 Welcome back to a new session in dentistry and more today's topic is developmental disturbances of teeth. So the developmental disturbances of teeth basically arranged in four categories that is the disturbances related to size, second one is number, third one is shape or form and the fourth one is which is involving formation of enamel and dentin. So the enamel and dentin related disturbances we have already covered that was enamel involving amylogenesis imperfecta, dentin involving dentinogenesis imperfecta, dentin dysplasia and regional odendo dysplasia. So now we are seeing about the size related developmental disturbances. So let's see what is the size related problems that is the developmental problems associated with teeth. So developmental disturbances of teeth related to size basically divided into two categories that is microdontia and macrodontia. So the name itself gives the answer for it one is micro and another one is macro. So we know what is micro and macro. Macro is nothing but smaller than normal, macro is larger than normal. So teeth which are smaller than normal is microdontia, teeth which are larger than normal is macrodontia. So in both categories we have three subdivisions that is true generalized microdontia, relative generalized microdontia, focal or localized microdontia. Similarly true generalized microdontia, relative generalized microdontia, focal or localized microdontia. Let's see one by one. The first one is microdontia that is true generalized microdontia. True generalized is actually the teeth are smaller than normal. The teeth actually are normal. It is commonly seen in pituitary dwarfism and which is very rare and teeth are well formed but it is smaller than normal. The next one is relative generalized microdontia. So here the thing is there is relative microdontia, the teeth are normal or slightly smaller than normal but there is no obvious microdontia. The teeth are actually normal or slightly smaller than normal but the problem is the jaws are little larger than the normal. So when comparing to a bigger or larger jaw the teeth appears smaller but actually it is a normal or slightly smaller teeth which are present in slightly larger jaws. So this is the point. The jaws are bigger. So it appears comparing with larger jaws it is smaller. That is why this name the relative generalized it is comparing to bigger jaws it is appearing as micro teeth. So that is the relative generalized microdontia. Now we have the third category that is focal or localized. So it is a very localized condition. So focal or localized are very common comparing with these three subtypes that is lateral incisor and third molar. The lateral incisor microdontia is also known as pegg lateral because there will be a conical shaped lateral incisor compared to the normal square almost square type lateral incisor because there will be converging of tooth incisor a con shaped crown will be in pegg lateral. So this is the pegg lateral. This is a normal tooth. This is central incisor lateral incisor canine. So the normal lateral incisor will have close contact with misal and distal side of misal side of canine and distal side of central incisor. But in pegg lateral the problem is with the in towards incisor edge it goes tapering there will be constriction or converging towards incisor end. So this is focal microdontia this is commonly seen and third molar also commonly involved but it is not very clinically obvious only dentist is able to visualize it. But since it coming in the anterior side the pegg lateral is very visible and even the person also is well aware of his pegg lateral rather than the third molar microdontia if the person has both. So pegg lateral is the microdontia or focal or localized microdontia which is common with the third molar. So it may be either one or two will be present in a patient or person. So while coming to microdontia we have the same categories that is true generalized, relative generalized or focal or localized. So true generalized means there is actual bigger teeth compared to the normal size. It is seen in pituitary giganticin the microdontia seen in pituitary dwarfism. So we know what is dwarf and what is a gigantic person. The person himself will be having a bigger body or lower body comparably all the body parts will be of that size if it is dwarf if it is a gigantic person. So that is true generalized, relative generalized. The problem is patient is having or the person is having smaller jaws. The teeth are normal in size but since the jaws are little smaller than the normal the teeth will look bigger or larger and it results in crowding. So there will be insufficient arch space because the jaws are smaller than the normal. So the crowding will be there and teeth appears to be larger. So it is because of the smaller jaws here it is because of the bigger jaws. And the third one is focal or localized which is commonly seen in third molar and it is a very rare condition. Unlike the microdontia which is actually very common. The focal or localized is very common in microdontia whereas this is a little rare in case of microdontia. So it is a very very simple topic what is microdontia and what is microdontia. Everything you need to understand this concept is relative generalized microdontia and relative generalized microdontia. This is only confusing terminology in this developmental disturbance of size. Here the jaws are normal, larger than normal, here the jaws are smaller than normal. So that is all about the size developmental disturbances of teeth. So I will come up with the number in next video. So the take away points is peculatrol. So peculatrol is a focal or localized microdontia. So I will come up with the developmental disturbances of number in my next video. Hello everyone, welcome back to a new session in dentistry and more. So let's continue our developmental disturbances of teeth. So last session we had covered regarding the size problem that was microdontia and macrodontia. So today's session is about the number of the developmental disturbances of teeth related to number. So basically we have two types that is supernumery and anodontia. So let's get into the details of developmental disturbances of teeth with respect to number. So the supernumery teeth it is also known as hyperdontia, hyperdontia is more number of teeth present compared to the normal and anodontia is loss of teeth. So first let's see anodontia then we will move on to the supernumery teeth. So anodontia we have four types. The first one is total anodontia, partial anodontia, false anodontia and pseudo anodontia. In all cases the teeth are missing compared to the number of teeth are less compared to the normal regular number of teeth that is 32 in permanent and 20 in deciduous. So what is total anodontia? Total anodontia is a complete loss of teeth. The patient is edentulous and it is very very rare condition and it is seen in a syndrome known as hereditary ectodermal dysplasia. We know teeth is formed from ectoderm we have seen ectoderm endoderm misoderm