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Developmental
Disturbances of the
Teeth
Dr. Baleegh Abdulraoof Alkadasi
 DENTAL ANOMALIES
I. Alterations in number of teeth
• Anodontia
• Supernumerary teeth
II. Alterations in size of teeth
• Macrodontia
• Microdontia
 DENTAL ANOMALIES
III. Alterations in shape of teeth
• Fusion • Taurodontism

• Gemination • Dilaceration
• Hypercementosis
• Concrescence
• Enamel Pearl
• Dens in dente
• Attrition
• Dens evaginatus • Abrasion
• Talon cusp • Erosion
Alterations in the Number of Teeth
 Decrease in Number
• Anodontia: congenital absence of all the teeth because of failure
of development of tooth germs. Total anodontia is a rare condition
but partial anodontia (hypodontia) is more common.
• Oligodontia: absence of numerous teeth.
• Hypodontia : (partial anodontia) congenital absence of one or a
few teeth. The affected teeth are usually the third molars and the
maxillary lateral incisors.
• Note: Anodontia or hypodontia is often associated with a syndrome
known as ectodermal dysplasia.
 Complete Anodontia

 when all teeth are missing

 rare

 often associated with a syndrome known as

hereditary ectodermal dysplasia
 Oligodontia

 lack of development
of six or more teeth
Oligodontia in Ectodermal Dysplasia
 Hypodontia

Absence of an incisor tooth.

Presence of only three incisors.
 Decrease in Number due to Eruption

 Impaction
- most often affects the
mandibular 3rd molars +
maxillary canines
- less commonly:
• premolars
• mandibular canines
• second molars
 Decrease in Number due to Eruption

 Impaction
Factors causing tooth impaction :
- Microgonathia .
- Malocclusion .
- Retained deciduous teeth .
- Supernumerary teeth .
- Odontogenic cyst
 Increase in Number
• Supernumerary teeth:
are additional number of teeth, over and above the
usual number for the dentition.
The tooth form may be normal or abnormal
Supernumerary teeth:

 results from continued proliferation of

permanent or primary dental lamina to form
third tooth germ

 teeth may have:

• normal morphology

• rudimentary

• miniature
 Increase in Number
• Mesiodens – supernumerary tooth in maxillary anterior
incisor region
• Distomolar/Distodens – accessory fourth molar
• Paramolar – posterior supernumerary tooth situated
lingually or buccally to a molar tooth
• Dental transposition – normal teeth erupted in an
inappropriate pattern
• Natal teeth – teeth present in newborns; teeth arising
during the first 30 days of life; (85% mandibular incisor
region)
Transposition (canine-first premolar)
 Mesiodens
 most common supernumerary tooth

 tooth situated between maxillary central incisors

- singly or paired
- erupted or impacted
- inverted
- small tooth
- cone-shaped crown
- short root
 Mesiodens
An erupted mesiodens between the
two maxillary central incisors.
The tooth is conical in shape.
Supernumerary teeth
Natal teeth (Riga-Fede syndrome)
 Supernumerary teeth

Mesiodens

Mesiodens

Supernumerary
premolar
 Supernumerary
- many are impacted
- characteristically found
in cleidocranial dysostosis
Supernumerary teeth

Supernumerary teeth in cleidocranial

dysplasia syndrome
Supernumerary teeth

Supernumerary teeth in cleidocranial

dysplasia syndrome
Alterations in size of teeth
 Size

 Microdontia

 Macrodontia
 Macrodontia
- Refers to teeth that are larger than normal.
- The disorder may affect a single tooth or
maybe generalized to all teeth as in pituitary
gigantism.
 Macrodontia
Macrodont (megadont) premolars and molars.
Macrodontia is a condition in which teeth are larger than
normal.
(1) Generalized Macrodontia
 all teeth are larger than normal

 associated with pituitary gigantism

 exceedingly rare
(2) Focal/Localized Macrodontia
 uncommon condition

 unknown etiology

 usually seen with mandibular 3rd molars

 Microdontia
• refers to teeth that are smaller than normal.

• Localized microdontia often involves the maxillary lateral incisors or maxillary third
molars.

• The shape of the tooth may be altered as in the case of maxillary lateral incisors
which appear as cone-shaped or peg shaped; hence the term "peg laterals".

