BeckwithWiedemann syndrome Cleidocranial dysplasia Crouzon syndrome craniofacial dysostosis EhlersDanlos syndrome Fetal alcohol syndrome.
Gorlin syndrome basal cell nevus syndrome Marfan syndrome Pierre Robin syndrome RubinsteinTaybi syndrome Treacher Collins syndrome mandibulofacial dysostosis Van der Woude syndrome.
The acquired form may be due to trauma, repeated sucking on the lip or as part of Aschers syndrome double lip, blepharochalasis and non-toxic thyroid enlargement. In most cases, it becomes visible only when the lip is tense or while smiling. Histopathologically normal structures are seen with a slight abundance of minor salivary glands.
Excision is the treatment for esthetic reasons. Bilateral cleft lip. Cleft Lip and Cleft Palate Cleft lip results from failure of merging of epithelial groove between the medial and lateral nasal process by penetration of mesodermal cells. Cleft palate is the result of epithelial breakdown with in growth failure of mesodermal tissue and lack of lateral palatal segment fusion.
Environmental factors like nutritional deficiencies, stress, infections, alcohol, drugs, toxins and ischemia may cause clefts. Veau system of classication is generally used where the emphasis is on the extent to which the clefting is seen. Submucosal clefts are not included here.
Class I: Unilateral notching of vermillion border that does not extend into the lip Class II: Unilateral notching of the vermillion extending into the lip but not involving the floor of the nose Class III: Unilateral clefts of the vermillion border extending through the lip into the floor of the nose Figure 26 Class IV: Any bilateral cleft of the lip exhibiting incomplete notching or a complete cleft Figure Orthopantomograph showing cleft alveolus on the right maxillary lateral incisor region.
They extend till the incisive foramen Cleft palate can either be complete or incomplete. Complete cleft includes cleft of soft and hard palate to the incisive foramen. Incomplete cleft involves the velum and a portion of the hard palate. Class III: These are complete unilateral clefts extending from the uvula to the incisive foramen in the midline and the alveolar process unilaterally Figure Class IV: Complete bilateral clefts involving the soft and hard palate and alveolar process on both sides of premaxilla leaving it free and often mobile.
Rarely, a lateral cleft lip can be seen due to non-fusion of the maxillary and mandibular process Figure Cleft of soft palate including submucosal clefts are associated with eustachian tube dysfunction, recurrent otitis media and hearing deficits. Prenatal Diagnosis of Clefts The facial structures of the fetus are best imaged after the 15th week in utero using ultrasound Figure Though It is also believed that the head is relatively smaller compared to the size of the transducer in the first 15 weeks of gestation.
Classication of clefts based on ultrasound imaging Type 1: Cleft lip Type 2: Unilateral cleft lip and palate Type 3: Bilateral cleft lip and palate Type 4: Midline clefts Type 5: Facial clefts associated with amniotic bands or limb-body wall complex. Treatment of clefts requires a multidisciplinary team including dental, medical and surgical specialists with assistance of allied health professionals in social services, child development and hearing and speech therapy.
Cheiloplasty is required later in life. By 1 year, closure of soft palate with. In utero diagnosis of bilateral cleft lip at 30 weeks pregnancy using ultrasound. Palatal obturators are used when there are feeding problems in cases of cleft palate Figure It can occur at any age. Oral melanotic macules usually occur on the gingiva, buccal mucosa and soft palate. Histopathologically there is an increased amount of melanin in the basal cells with a dropout of melanin from these basal cells into the macrophages of connective tissue.
This is called melanin incontinence. Unlike in actinic lentigo the rete ridges here are not elongated. Excision biopsy is done to rule out melanoma and other pigmented lesions.
Excision of these macules may be undertaken for esthetic reasons. Fibromatosis Gingivae This is an autosomal dominant disorder affecting the gingiva of one or both arches and characterized by noninflamed, non-painful smooth or nodular diffuse overgrowth Figure The overgrowth may prevent eruption of teeth or may be seen covering a large portion of the Diffuse non-inflammatory gingival enlargement in fibromatosis gingivae.
It may be associated with hypertrichosis, corneal dystrophy, craniofacial deformities, nail defects, deafness, epilepsy and mental retardation. Histopathologically dense non-inflamed collagenous connective tissue with the overlying epithelium showing elongated rete ridges are seen.
