Developmental Anomalies of

Teeth
S. BURCAK CEHRELI,DDS,PhD
The information presented herein is
summarised from:

C A K h D
B U R D S , P
S. E L I, D
E H R
CBOOK 1 BOOK 2 BOOK 3
• Various defects (anomalies/malformations) can develop in the tooth
structures depending on the causative agent and its relationship to
the stage of the tooth formation and calcification.
• The incidence of defects differs based on race, geographic region, and
sex, and these variations have been reported on different tooth parts
as well as tooth supporting structures.
 GENETIC

ACQUIRED
CAUSE OF DISTURBANCE

CONGENITAL
GENETIC
• Tooth shape and structural content can be influenced by genome
dictation. There may be a wide range of disturbances as part of a
much larger clinical manifestation, such as a syndrome involving
several body organs as well as the teeth, including those in
ectodermal dysplasia; or, alternatively, SOLELY teeth may be involved,
such as the case in amelogenesis imperfecta
CONGENITAL
• Congenital: There are instances when a child’s tooth development is
affected by events during pregnancy or at birth. This is known as
congenital, and there is no faulty gene involved, an example of which
is enamel hypoplasia caused by maternal dehydration or viral
infection during pregnancy.
ACQUIRED
• These cases are affected by environmental factors – for example,
fluorosis defects caused by water fluoride content or isolated enamel,
and dentine hypoplasias in permanent teeth caused by infections
involving primary antecedent teeth, such as in Turner’s hypoplasia
Extent of Involvement of the Dentition
Defects can either involve part or all of the teeth. They may also affect
one tooth, a few teeth, or the full dentition. It is important to classify
them on the level of involvement of the teeth:

a) Generalized b) Localized
Which stage
Which anomaly??
WHAT ARE THE DEVELOPMENTAL
ANOMALIES OF TEETH??

ANOMALIES OF
ANOMALIES OF ANOMALIES OF ANOMALIES OF TISSUE
NUMBER SIZE MORPHOLOGY COMPOSITION
&MORPHOLOGY
 1
3 2
4
1
HYPODONTIA
• Hypodontia refers to ”missing teeth”
• Other commonly used terms include oligodontia: defined as missing
more than six teeth excluding third molars,
• Anodontia:the complete absence of teeth
1
• Hypodontia can affect both permanent and primary dentitions as it is
genetically determined. If there is an abnormality of number in the
primary dentition, then there is a 40% chance of a numerical
abnormality in the permanent dentition.
1
Syndromes Demonstrating Hypodontia
HYPERDONTIA : MAXILLARY RIGHT INCISOR AND MANDIBULAR RIGT-LEFT LATERAL REGION, CASE OF CEHRELI SB
panoramic view showing missing second premolars, lower incisors, one lower molar, and upper lateral incisors.
TAKEN FROM BOOK 1 , PAGE 22
Missing upper lateral incisors and lower central incisors. TAKEN FROM BOOK 1 , PAGE 22
ANODONTIA :no teeth!/absence of all
•,

TAKEN FROM BOOK 1

1
HYPERDONTIA
Hyperdontia means extra teeth. The presence of
supernumerary teeth can be an isolated condition,
or it can be associated with a syndrome.
a) Mesiodens: Maxillary Midline supernumerary
b) Paramolar: Supernumerary of molar region
c) Multiple extra teeth
90%-to 98% of supernumerary teeth
occur in the maxilla, with the
permanent dentition being more
frequently affected than the primary
dentition. The most commonly
occurring supernumerary teeth are
called mesiodens, with a prevalence
of approximately 1% in the
population (reports vary from 0.15%
to 4%).
Mesiodens develop in the anterior
midline of the maxillary arch.
 mesiodens