misoderm. So ectoderm is a portion where from which other teeth origin. So hereditary condition of dysplasia of ectoderm. So it results in complete loss of teeth or there will not be any teeth at all that is anodontia. Now we have partial anodontia, partial means there will be few teeth are missing it can be hypodontia or oligodontia, hypodontia is if one or more teeth missing we can say that is hypodontia and six or more teeth are missing we can say oligodontia. So most common missing teeth are lateral incisor, third molars or maxillary or mandibular, second premolar. So which are these lateral incisor, third molars, maxillary and mandibular, second premolar. Now we have false anodontia, false anodontia is when the teeth are missing that is like exfoliated or extracted. So these two conditions there will be false anodontia, teeth will be missing when it is exfoliated normally or if it is extracted for any reasons. It could be dental caries extraction, it could be orthodontic extraction or any reasons if teeth are missing we can say it is a false anodontia. And another condition is pseudo anodontia actually pseudo anodontia the teeth are actually present but not clinically present. So it could be impacted, it could be delayed eruption. So these conditions the jaw appears to be without teeth one or more teeth so many teeth so that condition is on a pseudo anodontia. So teeth might erupt it might not erupt but teeth are there inside the gums or inside the jaw. So that is known as pseudo anodontia which is clinically absent teeth which is due to impaction or delayed eruption. So these are the four types of anodontia it is a common question one is total anodontia partial anodontia false anodontia and pseudo anodontia total is complete loss partial could be high power oligo false could be due to exfoliated or extracted and pseudo it could be clinically absent condition. So most common are lateral incisor third molar maxillary or mandibular second primolar. Now we will move on to the super numeric teeth super numeric teeth there will be more number of teeth it is due to the continued proliferation of permanent or primary dental lamina to form a third tooth germ. So basically we have two two gums that is one deciduous and one permanent tooth germ. So in addition to that there will be a third tooth germ why it is happening it is due to the proliferation of dental lamina from dental lamina we know we have learned in tooth formation from dental lamina the tooth arises so tooth origins so continuous proliferation so there will be an additional third tooth germ so that is super numeric teeth. So it could be a normal tooth a rudimentary tooth or a miniature version of that normal tooth so it is most commonly seen in permanent condition rather than primary and in the maxilla more seen in maxilla compared to mandible. So what happens when these are present so there will be always malposition of adjacent teeth because this will create crowding and it might prevent the eruption of adjacent teeth. So most commonly super numeric teeth associated with cledocranial dystosis. So this is hereditary ectodermal displaces that is related to anodontia this is super numeric teeth cledocranial dystosis. So we have super numeric teeth classification under two headings one is based on the location and one is based on the morphology. So based on the location we have mesiodense and we have fourth molar that is either it could be a paramolar or a dystomolar and paramolar. So mesiodense is the most common one it is seen between the two central incisors that is permanent central incisor this could be a single tooth or a paired tooth or an impacted tooth or an inverted tooth. So it can be in four versions single paired impacted and inverted it is basically a smaller version with con shaped crown and very short root. So that is mesiodense between the central incisor it is very common and fourth molar so there will be a fourth molar we have three molars first second and third so three molar in addition to that we have a fourth molar because it is super numeric tooth. So it could be a paramolar or a dystomolar dystomolar is a second most common because it is seen mostly distal to the third molar so that is why it is known as dystomolar or fourth molar. So it is also known as dystodense so patients will be having a four molar teeth in place of three molars. So this is distal to the third molar and also there could be a paramolar that is just addition additional molar not exactly at the distal position of third molar it could be between first and second molar or it could be between second and third molar it will be usually a small and rudimentary one. So dystomolar and paramolar and also paramolar additionally one premolar that is a third premolar will be there usually we have two premolars in each side each quadrant so there will be a additional premolar. So this is molar and paramolar so based on the location could be misodense paramolar dystomolar paramolar now we have based on the morphology morphology we have four types that is conical tuberculate supplemental odentomes. So conical is nothing but misodense it is conical in shape tuberculate is like barrel shaped tubercal shaped supernumeric tooth supplemental is duplicated one and important one is odentomes. Odentomes is nothing but hamatomatous malformation. Hamatomatous malformation means it is not basically neoplasm it is a same normal tooth or tissues or normal tissues it is multiplied in a different way it grows in a different unusual way it results in a special structure resulting hamatoma so tooth tissues multiplies in a different way and becoming odentomes. So we have two types of odentome one is complex and compound so if we have more than one type of tissue which is actually is known as composite odentome so we have two types basically complex and compound in complex so you cannot basically distinguish between any particular cells or tissues it is totally disintegrated whereas in compound the malformation where the superficial area is similar to the normal tooth so compound is more or less like normal tooth we can distinguish layers of teeth but in complex it is totally disintegrated. So odentomes is nothing but a hamatomatous malformation the tooth tissue is replicated or grown in a different format and it has two type composite means more than one type of tissue is there we should call it as composite odentomes and we have two types one is complex and compound complex totally disintegrated compound we can distinguish the layers. So that's all about developmental disturbances of teeth with respect to number so we have learned anodontia and supernumeric teeth supernumeric teeth also known as hypodontia anodontia we have total partial fold since you know supernumeric we have two types of classification based on location and morphology misiodens paramolar distumolar paramolar conical chubaculate supplemental odentomes odentome we have two type complex and compound which is coming under composite so I will come up with developmental disturbances