Developmental Disturbances of Teeth PDF

DEVELOPMENTAL DISTURBANCES OF TEETH Dr. Eser Rengin Nalbantoglu Pediatric Dentistry Department CLASSIFICATION OF DEVELOPMENTAL ANOMALIES § Position anomalies § Size anomalies § Number anomalies § Shape anomalies § Structure (Tissue) anomalies § Color anomalies 1-POSITION ANOMALIES(DISTOPIES)...

DEVELOPMENTAL DISTURBANCES OF TEETH Dr. Eser Rengin Nalbantoglu Pediatric Dentistry Department CLASSIFICATION OF DEVELOPMENTAL ANOMALIES § Position anomalies § Size anomalies § Number anomalies § Shape anomalies § Structure (Tissue) anomalies § Color anomalies 1-POSITION ANOMALIES(DISTOPIES) • They are anomalies defined as the displacement and orientation of the teeth. • These anomalies can be real or apparent. • Real dystopias are congenital and not based on a mechanical cause. • Apparent dystopias are caused by a defect in the development of the jaw, supernumerary teeth, or tumors, etc. leading to malpositions. 1-POSITION ANOMALIES(DISTOPIES) a. Transposition b. Ectopia c. Heterotopia d. Displacement e. Inversion f. Diastema between the upper middle incisors 1-POSITION ANOMALIES(DISTOPIES) a. Transposition: The displacement of two adjacent teeth • It is more common in the permanent dentition. • The maxillary canine is most frequently replaced by the first premolar. 1-POSITION ANOMALIES(DISTOPIES) b. Ectopia: The teeth are formed on the jaws, but are far from the dental arch. • Ectopic teeth can remain impacted or erupt like normal teeth. 1-POSITION ANOMALIES(DISTOPIES) 1-POSITION ANOMALIES(DISTOPIES) c. Heterotopia: The development of a tooth in an organ other than the jaws. • Inside the orbital cavity • In dermoid ovarian cysts 1-POSITION ANOMALIES(DISTOPIES) d. Displacement: The tooth is on the jaw arch, but not in the right place. Maxillary canine in vestibular or palatal position Location of premolars palatal or lingual 1-POSITION ANOMALIES(DISTOPIES) e. Inversion: It is when the tooth takes a completely opposite direction from the normal eruption direction. This type of teeth can erupt into the nasal cavity, sinus and orbit. This anomaly is common in supernumerary teeth and wisdom teeth. 1-POSITION ANOMALIES(DISTOPIES) f. Diastema between the upper middle incisors: There may be diastema between the upper incisors when they first erupt into the mouth. However, this diastema closes with the eruption of the lateral teeth and canines. The continuation of this diastema is pathological. 1-POSITION ANOMALIES(DISTOPIES) Local causes: General causes: • Presence of mesiodens • Rickets • Hypertrophic upper lip frenulum • Hormonal disorders • Heredity • Lip clefts etc. 2- SIZE ANOMALIES • Occurs during the morphological differentiation (morphodifferentiation) of tooth development. • Teeth can be large or small relative to their normal size. a. Microdontia b. Macrodontia stage 2- SIZE ANOMALIES a. Microdontia : It is the condition that the tooth or teeth are small compared to normal sizes. It appears in three ways: 1. True generalized 2. Relative generalized 3. Localized (focal) 2- SIZE ANOMALIES 1- True generalized microdontia • All teeth in the lower and upper jaw are small. • It is seen in dwarfism due to hypopituitarism. • The teeth are like normal teeth in terms of structure and are like a miniature of a normal sized tooth. 2- SIZE ANOMALIES 2- Relative generalized microdontia It is the appearance of relatively small teeth, which occurs as a result of the child's taking a large jaw from one of the parents and small teeth from the other as a result of cross hereditary. • Even if the teeth are of normal size, they are small compared to the jaw arch. • Polydiastema is seen. 2- SIZE ANOMALIES 3- Localized (focal) microdontia One or more teeth are dwarf. • It is mostly seen in the last tooth of each group, namely lateral teeth, 2nd premolars and 3rd molars. • Lateral teeth take conical shape, while canine teeth maintain their normal form. Premolar teeth retain their 2 cusps, but their crowns are rounded. The tubercles of the dwarf forms of molar teeth are missing. • Conical shaped lateral teeth are called Peg Shape-Peg Lateral. 