, Ashish; Marla, Vinay; Shrestha, Sushmita; Maharjan, Iccha K Developmental anomalies affecting
the morphology of teeth – a review RSBO Revista Sul-Brasileira de Odontologia, vol. 12, núm.1,enero-marzo,
2015, pp. 68-78

Case report
• Talon’s cusp of anterior teeth : A Case report
Moksha Nayak,Jitendra kumar,Krishna Prasad; Journal of
Endodontology

SHOVEL-SHAPED TEETH
• Characterstic shape on lingual side
• Lingual side is deeply concave giving tooth appearance of
shovel
• Seen in chinese, japanese, eskimos, north/south american
indians
• Anterior maxilla

PARAMOLAR TUBERCLES / BOLK CUSP
• Genetic basis
• Seen on buccal surface of mesiobuccal cusp in permanent and
deciduous teeth
• Vary in populations, never seen in negroes
• Observed in 31% of a group of Pima Indians

DENS EVAGINATUS
o Occlusal Tuberculated Premolar, Leong’s
Premolar, Evaginated Odontome, Occlusal
Enamel Pearl
o Prevalence : 2.2 % Yip 1974
o Appears clinically as an accessory cusp or
a globule of enamel
o Occlusal surface between buccal & lingual
cusps of premolars
o Unilaterally or bilaterally
58

o Pathogenesis: proliferation & evagination of an area of inner
enamel epithelium & subjacent odontogenic mesenchyme into
dental organ during early tooth development.
o Can cause:
* Incomplete eruption
* Displacement of teeth
* Pulp exposure
* Occlusal wear
* Fracture
59

Treatment
• Vital teeth : Selective grinding followed by fissure sealing
[Hill&Bellis(1984)]
• Selective pulpotomy
• Nonvital teeth : endodontic treatment

DENS INVAGINATUS
o Dens In Dente, Dilated Composite Odontome
o Developmental variation- Invagination in the surface of tooth
crown before calcification has occurred
o Etiology-
• Increased localized external pressure
• Focal growth retardation
• Focal growth stimulation in certain areas of tooth bud
61
Pediatric dentistry, scientific foundation and clinical practice by Stewart and Barber, 1st
edition.

 Type I
 Confined to the crown
 Type II
 Extends below cemento
enamel junction
 Ends in a blind sac
 May or may not communicate with adjacent dental
pulp
Type III
 Extends through the root
 Perforates in the apical or lateral radicular area
without any immediate communication with pulp

• It is a condition resulting from invagination of inner enamel
epithelium in enamel organ producing the appearance of tooth
within a tooth (pinkham)
• Radicular invagination results from infolding of Hertwig”s
sheath and takes its origin from the root after development is
complete ( Bhatt and Dholakia)
o Permanent maxillary lateral incisor
o Bilateral
o Mild form: deep invagination in the lingual pit area–- not
evident clinically.

o Radiographically- pear shaped invagination
of enamel & dentin
o Severe form: invagination extends nearly to
the apex of the root
o Can cause: caries, pulp infection,
premature loss of tooth
o Treatment: prophylactic restoration.
64

 Undersized lateral incisor
 Smaller than normal
 Occurs when permanent lateral
incisors do not fully develop
PEG SHAPED LATERALS

Dental condition usually associated
with congenital syphilis
 Characterized by multiple rounded
rudimentary enamel cusps on permanent
1st molars
MULBERRY MOLARS

 Dwarfed molars with cusps
covered with globular enamel
growths
 Giving the appearance of a
mulberry

 Root
 Concresence
 Enamel Pearl
 Dilaceration
 Flexion
 Ankylosis
Supernumerary roots
Shape and Form

 2 fully formed teeth
 Joined along the root surfaces
by cementum
 Noted more frequently in
posterior and maxillary regions
CONCRESCENCE

Case report
Concrescence in primary dentition: A case report
Zakirulla Meer, N Rakesh;International journal of clinical
dental science;May 2011;2(2)

