Radiographs

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 http://www.library.vcu.
edu/cfapps/tml/oralpath
ology/browse_oral.cfm

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Taurodontism
 Developmental dental
anomaly
 Elongated large pulp
chambers
 Uncommon
 Occurs in deciduous and
permanent dentition
 Affects molars most often
 Crown is clinically normal
 No treatment required
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Taurodontism

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Taurodontism

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Taurodontism

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Congenitally Missing Maxillary
Lateral Incisors

 Mid-treatment panoramic radiograph revealing

insufficient space between the roots of the teeth for
placement of the implant, although there is
sufficient space between the crowns.

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Congenitally Missing

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Congenitally Missing

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Congenitally Missing mandibular
Premolar

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Supernumerary mandibular
Premolar

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Mesiodens
 D Nasal Fossa
 F MPS
 H ANS
 I Mesiodens

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Microdontia of the Maxillary
Right Third Molar
 Abnormally small teeth

Location
 Maxillary lateral incisors
 Third molars

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Impaction

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Impactions

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 B Microdontia
 C Healed extraction site

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Mesioangular Impaction
 Mesioangular
 Distoangular
 Vertical
 Horizontal
 Transverse
 Inverted

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Transverse
 Kasle

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Mandibular Tori

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Mandibular Tori

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Max Tori
 Etiology: Inherited
 Clinically: Nodular
growth, bilateral, multiple
or solitary, lingual surface
of the mandible, middle of
palate
 Treatment: Nothing,
surgery only if needed such
as pain or large growth

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Dilaceration
 Sharp bend or curve in
the root of a formed
tooth

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Dilaceration Etiology

Trauma during tooth development

 Calcified area displaced
 Amount of tooth formed at the time of
trauma will affect the curve
 Usually affects the apical third

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Dilaceration
Radiographic appearance
 Sharp bend or curve in the root

Treatment
 None

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Hypercementosis
Appears like a radiopaque
bulbous enlargement
Caused by :
 Excessive cementin formation
 Chronic inflammation of the
tooth
 Loss of antagonist

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Hypercementosis

 Etiology :
 Increased or decreased forces
 Pagets disease
 Hyperpituitarism
 Chronic infection in adjacent area
 Excessive cementin formation
 Chronic inflammation of the tooth
 Loss of antagonist
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Hypercementosis
Location
 Apical area of one or all the teeth

Treatment none
Problems
 May have trouble extracting teeth

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Hypercementosis
Clinically
Undetectable

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External Resorption

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Internal Resorption

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Attrition

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Periapical Abscess

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Lateral or Periodontal Abscess
 Also called periodontal Abscess
 Results from bacterial infections
 Results from inadvertent
embedding of foreign objects
subgingivally
 Calculus
 Popcorn husks
 They obstruct normal sucular
drainage
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Lateral or Periodontal Abscess
 Sometimes seen following PD in deep
pockets
 Fistula may occur

Treatment
 Manage acute signs and symptoms by
getting drainage and remove foreign object
PD to establish drainage
 Eliminate pocket
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 Periodontal vs Periapical Abscess
Periodontal Abscess
 Vital Tooth
 No Caries
 Deep Pocket
 Tooth Mobility
 Draining Fistula at
lateral aspect of tooth
 Lateral Radiolucency
Periapical Abscess
 nonvital Tooth
 Caries
 No Pocket
 No or little Tooth
Mobility
 Draining Fistula at
apex
 ApicalRadiolucency

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Periapical Abscess

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Periapical Abscess
Almost one-third (32%) of
the mentally retarded and
developmentally disabled
patients had periapical
radiolucencies that had not
been suspected without
radiographs

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Odontoma
Radiographic Appearance
 Irregular mass of calcified
material (toothlike structures)
surrounded by a narrow
radiolucent band
 Smooth outer periphery ranging
from radiolucency to
radiopacity

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Odontoma
Compound
 Tooth structures are identified
radiographically
Complex
 Appears as a radiopaque mass
 Cyst involvement may occur

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Odontoma Etiology

 Infection
 Local trauma
 Inherited trait
 Mutant gene
 Postnatal interference

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Odontoma Treatment

 Surgical removal
 Prognosis good
 Rare recurrence

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Compound Odontoma

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Compound Odontoma
 Numerous small toothlike
radiopacities surrounded
by a radiolucent halo

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Compound Odontoma
 Dome-shaped radiodense
mass above the crown of the
unerupted canine composed
of numerous small tooth-like
structures
 The mass is surrounded by a
radiolucent zone.

