Developmental Defects

Acquired developmental conditions Hereditary conditions

Defects
Enamel
Hypoplasia Hypomineralisation
Generalised intrinsic stains

1. Enamel hypoplasia
Enamel hypoplasia (EH) is a defect in tooth enamel that results in less quantity of enamel than normal. The defect can be pits or dents, grooves, lines or larger areas of missing enamel surface in the tooth or can be so widespread that the entire tooth is small and/or mis - shaped. possible occlusal distortion, aesthetic problems, sensitivity It can appear white, yellow or brownish in colour with a rough or pitted surface.

Causes
Environmental and genetic factors that affect ameloblasts activity are thought to be responsible for EH. E.g. trauma to the teeth, infections during pregnancy or infancy, poor pre-natal and post-natal nutrition, hypoxia, exposure to toxic chemicals and a variety of hereditary disorders.

Enamel Hypoplasia associated with exanthematous fevers

Pitted

Chalky

Line

Management

The most conservative treatment consists of bonding a tooth colored material to the tooth to protect it from further wear or sensitivity. Less conservative treatment options, but frequently necessary include use of stainless steel crowns, permanent cast crowns or extraction of affected teeth and replacement with a bridge or implant. Desensitizing agent Direct or indirect composite composite or porcelain veneers. Porcelain crowns.

Management in posterior teeth

desensitizing agent (such as potassium nitrate) as needed. place pit and fissure sealant on the occlusal surface.

Continue management
Remove demineralised enamel and restore with composite. Perform minimal reduction of tooth and cement a stainless steel crown permanent cast crown in the late teen years or early adulthood. extraction prior to the eruption of the second molars may be a reasonable alternative.

Management of enamel hypoplasia

Composite filling (left). Stainless steel crowns (right).

2. Hypomineralized Enamel
Results when a normal amount of matrix fails to achieve full mineralization. The affected enamel has a normal shape and thickness but has creamy opaque to marked yellow/brown, surface of teeth is soft and rough and dental sensitivity and open bite is common . The degree of the above reflect its severity, timing and duration.

hypomineralisation

3. Generalized intrinsic enamel stain

dental fluorosis

Dental fluorosis

May occur when the total daily intake of fluoride ion is high. It may be seen as white flecks or brown discoloration sometimes accompanied by pitting.

Dental Fluorosis

Fluorosis
1. Mild 2. moderate 3. severe

3. Generalized intrinsic enamel stain

Tetracycline staining

Tetracycline Staining
This group of drugs should not be administered during pregnancy or to children under the age of 12 It has strong affinity to calcified tissue and can cross placenta It gets deposited in enamel resulting in discolored teeth

Hereditary Conditions
Tooth number: hypodontia Tooth size: microdontia Tooth structure: amlogenesis imperfecta or dentinogenesis imperfecta.

1. Hypodontia
Anodontia: teeth do not form at all. Hypodontia or oligodontia: some teeth might be congenitally missing or abnormal in shape. Upper lateral incisor is the most commonly affected tooth followed by the lower first premolar.

2. Microdontia, hypodontia
Short, abnormal shape, missing teeth.

3. Amelogenesis imperfecta
A spectrum of hereditary defects in the function of ameloblasts and the mineralization of enamel matrix that results in teeth with multiple generalized abnormalities affecting the enamel layer only. A. generalised hypoplasia B. generalised hypomineralisation

Amelogenesis imperfecta
hypoplastic

Amelogenesis imperfecta
hypocalcification

Amelogenesis imperfecta
Generalised hypoplasia: defective matrix formation with normal mineral Thin enamel yellow teeth as dentine shows through the enamel. Generalised hypomineralisation: normal matrix formation but faulty mineralization. Tissue is soft, and easily lost. Enamel stains usually.

Clinical Features:

teeth vary in colour from white opaque to yellow to brown all teeth are affected, smaller and pitted normal pulps and dentin but reduced enamel Type I (Hypoplastic Amelogenesis Imperfecta) Type II (Hypocalcified Amelogenesis Imperfecta) Type III (Hypomaturation Amelogenesis Imperfecta)

4. Dentinogenesis imperfecta
A hereditary defect consisting of teeth composed of irregularly formed and undermineralized dentin. Deficient formation of dentine. Enamel is prone to early fracture and wear. X-ray shows obliterated pulps and shortened roots.

Dentinogenesis imperfecta