ISOLATED DENTAL ANOMALIES

CLASS I ANGLE
 Supernumerary teeth
 Anodontia
 Supernumerary teeth
 Dental lamina superproduction
 Used terms :
- pleiodontia
- hyperdontia
 Frequent in: - permanent dentition
- upper maxilla,
- incisor region
- males
 It develops independently or associated with a normal
tooth
 Supernumerary teeth
 They can erupt or remain
impacted
 They can be observed in
different stages of development
 Some authors consider the
enamel pearl as a
supernumerary tooth, but, for a
structure to be considered
supernumerary tooth, it must
comprise 2 hard dental tissues,
enamel and dentine.
 Supernumerary teeth
 Can develop
independently or
associated with a normal
tooth. When they develop
independently, they can
present:
 A similar shape to the
neighbouring tooth
(eumorph)
 An atypical shape.
(dismorphya)
 Supernumerary teeth
 When they develop
associated with a normal
tooth, they can be:
 dentes confusi;
 dentes geminati. (the solder
can be total or partial);
 dens in dente (the
supernumerary tooth
develops inside another
tooth)
 Supernumerary teeth,
etiopathogenic factors:
 Supernumerary teeth are
frequently reduced in
volume, atypical and
lately developed.
 They can erupt or can
remain impacted in a
normal or inversed
position.
 Etiopathogenic factors
 The theory of the third
dentition
 According to this theory, the decidual
teeth derive from the primary lamina and
the permanent teeth from the secondary
one, which develops orally to the primary
lamina.
 Arguments in favour to this theory:
- late calcification of the supernumerary
tooth
- the supernumerary teeth are located
orally to the normal ones.
 Etiopathogenic factors
 Counterarguments to
this theory:
- do not explain the
supernumerary teeth which are
associated to the decidual
teeth;
- do not explain the presence of
buccaly located supernumerary
teeth;
 Atavic theory.
 According to this theory, the
supernumerary teeth represent
a return to the ancestral dental
formula: 3 incisors, 1 canine, 4
premolars, 3 molars.
 Etiopathogenic factors
 Dental germs division
theory:
 - a dental germ from the normal
series divides into 2 parts, which
evolve independently.
The theory doesn’t explain the
following:
- the existence of smaller
supernumerary teeth (if the
dental germ would divide
uniformly, the resultated teeth
would be reduced in volume
 Etiopathogenic factors
 The multiple adamantine
germs theory:
- there are accessory germs
which later atrophy;
-in some situations these germs
develop and calcify
 The theory:- explains the volume
and shape variations
 - was not histologically proven
 Etiopathogenic factors
 The theory of internal
adamantine epithelium
evagination
 - an evagination of the external
and then internal epithelium
happens, with the spreading of
extensions which form an
independent germ (due to local
irritation).
 The theory explains the high
frequency in the incisor area
 The theory does not explain the
presence of a dens in dente
 Clinical manifestations
 1. They can harmoniously fit in the arch.
 2. They can erupt outside the arch and produce:

