This document summarizes various dental anomalies: 1. Ankylosis is the fusion of tooth cementum to alveolar bone, which can occur during eruption. It is classified as mild, moderate, or severe based on occlusal surface location. 2. Ectopic eruption involves a tooth erupting in an abnormal path, often intercepting a primary tooth. It may cause premature loss of the primary tooth. 3. Primary failure of eruption is a rare condition where permanent teeth fail to erupt for unknown reasons, sometimes resulting in an open bite distal to the affected area.

2. 1. Ankylosis
2. Ectopic eruption
3. Premature loss of deciduous teeth
4. Delayed eruption
5. Primary failure of eruption
6. Single tooth in crossbite
7. Gingival recession
8. Midline diastema
9. Molar Incisor hypomineralization
10. Late lower incisor crowding

5.  Anatomical fusion of alveolar bone with
tooth cementum
 It can occur at any time during eruption
either before or after the tooth emerges into
the oral cavity

6. Mild The entire occlusal surface is located at least 1 mm below the
occlusal plane and above the contact point of the adjacent non-
ankylosed teeth.
Moderate The entire occlusal surface is located below the contact point level
but above the CEJ of adjacent tooth.
Severe The entire occlusal surface is level with or below the CEJ of the
adjacent tooth

7. 1. Syndromic
2. Non-Syndromic
a. Genetic
b. Trauma
c. Infection
d. Radiation and chemicals
e. Congenital absence of the second premolar.
f. Idiopathic
g. Iatrogenic

8.  Any tooth that reached the occlusal plane
and subsequently dropped out of occlusion
should be considered ankylosed
 Mobility test
 Percussion sound

9.  radiographic examination if the area of
ankylosis is of sufficient size

10.  Computerized tomography (CT)
 Failure of the tooth to move following the
application of orthodontic forces is believed to
be the definitive diagnostic test

11.  In the presence of permanent successor
1. Exfoliate naturally
2. Restore the vertical dimension or extract the
affected tooth with lingual or palatal arch to
maintain the space if the infraocclusion
becomes greater

12. In the absence of a permanent successor or if the
permanent tooth is severely displaced
1. Retention of the second deciduous molar
2. Early extraction to facilitate spontaneous space
closure
3. Premolaizing the E
4. Extraction and prosthetic replacement

13.  It depends on whether the patient is growing
or not
 If he is a growing patient then extract
ankylosed tooth to prevent bone deficiency in
the area of ankylosis
 If he is a non growing patient, maintain the
tooth as previously mentioned

14. If they survive to twenty years of age, continued
long-term function can be anticipated

15. 1. Extraction of the ankylosed tooth followed by prosthetic replacement.
2. Surgical luxation followed by periodontal ligament distraction
3. Osteotomy of the dentoalveolar segment with immediate repositioning of the
dentoalveolar structures.
4. Osteotomy followed by intraoral distraction.

16. 5. Osteotomy followed by heavy orthodontic forces.
6. Osteotomy followed by a combination of dentoalveolar distraction and light
orthodontic forces.
7. Osteotomy followed by conventional orthodontic forces.
8. Osteotomy with partial repositioning followed by heavy orthodontic forces
9. Lingual corticotomy of the dentoalveolar segment, followed by a labial
corticotomy three weeks later and a conventional orthodontic force.

19.  A condition in which the permanent teeth,
because of deficiency of growth in the jaw or
segment of jaw, assume a path of eruption
that intercepts a primary tooth, causes its
premature loss and produces a consequent
malposition of the permanent tooth.

20. Grade I Mild – limited resorption to cementum or with minimum dentin
penetration
Grade II Moderate – resorption of the dentin without pulp exposition
Grade III Severe – resorption of the distal root leading to pulp exposure
Grade IV Very severe – resorption that affects the mesial root of the primary
second molar

21.  If angle is from 15-30˚ of ectopic molar then
good prognosis of eruption

22. 1. Genetic
2. Associated with developmental disorders (ectopic
canines)
3. Increased mesial-distal width of 6
4. Increased mesial eruption angle of 6
5. Delayed calcification of the effected molars
6. Small maxilla

23.  Eruption path where distal cusps emerge before
mesial cusps
 Unilateral or bilateral delay in emergence of 6
 Bulbos E and small jaw
 Mobility of E
 Neuralgia at area of 6
 Diagnosis confirmed by dental radiographs
(superimposition and impaction against
distobuccal root of deciduous tooth)

