Alterations In Tooth Morphology

Presented By Sajjad Haghi

Supernumerary Roots

Developmental Extra RootsCan Affect Any ToothMore Frequent In Third Molars, Mandibular Canines , Mandibular PremolarsMay Be Fully Developed Or Rudimentary

Radiographic Diagnosis: • Root Canal Space Abruptly Diminishes In Size• Root Canal Space Bifurcates Into Two

Separate Canals

Supernumerary Root Is Result Of:

• Metabolic Dysfunction During Root Development After Birth

• Supernumerary Roots May Be Due To The Disturbances Of The Hertwig's Epithelial Root Sheath Forming The Root. 

• Turner Syndrome

Case:A 16-year old male patient presented with a chief complaint of pain in his lower right posterior region of mouth for one week.The patient revealed a history of mild intermittent pain for the past 2 months, which had increased in intensity since one week ago.The patient reported subjective symptoms of prolonged sensitivity to hot and cold food and drinks. The pain was spontaneous and aggravated particularly at night and required analgesic to get relief from pain. Clinical examination revealed a deep carious lesion on the proximal surface of right mandibular second molar (tooth #47).Palpation and percussion test of the involved tooth did not reveal any tenderness. The tooth was not mobile and periodontal probing around the tooth was within physiological limits.The preoperative diagnostic radiograph showed carious lesion closely approximating the pulp with no signs of periapical changes. From the clinical tests and radiographic findings, a diagnosis of symptomatic irreversible pulpitis was made and endodontic treatment was initiated.Radiographic evaluation of the involved tooth revealed an unusual anatomical configuration suggesting the possibility of the presence of two mesial roots.To confirm this rare and unusual morphology, dental imaging of the tooth with the help of CBCT was planned. 

Ectopic EnamelEnamel Pearl

also known as enamelous, enamel droplets, enamel globules, enamel nodules, enamel knots and enamel exostosesSmall Pearl Like , Dome Shaped Deposits Of Enamel At Unusual LocationsMore Common In Maxillary MolarsAssociated With Chronic Periodontal Infectionprevalence of enamel pearls is 2.69%The diameter can vary between 0.3 and 4 mm (mean 1.7 mm)

Types:

• enamel pearls (formed entirely of enamel)• composite enamel pearls or enamel dentin pearls (formed

by enamel and dentin) • enamel-dentin-pulp pearls (formed by enamel, dentin and

pulpal tissue)

Case:

A 30-year-old man systemically healthy presented with chief complaint of bleeding gums.Periapical radiograph revealed severe bone loss around the mandibular first molar ,The presence of one enamel pearl on the first right molar on mesial root surface.Periodontal probing showed local bleeding on interproximal areas.A diagnosis of chronic localized severe periodontitis was established.

Ectopic EnamelCervical Enamel Extension• Flat Ectopic Deposits Of Enamel That Are Triangular In Shape

And Tapering In Form, Extending Apically Into The Furcation Area.

• More Common On Asian Race• Mostly Seen On Mandibular Molars• Can Affect Plaque Removal, Complicate Scaling And Root

Planning, And May Be A Local Factor In The Development Of Gingivitis And Periodontitis.

• Can Cause Buccal Bifurcation Cyst

Classification

Grade I - The enamel projection extends from the cementoenamel junction of the tooth toward the furcation entrance.Grade II - The enamel projection approaches the entrance to the furcation. It does not enter the furcation, and therefore, no horizontal component is present.Grade III - The enamel projection extends horizontally into the furcation.

Case:A 24 year-old boy reported with the chief complaint of bleeding gums. A diagnosis of localized chronic periodontitis was made on the basis of history and clinical and radiological examination results.Clinical examination showed deep periodontal pockets on the lingual surface with Grade II furcation involvement in the right and left mandibular first molars.Radiographic examination showed cervical enamel projection.

Dilaceration

• sudden change in the axial inclination of root or between the crown and the root of a tooth.

• Common Causes: Crowding, Trauma, Adjacent Bony Lesions , Orthodontic Traction

• More Common In 3rd Molars & Lateral Incisors

Bull’s Eye:When bend Is Toward Buccal Or Lingual

Bulbous Root

• Normal Apical Taper of root replaced by widening of the root

• Genetic Condition• Result Of Increased amount of dentin

Hypercementosis

• Deposition Of excessive amount of secondary cementum on the root surface (mostly Apical third)

• Mostly seen in mandibular molars and pre molars•  The aetiopathogenesis of hypercementosis is ambiguous.

Although most of the cases are idiopathic, several local and systemic factors are also linked to this condition, such as Paget's disease, Thyroid Goiter, acromegaly, vitamin A deficiency, Apical Periodontal infection, occlusal trauma, etc.

Radiographic Features

• Thickening and Apparent Blunting Of Root with rounding of apex

• Bulbous apex• Irregular accumulation of cementum by related area of

bone resorption

Types:1- Generalized

A 33-year-old woman, diagnosed with SLE, pain in the right maxillary second premolar, which was extensively decayed. A panoramic radiograph was taken to evaluate the roots of other teeth. Most of them showed increased thickness of roots due to excessive deposition of cementum depicting a generalized thickening and mild interdental bone loss

2- localized

A 29-year-old woman diagnosed with SLE joint pains, fatigue, weight loss and rashes over her skin. IOPA's of first and third quadrants and a panoramic radiograph were advised to evaluate the status of the remaining teeth. Incidentally, these radiographs showed increased thickness of roots with respect to 15, 17, 27, 34 and 35, with mild periodontal bone loss

Taurdontism

• change in tooth shape caused by the failure of Hertwig's epithelial sheath diaphragm to invaginate at the proper horizontal level.

• characteristic features : a)An enlarged pulp chamberb)apical displacement of the pulpal floorc) no constriction at the level of the cemento-

enamel junction • Permanent molar is Mostly affected teeth

Related Syndromes:

Types:

(Mild) (Moderate)

(Severe)

Shovel-Shaped Incisor Syndrome

• prominent marginal (shovel-shaped) ridges especially in the anterior teeth, accentuated lingual pits in maxillary incisors, and markedly shortened roots

• seen in Native Americans, Eskimos, and Hispanics

• Patients are prone to class III and lingual pit caries in maxillary incisors.

(B–D) Variation in shoveling, which refers to the development of marginal ridges on the lingual surfaces of UI1. (B) shows grade 1, (C) shows grade 3, and (D) shows grade 5.

(E–G) Variation in double shoveling, which refers to the development of marginal ridges on the labial surfaces of UI1 (E) grade 1, (F) grade 3, and (G) grade 5. Arrows indicate pronounced mesial marginal ridges.

1. Common oral disease 2017- page : 52-532. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916505/3. https://www.researchgate.net/publication/11044800_Supernumerary_roots-PMID_124205794. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3981278/5. https://www.ncbi.nlm.nih.gov/pubmed/254279266. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756549/7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248133/8. http://www.slideshare.net/nehal288/21hypercementosis9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157250/

References:

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