DEVELOPMENTAL DISTURBANCES

OF TEETH

By
4/24/2024 Dr. Hagir Abd Rahman
classification

 Abnormalities of morphodifferentiation:
 abnormalities
in the differentiation of the dental
lamina and the tooth germs.

 Abnormalities of histodifferentiation:
 abnormalities in the formation of the dental hard
tissues resulting in disturbances in tooth structure

4/24/2024
Abnormalities of morphodifferentiation
1. Disturbances in number of teeth
2. Disturbances in size of teeth
3. Disturbances in shape of teeth

4/24/2024
Disturbances in
number of teeth

Hypodontia

Hyperdontia

4/24/2024
 etiology
 Genetic. As part of a syndrome or alone.

 autosomal dominant or autosomal recessive or X-linked

pattern.

 hyperdontia is the result of a localized and independent

hyperactivity of dental lamina.

 Hypodontia can result from damage before tooth

formation; Trauma, infection, radiation,
chemotherapeutic medications, endocrine disturbances,
and severe intrauterine disturbances
4/24/2024
Hypodontia

4/24/2024
 Anodontia: is a complete absence of one or both
dentitions.

 Hypodontia: lack of development of one or

more teeth

 Oligodontia: lack of development of six or more

teeth

4/24/2024
 more common in the permanent dentition.

 more common in females.

 If deciduous teeth were absent, permanent

successor tooth will also be absent.

 Hypodontia is associated positively with microdontia

4/24/2024
 In permanent: Third molars, maxillary lateral
incisors, and mandibular second premolars most
commonly involved.

 In deciduous: maxillary lateral incisors and

mandibular incisors.

4/24/2024
 Syndromes Associated with Hypodontia
Ectodermal dysplasia. Incontinentia pigmenti Hypoglossia-
hypodactylia syndrome

Down syndrome. Turner syndrome. Lacrimo-auriculo-

dento-digital (LADD)
syndrome

Crouzon syndrome. Sturge-Weber Cranio-oculo-dental

syndrome syndrome

Goldenhar syndrome Ehlers-Danlos hereditary hypohidrotic

syndrome ectodermal dysplasia

4/24/2024
Hypodontia

4/24/2024
Hypodontia

4/24/2024
Hypodontia

4/24/2024
Dental transposition
 normal teeth erupting
into an inappropriate
position

 increased prevalence
of hypodontia

 Maxillary canines and

first premolars
4/24/2024
Treatment and Prognosis

 Treatment: prosthetic replacement

4/24/2024
 Hypohidrotic ectodermal dysplasia
 inherited as an X-linked recessive trait.

 characterized by the congenital absence of ectodermal

structures.

 partial or total absence of sweat glands.

 smooth, dry skin with fine, scanty hairs.

 delayed eruption, deformed, and frequently have

conical crowns
4/24/2024
4/24/2024
Hyperdontia

4/24/2024
 is the development of an increased number of teeth

 The additional teeth are termed supernumerary

 more common in males

 maxillary incisor region, followed by the molar

region, then premolars, canines, and lateral incisors.

4/24/2024
 usually single.

 unusual in the deciduous dentition.

 Hyperdontia is positively correlated with

macrodontia

4/24/2024
 terms to describe supernumerary
teeth, depending on their location

mesiodens Paramolar Distomolar

• between the • lingually or • distal to a third
maxillary buccally to a molar
central incisors molar tooth
• The most
common

4/24/2024
 supernumerary

supplemental: Rudimentary:
normal size and abnormal shape
shape and size

Conical tuberculate molariform

(small, peg- (more than one (small premolar/
shaped) cusp) molarlike).
4/24/2024
Natal teeth
 present at or shortly after birth.

 teeth present in newborns have been called natal

teeth; those arising within the first 30 days of life are
designated neonatal teeth.

 May represent predeciduous supernumerary teeth,

however most are prematurely erupted deciduous
teeth.

 85% are mandibular incisors, 11% are maxillary incisors,

and 4% are posterior teeth.
4/24/2024
Hypohyperdontia
 both hypo- and hyperdontia.

 missing mandibular incisors followed by second

premolars.

 supernumerary teeth seen most frequently in the

anterior maxilla followed by canines or maxillary
premolars.

4/24/2024
 Syndromes Associated with Hyperdontia
Apert syndrome Crouzon syndrome Down syndrome

Cleidocranial Ehlers-Danlos Sturge-Weber

dysplasia syndrome syndrome

Gardner syndrome Incontinentia Leopard syndrome

pigmenti

4/24/2024
4/24/2024
Mesiodens

4/24/2024
Bilateral
inverted

4/24/2024
Right
mandibular
dentition
exhibiting
four erupted
bicuspids

4/24/2024
Distodens

4/24/2024
Paramolar

4/24/2024
Natal
Teeth

4/24/2024
Riga-Fede
syndrome:
Traumatic
ulcerations of
the adjacent
soft tissue

4/24/2024
Effects of supernumerary teeth

delay eruption and resorption of permanent teeth

displacement of the teeth with associated crowding

Dilaceration

eruption into the nasal cavity

development of odontogenic cysts and tumors

4/24/2024
Treatment

 Treated by surgical removal

4/24/2024
Disturbances in size of teeth

Macrodontia

Microdontia

4/24/2024
Microdontia

4/24/2024
 teeth that are physically smaller than usual.

 maxillary lateral incisor is affected most frequently

and typically appears as a peg shaped crown
overlying a root that often is of normal length.