2- SIZE ANOMALIES Peg Lateral 2- SIZE ANOMALIES b. Macrodontia : It is the condition that the tooth or teeth are larger than normal sizes. It appears in three ways: 1. True generalized 2. Relative generalized 3. Macrodontia of a single tooth 2- SIZE ANOMALIES 1- True generalized macrodontia • All teeth in the lower and upper jaw are large. • It is seen in gigantism due to hyperpituitarism. • The teeth are like normal teeth in terms of structure and are like a giant version of a normal sized tooth. • In these patients, the jaw bones are also overdeveloped. 2- SIZE ANOMALIES 2- Relative generalized macrodontia • It is the appearance of a relatively large tooth, which occurs as a result of the child's taking a small jaw from one of the parents and larger teeth from the other as a result of cross hereditary. • Even if the teeth are of normal size, they are larger than the jaw arch. • While crowding is observed in the incisors, the canines are located in the second premolar lingual in the vestibule. 2- SIZE ANOMALIES 3- Macrodontia of a single tooth • There is a size anomaly involving one or more teeth. • It is common in central teeth, canines and second molars. • Sometimes the root is extremely long while the crown is of normal size. • This type of macrodontia can be seen alone or together with osseous and vascular anomalies such as hemifascial hypertrophy, lymphangioma, and hemangioma. • Tooth displaying macrodontia resulting from gemination or fusion of two teeth. 2- SIZE ANOMALIES 3- NUMBER ANOMALIES • It is the case of missing or excess in the number of teeth. • Hyperdontia • Hypodontia 3- NUMBER ANOMALIES a. Hyperdontia (Supernumerary) • Division of the tooth germ • A fold in the epithelial lining of the dental lamina • Heredity • In the budding stage, in addition to the buds that form primary and permanent teeth, there are also buds that atrophy over time, disappear and leave epithelial residues in their places. Sometimes these develop where they would atrophy to form supernumerary teeth. 3- NUMBER ANOMALIES a. Hyperdontia • Supernumerary teeth • The incidence is 3% • 90% in maxilla • More common in men • More common in permanent dentition 3- NUMBER ANOMALIES a. Hyperdontia • Extra teeth of normal shape and size « supplemental supernumerary tooth» • Those that are not of normal shape and size are called rudimentary supernumerary teeth. 3- NUMBER ANOMALIES a. Hyperdontia • Between the upper central incisors, one or two conical plus teeth are called "mesiodens". 3- NUMBER ANOMALIES a. Hyperdontia Distomolar: Distomolars or fourth molars are the excess teeth located mesiodistally behind the third molar. 3- NUMBER ANOMALIES a. Hyperdontia 3- NUMBER ANOMALIES a. Hyperdontia Clinical problems caused by hyperdontia • Difficulty in tooth extraction • Impacted adjacent tooth • Ectopic eruption of adjacent tooth • Dentigerous cyst formation • Crown resorption 3- NUMBER ANOMALIES a. Hyperdontia Syndromes with supernumerary teeth • Apert syndrome • Cleidocranial dysostosis • Gardner's syndrome • Down syndrome • Crouzon syndrome • Sturge-Weber syndrome 3- NUMBER ANOMALIES b. Hypodontia • Familial inheritance • Except for the third molars, the most common deficiency; 2nd premolar (3.4%) and maxillary lateral incisor (2.2%) 3- NUMBER ANOMALIES b. Hypodontia • Tooth deficiency that occurs in cases where the teeth do not form at all in the bud stage or the formed tooth buds atrophy and disappear is called «real tooth deficiency". • The clinical picture that occurs as a result of the teeth developing in the jaw but cannot be erupted into the mouth for any reason is called "apparent tooth deficiency". 