ABNORMALITIES OF TEETH

CLASSIFICATION

Developmental abnormalities Numerical Size Alteration abnormali alterations in Shape ties Hypodonti Microdont Germinati a ia on Hyperdont Macrodon ia tia Fusion Accessory Cusps Taurodont ism Dilacerati on Dentinogenesis imperfecta Dentinal dysplasia ( I, II ) Regional odontodysplasi a Structural defects Enamel Hypoplasi a Diffuse opacities Demarcat ed opacities

Environmental abnormalities Discolour ation of teeth Exrinsic stains bacteria, tobacco, food, medicine, resto material Intrinsic stains Fluorosis,

Structural abnormalities Amelogenesis imperfecta

Post developmetal tooth structural loss Non bacterial Attrition,

Chronolog ical Turner's Hypoplasia by fluorosis by Chemotherapy

Hyperbilir ubinemia, medicatio n abrasion,

abfraction erosion

Hypercementosis

Conscresnce Talon cusp Dens in dente Dens evaginatus

DEVELOPMENTAL ABNORMALITIES Numerical Abnormalities Hypodontia Lack of development of one or more teeth. More common in the permanent dentition 3rd molars, lateral incisors, and 2nd premolars are absent more frequently Anodontia Complete absence of teeth, very rare Hyperdontia Development of increased number of teeth Common in the permanent dentition Mesiodense develops in the maxillary incisor region

Distomolars develop posterior to 3rd molar

Associated syndromeso Ectodermal dysplasia Paramolars - develop bucally to 3rd molar Associated syndromeso Cleido- cranial dysplasia

o Crouzon Syndrome o Downs Syndrome o Apert syndrome

Size Alterations Microdontia Presence of teeth physically smaller than normal Generalized true microdontia - rare Localized true microdontia- Downs Syndrome, Pituitary dwarfism Relative microdontia Normal sized teeth may appear smaller when the patient present with macrognathia

Alterations in Shape Germination A double tooth, which occurs from division of a single tooth bud

More common in deciduous dentition anterior maxillary teeth commonly affected.

Fusion Macrodontia Presence of teeth physically larger than normal Generalized true macrodontia Pituitary gigantism Localized true macrodontia of one quadrant - Hemi facial hyperplasia Relative microdontia Normal sized teeth may appear larger when the patient present with micrognathia A double tooth formed as result of fusion of two tooth buds.

More common in deciduous dentition anterior maxillary teeth commonly affected

Concrescence Union of two adjacent teeth by cementum. Involved teeth may show gross caries More common in posterior maxilla ( 2nd & 3rd molar)

Dens Invaginatus Deep surface invagination of crown or root that is lined by enamel. Coronal dens invaginatus: Three types o Type I : Invagination confined to crown o Type II : Invagination extends to cement enamel junction ( with / without pulp involvement) o Type III : Invagination extends through the root/

Accessory cusps Three distinct patterns present. 1. Cusp of carabelli: (A) Additional cusp located on the palatal surface of maxillary molar. 2. Talon cusp: (B) Dens evaginatus of anterior teeth 3. Dens evaginatus: (C) Cusp like elevation present on the occlusal surface of mandibular molar/ premolar teeth.

Radiological appearance

Taurodontism Enlargement of the body and the pulp chamber with apical displacement of the bifurcation of roots.

(A)

(B)

(C)
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Dilacerations A deformity in which the crown of the tooth is displaced from its normal alignment with the root. Result of acute mechanical trauma. Frequency involves the maxillary incisors.

Structural defects of Enamel Enamel defects can be classified in to three patterns.

Hypercementosis Non neoplastic deposition of excessive cemetum. Local factors o Abnormal Occlusal trauma o Adjacent inflammation o Unopposed teeth Systemic factors o Acromegaly o Pagets disease o Rheumatic fever

1. Hypoplasia (eg: Turners tooth, Chronological hypoplasia) 2. Diffuse opacities 3. Demarcated opacities Amelogenesis Imperfecta

Divided in to three patterns depending on the stage of development of enamel that is affected 1. Hypoplastic type ( a,b,c,d) 2. Hypomaturation type (e,f) 3. Hypocalcification type (g,h) It is not possible to differentiate enamel defects, which occur due to environmental influences from amelogenesis imperfect using histopathology alone. Therefore enamel defects are mainly diagnosed using clinic-pathological correlation.

Amelogenesis Imperfecta

Clinical & Radiological appearance of DI

Amelogenesis Imperfecta

Dentinogenesis imperfecta Hereditary developmental disorder of dentine. Clinical Presentatio n OI + DI only DI only DI Witkop Classificatio n DI Brandy wine isolate
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Shields Classificatio n DI - I DI - II DI - III