Developmental

Disturbances of
Teeth
D e v e lo p m e n t a l
Disturbances
 (1) Size

 (2) Number a nd Eruption

 (3) Shape/Form

 (4) Defects of Enamel and Dentin

S iz e

 Microdontia

 Macrodontia
S iz e

 Microdontia

 (1) True Generalized

Microdontia

 (2) Relative Generalized

Microdontia

 (3) Focal or Localized

Microdontia
(1) True Generalizedd
Microdontia
 all teeth are smaller t h a n
normal

 occur in some cases of

pituitary dawrfism

 exceedingly rare

 teeth are well formed

(2) R e l a t i v e G e ne r a liz e d Microdontia

 normal or slightly smaller t h a n

normal teeth

 are present in jaws t h a t are

somewhat larger t h a n normal
(3) Focal/Localized
Microdontia

 common condition

 affects most often maxillary

lateral incisior + 3 r d molar

 these 2 teeth are most often

congenitally missing
 (3) Focal/Localized
Microdontia

 common forms of localized

microdontia is t h a t which
affects maxillary lateral
incisior

 peg lateral

 instead of parall el or
diverging me si al + di stal
surfaces
(3) Focal/Localized
Microdontia

 sides converge or taper

together incisally

 forms cone-shaped
crown
 root is frequently
shorter t h a n usual
S iz e

 Macrodontia

 (1) True Generalized

Macrodontia

 (2) Relative Generalized

Macrodontia

 (3) Focal or Localized

Macrodontia
(1) True G e ne r a liz e d
Macrodontia

 all teeth are larger t h a n

normal

 associated with
pituitary gigantism

 exceedingly rare
(2) R e l a t i v e G e ne r a liz e d Macrodontia

 normal or slightly larger t h a n

normal teeth in small jaws

 results in crowding of
teeth

 insufficient arch space

(3) Focal/Localized
Macrodontia
 uncommon condition

 unknown etiology

 usually seen with

mandibular 3 rd molars
D e v e lo p m e n t a l
Disturbances
 (1) Size

 (2) Number a nd Eruption

 (3) Shape/Form

 (4) Defects of Enamel and Dentin

N u m b e r a n d E r u p t io n

 Supernumerary

 Anodontia

 Impaction
Number and Eruption

 Supernumerary

 results from continued

proliferation of permanent
or primary dental lamina
to form third tooth germ

 teeth may have:

• normal morphology
• rudimentary
• miniature
Number and Eruption

 Supernumerary

 more often in permanent

dentition t h a n primary
dentition

 more in the maxilla t h a n in

mandible
Number and Eruption

 Supernumerary

 may be impacted erupted

or impacted

 because of additional tooth

bulk, it causes:

• malposition of adjacent
teeth

• prevent their eruption

 Number and Eruption
 Supernumerary

 many are impacted

• characteristically found
in cleidocranial dysostosis
Number and Eruption
 Supernumerary

 Mesiodens

 Fourth molar

•Maxillary Paramolar
• Distomolar or Distodens

 Mandibular Premolar

 Maxillary lateral incisors

Number and Eruption

 Supernumerary

 Mandibular central incisors

 Maxillary Premolars
 M es io d e ns
 most common
supernumerary tooth

 tooth situated between

maxillary central incisors

 singly

 paired

 erupted or impacted

 inverted
Mesiodens

 small tooth

 cone-shaped crown

 short root
(

X-Ray of a Palatal Mesiodens I Roof of Mouth Supernumerary

Tooth
F o u r t h Molar

 2 nd most common

 situated distal to 3 r d molar

 small rudimentary tooth,

but may be of normal size

 mandibular 4 t h molar also is

seen occasionally, but less
common t h a n maxillary m olar
P a ram o la r

 small + rudimentary

 situated bucally or lingually

to one of the maxillary
molars

 interproximally between 1 st
+ 2 nd or 2 nd + 3 rd maxillary
molars
D is t o molar /Distodens

 molar located distal to molar

N u m b e r a n d E r u p t io n

 Supernumerary

 Anodontia

 Impaction
Number and Eruption

 Anodontia

 lack of tooth development

 absence of teeth
N u m b e r a n d E r u p t io n

 Anodontia

 Complete Anodontia

 Partial Anodontia
• Hypodontia
• Oligodontia

 Pseudoanodontia

 False Anodontia
C o m p l e t e A n o d o ntia

 when all teeth are missing

 rare

 often associated with a

syndrome known as hereditary
ectodermal dysplasia
Hypodontia

 lack of development of
one or more teeth
Oligodontia

 lack of development of
six or more teeth
Pseudoanodontia

 when teeth are absent

clinically because of
impaction or delayed
eruption
F a l s e A no do ntia

 when teeth have been

exfoliated or extracted
N u m b e r a n d E r u p t io n

 Supernumerary

 Anodontia

 Impaction
Number and Eruption

 Impaction

 most often affects the

mandibular 3 rd molars +
maxillary canines

 less commonly:
• premolars
• mandibular canines
• second molars
Number and Eruption
 Impaction

