Dental anomalies
DEVELOPMENTAL ABNORMALITIES
NUMBER OF TEETH
Synonyms Disease m.
hyperdontia, distodens, teeth that develop in addition to
Supernumerary Teeth
mesiodens, peridens, the normal complement as a
parateeth, and result of excess dental lamina in
supplemental teeth the jaws.
Developmentally: -may also be
the result of numerous
independent pathologic
mechanisms that can affect the
orderly formation of the dental
hypodontia, oligodontia, lamina (e.g., orofaciodigital
Missing Teeth
and anodontia syndrome)-failure of a tooth germ
to develop at the optimal time-
lack of necessary space imposed
by a malformed jaw -
disproportion between tooth
mass and jaw size
SIZE OF TEETH
-teeth larger than normal -rarely
affects the entire dentition -can
Macrodontia
also occur in hemihypertrophy of
the face or in pituitary gigantism
-teeth: smaller than normal
-lateral incisors and third molars:
Microdontia small
-Generalized microdontia =
extremely rare
ERUPTION OF TEETH
the condition in which two
typically adjacent teeth have
exchanged positions in the dental -permanent canine
arch.
Transposition
CF
-easily identified by counting and
identifying all the teeth in the jaws -
can arise in either the deciduous or the
permanent dentitions.
-mostly found in Asian and Native
American and indigenous populations -
when one tooth is missing; usually
maxillary incisor -most commonly
missing teeth: third molars, mandibular Oligodontia: the absence of numerous
2nd premolars, and maxillary lateral
and mandibular central incisors. -
absence may be either unilateral or
bilateral-Children who have
developmentally missing teeth tend to
have more than one absent and more
than one morphologic group (incisors,
premolars, and molars) involved.
appear large and may be associated
with crowding, malocclusion, or
impaction
involved teeth:
-small
-may have altered morphology
Microdont molars may have an altered
shape.
most frequently transposed teeth :
-first premolar
can occur with hypodontia,
supernumerary teeth, deciduous
predecessor
Imaging F. Differential Mngmnt
Mesiodens: occur in anterior maxilla
Peridens: occur in premolar area
Factors: -Potential effect on the developing
normal dentition
genetically inherited syndromes:
Distodens: occur in molar area -Position and number of teeths
-cleidocranial dysplasia -familial
-Potential complications that may
adenomatous polyposis (Gardner’
result from surgical intervention -Either to
s syndrome) -pyknodysostosis
remove a supernumerary
tooth or to keep it under observation.
-variable -may appear entirely normal in
both size and shape -may be smaller in
size compared with adjacent normal
dentition
-may be recognized by identifying and
counting the teeth present.
-For some individuals, the eruption of
some teeth may be delayed by a number
of years after the established time
Hypodontia: absence of one or a few
teeth
teeth
Anodontia/oligodontia: patients Mild: orthodontic severe: restorative,
with ectodermal dysplasia implant, and prosthetic procedures
Anodontia: the failure of all teeth to
develop
-does not require treatment -Orthodontic
treatment may be necessary if a
malocclusion is present.
Gemination & Fusion
increased size of both unerupted and
erupted macrodont teeth
-small teeth indicates the
diagnosis.
-syndromes: Restorative or prosthetic treatment
-congenital heart disease
-progeria
frequently malformed
Transposed teeth are frequently altered
Transposed teeth are usually
prosthetically for function or esthetics or
easily recognized
both.

Transposition
ALTERED MORPHOLOGY OF TEETH
-union of adjacent tooth germs of
developing teeth.
-Males and females experience
Fusion synodontia in equal numbers
-Higher incidence in Asian,
Native American, and indigenous
populations
-occurs when the roots of two or
more primary or permanent teeth
are fused by cementum. true
concrescence: occurs during
development, acquired
concrescence: If the condition
occurs later
Concrescence
-rare anomaly -arises when a
single tooth bud attempts to
divide -rare cases: complete
division through the crown and
root, producing identical
structures -Complete twinning
results in a normal tooth plus a
supernumerary tooth in the arch.
Gemination twinning
-Tooth has elongated bodies and
short roots.
