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Dental Anomalies: An Update

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Volume 6 • Issue 3 • September-December 2016

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 Review Article

Dental Anomalies: An Update

Fatemeh Jahanimoghadam
Department of Pediatric Dentistry, Oral and Dental Research Center, Kerman University of Medical Sciences, Kerman, Iran

Abstract
Dental anomalies are usual congenital malformation that can happen either as isolated findings or as a part of a syndrome. Developmental
anomalies influencing the morphology exists in both deciduous and permanent dentition and shows different forms such as gemination, fusion,
concrescence, dilaceration, dens evaginatus (DE), enamel pearls, taurodontism or peg-shaped laterals. All These anomalies have clinical
significance concerning aesthetics, malocclusion and more necessary preparing of the development of dental decays and oral diseases.
Through a search in PubMed, Google, Scopus and Medline, a total of eighty original research papers during 1928–2016 were found with
the keywords such as dental anomaly, syndrome, tooth and hypodontia. One hundred review titles were identified, eighty reviews were
retrieved that were finally included as being relevant and of sufficient quality. In this review, dental anomalies including gemination,
fusion, concrescence, dilaceration, dens invaginatus, DE, taurodontism, enamel pearls, fluorosis, peg-shaped laterals, dentinal dysplasia,
regional odontodysplasia and hypodontia are discussed. Diagnosing dental abnormality needs a thorough evaluation of the patient,
involving a medical, dental, familial and clinical history. Clinical examination and radiographic evaluation and in some of the cases,
specific laboratory tests are also needed. Developmental dental anomalies require careful examination and treatment planning. Where one
anomaly is present, clinicians should suspect that other anomalies may also be present. Moreover, careful clinical and radiographical
examination is required. Furthermore, more complex cases need multidisciplinary planning and treatment.

Keywords: Dental anomaly, hypodontia, syndrome, tooth

INTRODUCTION patient, involving a medical, dental, familial and clinical

Anomaly (irregular) is opposite from what is known as
normal. Disturbance of the epithelium and mesenchyme can
markedly alter the normal odontogenesis leading to the
developmental anomaly of teeth. Depending on the
developmental stage in which the difference has taken place,
various anomalies could take place, for example, anomalies
of number, structure, size and/or shape.[1] A majority of
uncommon dental anomalies occur during childhood years.
Developmental dental anomalies are classified according to
their abnormalities in number, shape, colour, structure,
texture, eruption, exfoliation and position.[2] Local as well as
systemic factors may be responsible for these developmental
anomalies. Such effects may begin before or after birth,
therefore both the dentition might be affected.[3]
More than 300 genes have been identified to be expressed
in teeth that are responsible for odontogenesis. Defects
in these genes have been found to be one of the reasons
for variation of the morphology of tooth.[4] Diagnosing
dental abnormality needs a thorough evaluation of the
history. Clinical examination and radiographic evaluation
and in some of the cases, specific laboratory tests are
also needed.[3] Dental anomalies including the number
of teeth involve hypodontia (one or more missing teeth),
oligodontia (six or more missing teeth), anodontia (complete
absent of teeth) and hyperdontia (one or more extra teeth,
also identify as supernumeraries). Variations in the size of
teeth include microdontia (teeth smaller than normal) and
macrodontia (enlargement of the teeth compare to normal).
Both these situations may be either generalised to all the
teeth or isolated to one or several teeth. Alterations in
the morphology of teeth include double teeth (fusion and
gemination), talon cusp, dens evaginatus (DE) and dens
invaginatus (DI) (dens in dente).[4] Early diagnosis of dental
Address for correspondence: Dr. Fatemeh
Jahanimoghadam, Department of Pediatric Dentistry, Oral and Dental
Research Center, Kerman
University of Medical Sciences, Kerman,

