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Dental%20Anomalies%20in%20Radiology

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Title: Dental%20Anomalies%20in%20Radiology


1
Dental Anomalies in Radiology
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2
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  • ??X????????
  • Developmental abnormalities v.s. acquired
  • ????
  • Ref 1 White SC, Pharoah MJ. Oral Radiology
  • Principles and interpretation 6th ed. 2009.
  • Ref 2 Neville BW, Damm DD, Allen CM and Bouquot
    JE. Oral maxillofacial patholgy 3nd ed. 2009.
  • Ref 3????????????

3
Supernumerary Teeth (hyperdontia, supplemental
teeth)
Developmental Abnormalities
  • 14 , familial tendency
  • Mesiodens, paramolar
  • Distodens, distomolar teeth
  • Peridens
  • Single premaxilla, maxillary molar
  • Multiple premolar area, mandibular
  • M F 2 1
  • Impaction or delay eruption of normal teeth
    dentigerous cyst
  • Syndrome
  • Cleidocranial dysplasia, Gardners syn.

Ref.1
4
Ref.3
5
Cleidocranial dysplasia
Ref.3
6
Cleidocranial dysplasia
Ref.3
7
Cleidocranial dysplasia
Ref.3
8
Cleidocranial dysplasia
Ref.3
9
Cleidocranial dysplasia
Ref.3
10
Missing Teeth
  • 310, excluding 3rd molars
  • Hypodontia
  • Oligodontia
  • Anodontia
  • 8 gt 5 gt 2 gt 1
  • 1. Ectodermal
  • dysplasia
  • 2. orofaciodigital
  • syndrome

Ref.1
11
Submergence
Infraocclusion, Secondary retention, Reimpaction,
Reinclusion
  • most affect 89y/o children and teeth D E
  • PDL absent , ankylosis
  • Occlusal and periodontal problems

Ref.3
12
ectodermal dysplasia
Ref.1
13
Ectodermal dysplasia
Ref.3
14
SIZE OF TEETH
  • True generalized type and relative type
  • Macrodontia
  • Hemangioma, hemihypertrophy of the face,
    pituitary giantism
  • Microdontia
  • pituitary dwarfism
  • supernumerary teeth, 3rd molars, lateral incisors

15
Macrodontia
Microdontia
Ref.1
16
ERUPTION OF TEETH
  • Transposition
  • Two teeth exchanged positions
  • 3 4 3 2, 657

Ref.1
17
Transposition
Ref.3
18
Gemination (twinning)
Altered Morphology of Teeth
  • -Division of a single tooth bud
  • primary dentition , esp. incisor region
  • complete twinning increase tooth number
  • pulp chamber is single enlarged, maybe partial
    divided

Ref.3
Ref.1
19
Fusion (synodontia)
-Adjacent tooth germs combined with dentin or
enamel
  • bifid crown or two recognizable teeth, reduced
    number of teeth
  • more common in the primary dentition, esp.
    anterior region

Ref.1,2
20
Concresence
- Roots of two or more teeth united by cementum
  • Fusion after root formation
  • Traumatic injury or crowding
  • Pre-extraction x-ray check
  • maxillary molars 3rd molar a supernumerary
    tooth

Ref.1
21
Taurodontism
-Longitudinal enlarged pulp chamber, increased
distance between CEJ to the bifurcation
  • normal crown size tooth length, shortened roots
  • not recognizable clinically
  • most in molars
  • Trisomy 21

Ref.1
22
Dilaceration
  • A sharp bend or curve in the crown or root
  • maxillary premolars

Ref.1
23
Dens in Dente (dens invaginatus)
  • - Infolding of the outer enamel surface into
    the interior
  • at the anatomically defined pit
  • caries?pulpal disease
  • coronal type enamel organ infolding into the
    dental papilla 2gt1gt4,5gt3
  • radicular type invagination of Hertwigs
    epithelial root sheath, lined with cementum
  • 4, 7

Ref.1
24
Dens in Dente
radicular type
coronal type
Ref.1
Dilated odontome
25
Dens Evaginatus
  • - Outfolding of enamel organ
  • a tubercle on occlusal surface,
  • with enamel surface dentin core,
  • pulp horn often extends into the
  • evagination
  • premolar or molar
  • pulp infection due to fracture

