Anomalies of Structure

Enamel
Dentin
Cementum

Enamel
Tooth structure abnormalities result from disruption

during the histodifferentiation, apposition, and

mineralization stages of tooth development.
Enamel defects manifested as:
Hypoplasia
Hypocalcification
Can be:
Heritable defects
Environmental defects

 Hypoplasia: disturbance of matrix deposition,

characterized by irregular enamel in thickness or

deficient in structure.
Hypocalcification: disturbance in mineralization,
characterized by normal enamel in thickness but part
of it is poorly mineralized

Amelogenesis Imperfecta
Distinct patterns of inheritance.
Defective enamel, so on radiograph the pulpal outline

appears normal and root morphology.

Hypoplastic vs hypomaturation vs hypocalcified

Hypoplastic Amelogenesis
Imperfecta
Occurs in histodifferentiation
stage of tooth development
Thin Enamel resulting in high
sensitivity to thermal stimuli
Lack of contact points between
teeth
Rough smooth or randomly
pitted enamel

Hypomaturation Amelogenesis
Imperfecta
Defect in enamel matrix

apposition
normal enamel thickness
a low value of radiodensity and
mineral content
porous surface that becomes
stained

 Hypocalcification

Amelogenesis Imperfecta
Defect in the calcification

stage of enamel formation

Qualitatively the matrix is
poorly calcified with a
resultant fracturing of the
enamel surface exposing
dentin surface especially at
incisal edge

Environmental Enamel Hypoplasia

Systemic causes
Nutritional deficiencies (Vit. A ,C, D, Ca+ PO4 )
Severe Infections, Fever ( Rubella , Syphilis ..)
Asthma
Neurologic defects as cerebral palsy
Radiation
Flouride
Syndromes ??

Localized Enamel Hypoplasia

Local infection,
Local trauma,
Iatrogenic surgery as occurs in cleft palate closure

Primary tooth overretention.

Turner hypoplasia
Turner hypoplasia is a

classic example of
hypoplastic defects in
permanent teeth
resulting from local
infection or trauma to
the primary precursor

Post-operative
Pre-operative

Full mouth rehabilitation of

Amelogenesis Imperfecta

Dentin
Dentinogenesis Imperfecta
defect during the histodifferentiation stage of tooth
development
defect of predentin matrix results in amorphic,
disorganized, and atubular circumpulpal dentin(
which is high in organic content and contains
interglobular calcification)
The mantle dentin is normal.

Dentinogenesis Imperfecta
Shields type 1 occurs with osteogenesis imperfecta.
Defect in collagen formation
Blue sclera, brittle bones, bowing of limbs

Periapical radiolucencies
Bulbous crowns
Obliteration of pulp chambers
Root fractures

Dentinogenesis Imperfecta
Shields type 2, (hereditary opalescent dentin)
Periapical radiolucencies
Bulbous crowns

Obliteration of pulp chambers

Root fractures

Dentinogenesis imperfecta (Hereditary opalescent dentine)

Dentinogenesis Imperfecta
Shields type 3
a predominance of bell-shaped crowns
involves teeth with a shell-like appearance and

multiple pulp exposures.

It has occurred exclusively in a triracial isolated group
in Maryland known as the Brandywine population

Dentin Dysplasia
Inherited dentin disorders resulting in characteristic

features involving the circumpulpal dentin and root

morphology.

Dentin Dysplasia
Shields type 1 (Radicular Dentin
Dysplasia, rootless teeth)
Normal crown morphology with
an amber translucency).
The roots tend to be short and
sharply constricted.
Multiple periapical
radiolucencies and absent pulp
chambers.

Dentin Dysplasia
Shields type 2
Involves amber-colored primary teeth closely
resembling dentinogenesis imperfecta
Permanent teeth appear normal, but radiographically
they demonstrate thistle-tube-shaped pulp chambers
with multiple pulp stones
no periapical radiolucencies are visible

Regional Odontodysplasia
Localized arrest in tooth development thought to

result from a regional vascular developmental

anomaly.
Affected teeth have thin layers of poorly calcified
enamel and dentin with large, diffusely calcified pulp
chambers and shortened, poorly defined roots

Regional Odontodysplasia
Ghost teeth radiographic appearance with shortened

roots and shell-like crowns

Cementum
Epidermolysis bullosa dystrophica, an inherited

vesicular and bullous disease of the skin and mucous

membranes,
involves formation of fibrous, poorly calcified acellular
cementum and overproduction of cellular cementum.

Hypophosphatasia
Failure of bone to mineralize properly, which is
associated with low serum alkaline phosphatase levels.
Osteoporosis
bone fragility
premature loss of primary incisors
Failure of cementum formation

REFERENCES:
Pediatric Dentistry : Infancy through Adolescence
Pinkham
Ch. 4 (Anomalies of Developing Dentition)