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 Jahanimoghadam: Dental anomalies
anomalies should allow for more comprehensive prolonged
treatment planning, more proper prognosis and in certain
instances, less extensive interception.[5]
METHODS
A search was performed through PubMed, Google Scholar,
Scopus and Medline for different dental anomalies. One
hundred review titles were identified, eighty papers were
retrieved that were finally included as being relevant and of
sufficient quality. A total of eighty original research papers
that have been published from 1928 to 2016, with the
keywords such as dental anomaly, syndrome, tooth and
hypodontia were selected. Information from selected articles
was extracted and classified to assess the significance of
different dental anomalies.
DISCUSSION
Description of the anomalies
Gemination
Tannenbaum and Alling in 1963 determined gemination as
the formation of equivalent of two teeth from the same
follicle, with evidence of an endeavour for the teeth to be
completely separate.[6]
Gemination also determined as twin teeth, twin formations,
joined teeth, fused teeth or dental twinning is commonly
seen in the maxillary anterior area.[7,8]
Geminated teeth arise from an endeavour at the division of a
single tooth germ by invagination, results a single tooth with
two completely separated crowns; or a large, incompletely
separated crown having a single root and root canal. [9] This
condition can be confirmed radiographically.[10] The
anomalous tooth has an enlargement in mesial-distal diameter
than normal and is counted as one.[10,11] However, the total
number of teeth in dental arch is also normal.[10]
The aetiology of geminated teeth stays unknown but
nutritional deficiency, endocrine influences,
infectious/inflammatory progress, excessive ingestion of
medicines, congenital diseases; local trauma and ionising
radiation are included as causative factors.[8]
Clinically, gemination happening in the anterior tooth side
causes aesthetic disorders related to tooth alignment,
spacing and arch asymmetry. The presence of deep grooves
on the surface forms it susceptible to caries and periodontal
problems by facilitating bacterial plaque accumulation. The
eruption of adjacent tooth may also be obstacle.[9]
Fusion
Pindborg defined fusion as the combination between dentin
and enamel of two or more separate developing teeth.[12]
Fusion is developmental anomaly of dental hard tissue and
defined as the joining of two developing tooth germs
resulting in a single large tooth structure different treatment
methods can be used according to the requirements of
situation.[13] This anatomic
Advances in Human Biology ¦ Volume 6 ¦ Issue 3 ¦ Sep-Dec 2016
abnormality happens more often in deciduous dentition with
a predilection for the anterior region.[10]
Fusion can be complete (total/true fusion) or incomplete
(partial/late fusion), it depends on level of development.[10,11]
If fusion starts before calcification stage, the teeth unite
completely and the crown incorporates enamel, dentin,
cementum and pulp of both the teeth. Incomplete fusion
happens at a later level and resultant tooth may exhibitive
separate crowns and limited to root alone with combined
or separate pulp canals.[14]
Different theories have been put forward to describe
the aetiology of fusion. It has been suggested that when
the tooth germs are too close together they come in contact
and fuse as they develop because of the physical pressure
or force generated during growth. The other theories
suggested the use of thalidomide or occurrence of viral
infection while pregnancy.[15] A genetic aetiology has also
been included.[16] Fusion has been noted with congenital
anomalies like cleft lip and also in X-linked congenital
conditions. Some dental and non-dental abnormalities such
as supernumerary teeth, hypodontia, peg-shaped incisors,
dens in dente, nail disorders, syndactyly, successional conical
teeth, macrodontia and double permanent teeth have been
attendant with fusion.[17,18]
On some occasions, two independent pulp chambers and
root canals can be seen. However, fusion can also be the
union of a normal tooth bud to a supernumerary tooth germ.
[19]
Fusion may cause aesthetic disorders and occlusal
disturbances due to crowding and irregular morphology and
shape, respectively. The presence of deep grooves may
prepare for caries or periodontal diseases and cause early
pulp exposure. The larger root mass and increased surface
region would result in late resorption and subsequently bring
late or ectopic eruption of the permanent successors.[10]
Concrescence
Concrescence is determined as the cemented combination of
two adjacent teeth without confluence of the underlying dentin
showing independent pulp chambers and root canals.[20,21]
It may happen before or after the teeth have erupted. This
condition can frequently be attributed to trauma or crowding
of teeth.[22] If the condition happens while developmental
stage, it is called true/developmental concrescence and
achieved/post-inflammatory concrescence if after root
formation.[23,24]
Concrescence is seen often in the posterior maxillary region.
The developmental pattern frequently involves a second
molar tooth in which its roots closely approximate to the
adjacent impacted third molar.[24] Few cases have shown the
concrescence of a third molars and a supernumerary tooth.
[21]
It is suspected that space restriction while developmental
stage, local trauma, too much occlusal force, or local
infection after development play an important role in the
happening of concrescence.[21,25] True concrescence is
11
 Jahanimoghadam: Dental anomalies
attributed to the close proximity of developing roots of the
adjacent teeth whereas