 Third molars are also commonly affected.

4/24/2024
 Diffuse microdontia is uncommon but may occur in
Down syndrome., and pituitary dwarfism.

 relative microdontia: Normal-sized teeth that

appear small when widely spaced within jaws that
are larger than normal (macrognathia).

4/24/2024
Diffuse
Microdontia.

4/24/2024
Isolated
Microdontia
(Peg Lateral).
Small, cone-
shaped right
maxillary
lateral incisor.

4/24/2024
Macrodontia
megalodontia
megadontia

4/24/2024
 teeth that are physically larger than usual.

 Diffuse involvement is rare, and has been noted in association

with pituitary gigantism

 Unilateral cases are associated with hemifacial hyperplasia.

 Isolated macrodontia is most common in incisors or canines

 relative macrodontia: normal-sized teeth crowded within a

small jaw
4/24/2024
Macrodontia.
The patient’s
left maxillary
central incisor
is abnormally
large

4/24/2024
Disturbances in shape of teeth

Accessory
Double teeth Concrescence
cusps

Dens
Ectopic enamel Taurodontism
invaginatus

Hypercementosis Dilaceration
4/24/2024
DOUBLE TEETH
connate teeth
conjoined teeth

4/24/2024
 two teeth appear joined together.

 They exhibit union by dentin and (perhaps) pulps.

 The union may be the result of fusion of two

adjacent tooth buds or the partial splitting of one.

 The degree of union is variable and may involve the

crown, the roots, or both.

 higher frequency in the anterior maxillary regions

4/24/2024
 Double
teeth

fusion gemination

4/24/2024
 Fusion

 the union of two normally separated tooth buds with the

resultant formation of a joined tooth.

 The fusion may be complete over the full length of the

teeth or only partial.

 The tooth count reveals a missing tooth when the

anomalous tooth is counted as one.

 Occasionally, fusion in the primary dentition is associated

with absence of the underlying permanent successor
4/24/2024
 Gemination

 the partial development of two teeth from a single

tooth bud following incomplete division.

 abnormally formed tooth with usually one root and

root canal.

 the tooth count is normal when the anomalous tooth

is counted as one

4/24/2024
 Gemination

Two double
teeth. The
tooth count
was normal
when each
anomalous
tooth was
counted as
one

4/24/2024
 Gemination
Mandibular bicuspid bifid crown and shared root
exhibiting bifid crown canal

4/24/2024
 Fusion

Double tooth
in the place of
the
mandibular
right lateral
incisor and
cuspid

4/24/2024
 Fusion

Bilateral double teeth in the place of

the mandibular lateral incisors and
cuspids

4/24/2024
treatment
 sectioning: with or without endodontic therapy.

 shaping with or without placement of full crowns.

 surgical removal with prosthetic replacement.

4/24/2024
CONCRESCENCE

4/24/2024
 the union of two
teeth by cementum
without confluence
of the dentin.

4/24/2024
Union by cementum of
maxillary second and third
molars

4/24/2024
4/24/2024
ACCESSORY CUSPS

4/24/2024
three distinctive patterns:

cusp of Carabelli

talon cusp

dens evaginatus

4/24/2024
 Cusp of Carabelli
 is an accessory cusp located on the palatal surface of
the mesialingual cusp of a maxillary molar.

 varies from a definite cusp to a small pit or fissure.

 most pronounced on the first molar.

 When present, the remaining permanent teeth often

are larger than normal mesiodistally.
4/24/2024
Cusp of Carabelli

4/24/2024
 Talon cusp
 Additional cusp that is located on the surface of an
anterior tooth and extends at least half the distance
from the cemento-enamel junction to the incisal
edge.

 Most common in maxillary incisors.

 A deep developmental groove may be present where

the cusp fuses with the affected tooth .
4/24/2024
4/24/2024
 Radiographically, the
cusp is seen overlying
the central portion of
the crown and
includes enamel and
dentin. Only a few
cases demonstrate
visible pulpal

4/24/2024
 Syndromes associated with talon cusp

• Rubinstein-Taybi syndrome
1

• Mohr syndrome
2

• Ellis-van Creveld syndrome

3

• incontinentia pigmenti
4

• Sturge-Weber syndrome
5
4/24/2024
 Dens Evaginatus
 a cusp-like elevation of enamel located in the central
groove or lingual ridge of the buccal cusp of premolar
or molar teeth

 Mandible.

 usually bilateral

 Consists of enamel, dentin, and sometimes pulp.

4/24/2024
4/24/2024
 tuberculated occlusal
anatomy.

 Attrition on the
accessory cusp led to
pulpal necrosis and
periapical
inflammation.