- esthetic disorders tulb. fizionomice

- neighbouring teeth position modifications
(rotations, crowding)
- neural disorders (sensitive, neuralgia)
- cystic degeneration (tumours)
3. Remain impacted:
a) - do not stop the evolution of permanent
teeth
b) – determine the impaction of normal teeth
 Complementary examinations
 Xray exam is compulsory for
the diagnosis of:
-presence of impacted and
supernumerary teeth;
-development stage;
-neighbouring teeth relations;
-size;
 Panoramic and bite Xrays are useful
when a lower number of
supernumerary teeth can be observed
due to scarce mineralization
compared to the intraoperatory
situation.
 Treatment
 In the 3rd a clinical situation,
extraction and orthodontic
correction is recommended.
 No extraction is to be perfomed
in:
-microdontia;
-affected neighbouring teeth.
In this situation the affected tooth
will be extracted and the
supernumerary tooth analyzed
 Treatment
 In the 3rd b clinical situation, the following are
indicated:
 Arch expansion
 Impacted tooth traction to the arch.
 Extraction is performed after 6 years of age in
order to not hurt and move the permanent teeth
germs. The most malpositioned tooth is to be
extracted.
 The prognosis is favourable if the anomaly
has been detected early.
 Mesiodens
 It is a dysmorphic conical or
tubercular supernumerary tooth,
situated at the level of the upper
midline.
 It can be single or multiple (in the
case of 2, they erupt palatally)
 Its calcification can be early, erupting
before the incisors.
 It can remain impacted, sometimes in
situs invertus and its presence is
presumed due to incisor eruption
modifications.
 Mesiodens
 Determines:
 late permanent incisors
eruption;
 incisor movement;
 Large interincisor diastema
occurrence.
 Treatment
 Extaction
 Orthodontic correction of the
diastema
 Keeping it in the arch and
performing coronoplasty if
there are other associated
anomalies.
 ANODONTIA
 It is a number anomaly
which affects both
dentitions (more
frequently the permanent
one).
 It is characterized by the
absence of some teeth to
the absence of all teeth .
 It occurs due to disorders
during the formation of the
dental lamina.
 Anodontia
 Terminology:
- anodontia = total lack
- hypodontia = reduced forms
- oligodontia = extended forms
- aplasia = phylogenetic forms (lateral incisor, 2nd
premolar, 3rd M)
 The following terms are also used:
- agenesis (lack of teeth for which there was no
germ)
-anodontia (lack of teeth that had germs but got lost
for various reasons)
 Romanian school classification
 Boboc recommends the
following classification:
- reduced partial anodontia
(upper lateral incisor,
inferior central incisor, 2nd
premolar)
- extended partial anodontia
- subtotal and total anodontia
Diagnosis – confirmed by Xray exam
The numeric anomaly can occur as:
 An isolated anomaly
 As a symptom in
hereditary
multimalformative
syndromes (ex. Down
syndrome)
 Etiology
 In the case of lip-
maxillary-palatal clefts
 Even resistant teeth can
be absent: canine, first
molar
 The remaining teeth
present shape and size
anomalies (microdontia)
 Oligodontia, total anodontia
 Occurs as a symptom in:
- ectodermal dysplasia, with the
involvement of several ectodermal
system elements:
- dry, fragile skin, with
hyperkeratosis areas
-reduced number of sebaceous and
sweat glands, with thermoregulation
disorders
- hypotrichosis with fragile hair
- upper and lower limbs modifications
(hypo- and sindactylia)
 Clinical examination
 Edentulous facial modifications:
- reduced lower face
- retracted chin
- acctentuated labiomental fold
- convex profile
 Osseous underdevelopment, with
reduced crests, limited by a fibrous
area.
 Clinical examination
 The remaining teeth are
atypically shaped and reduced
in volume
 Severe functional disorders
(esthetics, mastication,
phonation)
 General development is late
and disturbed due to functional
deficiencies.
 Oligodontia therapy
 In children, total or subtotal
anodontia presents aggravating
particularities:
- growing organism;
- unfavourable crests
concerning prosthesis
stabilization and force
transmission.
 Oligodontia therapy
 The bjectives of the
prosthesis are:
-obtaining masticatory
efficiency which can assure
child nourishment in normal
conditions;
-obtaining a vertical dimension
and a good profile of the
inferior face to improve
esthetics.
 Oligodontia therapy
 Applying a prosthesis around the
free parts of the maxilla restrains
their development; they must be
changed every year or every
other year.
 In subtotal anodontia, the
remaining teeth will be used for
prosthesis stabilization.
 Oligodontia therapy
 For force attenuation, creating an
artificial parodontium is
recommended by introducing an
elastic acrylic layer for
amortization. It can be placed
like this:
 Between the teeth and the base of
the prosthesis.
 In the base between two hard
acrylate layers
 On the mucosal side of the
prosthesis
 The aplasia frequently implies the:
 Upper lateral incisor
 Lower central incisor
 Upper 2nd premolar
 Lower 2nd premolar
 Upper lateral incisor aplasia
therapy
 Depends on:
- the arch size (spacing or
crowding)
- occlusal relations (class I,
III)
- patient’s desire
 2 alternatives:

- biological closing of the

gap
- keeping the gap
 Biological closure of the gap
 As sooner the extraction of the decidual tooth, as
better the conditions for mesial movement of the
teeth.
 Guided extraction of decidual teeth is
recommended.
 The upper decidual lateral incisor is extracted,
followed by the decidual canines so that,
spontaneously, the permanent canines can align
next to the central incisors, the esthetic demand
being accepted.
 Biological closure of the gap
 When we wish to direct the
permanent canine eruption
mezialization to occupy the spot
next to the central incisor, it is
recommended to keep the
decidual canine in the arch with
the role of an inclined plane.
The extraction of the temporary
canine is performed when the
permanent canine presents the
right intraosseous direction (the
evolution is observed
radiologically)
 Biological closure of the gap
 In case of early detection of
upper lateral incisor Lindner 1
anodontia, repeated grinding
of the mesial and distal sides
of the decidual molars and
canines is indicated; this
would favour a slow
mesialization of all teeth
without the need of any
appliance.
 Maintaining the gap
 This is indicated in situations
where excess of space is present
and in the case of a 3rd class
which could be worsened by
upper arch reduction.
 If a diastema can be noticed and
the space for the lateral incisor is
reduced, the gap will be closed to
assure favourable conditions for
prosthetic therapy.
 Maintaining the gap
 Mobile appliances with
diapason like clasps are used to
close the diastema and
maintaining the space for the
lateral incisor.
 When protrusion is associated,
closing of the gap is easened by
incisor retrusion.
 Dental implant solution.
 Lower central incisor aplasia
 Due to the absence of 2
adjacent teeth, a large gap can
be noticed, similar to the
edentulous one (esthetics
impingement)
 Frequent in females
 Hereditary implications
(mother, daughter))
 Genetic implications (X linked
transmission)
 Lower central incisor aplasia
 As a therapeutic solution,
closing of the gap by
posterior teeth movement
is recommended; this
situation is favoured by
crowding.
 Fixed or mobile
orthodontic reduction of
the gap
 Lower central incisor aplasia
 If the diagnonis is late,
keeping the lower decidual
incisors is recommended as
long as possible (technical
difficulties in prosthetic
restoration in the incisor area)
 Prosthetic solutions:
adhesive bridge
 Aplazia incisivilor centrali inferiori
 Puntea adezivă va fi înlo-
cuită dat. discromiei şi
uzurii materialului
compozit.
 Implant , după terminarea
creşt. os
 Aplazia Pm
 Mai frecv. la arc. inf
 Se obs. aplazii în diagonală ( 1.5 şi 3.5)
 Nu se extr.M2 sup. în scop ortod. fără Rx.panoramic
 Atit. terapeutică var. în funcţ. de anomaliile asociate
şi de clasa molară existentă.
 Dacă există exces de spaţiu, se păstr. mol temp
(permanentizarea d. temp până la 40-50 ani)
 Dacă există deficit de sp, se recurge la extr. D. temp.
 Sol. protetice