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 Jahanimoghadam: Dental anomalies

achieved concrescence may result from a chronic resorb), tooth transplantation, extraction of primary teeth and
inflammatory response to a non-vital tooth.[23] The hereditary and genes factors.[31,34,35]
combination may vary from one small site to a solid
cemented mass along the whole extent of approximating
root surfaces.[21]
Radiographic examination is necessary when concrescence
is suspected clinically. Although in cases of superimposition
of two closely approximated teeth, additional radiographic
projections at different angulations may be required.[21]
Concrescence should be identified to reduce the risk of
complications associated with surgical procedures. [25] It may
also affect the extraction of an adjacent tooth and may cause
fracture the tuberosity or floor of the maxillary sinus. In
such cases, sectioning of tooth should be considered to
reduce adverse and unexpected outcomes.[23]
Dilaceration
The term dilacerations was first used by Tomes in 1848, and
it is defined as a deviation or bend in the linear relationship
of a crown of a tooth to its root. Based on this definition,
dilacerations is distinguished from the rarely used term
flexion, which is defined as a tooth with a hooked or a bent
root.[26] It is an abnormal angulation or bend in the root and
less frequently, the crown of a tooth. Most cases are
idiopathic and have no clinical feature.[27] Dilaceration can
occur in both permanent and primary dentitions, however in
the latter is very low.[28,29] The prevalence rate is greater in
posterior teeth and in the maxilla.[30] Mentioned by some
authors, a tooth is considered to have a dilaceration towards
mesial or distal direction if there is a 90° angle or more
along the axis of the tooth or root, whereas others
determined dilaceration as a deflection from the normal axis
of the tooth of 20°. The most accepted reason of dilaceration
is acute mechanical injury to the primary predecessor tooth
that head to the dilaceration of the underlying developing
succedaneous permanent tooth.[31] Crown dilaceration is
rarer than root dilacerations. Crown dilacerations are usually
observed in the permanent maxillary incisors followed by
mandibular incisors. Clinically, the maxillary incisors show a
lingual deviation during the mandibular incisors incline
labially.[32] Crown dilaceration is the reason of a
developmental anomaly in which there has been an abrupt
change in the axial inclination between the crown and the
root of a tooth. Two possible reason of dilacerations are
trauma and developmental disturbances, and it has also been
suggested that it might be associated with some
developmental syndromes.[33] The other possible contributing
factors that have been noted such as scar formation,
developmental anomaly of the tooth germ, facial clefting,
advanced root canal infections, ectopic development of the
tooth germ and lack of space and area, effect of anatomic
formations (e.g., cortical bone of the maxillary sinus,
mandibular canal, or nasal fossa, which might perverse the
epithelial diaphragm), presence of an adjacent cyst, tumour,
or odontogenic hamartoma, mechanical interposition with
eruption (e.g., from an ankylosed primary tooth that does not