4/24/2024
 Frequently, dens
evaginatus is seen in
association with shovel-
shaped incisors.
 Affected incisors
demonstrate prominent
lateral margins, creating
a hollowed lingual
surface that resembles
the scoop of a shovel
4/24/2024
DENS INVAGINATUS
dens in dente

4/24/2024
 is a deep surface invagination of the crown or root
that is lined by enamel.

 Frequency in decreasing order; lateral incisors,

central incisors, premolars, canines, and molars.

 2 patterns: coronal and radicular

4/24/2024
  Type I: an
classification invagination that is
confined to the
crown.

 type II: extends below

the cementoenamel
junction.

 Type III extends

through the root and
perforates in the
apical or lateral
radicular area
without any
communication with
the pulp.
4/24/2024
 Type I is the most common pattern.

 the invagination may be large and resemble a

tooth within a tooth (dens in dente).

4/24/2024
4/24/2024
Type II Type II

4/24/2024
 Type III. enamel
invagination parallels the
pulp canal and perforates
the lateral root surface.

Type III. Parulis. The cuspid

contained a dens invaginatus
that perforated the mesial
surface of its root

4/24/2024
Radicular dens invaginatus:
 invagination in the root of

the tooth

 Radiographically, the
affected tooth demonstrates
an enlargement of the root.

4/24/2024
Treatment
 Restoration/ endodontic therapy.

 Extraction.

4/24/2024
ECTOPIC ENAMEL

4/24/2024
The presence of enamel in
unusual locations, mainly
the tooth root.
Enamel Pearls
ECTOPIC
ENAMEL
Cervical Enamel
Extensions
4/24/2024
Enamel pearls
 hemispheric structures that may consist entirely of
enamel or contain underlying dentin and pulp
tissue.

 Found most frequently on the-roots of maxillary

molars, followed by mandibular molars

 May consist entirely of enamel or contain

underlying dentin and pulp tissue.
4/24/2024
4/24/2024
 well-defined radiopaqe
nodules along the
root's surface

4/24/2024
4/24/2024
Cervical enamel extensions
 A triangular extension of the coronal enamel that
develops on the buccal surface of molar teeth.

 Mandibular molars are affected more frequently.

4/24/2024
Normal cervical Cervical enamel
enamel extension
4/24/2024
4/24/2024
Effects of the tooth
 The enamel pearls prevents normal periodontal
attachment.

 the exophytic nature of the pearl is conducive to

plaque retention and inadequate cleansing.

4/24/2024
Treatment
 Thorough oral hygiene should be maintained to
prevent localized loss of periodontal support.

 Exposed enamel pearl: surgical removal.

 For teeth with cervical enamel extensions:

appropriate cleaning.

4/24/2024
TAURODONTISM

4/24/2024
 tauro = bull; dont = tooth. Bull-like tooth.

 is an enlargement of the pulp chamber of a

multirooted tooth, with apical displacement
of the pulpal floor and bifurcation of the
roots.

4/24/2024
 The pulp chamber has a greater apico-occlusal
height than in normal teeth, with no constriction at
the level of the cemento-enamel junction.

 affects multi-rooted teeth.

 unilateral or bilateral

4/24/2024
 TAURODONTISM

Normal mild moderate severe

4/24/2024
4/24/2024
 syndromes associated with Taurodontism

1 • Amelogenesis imperfecta

2 • Ectodermal dysplasia

3 • Down syndrome

4 • Hypophosphatasia

5 • Ellis-van Creveld

6 • Microdontia-taurodontia-dens invaginatus

7 • Oculo-dento-digital dysplasia

8 • Cranioectodermal dysplasia
4/24/2024
DILACERATION

4/24/2024
 is an abnormal angulation or bend in the root or,
less frequently, the crown of a tooth

 displacement of the root from its normal

alignment with the crown.

 usually the result of mechanical trauma.

 most frequently involves the maxillary incisors.

4/24/2024
4/24/2024
4/24/2024
4/24/2024
HYPERCEMENTOSIS

4/24/2024
 Is the deposition of excessive cementum that is
continuous with the normal cementum.

 May be isolated, may involve multiple teeth, or

may appear as a generalized process.

 Radiographically, affected teeth demonstrate a

thickening or blunting of the root.

4/24/2024
Factors Associated with ↑ Hypercementosis

Local Factors Systemic Factors

Abnormal occlusal trauma Gardner syndrome

Unopposed teeth Thyroid goiter

Adjacent inflammation Paget's disease of bone

Arthritis & Rheumatic

fever

Acromegaly and pituitary

gigantism
4/24/2024
4/24/2024
Histopathologic Features
 The periphery of the root exhibits deposition of an
excessive amount of cementum.

 The excessive cementum may be hypocellular or

exhibit areas of cellular cementum that resemble
bone (osteocementum).

4/24/2024
 Polarized light: the sharp
The dividing line between
dividing line between the
dentin and cementum is
tubular dentin and
indistinct
osteocementum.

4/24/2024
Thank you

4/24/2024