Taurodontism
-Increased apico-occlusal height
of the Pulp Chamber
-disturbance in tooth formation
that produces a sharp bend or
curve in the tooth in: crown or
Dilaceration root
-Can be caused by mechanical
trauma to the calcified portion of
a partially formed tooth
most frequently transposed teeth :
-permanent canine
Transposed teeth are frequently altered
-first premolar Transposed teeth are usually
prosthetically for function or esthetics or
can occur with hypodontia, easily recognized
both.
supernumerary teeth, deciduous
predecessor may reveal when the teeth are not in their
usual sequence in the dental arch
-unusual shape or size of the fused teeth -
more evident on the image than can be
determined by clinical examination -
show an unusual configuration of the pulp
chamber or root canal
-reduced number of teeth in the arch -
depends on:
more common in anterior teeth of both
gemination & macrodontia which teeth are involved, the degree of
the permanent and the deciduous
fusion, and the morphologic result.
dentition
-Teeth most frequently involved: -usually impossible to determine Extraction of one tooth may result in the
Maxillary molars (especially 3rd molar with certainty whether teeth unintended removal of the second because
and supernumerary tooth -Involved whose root images are the cementum bridge may not be well
teeth may fail to erupt or may erupt superimposed are actually joined. visualized. -clinician should warn the patient
incompletely. The sexes are equally -with this regard, the absence of a that an effort to remove one might result in
affected. periodontal ligament (PDL) space the unintended and simultaneous removal of
between the roots may be helpful. the other.
-May not always distinguish concrescence
-Additional projections at different angles
may be obtained to delineate the condition
better
-Shows alteration of the hard tissues and
pulp chamber
-Radiopaque cleft or invagination between
the crowns
-Enlarged or divided pulp chamber
-occur in both the deciduous and the
permanent dentitions -more frequently
affects the primary teeth, usually in the
-Fusion -individuals with fusion Tooth may be removed, restored or
incisor region. - can be detected
are seen to be missing a tooth. reshaped, or left untreated
clinically after the anomalous tooth
erupts. -occurrence in males and
females is about equal.
Partial Cleavage - cleavage on crown
Complete Cleavage: cleave on crown
and root
-Elongated pulp chamber -Apically
placed furcation of roots
-Crown appears normal
body and roots of taurodont teeth lie
The image of the taurodont tooth
below the alveolar margin, the
is characteristic and easily Taurodont teeth do not require treatment.
distinguishing features of these teeth
recognized on imaging.
are not recognizable clinically.
-Images provide the best means of
detecting a radicular dilaceration. - occurs
most often in maxillary premolars. -One or
more teeth may be affected. -roots
dilacerate mesially or distally, the
condition is clearly apparent on a
periapical image
-root: dilacerated buccally (labially) or
lingually, the central x ray passes
approximately parallel with the deflected
portion of the root - the apical end of the
root may have the appearance of a circular -difficult to differentiate from fused
-Not recognized clinically -Does not require treatment
roots, sclerosing osteitis, or a
-The only clinical indication is a missing or oval radiopaque area with a central -If the tooth requires extraction, removal will
radiolucency (the apical foramen and root dense bone island - can be
tooth, which may be caused by a be complicated -Dilacerated crowns can be
canal), giving the appearance of a “bull’s discerned by images made at
pronounced dilaceration restored with prosthetic crown
eye.” different angles.
 trauma to the calcified portion of
a partially formed tooth
-The invagination or infolding of
the enamel surface into the
DENS INVAGINATUS, DENS interior of a tooth
-Gestant odontome - lingual surface of an incisor tooth -
EVAGINATUS, AND DILATED -Dens invaginatus: Invagination
“tooth within a tooth”
ODONTOME in cingulum area
-Dens in dente: Incisal edge of
the crown or in the root
result of an outpouching of the
enamel organ.
-Lateral incicors: most
commonly involved canines:
rarely affected
highest in Asian and Native
Dens Evaginatus Leong’s premolar American and indigenous
populations.
Abnormal formation of the
Amelogenesis Imperfecta enamel or the external layer of
the teeth.
-Dens invaginatus: Appears as a
small pit between the cingulum and the foramen is usually wide
Dens in dente: crown morphology is
abnormal having the appearance of
peg-shaped microdont tooth
-The presence of pulp within the cusp-
like tubercle
-Occur Bilateral and usually in the
mandible.
