developmental defectsof the oral and maxillofacial region

DEVELOPMENTAL DEFECTSOF THE ORAL

AND MAXILLOFACIAL REGION

DISORDERS OF DEVELOPMENT OF THE TEETH

• Abnormalities in number•Disturbances in form of teeth•Disorders of eruption•Defects of structure•Developmental anomalies of several dental tissue

ABNORMALITIES IN NUMBER

• Isolated hypodontia or anodontia•Hypodontia or anodontia with systemic defects• Anhidrotic (hereditary) ectodermal dysplasia•Down's syndrome

HYPODONTIA. MULTIPLE DEVELOPMENTALLY MISSING PERMANENTTEETH AND SEVERAL RETAINED DECIDUOUS TEETH IN A FEMALE

ADULT

HYPODONTIA. RADIOGRAPH OF THE SAME PATIENT. NO UNERUPTED TEETH WERE NOTED WITH IN

THE JAWS,

HYPODONTIA . DEVELOPMENTALLY MISSING MAXILLARYLATERAL INCISORS. RADIOGRAPHS REVEALED NO UNDERLYING TEETH , AND

THERE WAS NO HISTORY OF TRAUMA OR EXTRACTION.

ABNORMALITIES IN NUMBER

• Additional teeth: hyperdontia• Supernumerary teeth• Supplemental teeth

• Syndromes associated with hyperdontia: cleidocranial dysplasia

HYPERDONTIA (MESIODENS) . ERUPTED SUPERNUMERARY,RUDIMENTARY TOOTH OF THE ANTERIOR MAXILLA.

HYPERDONTIA (MESIODENS). UNILATERAL SUPERNUMERARYTOOTH OF THE ANTERIOR MAXILLA, WHICH HAS ALTERED THE

ERUPT ION PATH OF THE MAXILLARY RIGHT PERMANENT CENTRAL INCISOR

HYPERDONTIA (MESIODENS). BILATERAL INVERTEDSUPERNUMERARY TEETH OF THE ANTERIOR MAXILLA.

HYPERDONTIA. RIGHT MANDIBULAR DENTITIONEXHIBITING FOUR ERUPTED BICUSPIDS

DISTURBANCES IN FORM OF TEETH

• Dilaceration• Taurodontism• Double teeth• Fusion • Gemination

• Concrescence

DILACERATION

TAURODONTISM. MANDIBULAR MOLAR TEETH EXHIBITINGINCREASED PULPAL APICOOCCLUSAL HEIGHT WITH APICA LLY

POSITIONEDPULPAL FLOOR AND BIFURCATION

FUSION. DOUBLE TOOTH IN THE PLACE OF THEMANDIBULAR RIGHT LATERAL INCISOR AND CUSPID.

FUSION. RADIOGRAPHIC VIEW OF DOUBLE TOOTH IN THEPLACE OF THE MANDIBULAR CENTRAL AND LATERAL INCISORS. NOTE

SEPARATEROOT CANALS.

FUSION. RADIOGRAPH OF THE SAME PATIENT.NOTE THE BIFID CROWN OVERLYING THE SINGLE ROOT

CANAL; THE CONTRA LATERAL RADIOGRAPH REVEALED A SIMILAR PATTERN

BILATERAL GEMINATION. TWO DOUBLE TEETH. THETOOTH COUNT WAS NORMAL WHEN EACH ANOMALOUS TOOTH WAS

COUNTEDAS ONE.

GEMINATION. MANDIBULAR BICUSPID EXHIBITING BIFIDCROWN.

GEMINATION. SAME PATIENT. NOTE THE BIFID CROWN AND SHARED ROOT CANAL

CONCRESCENCE. UNION BY CEMENTUM OF ADJACENTMAXILLARY MOLARS.

CONCRESCENCE. UNION BY CEMENTUM OF MAXILLARYSECOND AND THIRD MOLARS. NOTE THE LARGE CARIOUS DEFECT OF

THESECOND MOLAR.