Dilaceration
• Angulation or a sharp bend or curve in
root or crown of a formed tooth
• Trauma to a developing tooth can cause
root to form at an angle to normal axis
of tooth
• Rare deformity
• Usually seen in deciduous dentition

Three main etiologic theories for dilacerations
• Acute trauma
Before 4-5yrs of age
• Scar formation
Trauma to primary tooth causes a wound – scar prevents normal
eruption, root adheres to scar & rotate around this fixed point
• Primary tooth germ developmental anomaly
Treatment:
• Deciduous teeth – Extraction
• Permanent teeth
Minor – no treatment
Delayed / abnormal eruption – surgical exposure and
extraction
• Nonvital teeth – Endodontic treatment /extraction
• Extensive --- Extraction

 Droplets of ectopic enamel so called
enamel pearls
 May occasionally be found on
roots of teeth
 Uncommon, minor abnormalities,
which are formed on normal
teeth
ENAMEL PEARLS

 Occur most commonly in bifurcation
or trifurcation of teeth
 May occur on single-rooted premolar
as well
 Maxillary molars are commonly
affected than mandibular molars

 also known as “submerged teeth”
 Fusion of a tooth to surrounding
bone
 Deciduous teeth most commonly
mandibular 2nd molars
 Undergone variable degree of root
resorption
ANKYLOSIS

 This process prevents their
exfoliation + subsequent replacement
by permanent teeth
 After adjacent permanent teeth have
erupted, ankylosed tooth appears to
have submerged below level of
occlusion

SUPERNUMERARY ROOTS
o Development of an increased number of roots in a tooth
compared with normal
o May involve any tooth
o Mandibular bicuspids & cuspids
o Both maxillary & mandibular molars–-particularly 3rd molars.
78

Deviation or bend restricted just to the root
portion
 Usually bend is less than 90 degrees
 May be a result of trauma to the
developing tooth
FLEXION

DEVELOPMENTAL DISTURBANCES
IN STRUCTURE OF TEETH
 Amelogenesis Imperfecta
 Environmental Enamel Hypoplasia
 Dentinogenesis Imperfecta
 Dentin Dysplasia
 Regional Odontodysplasia
80

AMELOGENESIS IMPERFECTA
o Amelogenesis = enamel formation
Imperfecta = imperfect
o Also known as
* Hereditary Enamel Dysplasia
* Hereditary Brown Enamel
* Hereditary Brown Opalescent Teeth
o It is a heterogeneous group of hereditary disorders of enamel
formation
81

• The first definition of AI – as a disease caused by a primary
defect in enamel – has been attributed to Weinmann et al
(1945)
• Subsequently, Witkop and Rao (1971) defined AI as
“A group of disfiguring hereditary conditions’ which
affect the clinical appearance of enamel of all or nearly all the
teeth, which occur in kindreds such that all the individuals in
the kindred show essentially the same defect and which are
unassociated with known morphologic or biochemical changes
elsewhere in the body”
82

Mutations in following genes:
• AMELX (associated with enamel protein amelogenin, X-
linked and linked with all 14 types)
• ENAM (associated with enamelin, associated with autosomal
dominant and recessive patterns of HP AI)
• MMP-20 (encodes for proteinase named enamelysin,
correlated with autosomal recessive, HM AI)
• KLK-4 (Protease kallikrein-4, associated with HM AI)
• DLX-3 (associated with various group of proteins that code
for craniofacial, tooth, hair, brain and neural development.
Correlated with HP-HM with taurodontism AI)

CLASSIFICATION – WITKOP’S (1988)
• Type I Hypoplastic (60-73%)
IA – hypoplastic, pitted autosomal dominant
lB – hypoplastic, local autosomal dominant (ENAM)
IC – hypoplastic, local autosomal recessive
ID – hypoplastic, smooth autosomal dominant (ENAM)
IE – hypoplastic, smooth X-linked dominant (AMELX)
IF – hypoplastic, rough autosomal dominant
IG – enamel agenesis, autosomal recessive
• Type II Hypomaturation (20-40%)
IIA – hypomaturation, pigmented autosomal recessive
IIB – hypomaturation, (AMELX)
IIC – snow-capped teeth, X-linked
lID – autosomal dominant