of shape or form in my next video thank you. So the disturbances of teeth which is seen in crown we have 9 types the first one is fusion germination torodontism talan's cusp or leon's cusp which is also known as dense evaginatus the next one is dense invaginatus peglatoral hechocens incisors mulberry molar the last two are seen in syphilis congenital syphilis whereas in root we have concresants enamel pearl dilaceration flexion and ankylosis so this is a very very important session because each question will be asked as a short note so all these are asked because not even one you can keep aside as unimportant all are important and it is very frequently asked question in short notes. So now let's start with fusion so what is fusion? Fusion has a picture says it is the joining of two developmental tooth germ it may involve the entire tooth length or just the root so two tooth germ which is joining and making or looking like a single tooth but there will be a slight separation between the teeth so it is a bigger tooth rather than a single normal tooth which adjoining two teeth the point is there will be two separate developing tooth germ so that is fusion so it may just involve the roots or entire length will be joined so it results in a single large tooth structure so if it is involving just the roots that will be like cement and dentine will be shared not like this there will be cement and dentine will be shared if it is joining at the root position suppose if it is like this so there will be cement and root sharing this is crown sharing and if it is happening at the root end there will be cement and dentine sharing between these two two germ and fusion is basically seen in lower teeth that is central and lateral or lateral incisors and canines in lower teeth next we will move on to the germination germination is nothing but fusion of two teeth from a single enamel organ so this is two enamel two tooth germ this is a single enamel organ but it looks like two teeth because there will be a partial cleavage so it appears as two crowns but with same root canal okay from the clinical point of view it appears as two crown but it has only one root and one root canal so this is germination fusion of two teeth from a single enamel organ so the exact etiology is not known possibly it could be due to trauma so fusion is different germination is different fusion is a name itself gives a clue it is a fusion of two separate two germ it appears as a bigger tooth but germination is it is a splitting of just the crown portion so there will be a small cleavage and it appears as two crowns so it has a single root or single root canal it may have two root canals now we have torodontism torodontism is variation in tooth form so we have elongated crown and apically displaced furcation so you can see that the furcation is apically displaced very elongated crown similarly the pulp chamber also very elongated so it results in a pulp chambers that have increased apical occlusal height so the apical occlusal height is very increased so you can see the occlusal side and the apical side usually it is not this much elongated but this is a longer crown so since longer crown there will be a increased height of pulp chamber so it is most commonly seen in down syndrome and clean filter syndrome basically it doesn't require any treatment that is torodontism elongated crown germination is split crown this is fused crown okay and now we have talons cusp talons cusp is an additional cusp which is seen in mostly the lingual side of anterior teeth additional small cusp-like structure at the singulum area we can observe in few teeth so that is known as talons cusp which is also known as dense imaginatus so there will be extra growth so that is known as imaginatus so it extends from cj to the half of the incisal edge so this is a cj and it extends from half of the incisal edge so it appears as a small cusp at the lingual portion from the sing in the singulum area of upper anterior teeth that is also known as dense imaginatus so we have two structures in dense imaginatus that is the extra structures which is projecting outward the leung spremolar and then talons cusp is coming under dense imaginatus now we have leung spremolar which is an accessory cusp or a globule which is located on occlusal surface between buccal and lingual cusps of primolus so this most commonly seen in primolus that's why it's called this name leung spremolar so it is nothing but a accessory cusp or a globule which is seen between buccal and lingual cusp of primolus so it can be seen unilaterally or even bilateral conditions also present so talons cusp and leung spremolar is known as dense imaginatus okay now we have dense imaginatus or also known as dense indent so tooth within tooth so that's why it's known as dense indent so it is due to the deep surface invagination invaginations inward growth of crown or root that is lined by enamel so it is invaginated so it is going inside so we have two forms one is coronal and radicular so this deep surface invagination of crown or root which will be lined by enamel so that will be lined by enamel this invagination this is type one type two type three or also we have coronal and radicular so depth varies from slight enlargement of singulum to a deep infolding that extent up to apex okay so this is type one type three is very extended up to apex so we have three types uh type one type two and type three so type one is confined to crown so this is type one type two is which extends below the cej junction and ends in a blind sac so it ends in a blind sac here so this is a blind sac and it may or may not communicate with adjacent dental pulp so sometimes it communicates this is a pulp so sometimes it communicates with the pulp sometimes it doesn't communicate so that is type two whereas type three which extends throughout through the root so see the roots you can see it extends from the crown and it extends downwards towards the root and it perforates in the apical or lateral radicular area so you can see it perforates here perforates here in the apical or lateral radicular area without any immediate communication with pulp so pulp is this red color so it doesn't have any communication with the pulp okay but it separates or it coming towards the root tip that is it perforates in the apical or lateral radicular area but without any communication with pulp so type one is within the crown type two is a little more deeper but it is which is ending in a blind sac but it doesn't communicate with the pulp so this is a pulp okay this is a pulp that red orange color type three is which perforates in the apical or lateral radicular area it has perforation in the root area but it doesn't communicate with the pulp so that is dense in invaginators or also known as dense in dent okay so this is a commonly asked question dense invaginators you can write talents cusp and leons cusp or leons primolar and next one is dense invaginators or dense in dent so it has two names dense in dent so we always get confused with