• Generalized microdontia may occur in a condition known as pituitary dwarfism.

(1) Generalized Microdontia

 all teeth are smaller than

normal

 occur in some cases of

pituitary dawrfism

 teeth are well formed

(2) Focal/Localized Microdontia

 common forms of localized

microdontia is that which
affects maxillary lateral
incisior

 peg lateral

 instead of parallel or
diverging mesial + distal
surfaces
Microdontia

“peg-shaped” laterals

“paramolar”
Alterations in shape of teeth
Shape and Form
 Crown

 Fusion

 Gemination

 Taurodontism

 Talon’s Cusp
Shape and Form

 Crown

 Dens Invaginatus

 Peg-shaped Lateral

 Hutchinson Incisor

 Mulberry Molar
Shape and Form

 Root

 Concresence

 Enamel Pearl

 Dilaceration

 Ankylosis
 Fusion
• Fusion is a developmental union of two or
more adjacent tooth germs.
• The union between the teeth results in an
abnormally large tooth, or union of the crowns,
or union of the roots only, and must involve the
dentin.
• The root canals may be separate or fused.
 Fusion
Fusion of the mandibular central incisors.

On the radiograph: Fusion of mandibular

central and lateral incisors on the right and
on the left side.
 Gemination
• Gemination is the incomplete attempt of a tooth germ to divide
into two. The resultant:
-tooth has two crowns or
-a large crown partially separated, and sharing a single
root and root canal.
• It is not always possible to differentiate between gemination and a
case in which there has been fusion between a normal tooth and a
supernumerary tooth.
 Gemination
Gemination of maxillary left central incisor.
The geminated tooth is between the right
central incisor and the left lateral incisor.

Gemination – single enlarged tooth or joined

(double) tooth in which tooth count is normal
when this tooth is counted as one.
Fusion – single enlarged tooth or joined
(double) tooth in which the tooth count is
short one when this tooth is counted as one.
 Gemination / Fusion

Fusion

Gemination
 Concrescence

• Concrescence is a form of fusion occurring after root

formation has been completed, resulting in teeth united by
their cementum.
Concrescence
 Dens in dente (dens invaginatus)
• Dens in dente, also known as dens invaginatus:
is produced by an invagination of the calcified
layers of a tooth into the body of the tooth.
• Dens in dente can also occur in the root portion of a
tooth from the invagination of Hertwig's epithelial
root sheath.
- The maxillary lateral incisor is the most frequently
affected tooth.
Dens Invaginatus
(Dens in Dente)

Type I
• confined to the crown
Type II
• extends below cemento-enamel junction
• ends in a blind sac
• may or may not communicate with
adjacent dental pulp
Dens Invaginatus
(Dens in Dente)

Type III

• extends through the root

• perforates in the apical or lateral

radicular area without any immediate

communication with pulp

 Dens in dente (dens invaginatus)

The maxillary lateral incisor shows the

invagination of the enamel into the tooth pulp
chamber.
 Dens Evaginatus
cusp-like elevation of enamel located in central
groove or lingual ridge of buccal cusp of
permanent premolar (Leung’s Cusp)or molar
teeth
Talon cusp (anterior dens evaginatus)
 Talon cusp (anterior dens evaginatus)
• The talon cusp is an accessory cusp
located on the lingual surface of
maxillary or mandibular teeth.
Cusp of Carabelli / Dens Evaginatus

Cusp of Carabelli Dens Evaginatus

Peg-Shaped Lateral
 undersized lateral incisor

 smaller than normal

 occurs when permanent lateral

incisors do not fully develop
Peg-Shaped Lateral
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
Mulberry Molar

 dwarfed molars with cusps covered with globular

enamel growths

 giving the appearance of a mulberry

 Enamel Pearl (Enameloma)
• Enamel pearl, also known as enameloma, is an ectopic mass of
enamel which can occur anywhere on the roots of teeth but is
usually found at the furcation area of roots.
 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
 Enamel Pearls

 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
 Enamel Pearls

 consist of only a nodule of enamel attached to dentin

 may have a core of dentin containing pulp horn

 may be detected on radiographic examination

 Enamel Pearls

 may cause stagnation at gingival margin but, if they

contain pulp, this will be exposed when pearl is
removed
Ectopic Enamel
 Taurodontism
• Taurodont teeth have crowns of normal size and shape
but have large rectangular bodies and pulp chambers
which are dramatically increased in their apico-occlusal
heights.
Taurodontism
 Dilaceration
• Dilaceration is an abnormal bend in the root of a tooth.
• Dilaceration of roots may produce difficulties during extraction or root
canal therapy.
Dilaceration
 Hypercementosis
• An excessive build-up of cementum around all or part of a root of a
tooth.