• Type III Hypocalcified (7%)
IIA – autosomal dominant
IIB – autosomal recessive
• Type IV -Hypomaturation–hypoplastic with taurodontism
IVA – Hypomaturation–hypoplastic with taurodontism,
autosomal dominant
IVB – Hypoplastic–hypomaturation with taurodontism,
autosomal dominant

 Inadequate formation of matrix
 Enamel is randomly:
 pitted
 grooved or very thin
 hard + translucent
 Defects become stained but teeth are
not especially susceptible to caries unless
enamel is scanty and easily damaged
Hypoplastic Amelogenesis Imperfecta

 Reduced enamel thickness
 abnormal contour
 absent interproximal
contact points
 Radiographically:
 Enamel reduced in bulk
Shows thin layer over occlusal
interproximal surfaces
 Dentin + pulp chambers
appear normal

 Enamel is normal in form on
eruption but:
 Opaque
 White to brownish-yellow
 Softer than normal
 Tends to chip from underlying dentin
Hypomaturation Amelogenesis
Imperfecta

Radiographic Features:
• Enamel may appear totally absent.
• When present-- appear as very thin layer
mainly over tips of the cusps &
interproximal surfaces
• Enamel & dentin–- same radiodensity

 Enamel matrix is formed in
normal quantity
 Poorly calcified
 When newly erupted:
 enamel is normal in thickness
 normal form
 but weak
 opaque or chalky in appearance
Hypocalcified Amelogenesis Imperfecta

 density of enamel + dentin are
similar

hypomaturation-hypoplastic amelogenesis
imperfecta with taurodontism
• Distinct from trichodentoosseous (TDO) syndrome
• Teeth meet at contact points, normal contour
• Softer than normal, ground glass opaque white appearance
• Shows alternate vertical bands of white opaque and normal
translucent enamel
• Seen commonly in boys

Histologic features:
• There is disturbance in the differentiation or viability of
ameloblast in the hypoplastic type, and this is reflected in
defect in matrix formation ,including total absence in matrix
formation
• In the hypocalcification types there are defect of matrix
structure and of mineral deposition.
• In hypomaturation types there are alterations in enamel rods
and rod sheath structure.

Radiographic features:
• Overall shape of the tooth may or may not be normal,
depending on the amount of enamel present on the tooth and
the amount of occlusal and incisal wear.
• Enamel may be totally absent on the radiographs or when
present may appear as a thin layer, chiefly over the tip of the
cusps and on interproximal surface.
• In some cases calcification of the enamel may be so affected
that it appears to have the same approximate radiodensity as
the dentin, making differentiation between the two difficult.

Diagnostic methods
• The family history
• Clinical observation
• Extraoral radiographs may reveal the presence of unerupted
and sometimes spontaneously resorbing teeth
• Intra-oral radiographs will reveal the relative contrast
between enamel and dentine in cases where mineralisation
may have been affected.
95

Differential diagnosis
• Extrinsic disorders of tooth formation
• Chronological disorders of tooth formation
• Localised disorders of tooth formation
96

Treatment:
Cases with rapid attrition
• Proper crown length : full coverage restorations
• Insufficient length: full dentures; overdentures
Esthetics as prime concern:
• Full crowns
• composite resin veneers for anterior
Lack of good enamel bonding may occur
• Overcome by - Using GIC with dentinal adhesives

ENAMEL HYPOPLASIA
Amelogenesis occurs in two stages.
• In the 1st stage enamel matrix forms,
In the 2nd stage matrix undergoes calcification.
• Defination : It may be defined as an incomplete or defective
formation of the organic enamel matrix of teeth. - SHAFER
- Factors that interfere with calcification and maturation of the
enamel produce a condition termed ENAMEL
HYPOCALCIFICATION.

