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DEVELOPMENTAL
DISTURBANCES
OF TEETH – LECTURE
III

By
Professor
Professor Dr/
Dr/ Heba
Heba Ahmed
Ahmed Farag
Farag
professor
professor of
of Oral&Maxilofacial
Oral&Maxilofacial Pathology
Pathology
Cairo
Cairo University
University
◦ Remembering the etiology and types of
developmental disturbances related to teeth
structure.

◦ Understanding defects related to enamel

structure.
DENS INVAGINATUS, DENS IN DENTE

a common malformation in its milder form in

which the enamel organ gets infolded
protruding into, or invaginating, the detine
papilla producing a deep
enamel lined pit within the dentine palatally
or lingually.
Maxillary lateral incisor most commonly

May be represented as a deep palatal pit

Caries and bacterial

invasion of the pulp may
develop and proceed deeply
from the invagination
Radiographic
Features
􀂾 The lesion appears as
a tooth within a tooth.
􀂾 The inner tooth may
reach different levels
within the outer tooth,
ranging
from being entirely
within the crown to
reaching near the apex
of the root.
Histopathologic Features
• A point of entry on the palatal or lingual
surface.
• The invagination cavity is lined, sometimes
only partially, by enamel.
• Remnants of the enamel organ may be
seen in younger individuals.
• The dentine surrounding the cavity usually
contains a slit-like pulp.
􀂾 The dentine between the floor of the
invagination and the pulp is often poorly
formed or incomplete.
DENS EVAGINATUS

The condition usually

appears as an accessory
cusp or a globule of
enamel on the occlusal
surface of premolars and
molars, or on the palatal
aspect of incisors and
canines.
• It is an extra cusp TALON CUSP
resembling an eagle's
talon. It projects lingually
from the
cingulum area of maxillary
or mandibular permanent
incisors and extends to
the incisal edge.
• It is composed of
normal enamel and
dentin and contains a
pulp horn.
- It is more common in
Mongoloid races, but it
has been reported in
Caucasians.
- The condition may be
unilateral or bilateral.

A pulp horn may extend intor this extra cusp

STRUCTURAL ANOMALIES OF TEETH
These are hereditary or acquired
developmental disturbances affecting the
structure of enamel, dentine or both.
Differences Between Hereditary and Acquired
Conditions
Hereditary Conditions Acquired Conditions

Usually affect both Only one dentition,

deciduous and usually the permanent,
permanent dentitions is affected

Affect either enamel or Affect both enamel and

dentine dentine

Produce diffuse or Produce horizontally

vertically oriented oriented defects
defects
 ENAMEL HYPOPLASIA
Hereditary or acquired defects in enamel formation
Causes of Enamel Hypoplasia

Hereditary Amelogenesis Imperfecta

Local Factors
Acquired
Systemic Factors
Hereditary
Amelogenesis imperfecta
Cleido-cranial dysplasia
Osteopetrosis
Mongolism

Acquired
Local Factors
Trauma
Infection
Irradiation
Systemic Factors
Nutritional deficiencies

Exanthematous fevers

Infantile GI disturbances

Congenital syphilis

Ingestion of chemicals

Birth injuries
Amelogenesis imperfecta
It represents a group of hereditary defects of enamel:
Type I:H. enamel hypoplasia
Type II:H. enamel hypocalcification
Type III:Hereditary enamel hypomaturation
 AMELOGENESIS IMPERFECTA
A spectrum of hereditary defects in the function of
ameloblasts and in the mineralization of enamel
matrix that result in teeth with multiple generalized
abnormalities affecting the enamel only.
Usually all the teeth of an affected individual are
involved, though not
necessarily to the same extent.
- Mutations in the
AMELX, ENAM, MMP20 and KLK-4 genes cause
amelogenesis imperfecta.
» The AMELX, ENAM, MMP20 and KLK-4 genes
provide instructions for
making proteins that are involved in the formation
of enamel
 Hypocalcification Hypoplasia
qualitative quantitative
Normal matrix Deficient matrix

Defective mineralization Normal mineralization

Soft enamel Normal hardness
rough Smooth in unpitted
areas
opaque translucent
Acid insoluble Acid soluble
Decreased radiopacity Normal radiopacity
indistinguishable from
dentin
Hereditary Enamel Hypoplasia
This is mainly a quantitative
defect reflected in:
» Localised or generalised
decrease in the amount of
organic matrix formed.
- In males, it usually takes
the form of a very thin but
hard and smooth enamel
layer.
- In extreme cases there may
be complete absence of
enamel.
In females, the enamel is
usually thicker but
vertically grooved, pitted
or wrinkled.
-Both deciduous and
permanent molars may
show taurodontism.

-Teeth frequently develop

abscesses early in life.
Radiographically, the normal radiopacity of enamel
is maintained.
-Enamel is distinguishable radiographically from
dentine.

Microscopically, only small areas of enamel maintain

their prismatic
structure.
- Most of the enamel shows a hyaline glassy
appearance with fine laminations lying parallel to
the surface.
-The dentine may show increased interglobular
spaces, but is otherwise normal.
Hereditary Enamel Hypocalcification
This is mainly a qualitative
defect reflected in:
» Normal amount of organic
matrix formed.
» Defective mineralization
and maturation.
The enamel will therefore
be:
» Soft to the probe.
» Lacking its surface lustre
and gloss, having instead an
opaque matt surface.
- The enamel is frequently stained.
- Enamel abrades easily exposing dentine which
wears down rapidly, often
becoming level with the gum margin.

Radiographically, the
normal radiopacity
of enamel is lost.
» Enamel is
indistinguishable
radiographically from
dentine.
Microscopically, the prismatic structure of
enamel is maintained.
» A surface layer of laminated material is initially
present.
» This quickly wears down through attrition.
 ACQUIRED ENAMEL HYPOPLASIA
Local Factors Systemic factors
Toxic damage to
-Trauma ameloblasts
- Infection ⇒ Ingestion of chemicals
(F-)
» Exanthematous fevers
» Infantile gastro-
intestinal disturbances
» Mineral deficiency
⇒ Ca++ deficiency during
childhood
Clinically
* In its milder forms, the
hypoplasia presents
itself in the form of
horizontally
oriented row or rows of
pits or grooves or
depressions on the
enamel surface.
-More severe cases may
large, horizontally
oriented areas of
enamel deficiency.
-The enamel may be
normal in colour and
translucency, or it may be
stained or opaque.

- The enamel in the non-

affected areas will be
normal in colour and
translucency
The clinically observable defects will be
found to correspond to areas where
the incremental lines of enamel lie closer
together.
» This is due to reduced rate of enamel
matrix formation during the period
when the affected parts were being formed.

- The prismatic structure of enamel is

usually maintained.
 Turner's Tooth or Turner's Hypoplasia
Enamel hypoplasia
involving a single
permanent tooth; related
to infection in
the primary tooth that
preceded it or to trauma
during odontogenesis

If Turner's hypoplasia is found in

the anterior area of the mouth,
the most likely cause is a traumatic
injury to a deciduous predecessor
If Turner's hypoplasia
is found on a
permanent canine or
a premolar, the
most likely cause is
periapical infection
of its deciduous

The affected area of

hypoplasia may be
white, yellow or
brownish in colour
Radiographically
-Teeth affected by Turner’s
hypoplasia show a typical
gnarled appearance of
their crowns.
- The gnarled part of the
crown corresponds to the
affected hypoplastic part
of the crown enamel.