3- NUMBER ANOMALIES b. Hypodontia § Hypodontia à Congenital absence of less than 6 teeth § Oligodontiaà Congenital absence of 6 or more teeth § Anodontia à Congenital absence of all primary and permanent teeth 3- NUMBER ANOMALIES Hypodontia 3- NUMBER ANOMALIES Oligodontia 3- NUMBER ANOMALIES Oligodontia 3- NUMBER ANOMALIES Anodontia 3- NUMBER ANOMALIES Anodontia 3- NUMBER ANOMALIES Syndromes associated with hypodontia: • Ectodermal dysplasia (hypohydrotic type) • Down syndrome • Chondroectodermal dysplasia • Rieger syndrome • Achondroplasia • Incontinentia pigment • Cleft lip and palate 3- SHAPE ANOMALIES • It is the deformities seen in the crowns and roots of the teeth. • Partial Shape Anomalies • Total Shape Anomalies PARTIAL SHAPE ANOMALIES a. Shape anomalies in the crown • Carabelli tubercle • Balk tubercle • Singulum hypertrophy, Talon tubercle • Dens invaginatus • Tuberculum intermedium PARTIAL SHAPE ANOMALIES • Carabelli tubercle: It is an excess tubercle seen next to the mesiopalatinal tubercle of the upper first molar and sometimes on the palatal surface of the upper primary second molar. PARTIAL SHAPE ANOMALIES • Balk tubercle: It is the tubercle that protrudes on the vestibular surface of the upper 2nd and 3rd molars. This formation is called “tuberculum molare” in primary teeth. PARTIAL SHAPE ANOMALIES • Talon tubercle: It is an anomaly defined as an accessory tubercle-like formation that extends from the cingulum region of the incisors in the incisal and lingual direction, and includes enamel, dentin, and sometimes a pulp extension. PARTIAL SHAPE ANOMALIES Talon Tubercle: • It is considered to occur as a result of genetic and environmental factors or hyperactivity of the dental lamina. • Facilitates plaque buildup. It can cause periodontal problems. It increases the susceptibility of this area to caries. • In cases where its size is large, it can create aesthetic problems. • May affect occlusion. • İt can irritate the tongue. • It can be progressively eroded. • Risk of pulp exposure during erosion • Fissure sealant • Composite resin restoration PARTIAL SHAPE ANOMALIES Dens Evaginatus: Usually in the central groove or ridge of the posterior teeth; It is the extra tubercle structure seen in the cingulum region of the lateral and central teeth. • It is formed as a result of evagination of inner enamel epithelial cells. • It is also seen in patients with Down syndrome. PARTIAL SHAPE ANOMALIES • Tuberculum intermedium: It is the third tubercle located on the lingual surface of mandibular molars. PARTIAL SHAPE ANOMALIES b. Shape anomalies in the root • Root adherent odontomes • Taurodontism • Excess number of roots • Shape anomalies of roots • Dilation PARTIAL SHAPE ANOMALIES Taurodontism: The separation of the roots is far below the column. • The height of the pulp chamber has increased. • Short and immature roots • Failure at the horizontal invagination level of the Hertwig epithelial root sheath • It is usually seen due to a chromosomal abnormality due to a syndrome. • The incidence is 0.5-5% PARTIAL SHAPE ANOMALIES Syndromes with taurodontism: • Down syndrome • Klinefelter syndrome • Ectodermal dysplasia • Amelogenesis imperfecta type 4 PARTIAL SHAPE ANOMALIES Hypercementosis: It is the thickening of cement on the entire root surface or localized. • Hereditary or due to trauma PARTIAL SHAPE ANOMALIES Hypercementosis: • Paget's disease: Very rapid and irregular new bone formation is seen. These bones are soft and weak. • Acromegaly: It is a disease caused by the secretion of too much growth hormone (growth hormone, GH) from the anterior lobe of the pituitary gland (adenohypophysis). Uncontrolled growth in body hard tissues • It may develop reactively as a result of incorrect orthodontic force. PARTIAL SHAPE ANOMALIES Dilaceration: The angulation that occurs in the crown and root of the tooth is bending. • During the development of the tooth, the position of the crown part due to trauma changes and takes an angled shape. • This bending can occur sometimes along the crown, sometimes in the cervical region, sometimes in the root. • These teeth may experience eruption problems. For this reason, exracting them can be an option. TOTAL SHAPE ANOMALIES • Amorphous teeth • Gemination (twin teeth) • Fusion • Concrescence • Dens in dente- dens invaginatus (tooth within a tooth) Text TOTAL SHAPE ANOMALIES Gemination (twin teeth): It is the clinical picture seen as a result of two teeth wanting to form from a single tooth germ and incomplete division of a single tooth bud. • Bifid crown appearance with a single pulp chamber • Since the size of the tooth increases, it can be confused with macrodontia. • They can cause malocclusion. • Its incidence is 0.5-1%. More common in primary dentition TOTAL SHAPE ANOMALIES Gemination: • Bifid crown appearance with a single pulp chamber TOTAL SHAPE ANOMALIES Fusion: It is the fusion of the dentin of two different embryologically developing teeth. • Although its etiology has not been fully explained, it is thought that adjacent teeth fuse with each other as a result of pressure or trauma. TOTAL SHAPE ANOMALIES Fusion (Fusion): • If there is a fusion after the crown maturation is completed, a single rooted tooth with two crowns, • If there is fusion before crown maturation, a tooth with a large crown and a large pulp chamber emerges. • Although fused teeth have two separate pulp chambers, most appear as large bifid crowns with a single pulp chamber. • Incidence 0.5% • More common in primary dentition • Wide crowns • Number of teeth decreased !!! TOTAL SHAPE ANOMALIES Fusion TOTAL SHAPE ANOMALIES DIFFERENTIAL DIAGNOSIS v Fusion is more common in the lower incisors, and gemination in the upper incisors. v Gemination is two crowns from a single germ, fusion is a single crown from two germs. v While there is plus tooth formation in gemination, tooth deficiency occurs in fusion. TOTAL SHAPE ANOMALIES Concrescence: It is an anomaly that occurs after tooth eruption, when two adjacent teeth merge from their cementum with a proliferation that occurs in the cementum after root formation is complete. • Concrescence is not considered a developmental anomaly because it occurs after root development. TOTAL SHAPE ANOMALIES Concresence: • The cause is thought to be trauma or malposition of the adjacent tooth. • It is mostly seen in the posterior maxillary region. TOTAL SHAPE ANOMALIES TOTAL SHAPE ANOMALIES Dens in Dente (Dens invaginatus): • It is the condition of invagination of the inner enamel epithelium towards the pulp, creating a tooth appearance inside the tooth. • Dens in dente can occur in the crown, root, or along the entire axis of the original tooth. • It is more common in the maxilla. • Its incidence is 7.7% TOTAL SHAPE ANOMALIES Dens in Dente: • The opening formed by the invaginated part of the lingual surface of the tooth carries the risk of caries. • They are difficult to treat. Since root canal treatment will not be very successful, extraction is preferred in case of infection. 4- TISSUE ANOMALIES Structural anomalies of teeth occur due to pauses during the histological differentiation, apposition and mineralization stages of tooth development. • Enamel • Dentine • Cementum 4- TISSUE ANOMALIES Dysplasia: Anomalies that occur in the differentiation and maturation of cells. If the tissue anomalies we see in the teeth occur in the period before the eruption period, it is called dysplasia. • They are cicatricial disorders that occur during the formation period, due to the effect of a general or local factor in the tooth germ. • They are more prominent in the enamel of permanent teeth. 