TAKEN FROM BOOK 2

Mesiodens

Upper occlusal radiograph shows the inverted conical mesiodens between the roots of erupted upper
permanent central incisors.
Rakesh N. Bahadure, Nilima Thosar, Eesha S. Jain, Vidhi Kharabe, Rahul
Gaikwad, "Supernumerary Teeth in Primary Dentition and Early Intervention: A Series of
Case Reports", Case Reports in Dentistry, vol. 2012, Article ID 614652, 4 pages, 2012.
Mesiodens:

https://doi.org/10.12968/ortu.2017.10.2.46
Supernumerary (extra) teeth
• In the mandible; the most common supernumerary teeth are
premolars.
• A supernumerary tooth may resemble the corresponding normal
tooth or it may be rudimentart with no resemblance to its normal
counterpart.
1
Syndromes Demonstrating Hyperdontia
 1
3 2
4
2
Disturbances and aberrations in morphodifferentiation lead to
abnormal forms and sizes of teeth, resulting in conditions such
as peg teeth, other types of microdontia, and macrodontia.

MICRODONTIA
Diminished tooth size can result from a
change in the overall tooth size or can
occur secondary to reduction in the
enamel thickness or both. Conditions
demonstrating microdontia include
many of the ectodermal dysplasias and
the tricho-dento-osseous syndrome
(OMIM #190320) that can have generally
small teeth with thin enamel
MACRODONTIA
Macrodontia can occur as a localized
trait, and most commonly occurs as
gemination of fusion.
Hereditary conditions with macrodontia
include otodental syndrome (OMIM
#166750) and the rare but quite
remarkable Ekman-Westborg and Julin
trait
2 Macrodontia

CASE OF CEHRELI SB
 Microdontia

TAKEN FROM BOOK 1

Generalized Microdontia

Generalized microdontia is seen in the late transitional denti- tion (permanent incisors) of this child affected
with the tricho-dento-osseous syndrome. TAKEN FROM BOOK 3
 1
3 2
4
3
• Developmental variances can involve one or more teeth and can affect
any portion or component of the tooth (e.g., crown, root, pulp).
3
Anomalies of Crown Size and Morphology
• Fusion
DOUBLE TEETH
• Gemination
• Dens Evaginatus
• Dens Invaginatus
• Hutchinson incisors, Mulberry Molars
• Talon cusp
• Cusp of Carabelli
DOUBLE TEETH
 FUSION
• Fusion represents the union of two
independently develop- ing primary
or permanent teeth. The condition
is usually limited to the anterior
teeth and, like gemination (see the
following discussion), may show a
familial tendency. Fusion of teeth
involving only cementum is termed
concrescence.
Fusion of a permanent central and lateral
incisor. .TAKEN FROM BOOK 2
FUSION 3

Cases of CEHRELI SB
 Bilateral gemination
3

Cehrelı, S. B. (2007). Süt dişlenmede çift taraflı füzyon: olgu Bildirimi. Ondokuz Mayıs
Üniversitesi Dişhekimliği Fakültesi Dergisi, 8(3), 183,185.
 GEMINATION
• Gemination is the incomplete twining of primary or
permanent teeth and is not known to have any
genetic predilection or heritable etiology
• A geminated tooth must be distinguished from a
fused tooth. It represents an attempted division of
a single tooth germ by invagination occurring
during the proliferation stage of the growth cycle
of the tooth, in which case the geminated tooth
appears clinically as a bifid crown on a single root.
• The crown is usually wider than normal, with a
shallow groove extending from the incisal edge to
the cervical region. The anomaly, which may follow Gemination of a mandibular lateral incisor.
a hereditary pattern of occurrence, is seen in both The crown has a groove on the labial
primary and permanent teeth, although it probably surface and is wider than normal. TAKEN
ap- pears more frequently in primary teeth. FROM BOOK 2
FUSION VERSUS GEMINATION (an
example from primary dentition)
• The prevalence of fused and geminated teeth is approximately 0.1%
to 0.5%.15 One can usually distinguish fusion of two primary teeth
from gemination without the aid of radiographs by counting the
number of teeth. If two teeth are fused, there should be 9 teeth in
the arch, one of which is very large, rather than 10 teeth. If
gemination has occurred, there should be 10 teeth in the arch and
one will be very large. A radiograph may be necessary to confirm the
preliminary diagnosis of fusion or gemination.
Dens Invaginatus (Dens ınDente)
The enamel and dentine fold into their own structure, producing a cleft.
This developmental anomaly is a lingual invagination of the enamel,
and can occur in primary and permanent teeth. This is usually seen on
the lingual aspect of the upper incisor teeth and more commonly on
lateral incisors.
Oehlers (1957a) has suggested the following classification:
• Type I: Invagination limited to the crown Type II: Invagination below
the Cemento

