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Developmental Abnormalities of Teeth :

Zhang Qi Wuhan University School of Stomatology Developmental Abnormalities of Teeth

Classification:

Classification Anomalies of Number Anomalies of Size Anomalies of Shape Anomalies of Structure Anomalies of Color

Anomalies of Number:

Anomalies of Number Anodontia: a complete absence of one or both dentition. 2. Hypodontia (partial anodontia): a deficiency in tooth number. Hyperdontia (Supernumerary Teeth): an excess in tooth number. a. Mesiodens b. Distomolar

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Mesiodens

Anomalies of Size :

Anomalies of Size Microdontia Macrodontia

Anomalies of Shape :

Anomalies of Shape Gemination Fusion Concrescence Dilaceration Enamel Pearl (enameloma) Talon Cusp Taurodontism Dens in Dente (dens invaginatus) Dens Evaginatus Supernumerary Roots 11.Hypercementosis

Gemination :

Gemination The partial development of two teeth from a single tooth bud following incomplete division. An incomplete division of a single tooth bud resulting in a bifid crown with a single pulp chamber.

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Gemination

Fusion :

The dentinal union of two embryologically developing teeth. Fused teeth can contain two separate pulp chamber, may appear as large bifid crowns with one chamber. Fusion

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Fusion

Concrescence:

An acquired disorder in which the roots of one or more teeth are united by cementun alone after formation of the crowns. Concrescence

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Concrescence

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GEMINATION FUSION CONCRESCENCE One bud One tooth One canal Two buds Two teeth Dentin union Two buds Two teeth Cementum union

Dens Invaginatus:

An extra cusp, usually in the central groove or ridge of a posterior tooth and lateral incisor. Dens Invaginatus

Dens in Dente:

A condition resulting from the invagination of the inner enamel epithelium producing the appearance of a tooth within a tooth. Dens in Dente

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Dens in Dente (dens invaginatus)

Taurodont:

Taurodont teeth are characterized by having a significantly elongated pulp chamber with short stunted roots, resulting from the failure of the proper level of horizontal invagination of Hertwig’s epithelial root sheath.. Taurodont

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Taurodontism-bull like tooth

Dilaceration:

Dilaceration refers to an abnormal bend of the root during its development and is thought to result from a traumatic Episode. Dilaceration

Anomalies of Structure:

Anomalies of Structure Enamel hypoplasia caused by amelogenesis imperfecta (genetic) Enamel Hypoplasia caused by febrile Illness or Vitamin Deficiency Enamel hypoplasia resulting from local infection or Trauma a. Turner's Tooth Enamel hypoplasia resulting from fluoride Ingestion (dental fluorosis) a. Mottling

Anomalies of Structure:

Anomalies of Structure Enamel hypoplasia resulting from congenital syphilis (Treponema pallidum) a. Hutchinson's incisors b. Mulberry molars Enamel hypoplasia resulting from birth injury, premature birth or idiopathic factors Enamel hypocalcification Dentinogenesis imperfecta Dentin dysplasia 10. Regional Odontodysplasia (Ghost teeth)

Amelogenesis Imperfecta:

Classification of AI Type I: hypoplastic TypeII: hypomaturation TypeIII: hypocalcified TypeIV: hypomaturation-hypoplastic with taurodontism Amelogenesis Imperfecta

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA A complicated group of condition that demonstrate developmental alterations in the structure of the enamel in the absence of a systemic disorder The formation of enamel is a multistep process and problems may arise in any one of the steps

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA Development of enamel can be divided into 3 major stages: Deposition of matrix (hypoplastic) Mineralization of matrix (hypocalcified) Maturation of enamel (hypomaturation)

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA CLASSIFICATION: Hypoplastic Generalized Localized X-linked dominant smooth Autosomal dominant smooth Rough pattern Enamel agenesis

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA Hypoplastic amelogenesis imperfecta: Due to inadequate deposition of enamel matrix The different patterns are discussed briefly as follows: GENERALIZED PATTERN: Pinpoint to pin head sized pits on surface of the teeth Buccal surface most severely involved Pits may be arranged in rows or columns Staining of pits may occur Enamel in between the pits is normal