-The appearance of a small circular
facet with a small black pit in the center
Hypoplastic type
-fails to develop to its normal thickness
-yellowish brown color to the tooth -
enamel may be abnormal. -
rough, pitted, smooth, or glossy. -
reduced enamel thickness also causes -normal thickness of the enamel, but its
a loss of contact between adjacent
teeth. -occlusal surfaces of the
posterior teeth: flat w/ low cusps;
result of the attrition of cusp; most
easily identifiable on imaging
Hypomaturation
-enamel: mottled appearance but
normal thickness; enamel is softer than
normal -color: range from clear to
cloudy white, yellow, or brown -teeth:
capped with white, opaque enamel;
“snow-capped” teeth.
Hypocalcification
-Associated with soft or poorly
mineralized enamel.
different angles.
angular distortion: defect is in the crown
of an erupted tooth
-can be identified in the image even before
the tooth erupts. -infolding of the enamel
lining: -more radiopaque than the
surrounding tooth structure -can be
identified easily as an inverted teardrop-
shaped radiolucency with a radiopaque
border
Extensive coronal invagination: -crown
is almost invariably malformed -apical The appearance and usual
occurrence in incisors are so
characteristic that, once placement of a prophylactic restoration in
recognized, little probability exists the defect
that the anomaly will be confused
with another condition.
most severe form (dilated odontome) -
tooth is severely deformed -circular or oval
shape with a radiolucent interior
-Fine pulp horn may extend into the
tubercle
-Pulpal Exposure will result to necrosis.
Difficulty to visualize the tubercle
removal of tubercle under antiseptic
once worn down to the occlusal
conditions
surface
Hypoplastic Amelogenesis
-a “picket fence”—type appearance
-Diffuse smooth
-Diffuse rough
Hypomaturation Amelogenesis
density is the same as that of dentin
restoration of the esthetics and function of
Amelogenesis imperfecta
the affected teeth.

Abnormal formation of the
Amelogenesis Imperfecta enamel or the external layer of
the teeth.
-Teeth are weaker than normal,
making them prone to rapid wear, The colors change according to
hereditary opalescent
Dentinogenesis Imperfecta breakage and loss.
dentin.
-characterized by abnormal
dentin formation.
Osteogenesis Imperfecta
-Genetically inherited autosomal-
dominant
abnormality
Two types:
Dentin Dysplasia -Type I: Radicular form
changes are found in the
appearances of the roots.
-Type II: Coronal form changes
in the crown
rare condition in which both
odontogenesis imperfecta
Regional Odontodysplasia enamel and dentin are
and ghost teeth.
hypoplastic and hypocalcified
*1-3 mm in diameter usually seen
on the roots of molars -Formed
Enamel drop, enamel by Hertwig's epithelial root sheath
Enamel Pearl
nodule, and enameloma -Usually only one pearl
develops, but occasionally more
develop
-yellowish brown color to the tooth -
enamel may be abnormal. -
rough, pitted, smooth, or glossy. -
reduced enamel thickness also causes
a loss of contact between adjacent
teeth. -occlusal surfaces of the
posterior teeth: flat w/ low cusps;
result of the attrition of cusp; most
restoration of the esthetics and function of
easily identifiable on imaging Amelogenesis imperfecta
the affected teeth.
Hypomaturation
-enamel: mottled appearance but
normal thickness; enamel is softer than
normal -color: range from clear to
cloudy white, yellow, or brown -teeth:
capped with white, opaque enamel; Hypocalcification Amelogenesis
“snow-capped” teeth. -enamel thickness is normal, but its density
Hypocalcification is even less (more radiolucent) than that of
-Associated with soft or poorly dentin
mineralized enamel.