 occurs due to obstruction

from crowding

 from some other physical

barrier

 occasionally, may be due

to a n abnormal eruption
path, presumably because
of unusual orientation of
tooth germ
Number and Eruption
 Impaction

 Ankylosis
An k y lo sis

 fusion of a tooth to surrounding

bone

 with focal loss of periodontal

ligament, bone + cementum
become inextricably mixed

 cause fusion of tooth to

alveolar bone
D e v e lo p m e n t a l
Disturbances
 (1) Size

 (2) Number a nd Eruption

 (3) Shape/Form

 (4) Defects of Enamel and Dentin

Shape and Form

 Crown

 Root
Shape and Form

 Crown

 F usion

 Gemination

 Taurodontism

 Talon’s Cusp

 Leong’s Cusp
Shape and Form

 Crown

 Dens Invaginatus

 Peg-shaped Lateral

 Hutchinson Incisor

 Mulberry Molar
Shape and Form

 Root

 Concresence

 Enamel Pearl

 Dilaceration

 Flexion

 Ankylosis
 F u s io n
 joining of 2 developing
tooth germs

 resulti n g i n a singl e
large tooth stru ctu re

 may inv ol ve en tire l en gt h

of teeth

 or may involve roots only,

in which case cementum +
dentin are SHARED
 F u s io n

Fig. 1-55
Ge m in a tio n
 Formation of 2 teet h
from a single enamel
or ga n

 partial cleavage

 appearance of 2 cr own s
t h a t share same root
canal

 t r a u m a has been suggested

as possible cause, the cause is
still unknown
Taurodontism

 variation in tooth form:

 elongated crowns

 apically displaced furcations

• resulting in pulp
chambers t h a t have
apical occlusal height
Taurodontism

 may bee seen as isolated

incident in families

 associated with syndromes

such as

 Down syndrome

 Klinefelter’s syndrome
Taurodontism

 little clinical significance

 No t r e atme nt is required
Dens Evaginatus

 Talon’s Cusp

 Leung’s Premolar

Lingual pit Accessory

extension cusp
I--

Dental
pulp
Talon’s C us p

 well-delineated additional
cusp

 located on the surface of

a n anterior tooth

 extends a t least half the

distance from C E J to
incisal edge
Leung’s C us p

 developmental condition

 clinically as a n accessory cusp

or a globule

 located on occlusal
surface between buccal +
lingual cusps of premolars

 unilaterally or bilaterally
 Dens Invaginatus
(Dens in Dente)
 deep surface invagination
of cr own or r oot t h a t is lined
by enam el

 2 forms:

 coronal
 radicular
Dens Invaginatus
(Dens in Dente)
 depth vari es fr om sl i gh t
enlarg emen t of ci ngu lum
to a de ep i nfolding t h a t
extends to apex

 Histologically,
Classified into

 Type I
 Type II
 Type III
Dens Invaginatus
(Dens in Dente)

 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
Dens Invaginatus
(Dens in Dente)

 Type III

• extends through the root

• perforates in the apical or
lateral radicular area
without any immediate
communication with pulp
P e g -S h a p e d
Lateral
 undersized lateral incisor

 smaller t h a n normal

 occurs when permanent lateral

incisors do not fully develop
P e g -S h a p e d
Lateral

Figure 7: Right lateral view prior to Figure 8: Right lateral view after bonding.
bonding.

Six porcelain veneers to close spaces

Two peg laterals with front teeth and cover peg lateral incisors
spaces and chipped central incisor
Hutchinson ’s Incisor

 characteristic of congenital
syphilis

 la t er a l incisor s a r e peg-sh a p ed
or screwdriver-shaped

 widely spaced

 notched a t the end

 with a crescent-shaped
deformity
Hutchinson ’s Incisor

 notches on their biting

surfaces

 named after Sir Jonat han

Hutchinson

 English surgeon +
pathologist who 1 st
described it
Mulberry Molar

 dental condition usually

associated with congenital
syphilis

 characterized by multiple
rounded rudimentary enamel
cusps on permanent 1 st molars
Mulberry Molar