24.  80% self-correct by age 7yrs while 10% self-
correct at age 8 or 9yrs

25. If resorption of E <1.5mm
observe 3-6months (to establish if reversible)
if no resorption and vertical position
improved
monitor eruption
if no resorption and vertical position not
improved
expose unerupted 6 and wait for 3 months
if still not improving treatment to move the impacted tooth
distally

26. If resorption of E >1.5mm
• If E symptomatic or mobility >1mm consider extraction and management of
space problem once 6 erupts
If E asymptomatic and mobility <1mm and
6 partially erupted
treatment to move the impacted tooth
distally
If E asymptomatic and mobility <1mm and
6 unerupted
expose 6 and commence treatment to
move the impacted tooth distally

27. 6 is partially erupted
 Brass wire ligature
 Elastomeric
 Halterman appliance
 Humphrey appliance
 Steel spring clip separators
 Orthodontic band on the E and a bonded bracket on the exposed cusp of
6, with an open coil spring
6 is unerupted
 Surgically expose and try above techniques or distal extension attached
to SS crown

29.  Orthodontic band on E with attached distal
spring +/- transpalatal arch when maximal
anchorage required (Halterman appliance)

30. A bonded button is placed on
the first permanent molar at the
same time the appliance is
cemented on the second
primary molar. The free arm
engages on the mesial side of
the button using reciprocal
anchorage to distalize the
permanent molar
Activation at 3 to 4-week
intervals is made with three-
prong pliers until overcorrection
occurs

33. Extent of it depends upon the degree of
crowding, the patient’s age, and the site

34. Local factors
1. Trauma
2. Periapical pathology
3. Periodontal problem
4. Caries
General factors
1. Congenital disease, fibrous dysplasia
2. Nutritional, vitamin D deficiency
3. Endocrine, diabetes
4. Genetic disease, hypophosphatemia or Ehler Danlos
syndrome
5. Tumour
6. Iatrogenic

35. 1. Stage of eruption of successors
2. Which tooth: space loss greater for E`s than D`s
by mesial drift of permanent teeth
3. rate of space closure is greater in maxilla than
mandible
4. Amount of crowding: greater space loss in
crowded dentitions
5. Occlusal interlocks

36.  Radiographic screening
To make sure permanent is present

37.  Loss of primary incisors – Early loss of primary incisors has little
effect. It is not necessary to balance or compensate the loss of a
primary incisor
 Loss of primary canines– In all but spaced dentitions is likely to
have most effect on centre lines.The more crowded the dentition,
the more the need for balance
 Loss of primary first molars – Balancing extraction may be
needed in a crowded arch but compensation is not needed
 Loss of primary second molars –There is no need to balance the
loss of a primary second molar because this will have no
appreciable effect on centreline coincidence. However, when a
primary second molar has to be extracted consideration should
be given to fitting a space maintainer

40.  Eruption time is defined either by chronological age
(Expected tooth eruption time )or biological age
(indicated by progression of root development)

41.  When teeth do not erupt at the expected age
(mean 2 SD)
 A disruption in the normal sequence of eruption
 An asymmetry in eruption pattern between
contra lateral teeth. If a tooth on one side of the
arch has erupted and 6 months later there is still
no sign of it’s equivalent on the other side
(radiographic examination is indicated)

42. Generalized Localized
Hereditary gingival fibromatosis Congenital absence
Down’s syndrome Crowding
Cleidocranial dysplasia Delayed exfoliation of primary
predecessor
Cleft lip and palate Supernumerary
Rickets Dilaceration
Abnormal position of cyst
Primary failure of eruption

43.  if root formation is not complete in
permanent follow up of root development by
periodic radiographic examination.
 If the tooth is lagging in its eruption status,
active treatment is recommended
 Obstruction must be removed ( soft tissue or
dental)

44.  If self-correction is not observed over time,
active treatment should begin. Exposure
accompanied by orthodontic traction has been
shown to be successful when more than 2/3 of
the root has developed
 If ectopic teeth deviate more than 90° from
the normal eruptive path, autotransplantation
might be an effective alternative.

47.  non syndromic eruption failure of permanent
teeth in the absence of mechanical obstruction
with no obvious local/systemic causative factor
 Teeth distal to affected tooth also involved.

48.  Complete failure of tooth eruption (primary retention)
 Initial eruption prior to the eruption failure (secondary
retention).