4- TISSUE ANOMALIES I. HYPOPLASIA the incomplete development or underdevelopment of an organ or tissue Hypoplasias according to their clinical appearance: • Simple hypoplasias • Complex hypoplasias 4- TISSUE ANOMALIES Complex Hypoplasias • Hypoplasia in all teeth of only one of the hard tissues of the entire tooth array • Clinical picture in which the entire dental organ is hypoplastic According to the causes of occurrence: • Hereditary hypoplasias • Congenital hypoplasias • Post-natal hypoplasias 4- TISSUE ANOMALIES Hereditary Hypoplasias • Amelogenesis Imperfecta • Dentinogenesis Imperfecta • Osteogenesis Imperfecta • Dentin Dysplasia • Regional Odontodysplasia • Enamel and Dentin Aplasia 4- TISSUE ANOMALIES AMELOGENESIS IMPERFECTA § Hereditary enamel defect § The structure, amount and composition of the enamel are affected. § It is not associated with syndromes and systemic or metabolic diseases. § It can be seen in both primary dentition and permanent dentition. § There are 4 main types: Type I: Hypoplastic Type Type II: Hypomature Type Type III: Hypocalcified Type Type IV: Taurodontism with hypomature, hypoplastic type 4- TISSUE ANOMALIES Hypoplastic Type • It occurs during the histodifferentiation period of tooth development. • It is characterized by an insufficient amount of enamel formation. • It occurs as a result of the decrease in the amount of enamel matrix during amelogenesis. 4- TISSUE ANOMALIES Hypoplastic Type • Enamel is calcified, its hardness is normal. Because the calcification and maturation phases of the matrix occur in a healthy way. • But enamel is very thin. • Grooves and pits appear in areas of hypoplasia. • The teeth are yellow-brown, their surfaces are rough and hard. 4- TISSUE ANOMALIES Hypoplastic Type • The teeth do not have proximal contacts. • High thermal sensitivity due to clinical crowns being surrounded by very thin or non-continuous enamel • Anterior open bite • Increase in tartar formation due to surface roughness, gingivitis • The teeth do not have proximal contacts. 4- TISSUE ANOMALIES Hypoplastic Type • Anterior open bite 4- TISSUE ANOMALIES Hypoplastic Type • Radiologically, enamel and dentin density are similar. 4- TISSUE ANOMALIES Hypoplastic Type • • • • • • • Hypoplastic enamel with the presence of pits: autosomal dominant Hypoplastic enamel localized to specific areas: autosomal dominant Hypoplastic enamel with a straight appearance: autosomal recessive Hypoplastic enamel with a straight appearance: autosomal dominant Hypoplastic enamel with a straight appearance: X-linked dominant Hypoplastic enamel with a rough texture: rough autosomal dominant Agenesis of enamel autosomal recessive 4- TISSUE ANOMALIES Hypomaturation Type • It is characterized by an inherited defect in enamel matrix apposition. • Enamel thickness is normal, but radiopacity and mineral content are low. • Maturation is poor • Poor calcification, low mineral content, high organic content of enamel • Rough surface that becomes stained • Enamel can range from opaque white to yellow-brown. 4- TISSUE ANOMALIES Hypomaturation Type • Rough surface that becomes stained • Enamel can range from opaque white to yellow-brown. 4- TISSUE ANOMALIES Hypomaturation Type • Hypomaturation, pigmented/ autosomal recessive • Hypomaturation /X-linked recessive • Snow-capped teeth /attached to X • Snow-capped teeth/autosomal dominant 4- TISSUE ANOMALIES Hypocalcified Type • It is an inherited defect that occurs during the calcification phase of enamel formation. • The amount of enamel is normal, but the enamel surface breaks due to poor calcification of the matrix. • Hypocalcified enamel is soft and fragile, especially in the incisal region. • Dentin is exposed, teeth are yellow-brown. 