DEVELOPMENTAL

DISTURBANCES OF TEETH
WHAT ARE DEVELOPMENTAL DISTURBANCES??

• Developmental disturbances means an abnormality where the pathology

starts in the embryonic stage of human life , before the formation of the
dentition
Developmental Disturbances

(1) Size

(2) Number and Eruption

(3) Shape/Form

(4) Defects of Enamel and Dentin

Size

❖ Microdontia

❖ Macrodontia
Size

Microdontia

(1) True Generalized Microdontia

(2) Relative Generalized Microdontia

(3) Focal or Localized Microdontia

 True Generalized Microdontia

✔ All teeth are smaller than normal

✔ Occur in some cases of pituitary
dawrfism
✔ Exceedingly rare
✔ Teeth are well formed

Relative Generalized Microdontia

 Normal or slightly smaller than normal teeth

 Are present in jaws that are somewhat larger than normal

 Focal/Localized Microdontia
⮚ common condition
⮚ affects most often maxillary lateral incisior
+ 3rd molar
▪ Common forms of localized microdontia
is that which affects maxillary lateral
incisior
▪ Peg lateral
▪ Instead of parallel or diverging mesial +
distal surfaces
Size

MACRODONTIA

(1) True Generalized Macrodontia

(2) Relative Generalized Macrodontia

(3) Focal or Localized Macrodontia

True Generalized Macrodontia

▪ All teeth are larger than normal

▪ Associated with pituitary

gigantism

▪ Exceedingly rare
Focal/Localized Macrodontia
⮚ uncommon condition
⮚ unknown etiology
⮚ usually seen with mandibular 3
molars
Relative Generalized Macrodontia
▪ Normal or slightly larger than
normal teeth in small jaws
▪ Results in crowding of
rd
teeth
▪ Insufficient arch space
Number and Eruption

❑ Supernumerary

❑ Anodontia

❑ Impaction
 Number and Eruption

Supernumerary

o Results from continued proliferation of

permanent or primary dental lamina to
form third tooth germ

o Teeth may have: o More often in permanent dentition

o Normal morphology than primary dentition
o Rudimentary
o Miniature o More in the maxilla than in mandible
 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

Anodontia

✔ lack of tooth development

✔ absence of teeth

TYPES:
▪ Complete
Anodontia

▪ Partial Anodontia
▪ Hypodontia
▪ Oligodontia

▪ Pseudoanodontia

▪ False Anodontia
Complete Anodontia Hypodontia
• When all teeth are missing
▪ Lack of development of one or more teeth
• Rare

• Often associated with a syndrome

known as hereditary ectodermal
dysplasia
Oligodontia
• lack of development of six or more teeth
 Pseudoanodontia

• when teeth are absent clinically because of

impaction or delayed eruption
False Anodontia

• when teeth have been exfoliated or extracted

 Number and Eruption

Impaction

• Most often affects the • Occurs due to obstruction from

mandibular 3rd molars + crowding
maxillary canines
• From some other physical barrier

• Less commonly: • Occasionally, may be due to an

• Premolars abnormal eruption path, presumably
• Mandibular canines because of unusual orientation of tooth
• Second molars germ
 Ankylosis

▪ 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
 Shape and Form
Crown

✔ Fusion
✔ Gemination
✔ Taurodontism
✔ Talon’s Cusp
✔ Leong’s Cusp
 Dens Invaginatus
 Peg-shaped Lateral
 Hutchinson Incisor
 Mulberry Mola
Shape and Form

Root

▪ Concresence

▪ Enamel Pearl

▪ Dilaceration

▪ Flexion

▪ Ankylosis
 Fusion

▪ Joining of 2 developing tooth

germs

▪ Resulting in a single large

tooth structure

▪ May involve entire length of teeth

▪ Or may involve roots only, in which

case cementum + dentin are shared
 Gemination

• Fusion of 2 teeth from a

single enamel organ

• Partial cleavage

• Appearance of 2 crowns that

share same root canal

• Trauma 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 that
have apical occlusal height
⮚ Associated with syndromes such as

⮚ Down syndrome

⮚ Klinefelter’s syndrome
Dens Evaginatus
Talon’s Cusp Leung’s Cusp
▪ Well-delineated additional cusp • Developmental condition
▪ Located on the surface of an anterior tooth • Clinically as an accessory cusp or a globule
▪ Extends at least half the distance from cej • Located on occlusal surface between
to incisal edge buccal + lingual cusps of premolars
• Unilaterally or bilaterally
 Dens Invaginatus (Dens in Dente)

• Deep surface invagination • Depth varies from slight enlargement

of crown or root that is lined by of cingulum to a deep infolding that
enamel extends to apex
• 2 forms: • Historically, it has been classified into 3
• Coronal
major types:
• Radicular • Type I
• Type II
• Type III
Dens Invaginatus (Dens in Dente)
• Type I
• Confined to the crown
• Type II • Type III
• Extends below cemento enamel
junction • Extends through the root.
• Ends in a blind sac
• Perforates in the apical or lateral
• May or may not communicate
radicular area without any immediate
with adjacent dental pulp
communication with pulp
Peg-shaped lateral