-placement of prosthetic crowns on the
affected teeth. -preferable to place full
whether the teeth are observed by Dentin dysplasia overdentures on the teeth to prevent
transmitted light or reflected light alveolar resorptio. -adults, extraction of the
teeth
Dentinogenesis imperfecta
characteristically shows bulbous crowns,
constriction of tooth at the cemen-
toenamel junction, short roots, and a
reduced size of the pulp chamber and root
canals.
disturbed production of collagen type I
-Characterized by osseous fractures,
brittle bones -Increased incidence of
impacted first and second molars
type I dentin dysplasia -the roots of both
the primary and the permanent teeth are
either short or abnormally shaped -molars:
shallow “W” shape -associated with
rarefying osteitis -important feature for
recognition: inflammatory lesions with
noncarious teeth
Type I (the radicular form) slight
bluish-brown translucency is apparent include only one other entity
type II dentin dysplasia -obliteration of Type I: prosthetic replacement.
teeth are often misaligned which is dentinogenesis
the pulp chamber -reduction in the caliber Type II: prosthetic treatment
Type II (the coronal form) appear to imperfecta
of the root canals occurs after eruption (at
be of the same color, size, and contour
least by 5 or 6 years) -anterior teeth and
premolars develop a pulp chamber "thistle
tube" in shape because of its extension
into the root.-roots of the coronal variety
are normal in shape and proportions.
-pulp chambers are large -root canals are
wide because the hypoplastic dentin is
thin, serving just to outline the image of the
root -poorly outlined roots are short -
enamel is thin and less dense than usual
-small and mottled brown -susceptible -Unerupted teeth should be retained
to caries -damaged permanent teeth that become
dentinogenesis imperfecta
-brittle pulpally involved may require removal and
-subject to fracture and pulpal infection replacement.
Smooth, round, and radiopaque
-Located below the crest of gingiva
-Develop in the furcal areas of molars
(apical to CEJ)
isolated piece of calculus or a
-Maxillary molars: Mesial or distal furca Removal of the mass
pulp stone
-Mandibular molars: buccal or lingual
furca -Usually no clinical symptoms
are associated with their presence

*1-3 mm in diameter usually seen
on the roots of molars -Formed
Enamel drop, enamel by Hertwig's epithelial root sheath
Enamel Pearl
nodule, and enameloma -Usually only one pearl
develops, but occasionally more
develop
-Anomalous hyperplasia of
cingulum of maxillary or
mandibular incisor
Talon Cusp -Results formation of
supernumerary cusp
-may or may not contain horn of
the pulp
-Permanent tooth with local
hypoplastic defect in its crown
Turner’s Hypoplasia Turner’s tooth
-Can be caused by periapical
infection or mechanical trauma
-Development of primary teeth is
seldom disturbed -affected
Congenital Syphilis incisors are called Hutchinson’s
incisors -molars are called
“mulberry molars.”
ACQUIRED ABNORMALITIES: changes that are initiated after tooth development
-physiologic wearing of the
dentition due to occlusal contacts
-90% young adults, more severe
in men
ATTRITION
-diet, salivary factors,
mineralization of the teeth, &
emotional tension
-BRUXISM
-non-physiologic wearing in
contact with foreign substances
-causes: toothbrush injury and
dental floss injury -Other
ABRASION cause: pipe smoking, opening
hairpins with the teeth, improper
use of tooth- picks, denture
clasps, and cutting thread with
the teeth.
-results from a chemical action
not involving bacteria -the contact
of acid with teeth
-Source of acid:
-chronic vomiting
-acid reflux from a
gastrointestinal disorder -diet rich
in acidic foods
-citrus fruits
-carbonated beverages
-some occupations -Regurgitated
EROSION acids: attack lingual and palatal
tooth surfaces
-Dietary acids: attack the labial
surfaces
It depends on the:
-location
-pattern of the eroded area -
appearance of the lesion
RESORPTION -classified into two:
-Internal Resorption -External
Resorption
-differ in the imaging appearance
and treatment -Idiopathic
-Sequelae of inflammation,
excessive pressure and function,
or factors of local tumors and
cysts.
Internal Resorption occurs:
within the pulp chamber or canal
-involves the surrounding dentin
-Results in the enlargement of
the pulp space
-transient and self-limiting
-progressive
-Initiated by acute trauma to the
tooth, direct and indirect pulp
capping, pulpotomy, and enamel
invagination
-Located below the crest of gingiva
-Develop in the furcal areas of molars
(apical to CEJ)
-Maxillary molars: Mesial or distal furca
-Mandibular molars: buccal or lingual
furca -Usually no clinical symptoms
are associated with their presence
-Both primary and secondary incisors
-Cleft palate syndromes and other
anomalies have been reported to
increase its incidence.