Types of enamel hypoplasia
1. Hereditary type ( amelogenesis imperfecta)
2. A type caused by environmental factors :
a)Nutritional deficiency &
Exanthematous fever
b) Congenital Syphilis
c)Hypocalcemia
d)Birth Injuries
e)Local infection, trauma
f)Flouride
g)Idiopathic Factors

Treatment (AAPD 2013)
• General considerations and principles of management: A
primary goal for treatment is to address each concern as it
presents but with an overall comprehensive plan that outlines
anticipated future treatment needs.
• Preventive care: Meticulous oral hygiene, calculus removal,
and oral rinses can improve periodontal health. Fluoride
applications and desensitizing agents may diminish tooth
sensitivity.
100

• Restorative care: When the enamel is intact but discolored,
bleaching and/or microabrasion may be used to enhance the
appearance.
• If the enamel is hypocalcified, composite resin or porcelain
veneers may be able to be retained with bonding.
• Primary teeth may require composite or veneered anterior
crowns with posterior full coverage steel or veneered crowns.
• Permanent teeth require veneers, full coverage crowns,
implants, and fixed or removable prostheses.
101

Amelogenesis imperfecta -lifelong management..Restorative management of the adult patient
m. Patel,*1 s. T. Mcdonnell,2 s. Iram1 and m. F. W-y. Chan1
British dental journal volume 215 no. 9 nov 9 2013
A mild case of AI which has been treated with microabrasion initially followed by placement
of direct composite veneers. Microabrasion has significantly improved the discolouration
making it easier to restore aesthetics with minimal intervention using composite resin

Case report
Dental rehabilitation of amelogenesis imperfecta using thermoformed templates ;
sockalingam snmp; journal of indian society of pedodontics and preventive
dentistry | jan - mar 2011 | issue 1 | vol 29 |

 Also known as “Hereditary
Opalascent Dentin”( Skillen, Finn & Hodges)
- Due to clinical discoloration of teeth
Incidence : 1in 6,000 to 1 in 8,000 (witkop 1957)
• Follows autosomal dominant trait
• Chromosome 4 (DSPP )– Dentin sialophosphoprotein
 Affects both primary and permanent dentition
Dentinogenesis Imperfecta

 Have blue to brown discoloration
 With distinctive translucence
 Enamel frequently separates
easily from underlying defective
dentin

DI has been classified by Shields and co-workers [1974] into
three types:
1. Type I
DI associated with osteogenesis imperfecta (OI). Both
are mesodermal defects, (although OI may occur without DI).
2. Type II
DI without OI.
3. Type III
Brandywine type. It is a rare variety characterized by
shell teeth, with very little dentin and multiple pulp exposures
in the primary teeth.
107

Revised Classification
108
• Dentinogenesis Imperfecta type 1 (Shield’s type 2) :
opalescent dentin. DI without OI
• Dentinogenesis Imperfecta type 2(shield’s type 3) :
Brandywine type DI (Shell teeth)

Type I : Dentinogenesis Imperfecta
• Never occurs in association with
osteogenesis imperfecta unless by chance
• Most frequently referred to as hereditary
opalascent dentin
• Clinical features:
– Blue gray or amber brown teeth.
– Bulbous crowns
– Narrow root canals or completely
obliterated.
– Brittle enamel

• Radiographically:
– partial or total obliteration of pulp chambers + root canals
– by continued formation of dentin
– roots may be short + blunted
– cementum, periodontal membrane + bone appear normal
• Increased Glycosaminoglycans seen

Type II : Dentinogenesis Imperfecta
• “Brandywine type”
• Multiple pulp exposures in deciduous
not seen in type I or II
• Periapical radiolucencies
• Enamel appears normal
• Large size of pulp chamber is not due
to resorption but rather to insufficient
+ defective dentin formation

• HISTOLOGICAL: enamel
formation seems normal. Tubules
seem to be larger in diameter and
not evenly distributed.
• TREATMENT: primarily toward
preventing loss of enamel. Cast
metal crowns, and jacket crowns