Gingivectomy is the treatment of choice. Recurrences may be seen but can be prevented by extraction of teeth. Abnormally small and large jaws are called micrognathia or macrognathia respectively. Apparent under-development or over-development due to skeletal malpositioning of the jaws e. Disorders of development of facial skeleton may also affect the jaws. In hemifacial hyperplasia one side of the facial skeleton is abnormally large and in hemifacial atrophy, it is under-developed.
Partial absence of mandible is more common. When there is unilateral absence of mandibular ramus, the ear too may be deformed or absent.
Micrognathia Congenital micrognathia is usually seen in association with other congenital abnormalities like congenital heart disease and Pierre Robin syndrome.
Occasionally, they may follow a hereditary pattern. Micrognathia of maxilla is usually due to deficiency in the premaxillary area.
The middle third of face appears retracted. Associated maldevelopment of nasal and nasopharyngeal structures can predispose to mouth breathing. Mandibular micrognathia is commonly due to agenesis of the condyles. Normal growth of mandible depends on the development of condyles as well as muscle function. If there is ankylosis of the joint due to trauma, infection of mastoid, middle ear or the joint, it causes acquired micrognathia of mandible.
Clinically, severe retrusion of chin, a steep mandibular angle, and a deficient chin button are observed Figure Table 4 lists few of the syndromes associated with micrognathia. Macrognathia Agnathia Though the term agnathia refers to absence of jaws, usually there is incomplete development of either maxilla Only the mandible, both maxilla and mandible or the entire skeleton may be abnormally large.
Mandibular macrognathia may be due to increased height of ramus Figure 36 ,. Both the jaws are affected in Pagets disease of bone, acromegaly, leontiasis ossea a form of brous dysplasia. Pituitary gigantism leads to generalized increase in size of entire skeleton. In addition to treating the underlying cause, the length of the mandible may be reduced by ostectomy.
Hemifacial Hyperplasia Although this is known more commonly as hemifacial hypertrophy, there is actually hyperplasia of the tissues. Some degree of facial asymmetry is common. Hemifacial hyperplasia refers to significant unilateral enlargement of the face including eyes, ears, nose and intraoral tissues Figure It is often noted at birth and sometimes at puberty.
The disproportionate growth continues until the patients overall growth ceases, resulting in permanent asymmetry. It may also be associated with malformation syndromes like BeckwithWiedemann syndrome, McCuneAlbrights syndrome and neurobromatosis. Etiology and clinical features Etiologic factors suggested include vascular or lymphatic abnormalities, central nervous system disturbances, endocrine dysfunction, aberrant twinning mechanisms and chromosomal anomalies.
Women are aficted twice as many as men. In them, either side is equally affected, while in males, right side is more commonly affected. Malignancies of adrenal cortex, liver and kidney e. Wilms tumor are more common in them. On the affected side, the skin is thick and coarse, hair is thick and abundant and sebaceous and sweat gland secretions are excessive.
Excessive pigmentation may also be evident. Lee et al described three cases with hemifacial hyperplasia of the muscles of facial expression with no other organ system involvement.
They proposed to name this condition with unique characteristics as hemifacial myohyperplasia. Malocclusion is common. Unilateral macroglossia with prominent papillae are characteristic. The facial skull bones mandible, maxilla, zygomatic, temporal and frontal are enlarged on the affected side Figure A Lateral cephalogram showing mandibular macrognathia. B Orthopantomograph showing increased ramal length and mandibular body in macrognathia.
A A child with hemifacial hyperplasia affecting the right side. B Right side of the tongue showing enlargement. C PA view showing enlargement of the mandible and soft tissues on the right side. D Enlarged body and ramus of the mandible on the right side. The roots and crown of the teeth particularly the permanent teeth are often enlarged and may erupt prematurely. Primary teeth are shed prematurely on the affected side.
The mandibular canal can appear enlarged. Management Functional and cosmetic improvements may be achieved through orthodontic tooth alignment and serial staged surgeries. Because enlargement is related to all tissue levels, perfect symmetry cannot be obtained. Hemifacial Atrophy Parry Romberg Syndrome, Romberg Syndrome Photograph showing atrophic changes of the tissues in one side of the face. This condition is characterized by atrophic changes of tissues on one side of the face including eyes, ears, nose and intraoral tissues.
Trophic malfunction of the cervical sympathetic nervous system, viral or borrelia. Many investigators believe that it represents a localized form of scleroderma. It commonly affects females in the rst two decades of life. The condition begins as a localized area of atrophy of skin and subcutaneous structures.
This atrophy progresses at a variable rate and affects the dermatome of one or more branches of the trigeminal nerve. Osseous hypoplasia may occur when the condition begins during the rst decade. The overlying skin often exhibits dark pigments Figure Some patients have a sharp line of demarcation resembling a large linear scar between normal and abnormal skin near the midline of the forehead known as coup de sabre strike of the sword.
Atrophy of upper lip may expose the maxillary teeth. Unilateral posterior open bite develops as a result of mandibular hypoplasia and delayed eruption of the teeth. Teeth on affected side may show decient root development or root resorption. Atrophy progresses for several years and then becomes stable. Cosmetic surgery and orthodontic therapy may help in correcting deformity and malocclusion respectively. This condition is managed using grafts followed by orthognathic surgery and orthodontic correction of malocclusion.
Condylar Hyperplasia Condylar hyperplasia refers to a unilateral enlargement of the mandibular condyle. Though the etiopathogenesis is still unclear, various causes have been proposed such as trauma, endocrinal disturbances and local deficiency of circulation. Clinical features. The complete failure of development of the mandibular condyle either unilaterally or bilaterally is referred to as condylar aplasia. It is estimated that the incidence of condylar aplasia is around 1 in 5, births.
The developmental defect is rarely seen in isolation. It may usually be associated with hemifacial microsomia, Goldenhaars syndrome and Treacher Collins syndrome. Lesser known associations of condylar malformations and agenesis are with Proteus syndrome, Morquio syndrome and auriculocondylar syndrome.
Santos et al reported a case of condylar aplasia without any syndrome association. In unilateral aplasia obvious facial asymmetry and shifting of the mandible to the affected side on mouth opening are common ndings. Condylar hyperplasia is usually encountered in the second and third decades of life. Patients generally complain of progressive facial asymmetry. On clinical examination unusually large condylar head can give arise to a clinically evident swelling in the temporomandibular joint region.
The mandible is deflected to the normal side. Open bite on the affected side is a characteristic feature. The progressive facial asymmetry can be conrmed by comparing photographs of the patient from childhood through adolescence to adulthood. Orthopantomograph OPG is a good scout radiograph for comparing the relative increase in size of the condyle with respect to the unaffected side. Other radiographic views that could prove benecial are the open and closed TMJ views, TMJ views transcranial, transpharyngeal and transorbital , posteroanterior skull view, submentovertex base of skull view and computed tomography.
Histopathologically the condition shows normal features after completion of the growth. However proliferation of the condylar cartilage is seen during the periods of active growth.
The condition is generally self-limiting. However unusually large condyles causing functional and esthetic disturbances can be managed by surgical recontouring. In some cases condylectomy may be required. Condylar hypoplasia results from congenital or developmental disturbances or due to acquired causes.
In this condition the condyle usually retains its shape but appears smaller. Unilateral involvement of the condyles is more common than bilateral involvement. Most of these patients also present with a proportionately smaller ramus and body of the mandible. A prominent antigonial notch may be seen. The acquired causes that result in hypoplasia of the condyle include traumatic. Hrdlicka in , was the first to describe bifid condyles in skull specimens.
Schier in described bifid condyles in a living person based on radiographic findings. Artvinli et al and Cagirankaya et al reported trifid mandibular condyle. Most of the cases reported were involving individuals over 20 years of age. Males and females are equally affected. Literature reveals the left condyle being twice more affected than the right side. Cropped orthopantomograph showing bifid condyle. Cropped orthopantomograph showing trifid condyle. The etiology for the condition is unknown.
Some authors believe that the condylar cartilage, during the early stages of its development, is divided by well-vascularized brous septa and the persistence of such a septum, within the growing cartilage might give rise to the bid condyle. It is also believed that the rupture of the septal vessels secondary to trauma can give rise to the bid condyle.
Various other factors that have been implicated are exposure to teratogenic substances, endocrinal disturbances, infections, exposure to therapeutic radiation and nutritional deciencies. It is believed that bid mandibular condyle resulting from trauma will exhibit one glenoid fossa, whereas those of developmental origin exhibit separate glenoid fossa for each of the two parts of the bid condyle.
It is also postulated that the anteroposterior sagittal form of bid condyle results from facial trauma during childhood, and the mediolateral form coronal with persistence of the brous septa at the condylar cartilage. Bid or trid condyles Figures 39 and 40 are usually found incidentally on radiographic investigations. Though commonly an orthopantomograph can reveal the possibility of a bid or trid condyle the best imaging modality to visualize the condyle for this condition is coronal computed tomography.
Moreover, a 3D reconstruction helps in accurately assessing the morphology of the condyles. Coronoid Hyperplasia Hyperplasia of the coronoid process is an uncommon developmental disturbance affecting the jaws.
The hyperplasia of the coronoid process can either be unilateral or bilateral. This condition is characterized by a progressive limitation in mandibular movement, due to impingement of the elongated coronoid processes on the posterior surface of the zygomas. The shape of the coronoid process usually does not change, however it only increases in size.
On clinical examination there is no apparent facial asymmetry or pain. It usually begins at puberty. Males are more commonly affected than females Apart from genetic inheritance other causes for coronoid hyperplasia to occur have been proposed such as trauma, increased activity of the temporalis muscle and endocrinal stimulus.
Waters view and orthopantomograph are usually sufcient to evaluate coronoid hyperplasia. It is believed that the projection of the tips of the coronoid processes at least 1 cm over the inferior rim of the zygomatic arch is pathognomonic of coronoid hyperplasia. The impingement. Literature reveals reports of coronoid hyperplasia in syndromes such as trismus-pseudocamptodactyly syndrome Yamashita et al, and nevoid basal cell carcinoma syndrome Leonardi et al, The condition can be managed by surgically contouring the coronoid process or by coronoidectomy followed by a rigorous regimen of physiotherapy.
Unusually elongated root in premolar. These include disorders of size, shape, number, structure and eruption of teeth. Figure Developmental Disturbances Affecting Size of Teeth These include either decreased or increased size of the teeth.
Localized microdontia is fairly common, especially that affecting maxillary lateral incisor peg lateral and the third molar. Similarly, rhizomicry or root dwarfism is the term used to refer to teeth with short roots Figure Microdontia In this condition the teeth are smaller than usual microdonts. Apparently small teeth due to abnormally large jaws pseudomicrodontia are not included here.
Microdontia can either be localized or generalized Figure In generalized microdontia all the teeth are smaller than normal. It may be seen in pituitary dwarsm and Down syndrome Figure 44A, B. Other conditions that are associated with microdontia are AxenfeldRieger syndrome ODwyer et al, , Fanconi anemia Tekcicek et al, , BardetBiedl syndrome Drugowick et al, and oculodentodigital dysplasia Vasconcellos et al, Remmers et al reported microdontia as a late effect of chemotherapy on dental development in a patient treated for neuroblastoma during the early years of life.
Localized microdontia is a rather common condition. It affects most often the maxillary lateral incisor and third molar. The common form which affects maxillary lateral incisor is called peg lateral Figure Localized microdontia can be seen in hemihyperplasia. Stunted root length in a maxillary central incisor. Macrodontia It refers to teeth that are larger than normal.
However, the term macrodontia should not be applied to teeth that appear large due to fusion or gemination. Localized macrodontia is seen in hemihyperplasia. All the teeth are larger than normal in generalized macrodontia. Microdontic tooth specimen. Generalized microdontia. It is associated with pituitary gigantism but is extremely rare.
Various other syndromes are associated with either generalized or partial macrodontia such as BerardinelliSeip syndrome Solanki et al, , KBG syndrome Brancati Gemination and fusion have been referred to by various names in literature such as double teeth, double formations, joined teeth, fused teeth and dental twinning.
In gemination, a single tooth bud divides and results in the formation of teeth with a bid crown and a common root and root canal. The crown may be clearly bid or there may just be a groove Figures 46 and It is seen commonly in the maxillary anterior regions. Aquilo et al classied gemination into four types based on the morphology.
Type I: Bid crown with a single root Crown is larger than normal with a notch on the incisal edge and a bid pulp chamber. The root and pulp chamber are of normal size. Type II: Large crown with a large root Crown is larger than normal and has no groove or notch. The pulp chamber is single and large.
The root is wider than normal and has one large root canal. The cervical portion of both crowns may be joined.
The pulp chamber may be separate. The root is conical shaped and larger than normal. Type IV: Two fused crowns with two fused roots. Gemination of the lower anterior tooth exhibiting a subtle groove on the incisal edge. Fusion of the central and lateral mandibular incisors. Fusion of the crown and roots.
Intraoral periapical radiograph showing a bifid crown with a common root and root canal. There are two crowns with a vertical groove. The cervical portion of both crowns is joined along with the pulp chambers.
Fusion occurs when there is union of two tooth buds with the conuence of dentin, resulting in single tooth. Fusion may occur between normal tooth and a supernumerary tooth like mesiodens or distomolar. The most reliable method of distinguishing between gemination and fusion is by counting the number of teeth in the arch. In gemination, the count of teeth remains normal, whereas in fusion the tooth count will reveal a missing tooth.
Concrescence is the union of two adjacent teeth by cementum alone without conuence of underlying dentin Figures 51 and The common teeth that may show concrescence are the maxillary molars, especially third molar and a supernumerary tooth.
Tooth specimen showing fusion of the roots. Radiograph showing concrescence. Figure 51 this may have to be resolved by radiography. Some authors have reported abnormal patterns in concrescence such as concrescence between an impacted third molar and an erupted second molar Romito, , concrescence between a third molar and a supernumerary fourth molar in the mandible Gunduz et al, and concrescence of the crown of an impacted tooth and the roots of the erupted tooth as a result of the deposition of acellular cementum on the crown Sugiyama et al, Presence of geminated and fused teeth in deciduous dentition can cause crowding, abnormal spacing, delayed or ectopic eruption of underlying permanent teeth.
Extraction may be necessary to prevent an abnormality in eruption. If the permanent teeth are affected, treatment of choice is determined by patients needs. Surgical division followed by endodontic treatment may be done. In some cases, surgical removal of tooth with prosthetic replacement is done. Concrescence fusion of the teeth via the cementum.
Unlike fusion and gemination, concrescence may be post inammatory too e. In these conditions, there is discrepancy in the number of teeth and roots, and Dilaceration It refers to a sharp bend or curve anywhere along the length of the tooth, most commonly at the root Figures Literature review reveals interesting names that have been used to describe dilaceration such as scorpion tooth Moreau, and hand of a traffic policeman Stewart, Intraoral periapical radiograph reveals dilacerated root of the mandibular third molar.
Dilacerated roots of a molar. Dilacerated root of a premolar. Factors which affect the normal development of the tooth, including trauma, cyst, tumor, etc. Dilaceration most commonly affects the anteriors and the teeth may be non-vital.
Dilaceration of deciduous. Malcic et al assessed the prevalence of dilaceration in Caucasian patients. Nine hundred and fty-three periapical intraoral radiographs and panoramic radiographs were evaluated.
The results of the study showed that dilacerations were found more commonly in the maxilla and posterior teeth were the highest affected. The prevalence of the root dilacerations were mandibular third molars Hamasha et al studied the prevalence of dilaceration in Jordanian adults. The results of the study showed that the mandibular third molar teeth were the most commonly affected teeth followed by the mandibular rst molars.
The maxillary anterior teeth and mandibular incisors were least affected. Radiographically when the roots are dilacerated toward the buccal or lingual directions, a round opaque area with a dark shadow in its central region, cast by the apical foramen along with the root canal surrounded by a radiolucent halo formed by the periodontal ligament space is typically seen. This nding has been termed bulls eye appearance.
Extraction may be difcult and result in root fracture on removal. Perforation of roots is a complication associated with root canal treatment of the dilacerated teeth. Talon Cusp Mitchell in first described talon cusp as a prominent accessory cusp on the lingual surface of a maxillary incisor. Intraoral photograph showing talon cusp in relation to the maxillary right lateral incisor. Courtesy: Department of Oral Medicine and Radiology. Talon cusp was later defined by Gorlin and Goldman as a very high accessory cusp, which may meet the incisal edge of the tooth to give rise to a T- or a Y-shaped configuration.
The name talon was used because this dental anomaly resembled the claw of an eagle Figure Talon cusp predominantly affects the permanent dentition. However there are reports of involvement of the deciduous dentition. The teeth commonly affected are the lateral incisors, central incisors and rarely the canines. Some authors have reported the presence of labial or facial talon cusps and very few reports mention the presence of facial and lingual talon cusp occurring on the same tooth.
Etiopathogenesis A polygenetic component along with various external influences is proposed to be the cause for the formation of the talon cusp. Clinical classification of talon cusp Hattab et al classified talon cusps as Type 1 talon, Type 2 semi talon and Type 3 trace talon.
However this classification did not take into consideration the presence of the talon cusp on the facial aspect of the tooth. Later on this classification was modified by Stephen-Ying et al, as major, minor and trace talon. Type 1 major talon : A morphologically well-delineated additional cusp that prominently projects from the facial Type 3 trace talon : Enlarged or prominent cingula and their variations, which occupy less than one-fourth the distance from the cementoenamel junction to the incisal edge.