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 Jahanimoghadam: Dental anomalies
Identification and diagnosis of dilaceration often needs
radiographs taken at different angulations.[36] Mesial or
distal root curvatures of dilacerated roots are perspicuity
discernible on periapical radiographs. However, if the
curvature lies in a labial-buccal direction, the central X-ray
beam crosses almost parallel to the deviating area of the
root giving a ‘bulls eye’ like appearance,[29] but still
periapical radiographs are the most appropriate way to
diagnose the presence of root dilacerations.[37] Clinical
identification of dilaceration is necessary because it can
lead to non-eruption, longer retention of predecessor tooth
or conceivable apical fenestration of the buccal or labial
cortical plate.[29] Dilaceration makes a challenge for
endodontic or orthodontic treatment as well as discomfort
in extraction.[38]

DENS INVAGINATUS
DI also determines as the pregnant woman anomaly, wide
compound odontoma, and dens in dente, happens as a
consequence of an invagination on the external surface area
of the tooth crown before calcification. The endodontic
treatment of invaginated teeth may be challenging cause
of difficulties in accessing the root canals and also
reason of complex variations of internal morphology.[39,40]
The invagination ranges from a short pit limited to the
crown to a deep invagination into the root, at times
widening to or beyond the root apex. The most severe
forms are odontome-like and are mostly termed invaginated
odontomes.[41] Most of the cases are encountered in maxilla
with the maxillary lateral incisors being mostly affected,
followed by central incisors, premolars, canines and molars.
[40,42]
The classical radiographic appearance of coronal DI is a
pear-shaped invagination of enamel and dentin with a
narrow structure at the opening on the surface area of the
tooth. The in folding of the enamel lining is more radio-
opaque than the surrounding tooth construction aiding easy
recognition.[43]
Oehlers et al. grouped coronal DI into three types
according to the radiographic appearance such as:
• Type I: An enamel-lined minor form happening within
the confines of the crown not extending beyond the
cementoenamel junction (CEJ)
• Type II: An enamel-lined form which invades the root
but remains limited as a blind sac. It may or may not
connect with the dental pulp
• Type IIIA: A form which crosses through the root
and connected laterally with the periodontal ligament
space through a pseudo-foramen. There is usually no
communication with the pulp, which lies also
compressed within the root
• Type IIIB: A form which crosses through the root and
perforating at the apical region through a pseudo-
foramen. The invagination may be completely lined by
enamel, but mostly cementum will be found lining the
invagination.[44]
A radicular form of DI has also been defined by Oehlers
et al. which is thought to arise because of the proliferation of
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 Jahanimoghadam: Dental anomalies
Hertwig’s root sheath. The root of this kind of tooth is
enlarged which can be demonstrated radiographically.[45]
Infection, trauma, pressure or difficulty from the growing
dental arch is thought to be responsible for DI. [39] A focal
failure of growth or a proliferation of a part of the inner
enamel epithelium may be included in the invagination.[46,47]
Ohlers suggested a distortion of the enamel organ and
further protrusion of a part of the enamel organ resulting in
the formation and shaping of enamel-lined channel.[44]
The invagination acts as a channel for entrance of irritants
and microorganisms; and prepare for the development of
dental caries. Since the thickness of enamel is less, pulp
necrosis happens at an earlier age. Coronal DI can also go
ahead to abscess formation, retention of neighbouring teeth,
cysts, internal resorption, cellulitis, etc.[48]
DENS EVAGINATUS
DE is a developmental aberration of a tooth resulting in
formation of one accessory cusp whose morphology of
shapes has been determined as abnormal tubercle, elevation,
protuberance, excrescence, extrusion or a bulge. It is also
mentioned to as tuberculated cusp, accessory tubercle,
occlusal tuberculated premolar, Leong’s premolar, evaginatus
odontoma and occlusal pearl.[49,50] Currently, DE is the
preferable terminology and was first recommended by
Oehlers et al. in 1967.[44] This unusual anomaly projects
above the adjacent tooth surface area, exhibitive enamel