the dense invaginators and dense invaginators so dense invaginators and dense in dent both has i n so that is how you can remember dense invaginators and dense in dent so you don't write dense in dent for dense invaginators okay so you might be know the answer but writing the proper answer will only get virtue marks so type one type two type three dense invaginators or dense in dent now we have pig lateral which we have seen in our size anomaly that is microdonchia which is seen as a tapered crown especially the lateral incisor and next is the Hutchison's incisors Hutchison's incisors is associated with congenital syphilis so in Hutchison's incisors where central or lateral incisors are peg shaped or screwdriver shaped can see there is a notching at the end and it is widely spaced notching and widely spaced with a crescent shaped deformity so there will be a crescent shaped deformity so you can see a crescent shaped deformity so it is seen in congenital syphilis similarly there will be notching notches on their biting surfaces so always notches will be present on the biting surfaces which is named after so Jonathan Hutchison is a English surgeon who first described it now we have mulberry molar which is also a condition seen in congenital syphilis in mulberry molars there will be multiple rounded rudimentary enamel cusp or which is seen on the permanent first molars so these doft molars with cusp covered with lots of globules or enamel projections gives it a mulberry appearance so these two conditions Hutchison's incisors and mulberry molars associated with congenital syphilis so that's all about the elemental disturbances of crown that is regarding shape or form so we learn fusion, germination, toroidontism, dense, evasinatus so talanska span liang sprimolar comes in dense, evasinatus, dense, invasinatus or dense indent, peg lateral, Hutchison's incisors, mulberry molars so fusion is fusion of crowns, germination there will be a twinning or a single enamel organ which gives a two crowns toroidontism is elongated crown, talanska span and lingual part of antedias, liang sprimolar are extra globule between the buccal and lingual cusp dense invasinatus there will be invasination which has type 1, type 2 and type 3 peg lateral is a converged lateral Hutchison's incisors notched crescent shaped incisors mulberry molars there will be enamel globules gives it a mulberry appearance which are seen in congenital syphilis next we have the developmental disturbances with respect to the shape or form seen in root so I will come up with that topic in my next video thank you hello everyone welcome back to another session in dentistry and more so let's continue our developmental disturbances of teeth related to shape or form so last session we had covered various anomalies which we're seeing with respect to crown so today's session is about the anomalies with respect to shape or form seen in root so let's see what are the anomalies seen in root regarding shape or form concrescence is when there is two fully formed teeth which joins at the root okay by cement so it's like this when two different teeth joining at the root side by cement it is known as concrescence so it is only in cementile side it is not coming into coronal part only roots are joined but the crowns are different so most commonly it is seen in maxilla and also in posterior part compared to anterior part so compared to mandible it is commonly seen in maxilla and also compared to the anterior side it is seen mostly on posterior region and the common two teeth are involved the second molars second molars roots closely approximate adjacent impacted third molar so the second molar and the adjacent impacted third molar are united at roots and it may occur before or after the teeth have erupted so usually involve only two teeth and we need x-ray for diagnosis and no special treatment required for this condition so usually diagnosed or it found that when we take x-rays for other reasons so we can see there is a joint roots of two adjacent teeth mostly second molar and impacted third molar or the posterior region two teeth so that is concrescence the next is enamel pearl which is droplets of in a ectopic enamel which is found on the roots okay it is commonly seen on bifurcated or trifurcated teeth may occur on single rooted pre molar as well so it is seen as a small globule or enamel projection which is seen between the trifurcation or trifurcation or even the single rooted pre molars so maxillary molars are more commonly associated with enamel pearl compared to mandibular molars and it consists only a nodule of enamel attached to dentin and it may have a core of dentin which contains pulp horn and it is also detected while taking radiographs for other reasons and may cause stagnation at ginger margin but if they contain pulp this will be exposed when the pearl is removed so if it is exposed if it contain pulp there will be this will be exposed when this pearl is removed so that is about enamel pearl which is a droplet of ectopic enamel which is seen between the bifurcated or trifurcated teeth now we have dilaceration dilaceration is a bending of root so angulation or sharp bend or curve in root or crown of a formed tooth so why it is happening it is due to the trauma to developing tooth so there will be root to form at an angle to the normal axis so this is dilaceration it forms an at an angle so movement of crown or part of root from remaining developing root which results in a sharp angulation after the tooth complete its development so this particular trauma will results will cause the root to form at an angle compared to the normal axis so this movement of crown or this part of root from the remaining developing root which results in angulation and it is commonly seen in a syndrome known as earless danlos syndrome earless danlos syndrome associated with dilaceration now we have flexion flexion is deviation or bent restricted just to the root portion and usually this bent is less than 90 degrees so that is the difference between flexion and dilaceration dilaceration always the bent is greater than 90 degree and flexion the bend will be less than 90 degree this is also due to the trauma to the developing tooth and the last one is ankylosis ankylosis is submerged tooth so what happens is the fusion of teeth to the surrounding bone usually deciduous teeth especially mantibular second molar what happens it joins with the alveolar bone the root joins with the alveolar bone so extraction or exfoliation will be difficult because of its fusion between the bone and this particular root it is commonly seen in mantibular second molars so these are the five developmental disturbances or anomaly with respect to teeth and especially root so we covered the developmental disturbances of size number shape and so let's wind up this anomalies concrecent which is joining of roots by cementum enamel pearl is a globule or ectopic enamel present between the roots that is bifurcated or trifurcated dilaceration and flexion are the bending of root