49.  Rare condition of unknown aetiology
 Significant genetic influence suggested (PTH1
gene)
 Commonly family history

50.  Effect on vertical facial growth, the bite distal to
the first affected tooth is usually open
 Permanent teeth may become ankylosed
 Diagnosis often made retrospectively and
orthodontic extrusion is unsuccessful
 May be associated with infra-occluded
deciduous teeth, in particular E's

51.  No orthodontic solution, will tend to intrude
the rest of options dentition
 Consider restorative options, e.g. Crown
build-ups
 May consider segmental osteotomy
 Extraction

54.  Dental malocclusion resulting from the
abnormal axial inclination of one or more
maxillary teeth

55. Depends on:
1. Adequate space to reposition the tooth in the
arch
2. Sufficient overbite to hold the tooth in position
following correction
3. An apical position of the tooth in cross bite that
is the same as it would be if the tooth was in
normal occlusion

56. Tongue blade therapy
Inclined planes
Reverse stainless steel crown
Removable appliance
Fixed appliance

57.  The “reverse” stainless
steel crown
 Two disadvantages :
1. Unsightly silver
appearance of the crown
form
2. The limitations of working
with an inclined slope that
is already formed.
Both problems can be avoided
by using a bonded resin-
based composite custom
formed inclined slope.

60. Miller’s classification
Miller’s classification

61. 1. Plaque
2. Position of the tooth
3. Vigorous tooth brushing
4. Traumatic occlusion
5. Prominent frenum
6. Thin marginal gingiva
7. Alveolar plate is thin
8. Orthodontic movement (position the tooth labially)

62. 1. Maintain good oral hygiene throughout orthodontic
treatment
2. Eliminate potential causes of recession
3. Avoid uncontrolled dento-alveolar expansion and maintain
arch form by extraction or IDS
4. Modify tooth anatomy whenever indicated
5. in lower incisor crowding, consider segment arch mechanics
and create space before using it and use it wisely
6. Consider atypical extractions of severly involved tooth
7. Avoid jiggling because it may cause periodontal problems
8. Treat early
9. Gingival grafting before orthodontic treatment

63. 1. Thorough instructions on plaque control should be provided.
2. Free gingival graft before orthodontic treatment
3. Modified coronally advanced tunnel flap approach
4. envelope technique with connective tissue graft
5. The laterally positioned flap with or without connective
tissue graft.
6. A frenectomy can also be considered
7. The gingiva is attached to the supracrestal portion of the
root so that lingual movement of the incisor will result in a
labial increase in gingival height

66. 1. Normal development in the deciduous dentition
2. Ugly duckling stage before the eruption of the permanent canines
3. Abnormal frenal attachments
4. Microdontia (peg-lateral incisors)
5. Presence of a supernumerary
6. Abnormal shape or crown-root angulation of the centrals
7. Congenitally missing teeth
8. Abnormal pressure habits (tongue thrust, digit sucking,
9. Trauma, leading to tooth loss in the incisor region
10. Hereditary & Racial predisposition, Negros
11. Pathological migration of the anterior maxilla teeth (rarely)
12. during RME
13. Iatrogenic

67.  Direct visualization
 Blanching in the region of the frenum can occur
when tension is applied by lifting the upper lip
 A spade-shaped or notched intermaxillary segment
can be visible on radiographic examination

68.  Depends primarily upon the removal of the underlying cause
 In the deciduous dentition: no treatment
 In mixed dentition: reassurance
 In permanent dentition: aesthetic build-up of the centrals
 Active orthodontic treatment to close a diastema is usually
carried out in the permanent dentition using fixed appliance

69.  Long-term retention is usually mandatory.
 Adjunctive procedure like frenectomy

72.  Hypomineralization of systemic origin that
affects one to all of the first permanent
molars and is often associated with affected
permanent incisors

73. The etiology of MIH still remains unclear
Environmental conditions:
 Respiratory tract infections
 Perinatal complications
 Oxygen starvation and low birth weight
 Calcium and phosphate metabolic disorders
 Childhood diseases
 Antibiotics
 Prolonged breast feeding

74.  Primary teeth are not affected
The remaining permanent dentition is usually not affected
 One, two, three or four permanent first molars affected
White/yellow/brown opacities well demarcated compared to normal
enamel
The lesions on the incisors are usually not as extensive as those in the
molars and present mainly a cosmetic problem
The risk of defects to the incisors appears to increase when more first
permanent molars have been affected