 MacDougall et al in 1999 stated:
DGI – 1 can be differentiated from DGI – 2 by :-
 Presence of multiple pulp exposures.
 Normal nonmineralized pulp chamber and canals.
 Shell teeth

 Normal thickness enamel
 Extremely thin dentin
 Enlarged pulps
 Thin dentin may involve
entire tooth or be isolated
to the root
 Most frequently in deciduous
Shell Tooth

AAPD guidelines 2013
• Preventive care : Meticulous oral hygiene, calculus removal,
and oral rinses can improve periodontal health. Fluoride
applications and desensitizing agents may diminish tooth
sensitivity.
• Restorative care: the treatment of choice is full coverage
restorations in both the primary and permanent dentitions.
• Overlay dentures placed on teeth that are covered with
fluoride-releasing glass ionomer cement
115

• Endodontic considerations: multiple periapical abscesses are
common and routine radiographic check ups required.
• Because of pulpal obliteration, apical surgery may be to
maintain the abscessed teeth.
• Occlusion: Class III malocclussion with high incidences of
posterior cross bites and anterior open bites occur in DI Type
I.
116

Case report
Subramaniam p., Mathew s., Sugnani s. N. Dentinogenesis
imperfecta: a case report ; j indian soc pedod prevent dent -
June 2008
117

DENTIN DYSPLASIA
• Originally termed “rootless teeth”
• Autosomal dominant inherited disorder characterized by
abnormal dentin formation and abnormal pulpal
morphology.
• Incidence 1 in 100,000 (witkop 1957)
118
A hereditary defect in dentin formation in which the coronal
dentin and tooth color are normal; the root dentin is abnormal
with a gnarled pattern and associated shortened and tapered
roots.

• Also known as “Rootless Teeth”
• Rare disturbance of dentin formation
• Normal enamel
• Atypical dentin formation
• Abnormal pulpal morphology
• Hereditary disease
• Classification:
– Type I (Radicular Type)
– Type II (Coronal Type)

Dentin Dysplasia : Type I (Radicular Type)
• Both dentitions are of normal color, periapical
lesion
• Premature tooth loss may occur because of
short roots or periapical inflammatory lesions
– roots are extremely short
– pulps almost completely obliterated
– periapical radiolucencies:
 granulomas
 cysts
 chronic abscesses

121
o Histological feature :
• Dentinal tubules formation
appear to be blocked so new
dentin forms around obstacles.
• Characteristic appearance – lava
flowing around boulders.
• Forms due to repetitive attempts
to form root.

Dentin Dysplasia : Type II (Coronal Type)
• Color of primary dentition is opalescent
• Permanent dentition is normal
• Coronal pulps are usually large (thistle tube
appearance)
• filled with globules of abnormal dentin
(Deciduous)
– roots are extremely short
– pulps almost completely obliterated
(Permanent)
– abnormally large pulp chambers in
coronal portion of tooth

Treatment and Prognosis
• General considerations and principles of management: Due
to shortened roots and periapical lesions, the prognosis for
prolonged tooth retention is poor. Prosthetic replacement
including dentures, overdentures, partial dentures, and/or dental
implants may be required
• Preventive care: Meticulous oral hygiene must be established
and maintained. As a result of shortened roots with DD Type I,
early tooth loss from periodontitis is frequent.
123

• Restorative care: Teeth with DD Type I have such poor
crown to root ratios that prosthetic replacement including
dentures, overdentures, partial dentures, and/or dental
implants are the only practical courses for dental
rehabilitation.
• Teeth with DD Type II that are of normal shape, size, and
support can be restored with full coverage restorations if
necessary.
• For esthetics, discolored anterior teeth can be improved with
resin bonding, veneering, or full coverage esthetic
restorations.
124

• Endodontic considerations:
Endodontic therapy, negotiating around pulp stones and
through whorls of tubular dentin, has been successful in
teeth without extremely short roots.
(AAPD 2013)
125

Dentin dysplasia - A case report
Hegde M and Hegde ND Endodontology, Vol. 16,
2004
Intra oral periapical radiograph showing
lower central incisors, lateral incisors
and canines with no roots
Intra oral periapical radiograph of the
upper anterior teeth showing short
malformed roots.