greater than 90 degree and less than 90 degree ankylosis is a fusion of teeth to the surrounding bone so i'll come up with a new topic in dentistry and more thank you hello everyone welcome back to a new session in dentistry and more today's topic is amylogenesis imperfecta so in developmental anomalies we have learned the various categories of anomalies it depends on size number shape of teeth and also the defects of enamel and dentine so amylogenesis coming under the defects of enamel so let's get into the details of amylogenesis imperfecta amylogenesis imperfecta the name itself gives some clue about this problem that is imperfect genesis of amyloblast so genesis is nothing but creation amyloblast means we know it give rise to enamel in future so there is a imperfect production or creation of amyloblast or amyloblast is not working perfectly so it is a problem associated with amyloblast that means enamel so enamel is not forming properly so imperfect formation of enamel is nothing but amylogenesis imperfecta so it has got many names one is ai so ai is very popular nowadays so the popular name is artificial intelligence but in dentistry ai is amylogenesis imperfecta and also we have another name hereditary enamel dysplasia so it is a hereditary condition dysplasia placia means the production of cells we know aplasia metaplasia dysplasia is improper production and also the hereditary brown enamel it is because of the color of particular enamel in amylogenesis imperfecta and also hereditary brown appallicent teeth because of the appallicent appearance of this teeth so that is about the various names it has got now let's see what is ai it is a group of hereditary defects of enamel it's not associated with any other generalized defects so it is solely exclusively attacking enamel or on the enamel it is an entirely ectodermal disturbances normal mesoderm is present so we know endoderm ectoderm and mesoderm present various tooth layers or tooth germs and ectoderm give rise to enamel so it is entirely an ectodermal disturbances not affecting mesoderm or other layers and it is a excellent autosomal recessive or autosomal dominant disease so it's about its genetical transmission it is a excellent autosomal recessive or autosomal dominant disease so how it transfers from parent to child so etiology is nothing but it is hereditary condition so obviously there will be mutation and proteins so we have many proteins in enamel formation such as enamel in amylogenin amyloblastin tough clean or amyloatin so either any of these proteins will be muted so mutation will create improper or imperfect enamel so we have basically three types of amylogenesis imperfecta before that we need to know various stages of tooth formation the first is a formative stage where the deposition of organic matrix happening the second stage is calcification stage where the matrix is getting mineralized and the third stage is it crystallizes enlarges and matures so these are the three processes starting from formative stage to maturity state so if something happens in these stage will result in enamel imperfecta or enamel improper enamel that is if it affects on the formative stage it will result in hypoplastic ai if it is affecting affecting the calcification it is creating a hypo calcified ai and if it is affecting the maturation stage there will be hypo maturation so we know hypo means it is less than normal hypo means it is more than normal so it is not actually forming up to the normal stage it is something less than normal so hypo plastic hypo calcified and hypo maturative so hypo plastic along with that we have one more type that is a fourth type which is a combination of hypo plastic and hypo maturative type it commonly seen along with taurodontism so hope you know what is taurodontism so that is a fourth type along with hypo plastic hypo calcified and hypo maturative so these two combined hypo plastic and hypo maturative combined with taurodontism will be the fourth type so the most common type is hypo plastic one it accounts for 60 to 73 percent then the hypo maturative one it accounts for 20 to 40 percent and the least one is hypo calcified it is around 7 percentage of total ai so in hypo plastic we have inadequate matrix formation because it is affecting the formative stage and reduced enamel thickness there will be abnormal contour the contour will be affected we have a perfect contour in a normal tooth aligned or normal tooth anatomy the contour will be there the tooth will be contacting misalcyr and distalcyr so that will be lost in hypo plastic that is absence of inter proximal contact because of the tooth will be where so it will be lost at the proximal surfaces it creates a particular appearance that is picket fence appearance before that it has dentine and pulp chamber perfectly normal so it is affecting only enamel so we will come back to the picket fence appearance so it gives rise to a picket fence appearance so what is picket fence so this is a picket fence because the inter proximal areas are lost you imagine this black thing as a tooth the inter proximal areas are lost because of the enamel enamel is very fragile it is lost at the inter proximal area ultimately it gives rise to this type of appearance when we take a radiograph this type of fence we have seen in railway station hope you have seen in railway station this type of fence in normal houses this type of fencing is not there so this type of fencing we know we have seen in railway station because it has inter dental spaces similar to the picket fence so square shaped crown spaced and spacing between teeth and there will be picket fence appearance in hypo plastic amylogenesis imperfecta in hypo calcified the enamel will be softer than normal and it tends to chip from underlying dentin because of its softness and the enamel has a peculiar appearance that is snow capped teeth so it will be like snow capped snow will be there on the teeth that is nothing but more whiter appearance that is white opaque areas so these white opaque areas are seen as snow capped teeth so the affected enamel exhibits radio density similar to dentin that is a problem so it will be very difficult to differentiate enamel and dentin from radiograph because the radio density of enamel and dentin usually is very different but in this case the enamel and dentin is having equal radio density the enamel matrix will be normal and obviously the calcification is very poor and normal thickness will be there now we will move on to the hypo maturity type the teeth become stained and rapidly wear down because the maturation processes happen and and it become easily stained and easily wear down because of its thin enamel so enamel is less radio opaque than dentin and hypo maturity type so I forgot to tell you about the prevalence of this condition that is 1 to 700 to 1 to 15 000 now we'll move on to the clinical features so what are the clinical features of amelogenesis imperfecta the most common clinical feature is discoloration of teeth and lack of proximal contact and