75.  Behavioural avoidance of erosive diet
 Preventive
 Applying desensitizing agent in combination with fluoride
varnish applications could be of some help in decreasing
sensitivity
 Fissure sealant
 Restorative requirements
 Extraction combined with orthodontic treatment should be
considered as an alternative treatment especially if the molars
have a poor longterm prospect.The optimal time for
extraction is indicated by the calcification of the bifurcation of
the roots of the lower second permanent molar

78.  Begins between the ages of 17 and mid-twenties
and progressing through into late adult life is
common
 Approximately 2/3 of adolescents with good
alignment and “normal” occlusions will develop
incisor irregularity be early adulthood

79. 1. Lack of attrition
2. Soft tissue maturation: late mandibular growth changes
may bring the lower incisors into a different soft tissue
3. Late anterior growth and mandibular remodelling
4. Anterior component of occlusal forces
5. Mesial vectors of muscular contraction
6. Degenerative periodontal changes allowing teeth to drift
under light pressures
7. Mesial drift of posterior teeth by trans-septal fibres
8. Tooth size and shape which can result in contact point
displacement
9. The mandibular third molar: Mandibular third molars–
presence and position

80.  Ades at al. (1990): 4 study groups all a
minimum of 10 years post retention
(Washington group) ( Absent 8s, Impacted 8s,
Erupted and functional, Extracted at least 10
years before post retention records)
No significant differences in mandibular
growth or LLS crowding between any of
the subgroups.

81.  Accept
 Prophylactic measurement: IPS as prophylactic
measure had been described by Peck and Peck
 Permanent retainer
 In the presence of significant malocclusion,
incisor crowding is best managed as part of a
comprehensive orthodontic treatment plan
either by IPS, extraction or proclination with
permanent retention.

82.  The work of Little and others has shown that
although larger lower incisor changes in
position are less stable, lower incisor
alignment tends to deteriorate after
retention whether or not the lower incisor
position has been maintained Rowland 2008
found PFR is more efficient in a maintaining
the LLS position post orthodontic treatment

83. 1. Gingival recession : State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the Angle
Society of Europe 2013 meeting)Ama Johal, Christos Katsaros, Stavros Kiliardis, Pedro Leito, Marco Rosa, Anton Sculean, Frank
Weiland, and Björn Zachrisson
2. Tooth ankylosis: Orthodontic implications P. PANOS Postgraduate Student, Department of Orthodontics, School of Dentistry,
Aristotle University of Thessaloniki, Thessaloniki, Greece
3. Ectopic eruption - A review and case report Syed Mohammed Yaseen, Saraswati Naik,1 and K. S. UloopiContemp Clin Dent. 2011
Jan-Mar; 2(1): 3–7. doi: 10.4103/0976-237X.79289 PMCID: PMC3220171
4. Single tooth in crossbite: Bonded compomer slope for anterior tooth crossbite correction Theodore P. Croll, DDS William H.
Lieberman, DDS Dr. Croll is in private practice in Doylestown, Pennsylvania and clinical professor, Department of Pediatric
Dentistry, University of Pennsylvania School of Dental Medicine; Dr. Lieberman is in private practice in Redbank, NJ and
coordinator of continuing education at Monmouth Medical Center in Monmouth, New Jersey.
5. Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor: clinical report Susan A.
McEvoy, DMD, MS
6. Delayed tooth eruption: Pathogenesis, diagnosis, and treatment. A literature review Lokesh Suri, BDS, DMD, MS,a Eleni Gagari,
DDS, DMSc,b and Heleni Vastardis, DDS, DMScc Boston, Mass
7. Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on
MIH held in Athens, 2003 K.L. WEERHEIJM1 , M. DUGGAL2 , I. MEJÀRE3 , L. PAPAGIANNOULIS4 , G. KOCH5 , L.C. MARTENS6 ,
A-L HALLONSTEN
8. Primary eruption failure: A review Vijesh, Prashanth Kamath, Arun Kumar BR, Rajat Scindhia, Raghuraj MB
9. A long-term study of the relationship of third molars to changes in the mandibular dental arch
10. Author links open overlay panelDDS, MSDAmin G.Adesa12DDS, MSDonald R.Joondephb12DDS, MSD, PhDRobert
M.Littlec12PhDMichael K.Chapkod12
11. Contemporary Orthodontics, 5th EditionBy William R. Proffit, DDS, PhD, Henry W. Fields, Jr., DDS, MS, MSD and David M.
Sarver, DMD, MS
12. An Introduction to Orthodontics PDF by Laura Mitchell
13. Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol