Developmental Alterations of Teeth II
Amelogenesis Imperfecta
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General Information General Information
Classification is impractical for clinicians Absence of systemic disorder
Problems arise in one or more of the three Can be part of a syndrome
stages of enamel formation
Many types
Elaboration of enamel matrix; hypoplastic
Mineralization; hypocalcified Different modes of inheritance
Maturation; hypomaturation Understanding of molecular events
1:800 1:15,000 (clustering)
Both dentitions
Hypoplastic type
Inadequate deposition of organic matrix
Normal mineralization
Radiographic contrast
Seven types
1
Hypoplastic type Hypoplastic type
Generalized Pitted Generalized Pitted
A.D.
Pinpoint/head pits in rows or columns
In-between enamel normal
Across the surface
Buccal surface more severely affected
Does not correlate with pattern of
environmental damage
Hypoplastic type Hypoplastic type
Generalized Pitted Generalized Pitted
Hypoplastic type Hypoplastic type
Generalized Pitted Localized Pitted
A.D. or A.R. (more severe)
Pinpoint/head pits in rows
Linear depression or area of hypoplasia
Middle third of buccal surface
Incisal or occlusal unaffected
All teeth or some teeth
Primary or both dentitions
2
Hypoplastic type Hypoplastic type
Localized Pitted Diffuse Smooth A.D.
Thin, hard, glossy
Like crown preparations, open bite
Opaque white to brown
X-ray: peripheral thin enamel outline
Unerupted exhibit resorption
Hypoplastic type Hypoplastic type
Diffuse Smooth A.D. Diffuse Smooth A.D.
Hypoplastic type Hypoplastic type
Diffuse Smooth X-linked dominant Diffuse Smooth X-linked
Males
Thin, hard, glossy
Like crown preparations, open bite
Opaque white to brown
X-ray: peripheral thin enamel outline
Females
Alternating vertical bands of normal and
abnormal enamel
Lyonization
3
Hypoplastic type Hypoplastic type
Diffuse Rough Diffuse Rough
A.D.
Thin, hard, rough
Tapering of occlusal and incisal surfaces
Open contact
Open bite
Hypoplastic type Hypoplastic type
Diffuse Rough Enamel Agenesis
No enamel
Yellow teeth
Tapering
There is also a type of enamel agenesis
associated with nephrocalcinosis
Hypomaturation Type Hypomaturation Type
Defect in the maturation of enamel crystals
Normal shape
Mottled appearance
White, yellow or brown
Enamel is soft
Radiodensity similar to dentin
4
Hypomaturation Type Hypomaturation Type
Diffuse Pigmented A.D. Diffuse Pigmented A.D.
Mottled brown
Chipping from dentin with an explorer
Very uncommon anterior open bite
Soft similar to hypocalcified
Calculus
Hypomaturation Type Hypomaturation Type
Diffuse Pigmented A.D. Diffuse X-linked
Deciduous are opaque white with mottling
Permanent are yellow-white; darken with age
Fast enamel loss
Reduced contrast
Females exhibit lyonization
Random asymmetric bands
Transillumination highlights bands
Hypomaturation Type Hypomaturation Type
Diffuse X-linked Diffuse X-linked (female)
5
Hypomaturation Type Hypomaturation Type
Diffuse X-linked (female) Snow-capped Teeth
X-linked, A.D.?
Zone of white opaque enamel on incisal and
occlusal surface (1/4 to 1/3 of the surface)
Looks like fluorosis
Anteriors, anteriors/bicuspids, premolars/molars
Both dentitions
Hypomaturation Type Hypomaturation Type
Snow-capped Teeth Snow-capped Teeth
Hypocalcified Type Hypocalcified Type
A.D. or A.R. (more severe)
No significant mineralization
Normally shaped teeth at eruption
Enamel very thin and easily lost
Yellow or brown color
Calculus
Open bite
6
Hypocalcified Type Hypocalcified Type
Hypocalcified Type Hypomaturation/Hypoplastic
Enamel hypoplasia and hypomaturation
One kindred
Present in tricho-dento-osseous syndrome
Kinky hair
Osteosclerosis
Brittle nails
Taurodontism
Tricho-dento-osseous syndrome Tricho-dento-osseous syndrome
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Tricho-dento-osseous syndrome Tricho-dento-osseous syndrome
Amelogenesis Imperfecta
Treatment
Restorations as soon as possible
Dentinogenesis Imperfecta
Dentures (overdentures)
Veneers in mild cases
Glassionomers for better adhesion to dentin
General Information General Information
Two types Blue/brown discoloration
Dentinogenesis imperfecta with osteogenesis imperfecta Bulbous crowns with cervical constrictions
Hereditary opalescent dentin ~100% penetrance; variable expressivity
(Brandywine isolate)
Enamel defects (hypoplasia)
1:8,000
Generally obliterated pulp chambers and canals
Both dentitions except shell teeth (Brandywine isolate)
Deciduous more severely
Periapical pathology
Permanent incisors, first molars
Treatment very difficult
Least 2nd and 3rd molars
8
Osteogenenesis/Dentinogenesis Osteogenenesis/Dentinogenesis
Imperfecta Imperfecta
Osteogenenesis/Dentinogenesis Osteogenenesis/Dentinogenesis
Imperfecta Imperfecta
Osteogenenesis/Dentinogenesis
Imperfecta
Hereditary Opalescent Dentin
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Hereditary Opalescent Dentin
Shell Teeth
General Information
No correlation with systemic disease
Dentin Dysplasia No correlation with dentinogenesis imperfecta (HOD)
A.D.
Two types
Radicular type (Type I)
Coronal type (Type II)
Dentin Dysplasia Type I Dentin Dysplasia Type I
Rootless teeth Little or no detectable pulp
Severity varies Crescent or chevron-like pulp chamber
A.D. 1:100,000 Pulp stones in less severe cases
Normal color and anatomy of crown in both Multiple periapical lesions (caries, exposure)
dentitions
Dentinal disorganization
Tooth mobility and premature exfoliation
Teeth fracture easily
10
Dentin Dysplasia Type I Dentin Dysplasia Type I
Dentin Dysplasia Type II Dentin Dysplasia Type II
Might be a form of hereditary opalescent dentin
Normal root length
Multiple periapical lesions uncommon
Deciduous teeth like HOD
Amber to brown color
Bulbous crowns, cervical constrictions, thin roots and
obliterated pulp chambers (not before eruption)
Permanent teeth
Normal color
Enlarged pulp chambers (flame-like)
Dentin Dysplasia Type II Dentin Dysplasia Type II
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Dentin Dysplasia Type II Dentin Dysplasia Type II
General Information
Regional Odontodysplasia Non-hereditary
Can be associated with other pathoses
Various theories of pathogenesis
Maxilla > mandible
Usually one quadrant
Both dentitions
General Information Regional Odontodysplasia
Affected teeth fail to erupt frequently
Yellow/brown color
Ghost teeth
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Regional Odontodysplasia Regional Odontodysplasia
Regional Odontodysplasia
Vitamin D-resistant Rickets
General Information Vitamin D-resistant Rickets
X-linked dominant
Lyonization in females
Hypophosphatemia
Decreased intestinal absorption of calcium
Rachitic changes
Teeth have large pulp chambers and pulp horns extending
to the DE junction
Microexposures
Multiple periapical lesions
13
General Information
Alkaline phosphatase mutation
Hypophosphatasia A.D. or A.R.
Decreased levels of alkaline phosphatase
Increased levels of phosphoethanolamine
Rickets
Premature loss of teeth
Teeth lack cementum
Hypophosphatasia Hypophosphatasia
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