loss of vertical dimension so vertical dimension will be lost why because the incisal edges will be easily wear down and it creates an open bite and there will be loss of vertical dimension and decreased masticatory deficiency mastication will be always affected because of this thin friable enamel so enamel will be easily wear down from the it easily chips off from dentin so always the mastication will be a problem and there will be anterior open bite and posterior open bite open bite is nothing but when teeth are occluding in normal condition there will not be any space between the teeth even if it is the anterior side or posterior side but open bite means if teeth are occluding the teeth will not contact that is anterior if it is not contacting in the anterior side that will be anterior open bite if the teeth are not contacting at posterior side that will be posterior open bite and negative object so usually we have positive object that is the upper teeth at the front position and the lower teeth at the back position negative object is nothing but the reverse of it that is the cross bite condition the lower teeth will be at front position and the upper teeth will be inside of it so that will be there negative object and there will be altered vertical jaw relation so the vertical height and it is the jaw relation will be changed so in radiographs we have already seen picket fins appearance in hypoplastic so usually enamel sometimes may appear completely lost or completely absent in radiographs sometimes radio density is similar to dentin making differentiation between enamel and dentin very difficult because usually how in radiographs are interpreted the enamel and the dentin the radio density the enamel has high mineralization content that is around 96 percentage compared to dentin dentin has much lesser than 96 so this density mineral density is different so the radio density will be similarly different but in amelogenesis imperfecta the enamel is hypomenalized so that's why there will be not much difference between the mineral content so likewise the radio density will be almost same so it is very difficult to differentiate enamel and dentin from a radiograph well coming to the histological explanation the hypoplastic there will be defect in matrix formation and sometimes there will be total absence of matrix in hypo calcification the defects in matrix structure and mineral deposition in hypo maturative there will be alteration in enamel roads and road sheath structures so that is a histologic part in histology there will be matrix absence sometimes with defects and hypo calcification it is a matric mineral deposition and matrix structure defects in hypo maturative there will be enamel roads and road sheath changes so how do we treat amelogenesis imperfecta we have various options to treat amelogenesis imperfecta we can go for a ortho treatment for correcting anterior open bite and vertical growth pattern we need to do a ortho treatment sometimes not in all the cases sometimes we need to do surgical approach that is extraction of few teeth and surgical correction of anterior open bite and restorative treatment will be very common like the composite restoration composite restorations are tooth colored restorations because since it is an anterior teeth the front teeth so aesthetic is a concern so we can do composite restorations and also prosthetic methods like crowns can be done full metal crowns on posterior teeth and ceramic or crowns in anterior also we can do venery so that's about our treatment part so that's how we finishes our amelogenesis imperfecta it is a defect developmental anomaly related to the defect of enamel it has got many names heritetry enamel dysplasia heritry brown enamel heritry brown or palacent teeth it is a ectodermal disturbance mutation in any of these proteins basically three types hypoplastic calcified maturity and picket fence is seen in hypoplastic snow capped seen in hypocalcified and the clinical features radiographic and histological features and various treatment options so i'll come up with a new session on dentistry enamel thank you hello everyone welcome back to a new session on dentistry enamel today's topic is dentinogenesis imperfecta as we have seen amelogenesis imperfecta just like the same way it was interpreted we need to interpret dentinogenesis imperfecta the imperfect formation of dentin or the problem with ordinal blast so let's see the details of dentinogenesis imperfecta dentinogenesis is a formation of dentin which starts even before amelogenesis so the first tooth element is forming is dentin only after that enamel forms so dentinogenesis is the first process happening while tooth formation and it was ordinal blast which creates dentin so basically two phases of dentinogenesis is there the first one is organic collagen matrix formation later there will be deposition of hydroxy appetite crystals so the collagen matrix will be laid out first after that there will be mineralization or hydroxy appetite crystals will be deposited so it is a autosomal dominant condition that is dentinogenesis imperfecta and it affects both deciduous and permanent teeth so now we'll move on to the classification so the most common classification is shield classification then we have a revised classification and whitcock classification so the shields classification is most commonly accepted and commonly used one he classified dentinogenesis imperfecta into three types type one two and three type one is dentinogenesis imperfecta with osteogenesis imperfecta type two is Dentenogenesis Imperfecta without Osteogenesis Imperfecta. I just made it as OI and type 3 is a Brandywine type which is a rare form with multiple pulp exposure and periapical lesions in deciduous teeth. And why it got this Brandywine name? It is because Brandywine is a place in Maryland USA. So that place has reported these type of Dentenogenesis Imperfecta for the first time and there were many cases reported in that area. So that particular Dentenogenesis Imperfecta with multiple pulp exposure and periapical lesions in deciduous teeth named after the particular place. So Brandywine is a place in Maryland USA that is a type 3 classification in SHIELD. In revised classification Dentenogenesis Imperfecta 1 is type 2 of SHIELD classification and in revised classification Dentenogenesis Imperfecta 2 is type 3 SHIELD classification and in revised classification there is no substitute for type 1 SHIELD classification. So do not get confused. So we have only 2 types in revised classification that is Dentenogenesis Imperfecta 1 and 2 which corresponds with SHIELD classification type 2 and type 3. Now let us see what is Dentenogenesis Imperfecta 1 which is SHIELD type 2 or Appalachian Dendin or also known as Captipon Teeth. In etiology it is a mutation which causing this Dentenogenesis Imperfecta 1 that is DSPP gene the gene which is for Dentane-Sialo-Phosphor protein. So the mutation in that gene causing Dentenogenesis Imperfecta 1. Dentenogenesis Imperfecta 1 is type 2 SHIELD