Ref.1 Ref.2
26
Amelogenesis Imperfecta
  • -Disturbance in enamel development
  • Normal dentin root
  • autosomal dominant or recessive , X-linked
  • 1.Hypoplastic type
  • Thin enamel with pitted, rough or smooth glossy
    surface yellowish to brown
  • undersized, squared crown, lack of contact
  • flat occlusal surface low cusps, attrition
  • 2.Hypomaturation
  • normal thickness of enamel, but mottled surface
    cloudy white, yellow or brown, opaque in color
  • softer than normal
  • same density as dentin
  • 3.Hypocalcified type
  • normal thickness of enamel, density less than
    dentin
  • normal size shape when erupt, abrade or
    fracture away rapidly
  • permeability increase, darkened stained
  • 4.Hypomaturation-hypocalcified with taurodontism

27
Amelogenesis Imperfecta
Hypocalcified type
Hypoplastic type
Ref.1
28
Dentinogenesis Imperfecta (hereditary opalescent
dentin)
  • Autosomal dominant hereditary
  • Type I DI OI (osteogenesis imperfecta)
    COL1A1, COL1A2
  • Type II Isolated DI. (1/8000)
    DSPP
  • Type III DI of the Brandywine type
    DSPP
  • A racial isolate in Maryland,
  • DI multiple pulp exposures in deciduous
    teeth
  • enamel fractures, attrition severely
  • dark brown to black
  • Radiographic Features of D.I.
  • bulbous crown, normal size, constriction of the
    cervical area
  • short slender roots, occlusal attrition
  • partial or complete obliteration of the pulp
    chambers, root canals absent or threadlike

29
Dentinogenesis Imperfecta
Ref.1
30
Dentin Dysplasia
  • -autosomal dominant disturbance
  • rare (1100,000)
  • Type I (radicular)
  • normal color shaped in both dentition
  • malaligned arch, drifting and exfoliate with
    little or no trauma
  • short or abnormal root shaped, pulp chamber
    root canals completely filled in before eruption
  • 20 of teeth with type I disease have apical
    radiolucencies

Ref.1
31
Dentin Dysplasia
  • TypeII (coronal)
  • primary dentition appears as D.I., but permanent
    dentition is normal
  • obliterated of the pulp chamber reduced root
    canals after eruption
  • roots are normal in shape proportion

Ref.1
32
Regional Odontodysplasia (odontogenesis
imperfecta)
  • - hypoplastic hypocalcified of both dentin
    enamel
  • only a few adjacent teeth in a quadrant affected
    either primary or permanent teeth
  • central incisors gt lateral incisors gtcanines
    (maxillary)
  • delayed eruption
  • ghostlike appearance in image
  • large pulp chamber wide root canals, roots are
    short poorly outlined
  • thin enamel , less dense as usual

33
Regional Odontodysplasia
Ref.1
34
Enamel Pearl (enameloma, enamel
drop, enamel nodule)
  • - small globule of enamel on the roots furcation
    area of molars
  • prevalence 3
  • mesial or distal aspect in Max. molar and buccal
    or lingual in Mand. molars

Ref.1
35
Talon Cusp
  • - Anomalous hyperplasia of the cingulum of a
    Max. or Mand. incisor ?a supernumerary cusp
  • T shaped in incisal view
  • Differential diagnosed with supernumerary tooth

Ref.1 Ref.2
36
Turners Hypoplasia (Turners tooth)
  • -a type of enamel hypoplasia
  • - local hypoplastic or hypomineralized defect
    in crown of a permanent tooth
  • extension of a periapical infection or mechanical
    trauma from deciduous predecessor
  • most common in lower premolars

Ref.2,3
37
Turners tooth (enamel hypoplasia)
Ref.1
Ref.3
38
Congenital Syphilis
  • 30 pt develop dental hypoplasia
  • Hutchinsons incisors mulberry molars
  • not all pt with Hutchinsons teeth or mulberry
    molars will have congenital syphilis