-Affects mandibular premolars -
Hypomineralized defect or brownish
spot in enamel
-Affected incisors: screwdriver-shaped
crown -incisal edge is also frequently
notched -usually smaller than normal
and may be even smaller than second
molar crowns. -most distinctive
feature: constricted occlusal third of
the crown
most distinctive feature is the
constricted occlusal third of the crown,
-incisal edges shows broadening
-dentin becomes exposed and stained
-“back-and-forth” movement, wears a
V-shaped wedge in cervical area
-improper flossing
-denture clasp
-usually found on incisors, often
involving multiple teeth -lesions:
smooth, glistening depressions in the
enamel surface, frequently near the
gingiva -may result in so much loss of
enamel that a pink spot shows through
the remaining enamel.
Internal Resorption -mainly affects
either the primary or secondary
dentition.
-can affect any of the tooth
-Most frequent in permanent teeth:
central incisors, first and second
molars.
-More common in males; fourth & fifth
decades of life
isolated piece of calculus or a
Removal of the mass
pulp stone
-radiopaque image of a talon cusp is
superimposed on that of the crown of the
involved incisor -outline is smooth -layer of
normal-appearing enamel is generally
distinguishable -image may not reveal a
pulp horn.
Removal of the cusp
supernumerary tooth To avoid decay
To avoid occlusal problems
-enamel irregularities associated with
Turner’s hypoplasia alter the normal
contours of the affected tooth; apparent on
an image -stained hypomineralized spot
may not be apparent
If an image of a tooth affected by Turner’s
-Delivery of high doses of
hypo- plasia shows that the tooth has good
therapeutic radiation -Carious
root support, the esthetics and function of
lesion
the deformed crown can be restored.
-characteristic shapes of the affected
incisor and molar crowns can be identified
in the image. -crowns: form about 1 year of
age -images may reveal the dental
features: 4 to 5 years before the teeth
erupt.
-Hutchinson’s teeth and mulberry molars
often do not require dental treatment -
Esthetic restorations
-change in the normal outline, from curved
to flat planes
-crown is shortened and is bereft of the
incisal or occlusal surface enamel
-Interproximally, contact points become
broad and flattened.
usually not difficult given the
characteristic history, location,
dental restoration, night guard
and extent of wear. The general
pattern is predictable and familiar.
-radiolucent defects; well-defined
semicircular or semilunar shapes with
borders of increasing radiopacity -pulp
chambers are obliterated
-narrow semilunar radiolucency in the
interproximal surfaces of the cervical area.
-Dental floss abrasion is readily
identified by its clinical and
imaging appearances - elimination of the causative agents or habits.
accomplished with clinical
inspection.
-Areas: appear as radiolucent defects on
the crown -margins: either well defined
or diffuse. -clinical examination: usually
resolves any questionable lesions.
-Identification and removal of the causative
based on the recognition of agent
dished-out or V-shaped defects in -Chronic vomiting: Daily fluoride
the buccal and labial enamel and -Idiopathic: Restoration
the den- tinal surfaces : to prevent further damage, pulp exposure,
and unpleasant appearance of the tooth
The lesions of this type of resorption are: dental caries on the buccal or Endodontic treatment
-localized lingual surface of a tooth and -Not led to a serious weakening defect
-radiolucent external root resorption Surgery
-Round -If there is perforation of the root
-Oval Tooth extraction
-Elongated within the root or crown - -Tooth is weakened by resorption
Continuous with the image of the pulp
chamber or root canal -Outline: sharply
defined and smooth or slightly scalloped
-results to an irregular widening of the pulp
chamber or canal
 -Initiated by acute trauma to the
tooth, direct and indirect pulp
capping, pulpotomy, and enamel
invagination
External ResorptionThe
odontoclasts resorb the outer
surface of the tooth which
commonly involves:
-crown of an unerupted tooth -
Cementum
- Dentin
-root surface: most common -
Resorption may occur to: single,
multiple, or all of the dentition
-Idiopathic
-can be attributed to localized
inflammatory lesions, reimplanted
teeth, tumors and cysts,
excessive mechanical and
occlusal forces, and impacted
teeth.