 dwarfed molars with cusps

covered with globular enamel
growths

 giving the appearance of a

mulberry
Shape and Form

 Root

 Concresence

 Enamel Pearl

 Dilaceration

 Flexion

 Ankylosis
Co n c re s c e n c e

 2 fully formed teeth

 joined along the root surfaces

by cementum

 noted more frequently in

posterior and maxillary regions
Co n c re s c e n c e

 often involves a 2 n d molar

tooth in which its roots
closely approximate the
adjacent impacted 3 rd molar

 may occur before or after the

teeth have erupted

 usually involves only 2 teeth

Co n c re s c e n c e

 diagnosis can frequently be

established by
roentgenographic examination

 often requires no therapy

unless union interferes with
eruption; then surgical
removal may be warranted

 since with fused teeth,

extraction of one may result in
extraction of the other
Enamel Pearls

 droplets of ectopic enamel

 or 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 t h a n
mandibular molars
Enamel Pearls

 consist of only a nodule

of enamel attached to dentin

 may have a core of dentin

containing pulp horn

 may be detected on
radiographic examination
Enamel Pearls

 may cause stagnation a t

gingival margin but, if
they contain pulp, this
will be exposed when
pearl is removed
D ila c e ra tio n

 angulation or a sharp
bend or curve in root
or crown of a formed tooth

 t r a u m a to a developing
tooth can cause root to for m
a t a n angle to normal
axis of tooth

 rare deformity
D ila c e ra tio n

 movement of crown or
of the crown a nd par t of root
from remaining developing
root may result in sharp
angulation after tooth
completes development
D ila c e ra tio n

 hereditary factors are

believed to be involved
in small number ofcases

 eruption generally continues

without problems
F l e x io n

 deviation or bend restricted

just to the root portion

 usually bend is less t h a n 90

degrees

 may be a result of t r a u m a to
the developing tooth
An k y lo sis

 also known as
“submerged teeth”

 fusion of a tooth to surr oundin g

bone

 deciduous teeth most c ommon ly

mandibular 2 nd molars

 undergone variable
degree of root resor ption
An k y lo sis
 have become ankylosed
to bone

 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
D e v e lo p m e n t a l
Disturbances
 (1) Size

 (2) Number a nd Eruption

 (3) Shape/Form

 (4) Defects of Enamel and Dentin

Am e lo g e n e s is
I mpe r f ec ta

 also known as:

 Hereditary Enamel
Dysplasia
 Hereditary Brown Enamel
 Hereditary Brow Opalescent
Teeth
Am e lo g e n e s is
I mpe r f ec ta
 group of conditions caused by
defects in the genes encoding
enamel matrix proteins

 genes t h a t encode for enamel

proteins:

 amelogenin mutated in
 enamelin in patients
 others with this
condition
Am e lo g e n e s is
I mpe r f ec ta

 affects both dentition

 deciduous
 permanent

 classified based on pattern of

inheritance:

 hypoplasia
 hypomaturation
 hypocalcified
Am e lo g e n e s is
I mpe r f ec ta
 No t r eatment except for
improvement of cosmetic
appearance
 H y po pla s t ic
A m e l o g e n e s i s I m pe r fec ta
 inadequate formation of m atrix

 enamel is randomly:

 pitted
 grooved or very thin
 h a r d + translucent

 defects become stained b u t teeth

are not especially susc eptible to
caries unless enamel is sc a n ty
and easily damaged
 H y po pla s t ic
A m e l o g e n e s i s I mpe r f ec ta
 reduced enamel thickness

 abnormal contour
 absent interproximal
contact points

 Radiographically:

 enamel reduced in bulk

 Shows thin layer over
occlusal + interproximal
surfaces
H y po pla s t ic
A m e l o g e n e s i s I mpe r f ec ta
 dentin + pulp chambers
appear normal

 no t r e at me nt is necessary
Hypomaturation
A m e l o g e n e s i s Impe r fe cta
 enamel is normal in form on
eruption but:

 opaque
 white to brownish-yellow
 softer t h a n normal
 tends to chip from
underlying dentin
Hypomaturation
A m e l o g e n e s i s I mpe r f ec ta
 Radiographically:

 affected enamel exhibits

radiodensity similar to
dentin
 H y po calcifie d
A m e l o g e n e s i s Imperfecta
 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
H y po calcifie d
A m e l o g e n e s i s I mpe r f e c ta
 with years of function:

 coronal enamel is removed

 except for cervical portion
t h a t is occasionally calcified
better

 Radiographically:

 density of enamel + dentin are

similar
D e n t i n o g e n e s i s Imperfecta

 also known as “Hereditary

Opalascent Dentin”

 due to clinical discoloration

of teeth

 mutation in the dentin

sialophosphoprotein

 affect s bot h p rim ar y + perm a n t

dentition
D e n t i n o g e n e s i s Imp e r fec ta

 have blue to brown

discoloration

 with distinctive translucence

 enamel frequently separates

easily from underlying defective
dentin
D e n t i n o g e n e s i s I mpe r fec ta