4- TISSUE ANOMALIES Hypocalcified Type • Teeth are easily stained because the dentin is exposed. • Tartar is formed very quickly and therefore periodontitis is seen. • An anterior open bite can be seen. 4- TISSUE ANOMALIES Hypocalcified Type • Autosomal dominant • Autosomal recessive 4- TISSUE ANOMALIES Taurodontism with hypomaturated, hypoplastic type • It is characterized by hereditary defects occurring in both apposition and histological differentiation stages of enamel formation. • Enamel yellow-brown, mottled, pitted facial surfaces • Taurodontism in molars • Large pulp chamber in all teeth 4- TISSUE ANOMALIES Hypomaturated, hypoplastic type with taurodontism • Hypomaturation, taurodontism with hypoplastic, autosomal dominant • Hypoplastic- taurodontism with hypomaturation, autosomal dominant 4- TISSUE ANOMALIES 4- TISSUE ANOMALIES DENTINOGENESIS IMPERFECTA • Hereditary dentin defects that occur during the histological differentiation stage of tooth development • It can be seen in both primary and permanent dentition. • It is manifested by an amorphous, irregular and atubular structure of the dentin surrounding the pulp due to the defect in the predentin matrix. 4- TISSUE ANOMALIES DENTINOGENESIS IMPERFECTA • The dentin of the mantle is normal, unlike the dentin that surrounds the pulp. The tubules of the surrounding dentin are irregular and their number is reduced. • Less sensitive than amelogenesis imperfecta with an obliterated pulp • Teeth appear transparent when illuminated in various colors such as gray, brown, bluish, pink-soaked candy. 4- TISSUE ANOMALIES • Teeth appear transparent when illuminated in various colors such as gray, brown, bluish, pink wet sugar. 4- TISSUE ANOMALIES DENTINOGENESIS IMPERFECTA • The enamel is easily separated from the dentin with light pressure because the enamel-dentin junction is broken. • Serious wear on teeth • Since the closing height will change with excessive wear, jaw joint disorders may occur. 4- TISSUE ANOMALIES DENTINOGENESIS IMPERFECTA • On radiographic control, there is an excessive narrowing of the cervical area of the teeth. • Roots are short and narrow • This structure gives the teeth a bell-ringed appearance. • Before root development is complete, the pulp chamber may be completely erased and the channels may narrow. 4- TISSUE ANOMALIES DENTINOGENESIS IMPERFECTA 4- TISSUE ANOMALIES DENTINOGENESIS IMPERFECTA It is divided into 3 basic types: Type 1: Associated with osteogenesis imperfecta Type 2: Hereditary opalescent dentin - Independent of osteogenesis imperfecta Type 3: Shell teeth- bell-shaped crowns, multiple pulp exposures 4- TISSUE ANOMALIES Type 1: With osteogenesis imperfecta • Hereditary defects in collagen formation; osteoporous vitreous bones, flexion in extremities, blue sclera • Primary teeth are more affected. • Bulb-shaped crowns • Obliteration in pulp chambers • Root fractures • The tooth color is yellow translucent; (amber translucency) 4- TISSUE ANOMALIES Type 2: Hereditary opalescent dentin • Independent of osteogenesis imperfecta • Primary and permanent dentition are equally affected • Autosomal dominant inherited • Same characteristics as type 1 4- TISSUE ANOMALIES Type 3: Shell teeth • Rare • Bell-shaped crowns in continuous dentition • The teeth are seashell-like, with numerous pulp exposures. • It is important to stop the attrition. • It has been seen in the Brandywine community in Maryland, USA. 4- TISSUE ANOMALIES OSTEOGENESIS IMPERFECTA • It is autosomal dominant. • Blue sclera and bone fragility are seen together. • Bone deformations occur due to spontaneous fractures. • Deafness, developmental disorders and dental hypoplasia are seen. 4- TISSUE ANOMALIES DENTIN DYSPLASIA • Inherited dentin disorders in which the dentin surrounding the pulp and root morphology exhibit characteristic