CONCRESCENCE. GROSS PHOTOGRAPH OF THE SAMETEETH. HISTOPATHOLOGIC EXAMINATION

REVEALED THAT UNION OCCURRED IN THE AREA OF CEMENTAL REPAIRPREVIOUSLY DAMAGED BY A PERIAPICAL INFLAMMATORY LESION.

DISORDERS OF ERUPTION

• Metabolic diseases particularly cretinism and rickets• Cleidocranial dysplasia• hereditary gingival fibromatosis• cherubism

CRETINISM

RICKETS

CLEIDOCRANIAL DYSPLASIA

HEREDITARY GINGIVAL FIBROMATOSIS

CHERUBISM

DEFECTS OF STRUCTURE

•HYPOPLASIA AND HYPOCALCIFICATION• Defects of deciduous teeth• congenital porphyria• Tetracycline

• Defects of permanent teeth• Genetic• Amelogenesis imperfecta• Dentinogenesis imperfecta• Shell teeth• Dentinal dysplasia• Regional odontodysplasia• Multisystem disorders with associated dental defects

DEFECTS OF STRUCTURECONTINUED

• Defects of permanent teeth• Infective• Congenital syphilis

• Metabolic• Childhood infections, rickets, hypoparathyroidism

• Drugs• Tetracycline pigmentation• Cytotoxic chemotherapy

• Fluorosis• Other acquired developmental anomalies:Fetal

alcohol syndrome

HYPOPLASTIC AMELOGENESIS IMPERFECTA, GENERAT- EIZED PITTED PATTERN . NOTE THE NUMEROUS PIN POINT PITS SCATTERED

ACROSS THE SURFACE OF THE TEETH. THE ENAMEL BETWEEN THE PITS IS OFNORMAL THICKNESS. HARDNESS. AND COLORATION.

HYPOPLASTIC AMELOGENESIS IMPERFECTA, AUTO SOMALDOMINANT SMOOTH PATTERN. SMALL. YELLOWISH TEETH

EXHIBITING HARD, GLOSSY ENAMEL WITH NUMEROUS OPEN CONTACTPOINTS AND ANTERIOR OPEN BITE.

HYPOPLAST IC AMELOGENESIS IMPERFECTA, AUTOSOMALDOMINANT SMOOTH PATTERN. RADIOGRAPH OF THE SAME

PATIENT . NOTE THE THIN PERIPHERAL OUTLINEOF RADIOPAQUE ENAMEL

HYPOMATURATION AMELOGENESIS IMPERFECTA.DENTITION EXHIBITING MOTTLED, OPAQUE WHITE ENAMEL

WITH SCATTEREDAREAS OF BROWN DISCOLORATION.

HYPOMATURATION AMELOGENESIS IMPERFECTA,SNOWCAPPED PATTERN. DENTITION EXHIBITING ZONE OF WHITE OPAQUEENAMEL IN T HE INCISAL AND OCCLUSAL ONE FOURTH OF THE ENAMEL

SURFACE

HYPOCALCIFIED AMELOGENESIS IMPERFECT A. DENTITIONEXHIBITING DIFFUSE YELLOW-BROWN DISCOLORATION . NOTE NUMEROUS

TEETH WITH LOSS OF CORONAL ENAMEL EXCEPT FOR THE CERVICAL PORTION.

HYPOCALCIFIED AMELOGENESIS IMPERFECTA.RADIOGRAPH OF THE SAME PATIENT. NOTE THE

EXTENSIVE LOSS OF CORONAL ENAMEL AND T HE SIMILAR DENSITY OF ENAMEL

AND DENTIN.

DENTINOGENESIS IMPERFECTA. RADIOGRAPH OFDENTITION EXHIBITING BULBOUS CROWNS, CERVICAL

CONSTRICTION, ANDOBLITERATED PULP CANALS AND CHAMBERS.