classification it is without osteogenesis Imperfecta. So it can be distinct from osteogenesis Imperfecta with Appalachian Teeth and affects only the teeth not bones. So there will be no increased bone fracture. So when you get this type 1 never get confused with SHIELD type 1 this is actually SHIELD type 2. This is a revised classification and incidences one needs to 6000 or 8000 while moving on to the type 2 that is Dentenogenesis Imperfecta 2 which is SHIELD type 3 or Brandywine type. So it is the mutation is not same as type 2 that is DSPP it is different from this Dentenogen Imperfecta 1. But the difference is there will be enlarged pulp chamber and pulp exposure which is not present in this type 1 of Dentenogenesis Imperfecta. In clinical features the gender prediction is almost same males and females are equally affected there will be blue gray or amber brown and Appalachian tooth few days after eruption teeth may achieve a normal color following which they become translucent and finally become gray or brown with bluish reflection from enamel. The enamel may easily split readily from Denten when subjected to occlusion stress. So the first part is saying about the color change normally it is when it irreps it is having normal color later it is getting changed to the bluish or palacent one and the second part about the occlusion stress and it easily chips off that enamel and there will be severe attrition and obliterated pulp chamber teeth are not very sensitive and Denten is basically soft and easily penetrable but Cary's incidence is very less because of the structural change in Denten even though it has very soft Denten and it is easily penetrable Cary's is not very much present in Dentenogenesis Imperfecta 2 so that is shield type 2 and shield type 3. In radiographic features there will be bulb shaped or bell shaped crown with constriction at the cervical areas so the cervical areas will be constricted so it will be a bulb shaped or a bell shaped so you know how a bulb or bell looks like at the top end or the bottom end if it is keeping an upright or the opposite direction the tip will be constricted so like why is the cervical areas will be constricted and there will be thin and spiked roots obliteration of coronal and radical pulp chamber is a unique feature of Dentenogenesis Imperfecta but the cementum alveolar bone and periodontal ligament are perfectly normal so the type 2 that is shield type 3 brandy wine type which has large pulp chamber with very thin enamel and Denten will give a peculiar appearance which is known as shell teeth so it is shield type 3 and revised classification type 2 so that is shell teeth which is commonly asked question shell teeth which is a radiographic feature with large pulp chamber with thin shell of Denten and enamel in histopathology the enamel is normal the mantle Denten that is a narrow zone of Denten below enamel also normal the remaining Denten will be severely dysplastic with vast area of amorphous matrix with globular or inter globular foci of mineralization and there will be reduced number of dental tubules and the tubules are distorted irregular in shape widely spaced and larger in size and there will be absence of odendoblastic processes and degenerating cellular debris and there will be large areas of etubular Denten DJ will be smooth and flatten instead of scalloped nature so which is actually responsible for early chipping of enamel if it is scalloped there will be a interlocking between enamel and Denten since it is very smooth or flattened the enamel will be easily chipped off and in chemical or physical features there will be increased water content around 60 percentage more water content than normal and there will be decreased mineral content and micro hardness is near to cementum so while moving on to the treatment part the main goal is to prevent the loss of enamel and Denden through attrition so in mild to moderate cases we can go for veneering bleaching restorative procedures like composites and amalgam amalgam in posterior and composites in anterior teeth in severe case cases mostly we should do processes that is crown placement and always we should keep a importance in maintaining the vertical dimension because the vertical dimension will be lost because of the attrition so that's all about Dentenogenesis Imperfecta the takeaway points are retina type, capti point so this is type 1 and this is type 2 that is revised classification and shell teeth is a radiographic appearance of type 2 that is mostly you get confused between these two this is shield classification and revised classification so this is what we follow revised classification but we correspond with our shield classification so this type 1 is type 2 of shield and this type 2 is type 3 of shield so that's all about Dentenogenesis Imperfecta it is a developmental anomaly involving the dentine or the amalgam that odendoblast so we had seen amalgam genesis Imperfecta which is amalgam blast and enamel formation related problem and dentinogenesis is something related to odendoblast and dentine formation so welcome up with a new topic in dentistry and more thank you hello everyone welcome back to a new session in dentistry and today's topic is developmental anomaly known as dentine dysplasia so last sessions we had covered amalgam genesis Imperfecta and dentinogenesis Imperfecta where the formation of enamel and dentine is not proper likewise this this is that is dentine dysplasia it is a abnormal development of odendoblast or dentine formation in an improper or abnormal way dysplasia means we know it is abnormal development of cells within tissues or organs so let's get into details of dentine dysplasia so dentine dysplasia it is a autosomal dominant condition without a proper etiology but there is reports saying it is a mutation of the SPP that is dentine silo phosphor protein could be one of the reason for dentine dysplasia and it is a very rare disease which is seen in 1 in 1 lakh incidents basically it is classified as dentine dysplasia type 1 and type 2 so usually this is presented as a normal enamel with a typical dentine and abnormal pulp pathology so basically it has two types one is type 1 or shield type 1 or type 2 or shield type 2 that is dentine dysplasia type 1 and dentine dysplasia type 2 dentine dysplasia type 1 is radical dentine dysplasia so we know there are coronal dentine and radical dentine so this affects a radical dentine so most commonly it affects both the dentition deciduous and permanent the crown appears very normal but the problem is there is no or only rudimentary root development that is why it's known as radical dentine dysplasia so the name itself gives a clue radical dentine there is a root dentine the root formation is very minimal or maybe there is no root present at all and it is also known as rootless teeth and regarding the pulp there will be incomplete pulp or there may be total obliteration and teeth may exhibit extreme mobility because there is no root or very rudiment root and exfoliate prematurely so it will