Dental AnomaliesDental Anomalies

ArlArlétte S Setiawanétte S Setiawan

IntroductionIntroduction

Anomalies Anomalies deviation of normal condition deviation of normal condition Most dental anomalies will present in Most dental anomalies will present in

childhoodchildhood Diagnosis and management Diagnosis and management contribute contribute

important areas of paediatric dentistryimportant areas of paediatric dentistry Etiology: growth and development disturbanceEtiology: growth and development disturbance

Disturbance of Growth & DevelopmentDisturbance of Growth & Development

Genetic 78% Environment 22%

-Prenatal

-Postnatal

Growth and DevelopmentGrowth and Development

Initiation (bud stage)Initiation (bud stage) Embryo Embryo 5 weeks 5 weeks Oral epitheliumOral epithelium dental dental

laminalamina

Proliferation (cap stage)Proliferation (cap stage) Mesenchim cell Mesenchim cell proliferation, thicken, proliferation, thicken,

vascularatedvascularated dental papillae dental papillae Dental papillae Dental papillae pulp+dentine pulp+dentine Thicken of mesenchime cellThicken of mesenchime cell cementum, periodontal membrane,cementum, periodontal membrane,

alveolar bonealveolar bone

Histodifferentiation (bell stage)Histodifferentiation (bell stage) Cellular differentiationCellular differentiation Inner enamel epithelium Inner enamel epithelium ameloblast ameloblast enamel enamel Outer enamel epithelium Outer enamel epithelium odomtoblast odomtoblast dentine dentine

MorphodifferentiationMorphodifferentiation Differentiation of size and shapeDifferentiation of size and shape Dentinoenamel junctionDentinoenamel junction Lead to matrix depotitionLead to matrix depotition

ApotitionApotition Matrix depotitionMatrix depotition

Consideration in the ManagementConsideration in the Management

Informing and supporting child and parentInforming and supporting child and parent Establishing a diagnosisEstablishing a diagnosis Genetic counsellingGenetic counselling Interdisciplinary formulation of definitive treatment planInterdisciplinary formulation of definitive treatment plan Elimination of painElimination of pain Restoration of aestheticsRestoration of aesthetics Provision of adequate functionProvision of adequate function Maintenance of occlusal vertical dimensionMaintenance of occlusal vertical dimension Use of intermediate restoration in childhood and adolescenceUse of intermediate restoration in childhood and adolescence Planning for definitive treatment at an optimal agePlanning for definitive treatment at an optimal age

Dental anomalies at different stages Dental anomalies at different stages of dental developmentof dental development

Dental lamina formation stageDental lamina formation stage Hypodontia/oligodontia/anodontiaHypodontia/oligodontia/anodontia Supernumerary teethSupernumerary teeth Double teeth, geminated, or fused teethDouble teeth, geminated, or fused teeth OdontomesOdontomes Odontogenic tumourOdontogenic tumour Odontogenic keratocystOdontogenic keratocyst

HistodifferentiationHistodifferentiation Regional odontodysplasiaRegional odontodysplasia

MorphodifferentiationMorphodifferentiation MacrodontiaMacrodontia MicrodontiaMicrodontia Invaginated odontomeInvaginated odontome Evaginated odontomeEvaginated odontome Carabelli traitCarabelli trait Talon cuspTalon cusp Huchinson’s incisors and mulberry molarsHuchinson’s incisors and mulberry molars TaurodontismTaurodontism

Matrix depositionMatrix deposition Dentine : dentinogenesis imperfecta, dentinal Dentine : dentinogenesis imperfecta, dentinal

dysplasiadysplasia Enamel : amelogenesis imperfectaEnamel : amelogenesis imperfecta Enamel hypoplasiaEnamel hypoplasia Enamel opacitiesEnamel opacities fluorosisfluorosis

Eruption and root developmentEruption and root development Premature eruptionPremature eruption Natal and neontal teethNatal and neontal teeth Delayed eruptionDelayed eruption Ectopic eruptionEctopic eruption Eruption cystEruption cyst Transposition of teethTransposition of teeth ImpactionImpaction Arrested root developmentArrested root development Failure of eruption in amelogenesis imperfectaFailure of eruption in amelogenesis imperfecta Failure eruption in cleidocranial dysplasiaFailure eruption in cleidocranial dysplasia

HypodontiaHypodontia

Hypodontia; progressive Hypodontia; progressive degrees of missing teethdegrees of missing teeth

Oligodontia: >6 missing Oligodontia: >6 missing teethteeth

Anodontia: compolete Anodontia: compolete absence of teeth.absence of teeth.

Related to genetic Related to genetic syndromessyndromes

Supernumerary teethSupernumerary teeth Arising as a result of budding of dental laminaArising as a result of budding of dental lamina Frequency in primary teeth 0,3-0,8%Frequency in primary teeth 0,3-0,8% Permanent teeth 1,0-3,5%Permanent teeth 1,0-3,5% 98% in maxilla 98% in maxilla 75% of which are 75% of which are

mesiodensmesiodens

MacrodontiaMacrodontia

Any tooth or teeth Any tooth or teeth larger than normallarger than normal

Largely because of an Largely because of an isolated disturbace of isolated disturbace of developmentdevelopment

EtiologyEtiology unknown unknown

MicrodontiaMicrodontia

One or more teeth that are smaller than normal One or more teeth that are smaller than normal for the tooth typefor the tooth type

Maxillary lateral incisorsMaxillary lateral incisors Primary dentition <0,5%Primary dentition <0,5% Permanent dentition 2%Permanent dentition 2% More common in femalesMore common in females

Double toothDouble tooth

Formed by fusionFormed by fusion Fusion: joining of two Fusion: joining of two

teeth teeth Gemination: budding of Gemination: budding of

a second tooth from a a second tooth from a single tooth germ. single tooth germ. Usually one root canal Usually one root canal is presentis present

Talon cuspTalon cusp

Horn-like projection of Horn-like projection of the cingulum of the the cingulum of the maxillary incisor teethmaxillary incisor teeth

Primary dentition Primary dentition almost unknownalmost unknown

Permanent dentition 1-Permanent dentition 1-2%2%

Tooth discolorationTooth discoloration

OpacitizationOpacitization Result from a defect in the quality of the enamelResult from a defect in the quality of the enamel Hypomineralization result in a change in the Hypomineralization result in a change in the

porosity of the enamelporosity of the enamel FluorosisFluorosis

Manifest as hypomineralization of the enamelManifest as hypomineralization of the enamel

Enamel HypoplasiaEnamel Hypoplasia

Defect in quantityDefect in quantity Caused by failure of Caused by failure of

apposition and protein apposition and protein matrix formationmatrix formation

Alteration in the Alteration in the mineralization of the mineralization of the matrixmatrix

Amelogenesis ImperfectaAmelogenesis Imperfecta

Applied to inherited defects of the enamelApplied to inherited defects of the enamel Primary and permanent teethPrimary and permanent teeth Frequency estimated 1:14000 in the USAFrequency estimated 1:14000 in the USA Diagnosis based on a combination of the mode Diagnosis based on a combination of the mode

of inheritence and clinical and radiographic of inheritence and clinical and radiographic appearanceappearance

Dentinogenesis ImperfectaDentinogenesis Imperfecta

Inherited disorder of dentineInherited disorder of dentine May be associated with osteogenesis May be associated with osteogenesis

imperfectaimperfecta

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