features. • It is autosomal dominant. There are 2 types of dentinal dysplasia: • Type 1 Radicular Dentin Dysplasia • Type 2 Coronal Dentin Dysplasia 4- TISSUE ANOMALIES Type I (Radicular) Dentin Dysplasia: • The dental crown appears in normal morphology. • Short roots • It can be seen in both primary and permanent dentition. • Pulp cavities are often filled with dentin before the eruption of the tooth, remaining only as a horizontal line in the cervical region. • Root resorption and periapical cysts are common. • In cases where the primary dentition is affected, some teeth will shed prematurely. 4- TISSUE ANOMALIES DENTIN DYSPLASIA Type I (Radicular) Dentin Dysplasia: 4- TISSUE ANOMALIES Type II (Coronal) Dentin Dysplasia: • Amber colored translucent primary teeth • Permanent teeth are normal, but the pulp chambers are funnelshaped radiographically. Pulp stones may occur. • Periapical lesions are not seen. 4- TISSUE ANOMALIES REGIONAL ODONTODISPLASIA • It is caused by a regional vascular developmental anomaly. • It occurs as a result of localized pause in tooth development. • Teeth in only one half of the jaws are affected, sometimes crossing the midline • Thin and slightly calcified enamel and dentin 4- TISSUE ANOMALIES REGIONAL ODONTODISPLASIA • Large pulp chamber • Shortened roots • Seashell-like crowns • Ghost appearance radiographically • Ghost Teeth 4- TISSUE ANOMALIES Enamel Hypoplasies • They occur on the vestibular surface of the anterior teeth and the cusp crests of the molars. • Teeth size is normal. • They can occur in both primary and permanent dentition. • Systemic or local causes • Diffuse enamel hypoplasia; systemic causes such as nutritional deficiencies, vitamin A, C, D and calcium and phosphorus deficiency • 1 year of age with rash and febrile diseases, severe infections; affects ameloblast activity and leads to enamel hypoplasia. 4- TISSUE ANOMALIES Enamel Hypoplasia • The localization of the hypoplasia indicates the time of appearance of the harmful agent. • Hypoplasia is seen in certain parts of all teeth that developed at that time. • For example: As a result of a febrile disease, a hypoplasia involving the cutting edges of the central incisors is also encountered on the occlusal surfaces of the first molars. 4- TISSUE ANOMALIES Conditions with generalized enamel hypoplasia: • Asthma • Excessive radiation • Down syndrome • Vitamin D dependent rickets • Pseudohypoparathyroidism • Cerebral palsy • Congenital syphilis • Fluorosis 4- TISSUE ANOMALIES Localized Enamel Hypoplasia • Local infection • Local trauma • Primary tooth retention 4- TISSUE ANOMALIES Turner hypoplasia: • As a result of pulp gangrene, inflammation occurring in the apical region of the primary tooth damages the permanent tooth germ. • For permanent tooth germ to be damaged, it must be close to the site of inflammation and enamel mineralization must be incomplete. • The premolars are most affected, as the most inflamed primary teeth are the primary molars. 4- TISSUE ANOMALIES Other systemic disorders with dentin anomalies: • Vitamin D resistant rickets • Hypoparathyroidism • Pseudohypoparathyroidism 4- TISSUE ANOMALIES CEMENT • Developmental defects involving only cementum are rare. • Difficult to distinguish from periodontal ligament diseases • In addition to the coronal enamel defects in teeth with Turner hypoplasia, cement formation was observed in the coronal areas exposed by the enamel. 