‫صفوت حسن إسماعيل‬

‫‪1|Page‬‬
 ‫صفوت حسن إسماعيل‬

1.Abnormalities in number

 Number  Number

Supplemental Teeth Supernumerary teeth Total Partial Anodontia

Teeth not morphologically as natural dentition / Common in anodontia
permanent teeth / Familial tendency.

Extra teeth with normal a. Mesiodens b. Paramolar c. Distomolar Seen in a. True b. Pseudo c. False
morphological appearance as Hereditary
natural teeth. 1 or 2 peg-shaped Cone-shaped Peg-shaped ectodermal True failure of Absent History of
teeth in midline denticle on buccal denticle OR dysplasia tooth germ to clinically BUT previous
Due to division of enamel develop
between 2 upper aspect of upper rudimentary 3rd “Streeter’s presented extraction
organ OR continues growth Absence
of dental lamina. central incisors molars (Alone or molar distal to U. 3rd syndrome” radiographicall
As only clinically &
(Unerupted, fuse with related molar. y (Lack of
radiographically.
***U.2 / L 4&5 / 3rd molars are inverted or tooth as extra abnormality space or forces
most common. erupted into nasal cusp). OR with other ***3rd molars, 2nd of eruption).
floor). symptoms. premolar & 3rd
Complications molars.

1.Impaction / Delayed eruption of normal teeth.

2.Crwding & Mal-alignment.
3.Root resorption.
4.Follicles of un-erupted teeth  Dentigerous cyst.

Importance of X-Ray

Periapical, Occlusal & CBCT  location & number of un-erupted teeth.

Common with syndromes: Cleidocranial dysplasia, Gardener’s syndrome, pyknodysostosis or

familial adenomatous polyposis.

2|Page
 ‫صفوت حسن إسماعيل‬

2.Abnormalities in size

a. Microdontia b. Macrodontia

True generalized Relative generalized Localized True generalized Relative Localized

generalized
All teeth are Truely smaller than Teeth are smaller apparently Single / Multiple teeth. All teeth are Truely larger than Teeth are larger Single / Multiple
normal. due to Large Jaw. normal. apparently due to teeth.
EX: Peg-shaped lateral small jaws.
EX: Down’s syndrome / Pituitary EX: Paget’s disease of bone / / 3rd molars / EX: XYY males / Pituitary EX: Unilateral
dwarfism. dwarfism. facial
Acromegaly. supernumerary teeth.
hemihypertrophy

3.Abnormalities in position

Transposition

2 Teeth have exchanged their position.

Can occur with hypodontia, supernumerary teeth, ankylosed deciduous teeth.
Transposed teeth are usually fully erupted & in normal alignment.

***Most commonly in U.3 & U.4.

3|Page

1.Gemination
4.Dilaceration
Sharp bend or curve along the long axis of
the root.
Occur when deciduous teeth is traumatized
 Underlying permanent tooth is bent at
calcified & non-calcified parts.
The dilacerated part will deflect the X-ray
beam  round area with dark shadow in its
central portion.
‫صفوت حسن إسماعيل‬
4.Abnormalities in shape
2.Fusion 3.Concrescence
“Due to Space restriction / Local trauma / Excessive local force”
5.Taurodontism 6.Dens-in-dente (Dens 7.Dens Evaginatus
Evaginatus)
Failure of invagination of tongue-like Infolding of all layers of developing Out-folding of enamel organ  enamel-
projections in multi-rooted teeth  furcation enamel organ interiorly  covered tubercle near M1/3 Occlusal
area is displaced  Large pulp chamber / Invagination within the body of the surface of premolars.
Elongated root trunk / short roots. tooth lined with enamel.
Enamel + Dentin + Pulp horn.
Recognized radiographically only. Anteriors > Posteriors.
U.2 is the most common.
From mild form (blind sac) To Severe
form (Penetration as a 2nd foramen).
4|Page

8.Enamel pearl (Enameloma)
Localized formation of enamel at CEJ due to
stimuli of Ameloblasts.
Recognized radiographically by its globular
shape & similar density as enamel.
It may predispose to periodontal disease &
should be differentiated from pulp stones &
calculus deposits.
‫صفوت حسن إسماعيل‬
9.Pulp stones
Localized formation of dentin or Calcified
deposits in pulp due to stimuli of
Odontoblasts.
It appears as calcified mass within the pulp
chamber & less radiopaque than enamel.
10.Talon’s cusp
Hyperplasia of cingulum of
anterior incisors  formation of
supernumerary cusp.
Its image is usually superimposed
with that of the incisor on which
occurs.
11.Congenital syphilis
Dental manifestations in 30% of
cases of congenital syphilis.
The affected incisors =
“Hutchinson’s incisors / Screw-
driver incisors”
The affected molars are either
“Moon’s molars” OR “Mulberry
molars”.
5|Page
 ‫صفوت حسن إسماعيل‬