• undersized lateral incisor

• smaller than normal

• occurs when permanent lateral

incisors do not fully develop
 Hutchinson’s Incisor

• Characteristic of congenital
syphilis

• Lateral incisors are peg-shaped or

screwdriver-shaped.
• Widely spaced

• Notched at the end

• With a crescent-shaped
deformity
 Mulberry Molar

• Dental condition usually

associated with congenital
syphilis
• Characterized by multiple rounded
rudimentary enamel cusps on
permanent 1st molars
o Dwarfed molars with cusps covered with
globular enamel growths
o Giving the appearance of a mulberry
 Concrescence

• 2 fully formed teeth

• Joined along the root surfaces by

cementum

• Noted more frequently in posterior

and maxillary regions
 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
▪ Occur most commonly in bifurcation or
trifurcation of teeth
▪ May occur on single-rooted premolar as well
▪ Maxillary molars are commonly affected than
mandibular molars
 Dilaceration

• Angulation or a sharp
bend or curve in root or
crown of a formed tooth

• Trauma to a developing tooth

can cause root to form at an
angle to normal axis of tooth

• Rare deformity
 Ankylosis

▪ Also known as “Submerged teeth”

▪ Fusion of a tooth to surrounding bone

▪ Deciduous teeth most commonly

mandibular 2nd molars.
▪ Undergone variable degree of root
resorption
 Ankylosis
▪ 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
 Amelogenesis Imperfecta
▪ Hereditary enamel dysplasia, Hereditary brown enamel, Hereditary brow opalescent teeth

• Group of conditions caused by defects

in the genes encoding enamel matrix
proteins

• Genes that encode for enamel proteins:

• Amelogenin Mutated in in
• Enamelin patients
• Others with this
condition
Amelogenesis Imperfecta
• Affects both dentition

• Deciduous
• Permanent

• Classified based on pattern of

inheritance:

• Hypoplasia
• Hypomaturation
• Hypocalcified
 Hypoplastic Amelogenesis Imperfecta
• Inadequate formation of matrix

• Enamel is randomly:

• Pitted
• Grooved or very thin
• Hard + translucent

• Defects become stained but teeth are not

especially susceptible to caries unless enamel
is scanty and easily damaged
 Hypoplastic Amelogenesis Imperfecta
• Reduced enamel thickness
• Abnormal contour
• Absent interproximal
contact points

• Radiographically:
• Enamel reduced in bulk
• Shows thin layer over
occlusal + Interproximal
surfaces
 Hypomaturation Amelogenesis Imperfecta

Enamel is normal in form on eruption but:

✔ Opaque
✔ White to brownish-yellow
✔ Softer than normal
✔ Tends to chip from
underlying dentin
Radiographically:

• Affected enamel exhibits radiodensity

similar to dentin
Hypocalcified Amelogenesis 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
 Hypocalcified Amelogenesis Imperfecta

• With years of function:

• Coronal enamel is removed

• Except for cervical portion that is
occasionally calcified better

• Radiographically:

• Density of enamel + dentin are similar

 Dentinogenesis Imperfecta

▪ Also known as “hereditary opalascent

dentin”
▪ Due to clinical discoloration of teeth
▪ Mutation in the dentin
sialophosphoprotein • Have blue to brown
▪ Affects both primary + permanent dentition discoloration
• With distinctive translucence

• Enamel frequently separates easily from

underlying defective dentin
Dentinogenesis Imperfecta

Radiographically:

• Bulbous crowns
• Cervical constriction
• Thin roots
• Early obliteration of roots canals
+ pulp chambers
Type I Dentinogenesis Imperfecta

❖ Occurs in families with osteogenesis imperfecta

❖ Primary teeth are more severely affected than permanent teeth

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
Type II Dentinogenesis Imperfecta

⮚ 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

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
Type III Dentinogenesis Imperfecta

▪ “Bradwine type”

▪ Racial isolate in maryland

▪ Multiple pulp exposures in deciduous not seen in type i or ii

▪ Periapical radiolucencies

• enamel appears normal

• large size of pulp chamber is due not to resorption but rather to

insufficient + defective dentin formation
 Dentin Dysplasia
• Also known as “rootless teeth”

• Rare disturbance of dentin

formation

• Normal enamel
▪ Classification:
• Atypical dentin formation
▪ Type i (radicular type)
• Abnormal pulpal morphology
▪ Type ii (coronal type)
• Hereditary disease
 Type I (Radicular Type)

• Both dentitions are of

normal color

• Periapical lesion

• Premature tooth loss may occur

because of short roots or periapical
inflammatory lesions
 Type I (Radicular Type)

Radiographically:

✔ Roots are extremely short

✔ Pulps almost completely
obliterated
✔ Periapical radiolucencies:
✔ Granulomas
✔ Cysts
✔ Chronic abscesses
 Type 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
 Type II (Coronal Type)

• Radiographically:

(Deciduous)
• Roots are extremely short
• Pulps almost completely
obliterated

(Permanent)
• Abnormally large pulp chambers in
coronal portion of tooth
 Regional Odontodysplasia
Odontogenic dysplasia,Odontogenesis imperfecta, Ghost teeth

• One or several teeth in a localized area

are affected
• Maxillary teeth are involved more
frequently than mandibular area
• Etiology is unknown
• Teeth affected may exhibit a delay or total
failure in eruption
• Shape is altered, irregular in appearance
Regional Odontodysplasia
Radiographically:

• Marked reduction in radiodensity

• Teeth assume a “ghost” appearance
• Both enamel + dentin appear very thin
• Pulp chamber is exceedingly large