Hutchinsons incisors (screw driver shape)
Ref.1
39
Acquired Pathologic Conditions
  • Attrition
  • -Physiologic wearing from occlusal contacts
  • Incisal, occlusal and interproximal
    surfaces(contact points)
  • Depends on the abrasiveness of diet, salivary
    factors, mineralization, emotional tension
  • Bruxism--pathologic condition
  • Crown shorten, reduction of pulp chamber canals
  • Abrasion
  • -Nonphysiologic wearing by contact with foreign
    substances
  • Factitious habits or occupational hazards
  • tooth brushing, flossing, pipe smoking, opening
    hairpins with teeth

40
Tooth Brushing Injury
  • V-shaped groove in cervical area
  • Sensitive
  • Maxillary premolars gtcanines gt incisors
  • R-L defect at cervical level, well-defined
    semilunar shapes

Ref.1 Ref.3
41
Dental Floss Injury
  • Cervical portion of proximal surfaces just above
    gingiva
  • Narrow semilunar R-L, distal surface often deeper
    than mesial

Ref.1
42
Erosion
  • -Chemical action not involving bacteria
  • Contact acid with teeth
  • 1. chronic vomiting or acid reflux from
  • GI disorders
  • 2. consumes large amounts of acid
  • foods
  • 3. occupational exposure
  • Regurgitated acids attack lingual surfaces
    diet--labial industrialall surfaces
  • Radiolucent defect on the crown

43
Resorption
  • -Removal of tooth structure by odontoclast
  • Chronic infection (inflammation), excessive
    pressure and function, tumors and cysts

44
Internal Resorption
  • - within the pulp chamber or canal, involves
    resorption of surrounding dentin, results in
    enlarged pulp space

Ref.1
45
Internal Resorption
Ref.1
46
External Resorption
  • -outer surface of tooth resorbed, most commonly
    in root surface
  • Localized inflammatory lesions, reimplanted
    teeth, tumor cyst, excessive mechanical(orthodon
    tic) and occlusal forces, impactions
  • Common sites apical cervical (lateral root
    surface)

47
Apical ER
Lateral root surface ER
Ref.1
48
Secondary Dentin
  • - Dentin deposited in pulp chamber after primary
    dentin formatted completely
  • Normal aging process
  • tertiary dentin pathologic condition after
    chronic trauma
  • Reduction in size of pulp chamber and canals
  • Begins in the region adjacent to source of
    stimuli and alters normal shape of chamber

Ref.1
49
Pulp Stone
  • -- Foci of calcification in the pulp
  • R-O within pulp chambers or root canals or
    extending from pulp chamber into root canals,
    most common in molars
  • No uniform shape or number

Ref.1
50
Pulpal Sclerosis
  • - Diffuse calcification in pulp chamber and
    canals
  • Correlation strongly with age
  • Generalized, ill defined collection of fine RO
    throughout pulp chamber and canals

Ref.1
51
Hypercementosis
  • -Excessive deposition of cementum on roots
  • 1.supraerupated tooth after opposing
  • tooth loss
  • 2.periapical inflammatory lesions
  • 3.hyperocclusion or fractured
  • 4.Pagets disease
  • 5.hyperpituitarism
  • Smooth or irregular enlargement of root with
    lamina dura and PDL space

Ref.1
52
Summary
  • DEVELOPMENTAL ABNORMALITIES
  • NUMBER OF TEETH
  • SIZE OF TEETH
  • ERUPTION OF TEETH
  • ALTERED MORPHOLOGY OF TEETH
  • Fusion(synodontia)
  • Concresence
  • Gemination(twinning)
  • Taurodontism
  • Dilaceration
  • Dens in dente (dens invaginatus)
  • Dens evaginatus
  • Amelogenesis imperfecta
  • Dentinogenesis imperfecta
  • Dentin dysplasia
  • Enamel pearl
  • Talon cusp
  • Turners hypoplasia (Turners tooth)
  • ACQUIRED PATHOLOGIC CONDITIONS
  • Attrition
  • Abrasion
  • Tooth brushong injury
  • Dental floss injury
  • Erosion
  • Resorption
  • Internal resorption
  • External resorption
  • Secondary dentin
  • Pulp stone
  • Pulpal sclerosis
  • Hypercementosis
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