4- TISSUE ANOMALIES Histologically demecd cementum is seen in 3 different diseases: 1- Epidermolysis Bullosa 2- Cleidocranial dysostiosis (dysplasia) 3- Hypophosphatasia 4- TISSUE ANOMALIES Epidermolysis Bullosa; • It is a congenital, inherited, vesiculobullous disease. The bullae often occur in places exposed to trauma and increase in temperature. In advanced EB, blistering is not limited to the skin. It can also develop inside the body: such as the mouth, esophagus, stomach, intestines, upper respiratory tract. • Growth retardation, insufficient tooth enamel are observed. • Poor calcified cell-free cement formation, • Overproduction of cellular cementum 4- TISSUE ANOMALIES Cleidocranial dysplasia; • Histological changes in cementum formation, • It has been reported that cellular cementum is not seen and acellular cementum is hyperplastic. 4- TISSUE ANOMALIES Hypophosphatasia; • Low serum alkaline phosphatase level, • Bone mineralization fails • Early lost of primary incisors due to failure of cement formation • Decreased cement formation in primary teeth 5-COLOR ANOMALIES Physiologically; • Primary teeth are bluish-white • Permanent teeth are more yellowish-white 5-COLOR ANOMALIES Color anomalies in teeth; Intrinsic Colorations with factors affecting tooth development Extrinsic Colorations with factors affecting after tooth development 5-COLOR ANOMALIES INTERNAL COLORINGS Systemical Causes Local Causes • Caries • Amelogenesis Imperfecta • Internal resorption • Dentinogenesis Imperfecta • Turner hypoplasia • Erythroblastosis Fetalis • Trauma • Congenital Porphyria • Metallic restoration materials • Cystic fibrosis • Necrotic pulp • Fluorosis • Root canal materials • Tetracycline coloring 5-COLOR ANOMALIES Internal Coloration - Local Causes Internal Resorption Necrotic Pulp 5-COLOR ANOMALIES Internal Coloration - Local Causes Amalgam discoloration 5-COLOR ANOMALIES Internal Coloration - Systemic Causes Erythroblastosis Fetalis • It occurs due to Rh incompatibility of the mother and child. • Antibodies against the Rh antigen are formed and cause destruction of erythrocytes. As a result of the destruction of erythrocytes, blood pigments in the circulation affect dentin. • Also called hyperbilirubin discoloration. • Coloration may disappear over time with blood transfusion after birth. • Primary teeth are usually blue-green, rarely brown. 5-COLOR ANOMALIES Eritroblastosis Fetalis 5-COLOR ANOMALIES Internal Coloration - Systemic Causes Congenital Erythropoietic Porphyria • Rare, autosomal recessive • Characterized by excessive production of porphyrins in the body. • Sensitivity to light • Usually affects primary teeth • Purplish-brown discoloration of teeth with porphyrin pigment deposition 5-COLOR ANOMALIES Internal Coloration - Systemic Causes Cystic Fibrosis • An autosomal recessive disease of the lung, pancreas, intestine, exocrine glands • Normally, the secretion of the exocrine glands is water-rich fluid, whereas in CF, the secretions are anhydrous, their consistency has increased and their fluidity has been lost. • There is a yellow, gray, brown color change in the teeth 5-COLOR ANOMALIES Internal Coloration - Systemic Causes Fluorosis • It is effective on ameloblasts in excess fluor intake. • Color changes ranging from chalky white or yellow to brown are seen with hypoplasia • Mild cases have a whiter appearance, while more severe cases have a yellow-brown and chalky appearance. 5-COLOR ANOMALIES Internal Coloration - Systemic Causes Tetracycline coloring • Tetracycline acts by binding to orthocalcium phosphate ions. • Yellow-brown or gray-black discoloration • Tetracycline coloration is classified into 4 degrees. • 1st and 2nd degree discolorations may respond to bleaching. 5-COLOR ANOMALIES EXTERNAL COLORINGS • Green • Chromogenic bacterial dyes (Poor oral hygiene) • Brown- black • Nasmyth membrane discoloration • Orange • Tobacco • Food and beverage discolorations • Chemical discolorations Cherry, strawberry, black mulberry, coffee, tea and cola drinks • Iron drugs • Manganese, silver, mercury, copper, iodine • Chlorhexidine mouthwash 5-COLOR ANOMALIES EXTERNAL COLORINGS QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ QUIZ THANK YOU…