3
• Enamel Junction (CEJ)
Type III: Invagination fully extended to the
• apex of the tooth
Dens Invaginatus (Dens ınDente)

• Dens invaginatus (or a tooth within a tooth/ dens in dente) can be

diagnosed radiographically. Unusual cases of dens invaginatus have
been reported in a mandibular primary canine, a maxillary primary
central incisor, and a mandibular second primary molar. It is most
often seen in the permanent maxillary lateral incisors,
Dens Invaginatus

(a) Dens in dente Type III appearance on a sectioned extracted tooth; (b) radiographic view of invagination on the upper
primary canine. TAKEN FROM BOOK 1 PAGE 32
 Dens Invaginatus

This maxillary incisor has undergone pulpal necrosis as a result of dens in dente and presumably
communication between the dental pulp and the oral environment. TAKEN FROM BOOK 3
 Dens Evaginatus

• Dens evaginatus describes an outfolding of the enamel organ that

results in an extra cusp, usually in the central groove or ridge of
posterior teeth and in the cingulum area of the anterior teeth,
sometimes called a talon cusp .
• It occurs with a frequency of 1% to 4% and results from the
evagination of inner enamel epithelium cells, which are the
precursors of ameloblasts. The extra cusp contains enamel, dentin,
and pulp tissue; therefore pulp exposure is possible by radically
equilibrating the occlusion.
Dens Evaginatus

Dens evaginatus on the labial surface of the upper left central incisor. TAKEN FROM BOOK 1
TALON CUSP
TALON CUSP
 Hutchinson incisors and Mulberry Molars

.
• These defects are seen on the affected e
v es o n
incisors and molars of patients who had
a
h ch a l .
syphilis at the time of tooth o t nc i s
development. Molar teeth appear to
n ir i
have extra lobules around their natural t h e
cusps, giving them the appearance of a
Mulberry fruit. Incisor teeth have
incisal notches

Notched and pitted incisors in congenital syphilis

TAKEN FROM BOOK 1.
HUTCHINSON TEETH !!!!
• Hutchinson teeth is a sign of congenital syphilis, which occurs when a
pregnant mother transmits syphilis to her child in utero or at birth.
• Hutchinson teeth is part of what’s called the “Hutchinson triad,”
involving the teeth, ears, and eyes. The condition is named after Sir
Jonathan Hutchinson, an English surgeon and syphilis specialist, who
worked at London Hospital in the late 1800s.

https://www.healthline.com/health/hutchinson-teeth#pictures
HUTCHINSON TEETH !!!!----SPHILIS

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https://www.healthline.com/health/hutchinson-teeth#pictures
HUTCHINSON TEETH !!!----SPHILIS!

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MULBERRY MOLARS

A mulberry molar is usually caused by congenital syphilis,

which is passed from the mother to the child in the uterus
through the placenta. Since this particular symptom of
C congenital syphilis manifests later in childhood with the
eruption of the permanent molars, it is a late-stage marker
for this disease.