covering a dentinal core that commonly contains pulp tissue;
occasionally having slender pulp horn which extends to
different distances within the dentinal core.[50,51] The
tubercles of DE have been differentiated from the cusp of
carabelli which is a normal anatomical formation and is
differentiated from DE by the absent of a pulp core.[50]
The happening of DE shows too much racial differences
with a higher spreading among people of mongoloid origin.
[52]
It is commonly associated with the occlusal surface area
of premolars. Schulze (1987) distinguished the following
five types of DE for posterior teeth by the location and area
of the tubercle.[50,53]
1. A cone-like enlargement of the lingual cusp
2. A tubercle on the disposed plane of the lingual cusp
3. A cone-like enlargement of the buccal cusp
4. A tubercle on the disposed plane of the buccal cusp
5. A tubercle arising from the occlusal surface area
obliterating the central groove.
When DE appears in the anterior region area, it is commonly
observed on the lingual surface and is known as a talon’s
cusp.[50] Early diagnosis and management of DE are
necessary to prevent occlusal interference, compromised
aesthetics, carious developmental grooves, periodontal
problems because of excessive occlusal forces, or irritation
of the tongue while speech and mastication.[54] Mitchell was
the first to identify this anomaly in 1892, which was later
named talon by Mellor
11
and Ripa because of its resemblance to an eagle’s talon. [55] It
is usually seen in the maxillary lateral incisors region and
has been associated with syndromes such as Rubinstein and
Taybi, Berardinelli-Seip, Mohr, Ellis-van Creveld, Sturge-
Weber and incontinentia pigmenti achromians.[56] It
differentiated in size, shape, length and mode of attachment
to the crown and ranges from an enlarged cingulum to a
large, well-delineated cusp extending beyond the incisal
region of the tooth.[41] The cusp is composed of normal
enamel and dentin including varying extensions of pulp
tissue. It may also communicate with the incisal edge to
produce a T-form or, if more cervical, a Y-shaped crown
contour.[42] Talon cusp is an unusual anomaly, whose
etiology may be disturbances in the morph differentiation
stage. Talon cusp is a rare entity in which a prominent
wisplike structure originates from the cervical area of
lingual or labial surfaces of the anterior teeth, happening
lingually with the most frequency.[57]
Hattab et al. classified talons’ cusps into three types based on
the degree of cusp shapes formation and extension:[58]
• Type 1: Talon – refers to a morphologically well-
delineated accessories cusp that prominently projects
from the palatal (or facial) surface area of a primary or
permanent anterior tooth and extends at least half the
distance from CEJ to the incisal edge
• Type 2: Semi talon – refers to an additional cusp of a
millimeter or more extending less than half the distance
from CEJ to the incisal edge region. It may blend with
the palatal surface area or stand away from the rest of the
crown
• Type 3: Trace talon – an enlarged or eminent cingula and
their variations, i.e., conical, bifid or tubercle-like.
The DE or talons cusp may have fracture or be abraded as
soon as the tooth comes into occlusion, exposing the pulp.[15]
Hence, early identification of this anomaly and prompt
treatment should be instituted to avoid endodontic
complications.
Enamel pearls
Enamel which is normally confined to the anatomic crowns
of human teeth may be found ectopically on the root, either
as cervical enamel projections or enamel pearls.[58,59] Enamel
pearl is determined as an ectopic globule of enamel that
is firmly attached to the tooth root. [60] Enamel pearls may
include completely of enamel connected to cementum or
root dentin or may indicate incorporation of a cone of dentin
with or without pulpal extension, the last two are referred to
as composite enamel pearls and the composite type without
pulpal extension is the most usual type of macroscopically
detected enamel pearls.[61] It has been mentioned to as an
enameloma, enamel droplet, enamel nodule, enamel
exostoses and enamel globule. It is found usually on the
roots of maxillary molars, particularly the third molars
adjacent to the furcation or furrow of the root.[59]
Enamel which is usually restricted to the anatomic crowns
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 Jahanimoghadam: Dental anomalies
of human teeth may be found ectopically on the root, either
as cervical enamel projections or enamel pearls. These

