Dental Anomalies in Radiology

Developmental VS. acquired

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Developmental Abnormalities

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Supernumerary Teeth
(hyperdontia, supplemental teeth)

1~4% , 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.
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Cleidocranial dysplasia

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Missing Teeth

3~10%, excluding 3rd molars Hypodontia Oligodontia Anodontia

8>5>2>1 Ectodermal dysplasia ; orofaciodigital syndrome

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Q: X,
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ectodermal dysplasia

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SIZE OF TEETH

True generalized type and relative type

Macrodontia Hemangioma, hemihypertrophy of the face, pituitary giantism Microdontia pituitary dwarfism rd molars, supernumerary teeth, 3 lateral incisors
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Macrodontia

Microdontia

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ERUPTION OF TEETH

Transposition

Two teeth exchanged positions 3 & 4 ; 3 & 2, 657

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Altered Morphology of Teeth

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Gemination, Fusion, Concrescence

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Gemination (twinning)
-Division of a single tooth bud primary dentition , esp. incisor region complete twinning increase tooth number pulp chamber is single & enlarged, maybe partial divided
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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
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Concresence
- Roots of two or more teeth united by cementum

space restriction during develop., local trauma, excessive occlusal force or local infection after development maxillary molars; 3rd molar & a supernumerary tooth
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Fusion / Gemination

A tooth with two separated root canals and with one or two rootsFusion An enlarged tooth with a bifid crown containing an enlarged or possibly partially divided pulp chamberGemination
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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
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Dilaceration
-

A sharp bend or curve in the crown or root maxillary premolars

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Dens in Dente (dens invaginatus)

- Infolding of the outer enamel surface into the interior at the anatomically defined pit cariespulpal disease
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coronal type: enamel organ infolding into the dental papilla; 2>1>4,5>3

radicular type: invagination of Hertwigs epithelial root sheath, lined with cementum; 4, 7
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radicular type

Dilated odontome
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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
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Lingual pits

Dens Evaginatus

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Amelogenesis Imperfecta
-Disturbance in enamel development Normal dentin & root autosomal dominant or recessive , X-linked Four general types
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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
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2.Hypomaturation

normal thickness of enamel, but mottled surface; cloudy white, yellow or brown, opaque in color softer than normal same density as dentin
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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

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Amelogenesis Imperfecta

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Dentinogenesis Imperfecta
(hereditary opalescent dentin)

autosomal dominant hereditary Type I : D.I. + osteogenesis imperfecta Type II : D.I., no skeletal defects enamel fractures, attrition severely dark brown to black

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Dentinogenesis Imperfecta

Osteogenesis imperfecta
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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

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Dentinogenesis Imperfecta

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Dentin Dysplasia
-autosomal dominant disturbance

rare (1:100,000) 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 fill in before eruption 20 % of teeth with type I disease have apical radiolucencies

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Dentin Dysplasia

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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

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Dentin Dysplasia

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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 > lateral incisors >canines (maxillary) delayed eruption ghostlike appearance in image large pulp chamber & wide root canals, roots are short & poorly outlined thin enamel , less dense as usual
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Regional Odontodysplasia

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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

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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

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Turners Hypoplasia (Turners tooth)

-a 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

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Turner tooth

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Congenital Syphilis

30 % pt develop dental hypoplasia Hutchinsons incisors & mulberry molars not all pt with Hutchinsons teeth or mulberry molars will have congenital syphilis

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Congenital syphilis Hutchinsons incisors & mulberry molars

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Acquired Pathologic Conditions

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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
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Abrasion
-Nonphysiologic wearing by contact with foreign substances Factitious habits or occupational hazards tooth brushing, flossing, pipe smoking, opening hairpins with teeth

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Tooth Brushing Injury

V-shaped groove in cervical area Sensitive Maxillary premolars >canines > incisors R-L defect at cervical level, well-defined semilunar shapes
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Attrition

Tooth Brushing Injury

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Dental Floss Injury

Cervical portion of proximal surfaces just above gingiva Narrow semilunar R-L, distal surface often deeper than mesial

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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 R-L defect on the crown
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Resorption
-Removal of tooth structure by odontoclast

Chronic infection (inflammation), excessive pressure and function, tumors and cysts

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

Maybe related to inflammation of pulp tissues--acute trauma to tooth, pulp capping, pulpotomy

1>6>7; M>F, commonly begins during 30-50y/o

Pink spots
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Radigraphs reveal symptomless early lesions of IR R-L, round, oval, or elongated within root or crown and continuous with pulp chamber or canal Sharply defined and smooth or slightly scalloped irregular widening of the pulp chamber or canal

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Internal Resorption

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External Resorption
-outer surface of tooth resorbed, most commonly in root surface

Localized inflammatory lesions, reimplanted teeth, tumor & cyst, excessive mechanical(orthodontic) and occlusal forces, impactions

Common sites : apical & cervical (lateral root surface)

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Apical ER: -blunting with normal bone and lamina dura -root shortening, except due to periapical inflammatory lesions *canal is visible and abnormal wide at apex

Lateral root surface ER: -presence of an unerupted adjacent tooth

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Apical ER
Lateral root surface ER

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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
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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
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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
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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
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Hypercementosis

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