The cause of the molar atrophy seen in mulberry molars is

considered to be enamel hypoplasia or a deficiency in tooth
enamel. The underlying dentin and pulp of the tooth are
normal, but the enamel is thin and deformed.
3
Anomalies of Root Size and Morphology
• Molar Incisor Root Malformation
• Short Root Anomaly
• Hypercementosis
• Taurodontism
• Dilecaration
Molar Incisor Root Malformation
MIRM
• A novel dental phenotype has recently been described that is
characterized by diminished and dysplastic root formation of the first
permanent molars and a narrow abnormal pulp chamber
• The permanent anterior teeth can be involved and exhibit cervical
crown constrictions and changes in the pulp chamber morphology.
These phenotypic features have led to this condition being referred to
as molar incisor root malformation (MIRM)
• The etiology remains unclear; however, the majority of affected
individuals have a history of systemic illness or neonatal conditions,
such meningomyelocele or sacral dimple, meningitis, preterm birth, or
chronic renal disease to name a few.
MIRM
TAURODONTISM
• This abnormality is a developmental disturbance of a tooth that lacks
constriction at the level of the cementoenamel junction (CEJ) and is
characterized by vertically elongated pulp chambers, apical
displacement of the pulpal floor, and bifurcation or trifurcation of the
roots.
• The term taurodontism comes from the Latin term tauros, which
means “bull” and the Greek term odus, which means “tooth” or “bull
tooth”.
TAURODONTISM
TAURODONTISM
ASSOCIATED SYNDROMES--TAURODONTISM

• Klinefelter syndrome
• Cleft lip and palate,
• Orofaciodigital syndrome,
• Tricho- dento-osseous syndrome,
• Down’s syndrome,
• Ectodermal dysplasia, Hypo- and Oligodontia
Conditions Demonstrating Taurodontism
 DILACERATION
• Dilaceration is the name given
to those teeth with bends or
changes in the long axis of
their crowns, crown‐roots, or
roots .
• This is usually following
trauma to the developing
tooth bud. The severity of
dilaceration is dictated by the
severity of original trauma,
and dilacerated teeth may not
erupt normally.
DILACERATION

TAKEN FROM BOOK 1

CONCRESCENCE
• This is the case in which two independent adjacent teeth are
pathologically connected at their root surface

a) Root surface connection of a para‐molar

with a third molar; (b) mesial view of
the case. TAKEN FROM BOOK 1
 1
3 2
4
4 Environmental Influences on Enamel and/or Tooth Color
ANOMALIES OF ENAMEL
• Amelogenesis occurs in three stages.
• 1.the enamel matrix is secreted by ameloblasts
• 2.It undergoes calcification;
• 3.A final stage of enamel maturation, with crystal growth and removal
of water and protein, continues until eruption.
HYPOplasia VERSUS HYPOmineralisation
• In general, the resulting enamel defects can be classified as defects in
the amount of enamel (hypoplasia) or deficiencies in the mineral
content (hypomineralization). Changes in enamel mineralization result
in altered enamel translucency and color. Because enamel is
translucent, changes in dentin can result in tooth color changes even
when the enamel is relatively unchanged (e.g., tetracycline staining).
• Enamel hypoplasia or hypomineralization can be generalized or
localized.
• Environmental stressors that are of short duration often cause localized
defects (e.g., fever), whereas chronic stressors are more likely to be
associated with generalized defects (e.g., fluorosis).
TAKEN FROM BOOK 1
 HYPOPLASIA RESULTING FROM NUTRITIONAL
DEFICIENCIES

• Many clinical investigations have been

undertaken to determine the relationship
between hypoplastic defects of enamel and
systemic disabilities. Relatively little im-
portance has been placed on exanthematous
fevers, but deficiency states, particularly
those related to deficiencies in vitamins A, C,
and D, calcium, and phosphorus, can often
be related to the occurrence of enamel Irreversible enamel defects caused by an
hypoplasia. untreated celiac disease. They may be the only
clue to its diagnosis, even in absence of
• Celiac disease and neonatal tetany also gastrointestinal symptoms, but are often confused
contribute to enamel hypoplasia with fluorosis,tetracycline discoloration, or other
causes
HYPOPLASIA RELATED TO BRAIN INJURY AND
NEUROLOGIC DEFECTS
• Children with low intelligence quotients, mental retardation and
Cerebral Palsy are reported to have higher incidence of enamel
defects.