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA LOCALIZED PATTERN: Horizontal rows of pits, linear depression or one large area of hypoplastic enamel surrounded by a zone of hypocalcification Middle third area of buccal surface is usually affected Both dentitions but most commonly primary teeth are effected Scattered teeth or all teeth are affected at the same time Incisal edges or occlusal surfaces very rarely involved

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA AUTOSOMAL DOMINANT SMOOTH PATTERN : Enamel is thin, hard and glossy Smooth surface Look like crown prepared teeth and demonstrate open contact points Radiographically, the teeth exhibit a thin peripheral outline of radiopaque enamel

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA AUTOSOMAL DOMINANT SMOOTH PATTERN : Enamel is thin, hard and glossy Smooth surface Look like crown prepared teeth and demonstrate open contact points Radiographically, the teeth exhibit a thin peripheral outline of radiopaque enamel

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA Males: Teeth show thin, diffuse and shiny enamel in both primary and secondary dentition Teeth have shape of crown preparation with open contact points Colour varies from brown to yellow brown A peripheral outline of thin enamel is seen radiographically

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA FEMALES: Vertical furrows of thin hypoplastic enamel alternating between bands of normal enamel This banding can only be seen on radiographs

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA ENAMEL AGENESIS : A total lack of enamel formation Teeth are the shape and colour of dentine Yellowish brown hue, open contact points and tapering crowns Surface of dentine is rough Anterior open bite present Radiographically, no peripheral outline of enamel seen

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA Hypocalcified Amelogenesis Imperfecta: In this type, proper enamel is laid down but no proper mineralization is seen Teeth are appropriately shaped at the time of eruption but the enamel is later lost due to its softness Enamel is yellowish brown but later becomes blackish brown due to rapid calculus deposition

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA Most of the cuspal enamel is lost Cervical enamel is left behind due to its site Anterior open bite may also be seen

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA Hypomaturation Amelogenesis Imperfecta : The deposition of the enamel and its calcification is accurate but there is a defect in the maturation of enamel’s crystal structure Affected teeth are normal in shape but have mottled , opaque brownish yellow discolouration Enamel is softer and chips off easily Radigraphically, shows similar radiodensity to normal dentine

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA 3 patterns are seen: Snowcapped Pigmented X linked

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA Snow capped pattern : White opaque enamel on incisal edges Look like denture dipped in white paint

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA Pigmented pattern : Surface is mottled and agar brown Soft enough to be punctured by a dental explorer May often fracture from underlying dentine

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA X linked pattern : Males and females both effected Decidious teeth exhibit opaque white colour with a translucent mottling Permanent teeth are opaque white which may darken with age Degree of enamel loss is rapid Brown discolourations seen In females, vertical bands of white opaque enamel and normal translucent enamel is seen

AMELOGENESIS IMPERFECTA:

AMELOGENESIS IMPERFECTA X linked pattern : Males and females both effected Decidious teeth exhibit opaque white colour with a translucent mottling Permanent teeth are opaque white which may darken with age Degree of enamel loss is rapid Brown discolourations seen In females, vertical bands of white opaque enamel and normal translucent enamel is seen

Anomalies of Color :

Anomalies of Color — Discoloration of teeth Etiology Surface deposits (Extrinsic stains) Changes in structure or thickness of dental tissues Diffusion of pigments into dental tissues Pigments incorporated during formation of dental tissues.

Extrinsic stains:

Extrinsic stains Substances in the diet Habitual chewing, betel nut, tobacco Tobacco smoking Medicaments Chromogenic bacteria

Changes in structure:

Changes in structure Enamel hypoplasias, fluorosis Amelogenesis imperfecta, hypocalcified, hypomaturation, and hypoplastic types Enamel opacities Enamel caries Dentinogenesis imperfecta age changes in dental tissues

Diffusion of pigments:

Diffusion of pigments Extrinsic stains Endodontic materials Products of pulp necrosis

Pigments incorporation:

Pigments incorporation Bile pigments Porphyrins Tetracycline

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Tetracycline stained teeth

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Composite resin restoration

Other disorders of teeth:

Other disorders of teeth

Attrition:

Attrition

Erosion:

Erosion

Toothbrush abrasion:

Toothbrush abrasion

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