- Given by Pindborg 1970
- Also known as:
 Odontogenic Dysplasia
 Odontogenesis Imperfecta
 Ghost Teeth ( Rushton 1965)
Regional Odontodysplasia

 one or several teeth in a localized area are
affected
 maxillary teeth are involved more
frequently than mandibular area (2:1)
(Lutsman 1975)
 Etiology : local circulation disorders,
viral infections, local trauma , metabolic
disturbances , somatic and neural mutations
(Crawford and Aldred 1989)

 Teeth affected may exhibit
a delay or total failure in
eruption
 Shape is altered, irregular
in appearance

 Marked reduction in radiodensity
 Teeth assume a “ghost appearance
 Both enamel + dentin appears very thin
 Pulp chamber is exceedingly
large

 Treatment:
 Poor cosmetic appearance of teeth
 Extraction with restoration by
prosthetic appliance

Case report
Abel Cahuana, Yndira González, Camila Palma, Clinical
Management of Regional Odontodysplasia Pediatric
Dentistry – 27:1, 2005
132

DENTIN HYPOCALCIFICATION
• Normal dentin is calcified in the form of globules which
increase in size and coalesce with each other.
• Here, there is a failure of union of these globules.
• Presence of uncalcified interglobular areas.
• Although on the outside, tooth structure remains normal.
• Could be because of environmental factors similar to enamel
hypoplasia
• Example: parathyroid deficiency, rickets.

NATAL AND NEO-NATAL
TEETH
MYTHS AND MISCONCEPTIONS

ERUPTION SEQUESTRUM
• It’s a tiny irregular spicule of bone
overlying the crown of an erupting
permanent molar.
• ETIOLOGY: as the molar teeth erupt
through the bone, they will
occasionally separate a small osseous
fragment from the surrounding bone.
In most cases, the fragment resorbs
unless its too large for it to get
resorbed completely

Supernumerary teeth: A case report
• A boy, aged 14 years reported to our dental clinic with
complaints of many teeth in the mouth. He gave a history that
three teeth were already extracted in the upper anterior region
as they were ‘extra’
ARATHI R., ASHWINI R., J Indian Soc Pedod Prev Dent - June 2005,103-105.

Dens evaginatus of anterior teeth (talon cusp)
associated with other odontogenic anomalies
• An eight year old female patient reported to the department with the
complaint of malalignment of upper anterior teeth.
• Intraoral examination showed the maxillary permanent lateral incisors
exhibited pronounced cusp like structure projecting from the cingulum area
(semitalon).
• The other dental abnormality recorded was bilaterally, palatally erupting
two supernumerary teeth in the maxillary incisors region
SHARMA A. J Indian Soc Pedod Prev Dent - Special issue 2006,41-46.

• A nine year old boy reported with the chief complaint of odd
looking upper front teeth. Oral examination revealed both the
maxillary permanent lateral incisors with enlarged or
prominent cingula (trace talon).
• Other odontogenic variations detected were shovel shaped
central incisors with bifid cingula and a palatally erupted,
conical supernumerary tooth between the maxillary central
incisors
SHARMA A. J Indian Soc Pedod Prev Dent - Special issue 2006,41-46.

Authors
and year
Aim Study design Results Conclusion
Kruthika
S ,Puneet
Bhargava
, Renuka
in july
2010
To evaluate
the
frequency
of
developme
ntal dental
anomalies
in the
Indian
population
This prospective study was
conducted over a period of 1
year and comprised both
clinical and radiographic
examinations in oral
medicine and radiology
outpatient department. Adult
patients were screened for
the presence of dental
anomalies with appropriate
radiographs. A
comprehensive clinical
examination was performed
to detect hyperdontia, talon
cusp, fused teeth,
gemination, concrescence,
hypodontia, dens
invaginatus, dens evaginatus,
macro- and microdontia and
taurodontism.
Of the 20,182
patients screened,
350 had dental
anomalies. Of these,
57.43% of
anomalies occurred
in male patients and
42.57% occurred in
females.
Hyperdontia, root
dilaceration,
pegshaped laterals
(microdontia), and
hypodontia were
more frequent
compared to other
dental anomalies of
size and shape.
Dental anomalies
are clinically
evident
abnormalities.
They may be the
cause of various
dental problems.
Careful
observation and
appropriate
investigations are
required to
diagnose the
condition and
institute
treatment