• Thickness or blunting of root radiographically, localized or

generalized.

• Local or systemic factors:

loss of antagonist tooth, occlusal trauma, inflammation, Paget’s
disease, acromegaly, etc.
Hypercementosis
 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
 Attrition, Abrasion, Erosion
• Attrition is the loss of tooth structure that results from physiologic
wear on the incisal and occlusal surfaces of teeth. due to Chewing habits,
bruxism, dental occlusion.
• Abrasion is the loss of tooth structure that results from pathologic
(mechanical) wear, that is, from friction of a foreign body on a tooth
surface. Due to vigorous toothbrushing or the use of an abrasive
dentifrice.
• Erosion is the loss of tooth structure that results from a chemical
action not involving a bacterial process.
Abrasion
Erosion
 Attrition, Abrasion, Erosion
Attrition
Abrasion
Defects Of Enamel And/Or Dentin
 Hypoplasia
• Enamel hypocalcification occurs when a normal amount of enamel
matrix is formed but the matrix is not properly calcified.
Causes of hypoplasia:
Local - 1. Trauma (Turner's hypoplasia)
2. Infection (Turner's hypoplasia)
General - 1. Hereditary
a) Dentinogenesis imperfecta
b) Amelogenesis imperfecta
 Hypoplasia
Causes of hypoplasia:
2. Diseases of genetic or idiopathic
origin
a) Cleido-cranial dysostosis
b) Osteogenesis imperfecta
3. Prenatal or congenital syphilis
 Hypoplasia
Causes of hypoplasia:
4. Trophic disturbances
a) Gastro-intestinal disturbances
b) Infantile tetany
c) Vitamin D, calcium and phosphorus deficiency (rickets)
d) Vitamin C deficiency (infantile scurvy)
e) Exanthematous disease (measles, chicken pox, scarlet fever)
5. Endemic fluorosis
 Hypoplasia

Amelogenesis imperfecta
 Amelogenesis
Imperfecta
 group o f conditions caused by
defects in the genes encoding
enamel matrix proteins

 genes that encode for enamel

proteins:

 amelogenin mutated in
 enamelin in patients
 others with this
condition
Amelogenesis Imperfecta
 affects both dentition

 deciduous
 permanent

 classified based on pattern of

inheritance:

 hypoplasia
 hypomaturation
 hypocalcified
 Dentinogenesis Imperfecta

 also known as “Hereditary Opalascent Dentin”

- due to clinical discoloration of teeth
- mutation in the dentin sialophosphoprotein
- affects both primary + permanent
dentition
 Dentinogenesis Imperfecta

 have blue to brown discoloration

 enamel frequently separates easily from

underlying defective dentin
 Dentinogenesis Imperfecta

Radiographically:

- bulbous crowns
- cervical constriction
- thin roots
- early obliteration of roots canals + pulp
chambers
Dentinogenesis Imperfecta
Radiographic features of
type I or II
 Dentin Dysplasia

- also known as “Rootless Teeth”

- rare disturbance of dentin formation
- normal enamel
- atypical dentin formation
- abnormal pulpal morphology
- hereditary disease
Radiographically:

- roots are extremely short

- pulps almost completely obliterated
- periapical radiolucencies:
• granulomas
• cysts
• chronic abscesses
 Dentin Dysplasia

Type I
Type I
Regional Odontodysplasia

also known as:

-Odontogenic Dysplasia
- Odontogenesis Imperfecta
- Ghost Teeth
 Regional Odontodysplasia

 one or several teeth in a localized area are

affected

 maxillary teeth are involved more

frequently than mandibular area

 etiology is unknown
 Regional Odontodysplasia

- 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
 Odontodysplasia
showing the characteristic egg shell appearance.