 Radiographically:

 bulbous crowns
 cervical constriction
 thin roots
 early obliteration of root s
canals + pulp chamb ers
D e n t i n o g e n e s i s Impe r fec ta

 Treatment:

 prevent loss of enamel +

subsequent loss of dentin
through attrition

 cast metal crowns on posterior

 jacket crowns on anterior

teeth
D e n t i n o g e n e s i s Impe r fec ta

 Classification:

 Type I
 Type II
 Type III
Ty pe I D e n t i n o g e n e s i s
I mpe r f ec ta
 occurs in families with
Osteogenesis Imperfecta

 primary teeth are more severely

affected t h a n permanent teeth
Ty pe I D e n t i n o g e n e s i s
I mpe r f ec ta
 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
 Ty pe II D e n t i n o g e n e s i s
I mpe r f ec ta
 never occurs in association
with osteogenesis imperfecta
unless by chance

 most frequently referred to as

hereditary opalascent dentin

 only have dentin abnormalities

and no bone disease
 Ty pe II D e n t i n o g e n e s i s
I mpe r f ec ta
 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
Ty pe III D e n t i n o g e n e s i s
I mpe r f ec ta

 “Bradwine type”

 racial isolate in Maryland

 multiple pulp exposures in

deciduous not seen in type
I or II

 periapical radiolucencies
 Ty pe III D e n t i n o g e n e s i s
I mpe r f ec ta
 enamel appears normal

 large size of pulp chamber

is due not to resorption but
r a t he r to insufficient + defective
dentin formation
 Dentin Dysplasia

 also known as “Rootless Teeth”

 rare disturbance of dentin

formation

 normal enamel

 atypical dentin formation

 abnormal pulpal morphology

 hereditary disease
Dentin Dysplasia

 Classification:

 Type I (Radicular Type)

 Type II (Coronal Type)

Ty pe I (Radicular Typ e)

 both dentitions are of

normal color

 periapical lesion

 premature tooth loss may occur

because of short roots or
periapical inflammatory lesions
Ty pe I (Radicular Typ e)

 Radiographically:

 roots are extremely short

 pulps almost completely
obliterated
 periapical radiolucencies:
• granulomas
• cysts
• chronic abscesses
Ty pe 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
Ty pe II (Coronal Type)

 Radiographically:

(Deciduous)
 roots are extremely short
 pulps almost completely
obliterated

(Permanent)
 abnormally large pulp
chambers in coronal portion of
tooth
Regional
Od o n t o d y s p la s ia
 also known as:

 Odontogenic Dysplasia
 Odontogenesis Imperfecta
 Ghost Teeth
Regional
Od o n t o d y s pla s i a
 one or several teeth in a
localized area are affected

 maxillary teeth are involved

more frequently t h a n
mandibular a r e a

 etiology is unknown
Regional
Od o n t o d y s p la s ia
 teeth affected may exhibit
a delay or total failure in
eruption

 shape is altered, irregular

in appearance
 Regional
Od o n t o d y s p la s ia
 Radiographically:

 marked reduction in
radiodensity
 teeth assume a “ghost”
appearance
 both enamel + dentin appear
very thin
 pulp chamber is exceedingly
large
Regional
Od o n t o d y s p la s ia
 Treatment:

 poor cosmetic appearance

of teeth
 extraction with restoration
by prosthetic appliance
S h e l l Tooth

 normal thickness enamel

 extremely thin dentin

 enlarged pulps

 thin dentin may involve

entire tooth or be isolated
to the root

 most frequently in deciduous

References:
Books
 Cawson, R.A: Cawson’s Essentials of Oral
Oral Pathology and Oral Medicine,
8th Edition
• (pages 24-36)
 Neville, et al: Oral and Maxillofacial Pathology
3rd Edition
• (pages 77-113)
 Regezi, Joseph et al: Oral Pathology, Clinical
Pathological Correlations
5th Edition
• (pages 361-373)
 Shafer, et al: A textbook of Oral Pathology,
3rd Edition
• (pages 37-69)