Authors
and year
Rachana
V
Prabhu,
Prasanna
Kumar
Rao,
Veena
KM,
Prathima
Shetty,
Laxmika
nth
Chatra,
Prashant
h Shenai
in 2012
prevalence
of the talon
cusps in a
sample of
Indian
dental
patients and
their
distribution
among
different
types of
teeth.
presence of
other dental
anomalies
associated
with the
talon cusps.
2740 out patients
(1523 males and
1217 females)
attending Oral
Medicine department
from November
2010 to January
2011 were screened
for the presence of
talon cusps and were
subjected to Intra
Oral Peri-apical
(IOPA) radiograph to
rule out any
associated anomalies
or peri-apical
changes.
Talon cusps were detected in 16
out of 2740 patients (person
prevalence 0.58%). Thirty one
teeth were found to have talon
cusp. Maxillary lateral incisors
were the most commonly
affected teeth (54.8%, 17 teeth),
followed by maxillary central
incisors and canines (16.12%, 5
teeth).Talon cusp was found in
two mandibular central incisors
(6.45%) and one each in
mandibular second and third
molar (3.22% each). Seventeen
teeth in 7 patients (54.83%)
were found to be associated with
anomalies like dens invagination
(6 teeth, 19.35%), impacted 13,
23 (6 teeth, 19.35%), partial
anodontia (3 teeth, 9.67%),
geographic and fissured tongue
(2 teeth, 6.45%). Peri-apical
Attention
should be
paid to the
presence of
the talon
cusp and the
associated
anomalies.
Early
diagnosis of
the talon
cusp can help
the clinician
in preventing
the further
complication
s

Authors
and year
Santosh
Patil,
Bharati
Doni,
Sumita
Kaswan,
Farzan
Rahman
in 2013.
to
determine
the
prevalence
of dental
anomalies
in the
Indian
population.
A retrospective study of
4133 panoramic radiographs
of patients, who attended the
Department of Oral Medicine
and Radiology, Jodhpur
Dental College General
Hospital between September
2008 to December 2012 was
done. The ages of the
patients ranged from 13 to 38
years with a mean age of
21.8 years. The
orthopantomographs (OPGs)
and dental records were
examined for any unusual
finding such as congenitally
missing teeth, impactions,
ectopic eruption,
supernumerary teeth,
odontoma, dilacerations,
taurodontism, dens in dente,
germination and fusion,
1519 (36.7%)
patients had at least
one dental anomaly.
The congenitally
missing teeth 673
(16.3%) had the
highest prevalence,
followed by
impacted teeth 641
(15.5%),
supernumerary teeth
51 (1.2%) and
microdontia 41
(1.0%). Other
anomalies were
found at lower
prevalence ranging
from transposition 7
(0.1%) to ectopic
eruption 30 (0.7%).
The most
prevalent
anomaly in the
Indian population
was congenitally
missing teeth
(16.3%), and the
second frequent
anomaly was
impacted teeth
(15.5%),
whereas,
macrodontia,
odontoma and
transposition
were the least
frequent
anomalies, with a
prevalence of
0.2%, 0.2% and
0.1%
respectively.