HYPOPLASIA ASSOCIATED WITH NEPHROTIC SYNDROME

• Researchers found a high incidence of enamel defects in the primary

teeth of children diagnosed with chronic renal failure early in infancy
HYPOPLASIA ASSOCIATED WITH
ALLERGIES
• Lesions were localized in the occlusal third of the primary canines and
first molars

HYPOPLASIA ASSOCIATED WITH LEAD

POISONING (PLUMBISM)
Some researchers suggested that dentists treating children with
unexplained pitting hypoplasia should consider previous exposure to
lead as a part of their health evaluation, particularly if the child is from a
family in a low economic stratum.
HYPOPLASIA CAUSED BY LOCAL INFECTION AND TRAUMA

• Turner first described this

localized type of hypoplasia.
He noted defects in the
enamel of two premolars
and traced the defects to
apical infection of the
nearest primary molar.
Enamel hypoplasia resulting Infected mandibular second primary molar has caused
from local infection is called hypoplasia of the second premolar and delayed
Turner tooth. eruption of the tooth
 HYPOPLASIA CAUSED BY IONIZING RADIATION AND
CHEMOTHERAPY

• Children who receive high-dose

radiotherapy for the treatment of a
malignancy are at risk for developing
rampant caries in the irradiated area.
The main cause is due to reduced or
destroyed major salivary gland function.
• Ameloblasts are somewhat resistant to
x-radiation. However, a line of
hypoplastic enamel that corresponds to
the stage of development at the time of X-radiation caused hypoplastic defect on the
therapy may be seen crown of the first permanent molar (arrow) and
stunting of root development. From McDoald
CHAPTER 3
HYPOPLASIA RESULTING FROM RUBELLA
EMBRYOPATHY

• Intrauterine infection with the rubella virus can produce congenital

tooth defects such as enamel hypoplasia, tapered teeth, and dens
invaginatus.
 HYPOPLASIA CAUSED BY FLUORIDE (DENTAL
FLUOROSIS)

• Excess ingestion of fluoride can affect ameloblasts during the

appositional, calcification, and maturation stages of tooth
development, causing the clinical entity called dental fluorosis or
mottled enamel.

TAKEN FROM BOOK 1

MOLAR INCISOR HYPOMINERALISATION

• Molar incisor hypomineralization (MIH) is the hypomineralization of

systemic origin of one to four permanent first molars, frequently
associated with affected incisors. It is presented as demarcated
enamel opacities of different colors, occasionally undergoing
posteruptive breakdown
4
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2
3
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POSITION AND LOCATION ANOMALIES
• Tooth transposition (TT): positional interchange of two adjacent teeth, or the development or
eruption of a tooth in a position normally occupied by a non-adjacent tooth
• Ectopic Eruption: It is a condition in which the permanent teeth, because of deficiency of growth
in the jaw or segment of jaw, assume a path of eruption that intercepts a primary tooth, causes
its premature loss and produces a consequent malposition of the permanent tooth.
• Displacement of maxillary canine (DMC): a condition wherein a maxillary canine does not follow
its normal eruption path with asymmetry between the right and left maxillary canines; maxillary
lateral incisor is late erupting, with evidence of resorption or proclination. Radiographically
evaluated by the positional relationship between the maxillary canine cusp tip and adjacent
lateral incisor and measurement of the angle formed by the long axis of the maxillary canine and
the midline or the distance between the maxillary canine cusp tip and occlusal plane
Hafiz ZZ. Ectopic eruption of the maxillary first permanent molar: a review and case report. J Dent Health Oral Disord
Ther. 2018;9(2):154-158.