exfoliate before the time of actual exfoliation and there will be malalignment and malpositioning due to the extreme mobility of teeth so when there is no root you can imagine what all the problems it may have there will be mobility it exfoliate prematurely there will be malalignment and malpositioning so in radiography there will be short roots and sharp conical apacal construction and crescent or half moon shaped pulp chamber will be present in dentine dysplasia type 1 now let's move on to dentine dysplasia type 2 which is coronal dentine dysplasia where the problem is with crown or the coronal dentine so the pulpal obliteration will be partial and the peculiar appearance of pulp chamber or coronal pulp chamber is thistle tube or flame shaped thistle tube or flame shaped pulp is seen in type 2 rootless teeth is type 1 and the thread like root canals are another feature and there will be absence of periapical radiolucency and teeth roots are of normal shape and contour so here the problem is with coronal dentine but here it is radicular dentine so the root is rudimentary here the roots are normal and radiologically the multiple pulp stones will be there and thistle tube or flame shaped appearance can be seen so thistle tube or flame shape is in type 2 rootless in type 1 crescent or half moon shaped pulp chamber in type 1 so there will be blue and amber discoloration seen in dentine dysplasia type 2 but only with deciduous dentition permanent dentition it looks normal but deciduous dentition there will be blue and amber discoloration while moving on to histopathology there will be deeper dentine show a typical tubular pattern that is a dentine which is at the deeper part a typical tubular pattern with an amorphous a tubular area and irregular organization and this is very important the lava flowing around boulders so when there is normal dentine tubular formation happens but there are blockades so blockage is there so this dentine tubular formation still happens but it is happening around this blockade so it looks like a lava so when a volcano erupts the lava is flowing or overflowing around the boulders around the obstacles so it gets that peculiar characteristic appearance lava flowing around boulders so when we take a cross section we can see this peculiar appearance of dentine formation around the obstacles the lava flowing around the boulders so that is a histopathology feature of dentine dysplasia so that's all about dentine dysplasia the takeaway points are ruthless teeth that is type 1 thistle tuber flame shaped seen in type 2 lava flowing around the boulders it is a histopathology feature and crescent or half moon shaped pulp chamber in type 1 in management of dentine dysplasia proper oral hygiene measures periapical curatage and retrograde endodontic treatment so that's all about dentine dysplasia so it's a developmental anomaly affecting dentine which has two types coronal and radical dentine types so i'll come up with a new topic in dentistry and more thank you hello everyone welcome back to a new session on dentistry and more today's topic is ghost teeth or regional odendor dysplasia which is also known as odendogenesis imperfecta this comes under third year oral pathology and a1 and first year dental histology so it comes along with amelogenesis imperfecta and dentinogenesis imperfecta the first one was affecting enamel dentinogenesis imperfecta affecting the dentine and this affects both enamel and dentine so let's see what does ghost teeth or regional odendor dysplasia ghost is it's nothing but abnormalities of enamel dentine and pulp so it is the etiology is basically unknown so it could be local trauma radiation hypophosphatacea hypocalcemia and hyperpyroxia so due to these reasons there will be abnormalities in enamel dentine and pulp so it is most commonly recognized at the age of tooth eruption that is between two to four years in deciduous and seven to eleven years in permanent teeth that is mostly the central incisor lateral incisor and canines so the ghost teeth or regional odendor dysplasia it is an abnormal enamel dentine and pulp formation especially in the maxillary anterior teeth it can be seen both in deciduous and permanent dentition so let's see the etiology so it could be a local trauma or irradiation or hypophosphatacea hypocalcemia or even hyperpyroxia so what happens is there is abnormal formation of enamel dentine and pulp so it is most commonly recognized at the age of two to four years in deciduous dentition on seven to eleven years in permanent dentition so during this period the maxillary central incisor lateral incisor carions are erupting and it is most commonly seen in maxillary teeth or the anterior teeth so what happens is these teeth sometimes fail to erupt or if they erupt they show yellow formed yellow deformed crowns with a rough surface because it has very hypoplastic mineralized enamel and dentine which is not properly mineralized so they are very easy to undergo staining and deformation so there will be a rough surface and there will be a stained yellow stained deformed crowns so sometimes they won't erupt at all if it erupts it shows in this way so the affected tooth have very thin enamel and these teeth appear as crumbled that is because of its peculiar radiographic feature it shows abnormal radiolucency that is marked reduction in the radio density so the abnormal radiolucency makes the tooth as a ghost appearance that's why it's known as ghost teeth because the hypoplastic hypo calcified dentine and enamel with large pulp chamber makes it a ghost appearance there will be big pulp chamber very thin enamel very thin dentine makes it a ghost appearance that is why it's known as ghost teeth and it is regional odendoplasty and it is affecting the particular region and the odendome and dysplasia is malformation or improper formation of cells dysplasia is multiplication of cell so the name itself gives a clue so most of the diseases, syndromes, cysts everything gives a clue we get a bit of answer from the title itself so that is how it is becoming a ghost teeth a large pulp chamber with very thin enamel and dentine so in this case the roots will be very short and poorly outlined and there will be localized arrest in tooth development and it is most commonly diagnosed by the clinical appearance and radiographic appearance there will be irregular shaped brown discoloration and radiographic we can easily see in the ghost appearance of tooth and management either we can do extraction of these teeth and undergo a prosthetic rehabilitation and also respiratory procedures such as root canal treatment can be done so it depends on the patient's clinical profile so that's all about ghost teeth or regional odendodysplasia or odentogenesis imperfecta so this is odentogenesis imperfecta so dentino genesis imperfecta affecting dentine amylogenesis imperfecta is affecting enamel and odentogenesis imperfecta is affecting both enamel dentine and pulp giving a ghost teeth so i'll come up with a new session then to stay enamel thank you