B1.

Developmental anomalies of the teeth

• Disorders in number

1. Hyperodontia

A) Supernumerary teeth → more teeth (>32), but normal size

B) Accessory teeth → small and not normal form

 Mesiodens can occur when an extra tooth develops between the teeth.
 Retromolar → following the wisdom tooth, we find another small tooth.
 Paramolar → before the molar, there’s an extra tooth (Orally or vestibular)

2. Anodontia, hypodontia → missing teeth, can be total or partial

 Specially in the permanent teeth

 Mostly in females
 Mutations in regulatory genes

A) Aplasia → the tooth bud doesn’t develop

B) Agenesia → no tooth germ, i.e. a certain part of a tooth doesn’t develop

3. Double teeth → products of fusion and clefting, may be heredity

A) Germination/twinning → is a double crown with one root

 The tooth germ is divided by an invagination, which results in the incomplete formation of two
teeth.

B) Fusion → union of two normally separated teeth

C) Concrescence → fusion of roots, but still two separate teeth above the gingival margin

 Fusion after root formation has been completed and the roots are united by cementum only.

D) Talon cusp – extra cusp on anterior teeth, mostly central and lateral incisors

• Shape, or form anomalies

1. Dens invaginatus (“tooth within a tooth”)
 Invagination of dental papilla before calcification; outer surface folds inwards (outer surface of
the crown)
 The pulp cavity is open for bacteria accumulation
 There is coronal and radicular forms, coronal being more common

2. Dens evaginatus → evagination of enamel epithelium into dental organ during

development

 There is an extra cusp or bump on the outer surface of the tooth, mostly the premolar
 The pulp of the tooth may extend into the dens evaginatus
 Tooth can possibly lose it’s blood and nerve supply and thus may require a RCT

3. Hutchinson teeth → notches on biting surface, usually incisors

 Can be a sign of congenital syphilis

4. Enameloma → small deposits of enamel found in roots of teeth, usually molars

5. Taurodens → patients exhibit large crowns with small roots and an enlarged pulp chamber

6. Dilaceratio dentin (Dilaceration) → angulation of roots or crowns, with sharp bends in these
affected roots and/or crowns of already formed teeth

7. Confusio radicorus dentis → root fusion, concrescence (cementum overlying the roots of at least
two teeth join together)

8. Divergentia radicorum dentis → root bifurcation, occurring in the cervical, middle, or apical third

9. Radices supernumerariae → supernumerary roots (extra roots)

10. Talon cusp → anomalous structure project lingually from the cingulum of incisor

• Disorders in size

A. Macrodontia (Giant tooth) → teeth are larger than normal, associated with gigantism.

Three types:

1. True generalized macro → all teeth are larger (Uncommon)

2. Relative generalized macro → jaw smaller than normal (Illusion of true macro)

3. Macrodontia of single tooth → more common, usually due to a disturbance in morpho

differentiation

B. Microdontia (Dwarf tooth) → teeth are smaller than normal.

Three types:

1. True generalized micro → all teeth are smaller

2. Relative generalized micro → jaw larger than normal

3. Microdontia of single tooth (localized) → usually 3rd molar, upper lateral incisor

• Structure anomalies

1. Enamel Hypoplasia → incomplete or defective formation of enamel Can be

 a) Hereditary type, and only the enamel is affected Can be

 b) environmental type, as enamel and dentin are affected
2. Dentin Hypoplasia

 normal enamel but atypical dentin formation with abnormal pulp morphology
  defective matrix production by the ameloblasts

3. Amelogenesis imperfecta → hereditary defect of enamel, due to malfunctions of proteins in

enamel (Ameloblastin, enamelin, tuftelin, amelogenin)

a) Hypolastic type = enamel has not formed to full thickness

b) Hypocalcified type = soft enamel, can be removed

c) Hypomaturation type = enamel can be displaced under firm pressure

4. Dentinogenesis imperfecta

 is a genetic disorder of tooth development (dentin is defected)

 associated with osteogenesis imperfecta (Type I)
 autosomal dominant (Type II, only the teeth are affected)
 The condition causes teeth to be discolored and translucent
 Teeth are weaker than normal
 This condition is an inherited autosomal dominant pattern
 Occurs in 1 out of 6,000 people
 Type I: occurs in combination with the recessive disorder, Osteogenesis Imperfect (“Brittle bone
disease” – genetic bone disorder)

5. Dentinal dysplasia → rootless teeth

6. Hypercementosis

 idiopathic or resulted from known causes periapical inflammation , mechanical stimulation ,

Paget ’s disease

Eruption disturbances **

General characteristics

Rare

a.) Associated with other bone lesions

 cretinism
 rickets

b.) Local factors e.g. gingival fibromatosis

1. Premature eruption → teeth erupted prematurely in first 30 days of life

2. Eruption sequestrum

 A tiny irregular spicula of bone overlying the crown of an erupted permanent molar
 A needle like piece of calcified tissue located in the gingival tissue of an erupting tooth

3. Delayed eruption → of milk, or deciduous teeth

4. Multiple unerupted teeth → permanent delay of eruption

5. Embedded or impacted teeth → with a physical barrier in the eruption pathway (Physical issue or
no eruptive force)

 Embedded and impacted teeth, if occurring together, the teeth remain below the surface of the
gum and sometimes bone, rather than erupting into an exposed position within the mouth
 Impacted teeth result from a situation in which an unerupted tooth is wedged against another
tooth or teeth or otherwise directly so that it cannot erupt normally (Physically blocked)
 Embedded tooth is an unerupted tooth that is covered, usually completely, with bone (Lack of
eruptive force)

6. Ankylosed deciduous teeth → baby teeth that have undergone root resorption and become
ankylosed to the bone and so prevent exfoliation and replacement by a permanent tooth

 Ankylosed = stiffness or bound via adhesions

 Exfoliation = loss of deciduous teeth following the physiological loss of root structure

Position, situation anomalies: **

• Malocclusion = is a misalignment of teeth or incorrect relation between the teeth of the two
dental arches
 Can be divided into three types, depending on the sagittal relations of teeth and jaws, by Angel’s
classification method

Class I: Neutroocclusion = molar relationship is normal, but other teeth have problems, like spacing,
crowding, over or under eruption

Class II: Distoocclusion (Overjet) = Upper molars are not placed in the mesiobuccal groove but
anterior to it. Usually the MB cusp rests in between

the mandibular molar and second premolar. There are two subtypes:

a) Class II, division 1

The molar relationship are like that of class II and the anterior teeth are protruded

b) Class II, division 2

The molar relationship are class II but the central are retroclined and the lateral teeth are seen
overlapping the centrals

C) Class III: Mesioocclusion (Negative overjet)

when the lower front teeth are more prominent than the upper front teeth. In this case, the patient
usually has a very large mandible or short maxillary bone

Other positional issues include:

i) Vestibular occlusion
ii) Oral occlusion

iii) Supraoccluion – exceeding the occlusal line

iv) Infraocclusion – doesn’t reach the occlusal line

v) Torsion – twisting of the teeth

vi) Transposition – severe crowding with narrow arch formation

vii) Ectopy – the teeth are in the alveolar crest

viii) Heterotopy – tooth in the maxillary sinus