DENTINOGENESIS IMPERFECTA . DENT IT ION EXHIBITINGDIFFUSE BROWNISH DISCOLORATION AND SLIGHT

TRANSLUCENCE.

DENTINOGENESIS IMPERFECTA. DENTITION EXHIBITINGGRAYISH DISCOLORATION WITH SIGNIFICANT ENAMEL LOSS

AND ATTRITION.

SHELL TEETH . DENTITION EXHIBITING NORMAL THICKNESSENAMEL, EXTREMELY THIN DENTIN, AND DRAMATICALLY

ENLARGED PULPS.

DENTIN DYSPLASIA. DENTITION EXHIBITINGATTRITION BUT OTHERWISE NORMAL CORONAL COLORATION

AND MORPHOLOGY.

DENTIN DYSPLASIA. DENTITION EXHIBITINGSHORTENED ROOTS, NO PULP CANALS. AND SMALL CRESCENT-

SHAPED PULPCHAMBERS

DENTIN DYSPLASIA TYPE II. AFFECTED TOOTHEXHIBITING LARGE PULP STONE WITHIN THE PULP CHAMBER.

REGIONAL ODONTODYSPLASIA (GHOST TEETH) .POSTERIOR MANDIBULAR DENTITION EXHIBITING ENLARGED

PULPS ANDEXTREMELY THIN ENAMEL AND DENTIN.

REGIONAL ODONTODYSPLASIA. FOLLICULAR TISSUECONTAINS SCATTERED COLLECTIONS OF ENAMELOID

CONGLOMERATES ANDISLANDS OF ODONTOGENIC EPITHELIUM.

EHLERS-DANLOS

GARDNER'S SYNDROME

EPIDERMOLYSIS BULLOSA

CONGENITAL SYPHILIS

CONGENITAL SYPHILIS

HYPOPARATHYROIDISM

RICKETS

TETRACYCLINE PIGMENTATION

TETRACYCLINE PIGMENTATION

FLUOROSIS

FLUOROSIS

DENS INVAGINATUS. ILLUSTRATION DEPICTING THE THREETYPES OF CORONAL DENS INVAGINATUS.

DENS INVAGINATUS

CORONAL DENS INVAGINATUS. TYPE II . MANDIBULARLATERAL INCISOR EXHIBITING LINGUAL BULBOUS ENLARGEMENT AT

THE SITE OFCORONAL OPENING OF ENAMEL INVAGINATION .

ENAMEL PEARL. MASS OF ECTOPIC ENAMEL LOCATED INTHE FURCATION AREA OF A MOLAR TOOTH.

ENAMEL PEARL . RADIOPAQUE NODULE ON THE MESIALSURFACE OF THE ROOT OF THE MAXILLARY THIRD MOLAR.ANOTHER LESS

DISTINCTENAMEL PEARL IS PRESENT ON THE DISTAL ROOT OF THE SECOND MOLAR.

GENETIC DISORDERS OF THE JAWS

• 1- Hereditary prognathism• 2- Clefts of the palate and/or lip• 3- Craniofacial anomalies• 4- Cleidocranial dysplasia • 5- Cherubism• 6- Basal cell naevus syndrome • 7- Gardner's syndrome • 8- Osteogenesis imperfect

CLEFT LIP. INFANT WITH BILATERAL CLEFT OF THE UPPER LIP.

CLEFT PALATE. PALATAL DEFECT RESULTING IN COMMUNICATION

WITH THE NASAL CAVITY.

BIFID UVULA.

SUBMUCOUS PALATAL DEFT. THERE IS A CLEFT OF THEMIDLINE PALATAL BONE. BUT THE OVERLYING MUCOSA IS INTACT. A

BIFIDUVULA ALSO IS PRESENT.

MANAGEMENT

• Important aspects of management of clefts• Provision for feeding in infancy when palatal clefts

are severe• Prevention of collapse of the two halves of the

maxilla• Measures to counteract speech defects• Cosmetic repair of cleft lips