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 Jahanimoghadam: Dental anomalies

developmental aberrations in tooth morphology may prepare development of the stomatognathic system.[68]
the affected area to plaque accumulation and consequently
brings periodontal breakdown. Early diagnosis of these
anomalies may meliorate the prognosis of the involved
teeth. Enamel pearl is determined as an ectopic globule of
enamel that is firmly connected to the tooth root. The size of
clinically recognizable enamel pearls may vary from 0.3-4
mm. Risnes (1974) observed enamel pearls on 2.28% molars
of 8854 teeth examined grossly. The enamel pearls happened
more usually on the roots of maxillary molars, especially
third molars. The usual site of area of the enamel pearl is
adjacent to the furcation or furrow of the root, especially the
bifurcation or trifurcation locations of maxillary and
mandibular molars. Maxillary 2nd and 3rd molars are more
usually included than the first molars.[61]
Advanced localised periodontal destruction has been
attendant with cervical enamel projections and enamel pearl,
preparing for attachment loss.[62]
Taurodontism
Witkop determined taurodontism as teeth with large pulp
chambers in which the bifurcation or trifurcation has
displacement apically, so that the chamber has bigger
apical-occlusal height than in normal teeth and lacks
the constriction at the level of CEJ. The distance from
the trifurcation or bifurcation of the root to the CEJ is bigger
than the occlusal-cervical distance.[63]
This anomaly was first mentioned in the remnants of
prehistoric hominids by de Terra in 1903 and by Gorjanovic-
Kramberger and Aldoff in 1907.[64] Pickerill in 1909 noted
this in modern man.[65] Although the term ‘taurodontism’ was
first used by Sir Arthur Keith in 1913 to defined the teeth of
prehistoric people, the Neanderthals and Heidelberg.[26] He
coined this term from the Latin word tauro (for bull) and
Greek term dont (for tooth) due to the morphological
resemblance of affected tooth to the tooth of ungulates or
cud chewing animals. Shaw has classified taurodontism
arbitrarily based on comparative degree of apical
displacement of floor of pulp chamber into hypo, meso and
hyper-taurodontism.[66]
Peg-shaped laterals
A peg lateral is an undersized, tapered, maxillary, small,
lateral incisor.[67] The tooth is conical in shape; broadest
cervically and tapers incisally to a blunt point. An
uncommon happening is that of a peg-shaped maxillary
central incisor. Peg-shaped teeth grow from a single lobe
instead of four. The peg-shaped laterals are predominantly
genetically defined and can also be caused because of
endocrinal disturbances.[68] Peg-shaped laterals may be
attendant with other dental anomalies such as tooth
agenesis, canine transposition and over-retained primary
teeth. Studies of identical twins have showed that missing
teeth and peg-shaped lateral incisor might be a varied
expression of the same genetic trait. [67,69] Early management of
the peg-shaped laterals is important because of
psychological problems in children as well as for the correct
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 Jahanimoghadam: Dental anomalies
Fluorosis
Fluorosis is a cosmetic situation that affects the teeth. It is
happened due to overexposure to fluoride during the
first 8 years of life. This is the time when most permanent
teeth are being formed completely.[70]
Reason of the dental fluorosis is the increasing in
concentration within the fluoride microenvironment of the
ameloblasts while enamel formation. Fluorosis is increasing
in mostly the enamel proteins amelogenin and enamelin. In
such an anomaly, both primary and permanent dentition are
effected. Symptoms of fluorosis range from tiny white
specks or streaks that may be unnoticeable to dark brown
stains and rough, pitted enamel that is difficult to clean.
Teeth that are unaffected by fluorosis are smooth and
glossy. They should also be a pale creamy white. There are
ways of management of these anomaly such as, genetic
counselling, preservation of molar teeth with stainless steel
crowns or nickel chrome or gold onlays, composite resin
veneers over anterior teeth, certain treatment with porcelain
and precious metal must be delayed until late adolescence.
[70,71]