Authors
and year
Mitesh D
Kathariy,
Atul
Pralhad
Nikam,
Kirti
Chopra,
Namrata
N Patil,
Hitesh
Raheja,
Renuka
Kathariy
in 2013
to
investigate
the
prevalence
of dental
anomalies
according
to gender
among
children.
This cross-sectional study
was conducted a group of
600 children, of them 293
(48.8%) were males and
275 (45.8%) females which
were taken with proper
sampling technique. Type
III clinical examination was
done to know the
prevalence of dental
anomalies. The Statistical
software namely SPSS
version 16.0 was used for
data analysis.
Impactions (39.2%)
were the most
common anomaly in
this study and most of
the impacted teeth
were related to
maxilla. A significant
difference was seen
in case of hypodontia,
microdontia and
talons cusp according
to gender in which
first two anomalies
were more among
females and last one
among males.
Children with one
dental anomaly were
25.8%, and 13.4%
were having more
than one
The percentage
of dental
anomalies were
high specially
impaction and
rotated teeth. So
these anomalies
should be treated
earlier to avoid
further
complications.

Authors
and year
Rajesh T
Anegund
i,
Veeresh
S
Tegginm
ani1,
Prashant
Battepati,
Anand
Tavargeri
, Shruthi
Patil,
Vijay
Trasad,
Garima
Jain in
2014
To describe
the
distribution
and
characterist
ics of the
supernumer
ary teeth in
South
Indian
population
of
paediatric
patients.
In a 12 year
retrospective study, a
total of 63,569 patients
up to the age of 14 years
who visited our
department between June
2003 and May 2013
were revised.790 cases
of supernumerary teeth
were found. Patients
were evaluated for age,
sex, site, status of
dentition, number,
position, orientation and
type of supernumerary
teeth. Statistical analysis
was carried out using chi
square test
790 subjects with
supernumerary teeth (481
males and 309 females)
were detected, revealing
male-female ratio of
1.55:1.The most common
supernumerary teeth were
mesiodens (82.28%), the
most common site was
the anterior maxilla
(92.53%)region. Majority
of patients had a single
erupted supernumerary
oriented straight in the
arch. Patients in mixed
dentition stage reported
with maximum number of
supernumerary teeth.
The prevalence
of
supernumerary
teeth in non
syndromicSout
h Indian
paediatric
population is
1.24% with
slight male
predilection and
conical
mesiodens
being the
commonest.

CONCLUSION

 Since development of tooth forms the base of dentistry, a
thorough understanding and a sound knowledge is required by
a dentist regarding the development stages of tooth & the
anomalies related to it, so as to identify & treat them in a
proper fashion.

References
• Pediatric dentistry, scientific foundation and clinical practice
by Stewart and Barber, 1st edition.
• Shafer’s textbook of oral pathology, 7th edition
• Orban’s Oral Histology and Embryology : 12th edition
• Ten Cate’s Oral Histology Development, Structure, and
Function Antonio Nanci : 7th edition
• Seema D bagle, shital DP Kiran non-syndromic occurrence of
true generalized microdontia with mandibular mesiodens- a
name case Head face medicine 2011; 7 ; 19

• ARATHI R., ASHWINI R., J Indian Soc Pedod Prev Dent -
June 2005,103-105.
• SHARMA A. J Indian Soc Pedod Prev Dent - Special issue
2006,41-46.
• Patil S, Doni B, Kaswan S, Rahman F. Prevalence of dental
anomalies in Indian population. J Clin Exp Dent.
2013;5(4):e183-6.
• Anegundi RT, Tegginmani VS, Battepati P, Tavargeri A, Patil
S, Trasad V, Jain G. Prevalence and characteristics of
supernumerary teeth in a nonsyndromic South Indian pediatric
population. J Indian Soc Pedod Prev Dent 2014;32:9-12.

• Kruthika S Guttala Venkatesh G Naikmasurb Puneet
Bhargavac Renuka J Bathid ,Eur J Dent 2010;4:263-269.
• Kathariya MD, Nikam AP, Chopra K, Patil NN, Raheja H,
Kathariya R. Prevalence of Dental Anomalies among School
Going Children in India. J Int Oral Health 2013; 5(5):10-14.
• Prabhu RV, Rao PK, Veena KM, Shetty P, Chatra L,
Prashanth Shenai. Prevalence of Talon cusp in Indian
population. J Clin Exp Dent. 2012;4(1):e23-27.
•

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