5.Abnormalities in structure

1.Enamel Defects “Amelogenesis Imperfecta”

Hereditary enamel
hypoplasia “Quantitative”.
Thin / Square-shaped / pitted /
rough / Easily worn away enamel.
No contact between adjacent teeth.
Radiographically; Square-shaped
crowns with thin opaque layer of
enamel of normal density.
Hereditary enamel Hypomaturation.
hypocalcification “Qualitative”.
More common.
Regular enamel thickness that easily get
fractured due to poorly mineralization.
Radiographically; Normal enamel
thickness but with less density even from
dentin.
Hypomaturation-hypoplastic type
associated with Taurodontism.
Mottled & Softer enamel of normal Combination of Hypomaturation & hypoplasia with
thickness & may crack. Taurodontism.
Color ranges from clear to cloudy white,
yellow or brown.
Radiographically; Normal enamel
thickness same density even from dentin.

2.Dentin Defects “Dentinogenesis Imperfecta”

“Hereditary brown opalescent dentin”
Type I “Associated with osteogenesis imperfecta” Type II “No osteogenesis Type III “Shell teeth / Brandywine”
imperfecta”
Bulbous brown crowns. Thin layer of normal mantle dentin.
Short stunted roots. Enlarged pulp chamber with open apical
Obliterated pulp chambers. foramina  Periapical pathosis.
3.Dentinal dysplasia
Type I (Radicular type) Type II (Coronal type)
Bluish brown translucency. Same features of Dentinogenesis
Short obliterated pulp chambers + Periapical pathosis. imperfecta.
Mal-aligned teeth. Obliteration of pulp chambers with
numerous pulp stones.
Normal-shaped roots.
4.Enamel+Dentin Defects “Regional Odontodysplasia” “Ghost teeth”

Defects in both enamel + dentin (Hypocalcified & hypoplastic)  Prevent teeth eruption in full quad.

The teeth that can erupt are susceptible to caries, brittle, fracture & pulpal infection.

6|Page

“Changes initiated after development of tooth & ranges in severity from no clinical significance to tooth loss”
1.Attrition
Physiological wearing of dentition
due to continuous friction between
different teeth surfaces.
Occur: incisally, occlusally &
interproximally.
Contact point  Contact area.
Males > Females.
Depend on:
Abrasiveness of diet / salivary factors /
mineralization of teeth & emotional tension.
Pathological in Bruxism.
3.Erosion
Chemical resorption of teeth due to contact
of acids as in: GERD, Lemon, Citrus fruits,
Cola … etc.
expands peripherally & continuous with image pf pulp chamber.
Location, pattern & appearance of eroded
areas  clues regarding origin of
decalcifying agent.
‫صفوت حسن إسماعيل‬
6.Acquired Abnormalities
2.Abrasion
“Non-physiological wearing of teeth due to continuous friction with foreign material; pipe smoking, hair pins, toothpicks, denture
clasps & cutting thread with teeth.
Tooth brush injury “Most common type” Dental floss injury
Hard toothbrush bristles with “back-forth” movements  V-shaped wedge defects at Excessive & improper use of dental floss
cervical part of teeth.  Narrow semilunar radiolucency in
cervical portion of interproximal
Common in Left side for a right-handed person & vice versa. surfaces.
Semi-lunar OR semi-circular shapes with borders of increasing radiopacities.
4.Resorption
“Resorption of tooth structures by osteoclasts-like cells”
Internal resorption External resorption
“Within Pulp chamber or root canal system” “Most commonly the root”
“Ballooning-like expansion” originated from the dental pulp, Appears at apex of the tooth or on lateral root surface & MOST
COMMONLY in apical & cervical regions.
Initiated by acute trauma, direct OR indirect pulp capping, Initiated by localized inflammatory lesions, re-implanted teeth,
pulpotomy & enamel invagination. tumors, cysts, impacted teeth, excessive mechanical & occlusal
forces.
Mandible > Maxilla.
Most commonly in Central incisors, canines & premolars.
7|Page
 ‫صفوت حسن إسماعيل‬

6.Acquired Abnormalities
“Changes initiated after development of tooth & ranges in severity from no clinical significance to tooth loss”

5.Secondary dentin 6.Hypercementosis

Type of dentin deposited after eruption of
teeth.
Initiated as physiological aging, moderately
progressive caries, trauma, erosion.
Attrition, abrasion, dental restorative
procedures chewing or minor trauma 
reduction in pulp size & pulp recession.
Excessive deposits of cementum on tooth roots.
Cemental Hyperplasia Cementum hypertrophy
No specific cause & should be biopsied Some causes:
1.Supra-erupted tooth (Loss of opposing teeth).
2.Inflammation in rarefying / sclerosing osteitis.
3.Hyper-occlusion &  forces of mastication.

Alone in Paget’s disease of bone & Hyperpituitarism.

No signs or symptoms.
Normal LD & PDL space & Root outline is smooth.

8|Page