-dentin deposited in the pulp
chamber after the formation of
primary dentin has been
completed. -develops after long-
term trauma from pathologic
conditions: moderately
progressive caries, trauma,
erosion, attrition, abrasion, or a
dental restorative procedure.-
SECONDARY DENTIN
Idiopathic
-Physiologic aging
-Results from an innocuous
stimuli like chewing and
slight trauma. -tertiary dentin:
suggested to identify dentin
initiated by stimuli other than
normal aging response and
normal biologic function.
-foci of calcification in the dental
pulp -no firm evidence exists:
PULP STONES
being associated w/ any
systemic/pulpal disturbance.
-another form of calcification in
the pulp chamber and canals of
teeth -diffuse process -specific
PULPAL SCLEROSIS
cause: unknown -Histologically:
pattern of calcification is
amorphous and unorganized
-More common in males; fourth & fifth
decades of life
-Lesions start at the apex:-causes a -Caries -Removal of the etiologic factors
External Resorption -Advanced
smooth resorption of the tooth -Periapical -Internal resorption -Cessation of excessive mechanical forces,
resorption: there is some nonspecific
inflammatory lesion: - When the lesion is on the buccal removal of an adjacent impacted tooth, or
pain or fracture of the resorbed root
-lamina dura is lost around the apex - or lingual surface of a root eradication of a cyst, tumor, or the source of
-More prevalent in mandibular teeth:
Resorption of the apical region: inflammation
central incisors, canines, and
-pulp canal is visible and the apex tends to -Area of resorption is broad and accessible
premolars
be wider-Lateral aspect of the root: on the surface of the root
-Appears at: apex of the tooth or on
-lesions become irregular -curettage and restoration
the lateral root surface
-Common cause on the side of the root:
-Commonly occurs: apical and
-presence of an unerupted adjacent tooth
cervical regions
is present
-External resorption of an entire tooth can
occur when: -the tooth is unerupted and
completely embedded in bone usually
involving the maxillary canine or third
molar -the entire tooth, including the root
and crown, may undergo resorption.
-pulp horns disappear early ➡ reduction in
size of the normal size pulp chamber ➡
narrowing the canals
-Extreme cases: -small thread of viable
pulp tissue seen
-The response and role of
odontoblasts:
-It reduces the sensitivity of teeth to
stimuli from
-Does not require any treatment -
the external environment
Pulp stone precipitating cause: removed if possible,
-elderly people/patients who had
tooth is restored when appropriate.
recent dental restorations/coronal
fractures:
-the reduced sensitivity is more
prominent as well
-Appearance: quite variable -radiopaque
structures within pulp chambers or root
canals -may extend from the pulp chamber
into the root canals -may be round or oval -
outline: varies from sharply defined to a
more diffuse margin. -occurrence: all
tooth types; molars (common) -rare:
canal remodels and increases its girth to
accommodate a large stone.
-do not require treatment -but can cause
-Recognition: not difficult -some
Pulp stones are not clinically difficulty in the performance of endodontic
cases: differentiation from pulpal
discernible. therapy when such a procedure is indicated
sclerosis is difficult.
for other reasons.
-Early pulpal sclerosis:-degenerative
process, -not demonstrable on imaging -
Diffuse pulpal sclerosis:-produces a
generalized, ill-defined collection of fine
radiopacities on large areas of the pulp
chamber and pulp canals
clinically silent process without clinical
-Small pulp stones does not require treatment
manifestations.
 -evident on images as an excessive
buildup of cementum around all or part of a
root -outline: usually smooth but
occasionally may be seen as an irregular
but bulbous enlargement of the root. -most
does not cause any clinical signs or
evident: apical end; usually seen as a
symptoms
mildly irregular accumulation of cementum-
cementum: slightly more radiolucent than
-excessive deposition of dentin -Paget’s disease: hypercementosis
cementum on the tooth roots - ➡usually very exuberant and irregular in
cause: unknown -appears on a outline.
-dense bone island -mature
supraerupted tooth after the loss
periapical osseous dysplasia -
of an opposing tooth - -Does not require treatment -periapical
resemblance to a small
HYPERCEMENTOSIS inflammation: resulting from inflammatory lesion exist: treatment may
cementoblastoma -severely
rarefying or sclerosing osteitis- be necessary
dilacerated root may have the
occurrence: patients with Paget’
appearance of hypercementosis
s disease of bone and
hyperpituitarism (gigantism and
acromegaly).