Talon cusp can either occur as an isolated dental anomaly or found in association with other developmental disturbances like supernumerary teeth, microdont and macrodonts. Literature reveals the association of talon cusp with Mohr syndrome oral-facial-digital syndrome, type II , incontinenta pigmentii achromians Bloch Sulzberger syndrome , RubinsteinTaybi syndrome, Ellis van Creveld syndrome, SturgeWeber syndrome and Alagilles syndrome.
Radiographically, the talon cusp is seen as a radiopaque structure, in which the enamel, dentin and occasionally the pulp can be seen. Typically the cusp resembles a V-shaped structure superimposed over the normal image of the crown.
The common problems associated with talon cusps are increased susceptibility to caries, occlusal interferences and esthetic concerns.
Other associated problems are speech disturbances, tongue irritation, accidental cuspal fracture and periodontal problems due to excessive occlusal forces. This accessory cusp can be removed via periodic selective grinding, such that adequate time is allowed for deposition of tertiary dentin and pulpal recession.
Dens Invaginatus Dens invaginatus has also been referred to as dens in dente and gestant odontome. Dens invaginatus is an enamel-lined surface invagination of the crown or root. Based on the site the condition may be subdivided into coronal and radicular forms. Cementum-lined invaginations of the root are considered variations in the root morphology and are not a type of invaginatus. The coronal form is formed by the infolding of the enamel organ into the dental papilla.
The radicular form of dens invaginatus is produced because of the invagination of the Hertwigs epithelial root sheath. The invagination can be of varying lengths. It may be restricted to the coronal portion or it may extend into the root. When it extends into the root, it may or may not communicate with the pulp. If the invagination is too extensive it gives the appearance of a tooth within a tooth dens in dente Figure Some of the invaginations can get.
The three stages of dens in dente based on Oehlers classification. Courtesy: Dr Ravikiran Ongole. Intraoral radiograph showing dens in dente appearance. Such teeth usually show abnormal crowns. Others may perforate the root and cause inammatory lesions in spite of the vital pulp.
Oehlers in classied coronal dens invaginatus into three types, depending on the depth of invagination Figure Type I: Invagination ends in a blind sac, limited to the dental crown. Type II: Invagination extends to the cementoenamel junction, also ending in a blind sac.
Type III: Invagination extends to the interior of the root, providing an opening to the periodontium, sometimes presenting another foramen in the apical region of the tooth. The maxillary teeth are more commonly affected. Dens invaginatus most commonly affects the maxillary lateral incisor followed by the central incisors, premolars, canines and the molars. Radiographically dens invaginatus is evident as a looplike or pear-shaped defect lined by a radiopaque line with density equal to that of enamel, resembling a tooth within a tooth.
In severe forms of invagination, the crown is malformed and an open apex is present. The point of invagination is caries prone and as a preventive measure, restoration is recommended. If the tooth is carious and the invagination is close to the pulp then indirect pulp capping is done.
However pulpally involved invagination is best managed by endodontic treatment. Dens Evaginatus Dens evaginatus has also been referred to as occlusal enamel pearl, Leongs premolar, tuberculated cusp, accessory tubercle, occlusal tuberculated premolar and evaginatus odontomas. Dens evaginatus is a rare developmental anomaly characterized by the presence of an accessory cusp or enamel pearl on the occlusal surface of the premolars occurring between the cusps.
The tubercle consists of enamel, dentin and pulp. The condition occurs as a result of proliferation and evagination of an area of the inner enamel epithelium and the underlying dental papilla into the enamel organ during early stages of tooth development.
It occurs most commonly in the Mongoloids, Chinese, Thai and Caucasians. The premolars are most commonly affected followed by the molars, canines and incisors.
The mandibular teeth are ve times more frequently affected than the maxillary teeth. Presence of the occlusal tubercle can lead to occlusal disharmony, attrition and tendency to fracture thereby resulting in pulpal exposure. The involved tooth can turn non-vital. Some authors have reported fascial space infections and osteomyelitis. Grinding of the accessory cusp along with indirect pulp capping is recommended. Non-vital teeth are best treated endodontically.
Shovel-shaped incisors Shovel-shaped incisors may be seen in association with dens evaginatus. Notify me of new posts by email. Monday, November 22, Sign in. Forgot your password? Get help.
Password recovery. Balaji PDF Free. Please enter your comment! Diseases can be understood best when the interpreter understands not only the disease process but also the basic science associated with it. For this reason, I have included a separate section for basic science. I tried my best to cover all the aspects of oral diseases in this book. If this goal is achieved, then this textbook may contribute, in a small way, to better care of patients who suffer from these diseases.
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