DENTINAL DYSPLASIA
Dentinal dysplasia (DD) is frequent determined as rootless
teeth. Clinical specification includes very short or absent
roots but the crowns are normal clinically, pulpal
obliteration similar to dentinogenesis imperfecta and often
periapical radiolucencies surrounding the defective roots.
In such an anomaly all teeth and both dentitions are affected.
Management of this anomaly using prosthetic rehabilitation
is an effective treatment.[3]
In general, two main classes of DD are identified based on
clinical and radiographic appearance. [4] Witkop proposed
the classifications – Type I, or ‘dentin dysplasia’, and Type
II or ‘anomalous dysplasia of dentin’. Witkop later
determined Type I as ‘radicular dentin dysplasia’ and Type
II as ‘coronal dentin dysplasia’ to show the parts of the teeth
that are primarily involved. It is a rare anomaly of unknown
aetiology that affects approximately one patient in every
100,000. Histologically, in DD1, most of the coronal and
mantle dentin of the root is frequently reported to be
normal, and the dentin defect is limited mainly to the root.
[72]
The third type of dentin dysplasia, DD3or ‘focal
odontoblastic dysplasia’, also has been proposed.[73]
Regional odontodysplasia
Regional odontodysplasia (RO) is a rare developmental
anomaly that affects the primary and permanent dentitions.
This disturbance is generally localised in only one arch
and its aetiology is unknown yet. Clinically, the affected
teeth have an abnormal shape and are typically discoloured.
Radiographically, these teeth show a ghost-like aspect.
This anomaly tends to effect several adjacent teeth
within a particular segment of the jaw, and usually does not
cross the midline.[74] RO mostly involves one quadrant and
affects

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 Jahanimoghadam: Dental anomalies
the maxilla twice as frequently as the mandible, [75] with the
left maxillary quadrant being the most frequently affected
quadrant.[76] It has a predilection for the central and lateral
incisors, with higher prevalence in females.[77] Treatment
planning must be designed separately for each individual
case. It depends on many factors such as the patient’s age,
medical history, involvement extension, teeth eruption,
aesthetics and the development stage of this anomaly.[75]
Hypodontia
Congenitally missing teeth (CMT), or as usually named
hypodontia, is a highly prevalent feature. Besides an
unfavourable appearance, patients with missing teeth mostly
suffer from malocclusion, periodontal damage, insufficient
alveolar bone growth, less chewing ability, inarticulate
pronunciation and other problems.[78] Hypodontia is more
prevalent in women so it is necessary to manage these teeth
aesthetically. The frequency rate of hypodontia is variable in
different sexes and races. Physical disruption of dental
lamina may cause obliteration of tooth buds and agenesis of
tooth. This condition is seen in orofaciodigital syndrome,
Ellisvan syndrome and cleft lip and palate. It can also be the
result of metabolic misbalance that causes dental agenesis.
Finally, hereditary defect of the underlying mesenchyme
may lead to hypodontia.[79] The treatment plan for CMT is
challenging and requiring multidisciplinary approach to
achieve a successful outcome. A paediatric dentist often
initiates interdisciplinary treatment by the diagnosis of
hypodontia and maintenance of the primary teeth.
Definitive treatment plan is usually determined after the
eruption of all permanent teeth.[80]
CONCLUSION
Developmental anomalies of the teeth require careful
examination and treatment planning. Where one anomaly
is present, clinicians should suspect that other anomalies
may also be present. Developmental dental anomalies show
variations and no two anomalies of the same types are alike.
Hence, knowledge of various criteria which have been put
forward for the identification and classification of the different
anomalies is essential to diagnose the condition and perform
appropriate treatment.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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