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Compound Odontoma

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Complex Odontoma
 Radiopaque mass
surrounded by a
radiolucent halo

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Odontoma Complex
 Description: Large
irregular shaped
radiodense mass
preventing the eruption of
tooth #30
 Note that the
radiodensity of the mass
is the same as the
adjacent teeth.

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Odontoma

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Condensing Ostetitis

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Condensing Ostetitis
 Localized area of increased
radiodensity of the alveolar bone
extending from the apical portion of
the distal root into the underlying
bone forming a bulbous appearing
radiodense mass.
 Note the faint outline of the root
visible within this bone showing the
increased radiodensity.
 Location: Distal root of lower first
molar

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Sclerotic Bone

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Occlusal Trauma
 Widening of the
periodontal ligament
spaces
 Due to heavy trauma
 No alveolar crestal bone
loss
 No increased probing
depths

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Occlusal Trauma
 Reduced bony support
 Increasing tooth mobility

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History:
 A healthy 24 year old female
presented at a university dental
screening clinic with
 masticatory muscle pain on the left
side
 There was no regional
lymphadenopathy or cortical
expansion
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History:
 The marginal gingivae were "brick
red" but there was no periodontal
pocketing or bleeding when probing.
 Tooth # 3-5 (20) was mobile (grade
2), showing heavy wear facets due to
bruxing.
 Mild soreness.
 no history of trauma.
 The tooth failed to respond to
thermal testing
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 Differential Diagnoses
 Description: The periapical radiograph
shows a widened periodontal ligament
space around tooth #3-5 (20) with periapical
condensing osteitis.

Differential Diagnoses:
 1) Traumatogenic occlusion at #3-5

2) Rule out osteosarcoma (osteogenic 89

 Definitive Diagnoses
 A week after the original visit the patient
presented with a bruise on the left cheek
and chin.
 There was pain in the contralateral TMJ
area. The diagnosis was then made of
trauma due to physical abuse. Tooth #3-
5 (20) was reduced out of
hyperocclusion. Upon recall, one month
later, the involved tooth was less mobile
and more responsive to cold stimuli
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Gemination
 Division of a single tooth
germ
 1ry or permanent
 Most common 1ry
 Mand incisors or max
incisors

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Gemination
 Clinical view
 2 completely or
incompletely separate
crowns
 One root or root canal

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Globulomaxillary Cyst
 Often pear shaped
 Occurs between the
max lateral & canine
Clinical Features
 All teeth vital
 Adults males &
females equally

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Odontogenic Cysts
 Inflammatory  Developmental
 Radicular  Dentigerous Cyst
 Paradental

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Cysts
 Dentigerous cyst
 Radicular or Periapical
 Residual
 Incisive canal
 Globulary maxillary
 Nasopalatine

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Dentigerous Cyst
Radiographic Features
 Smooth uniocular radiolucency
 Larger than 4 mm extending
from the crown to the reduced
epithelium

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Dentigerous Cyst
 Also known as
 Follicular cyst
 Eruptive cyst

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Dentigerous Cyst
Age and Gender Affected

 Older than 25 years old; Males and females

equally affected

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Dentigerous Cyst
Location
 Mandibular 3rd molars- often extending to
and destroying the ramus
 Maxillary canine region- compromising the
maxillary sinus
 These areas also have a higher incidence of
impactions

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Dentigerous Cyst
Clinical Features
 Always associated with the crown of an
imbedded or unerupted tooth
 Aggressive lesion causing expansion of
bone and extreme displacement of teeth
 Painful

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Dentigerous Cyst
Histologic Characteristics
Stratified squamous epithelium lining the
lumen
 Surrounded by a thin connective tissue
wall
 Epithelial lining is not keratinized

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Dentigerous Cyst

 Large well-defined
unilocular
radiolucency
associated with the
crown of the
unerupted molar

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Dentigerous Cyst

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Eruption Sac

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Radicular

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Radicular or Periapical

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Incisive Canal Cyst or Nasopalatine
duct cyst

 Description: Heart-shaped
well-circumscribed
radiolucency of the midline
of the anterior hard palate
 Location: Midline of the
anterior maxilla above and
between the apices of
central incisors
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 Floor of Nasal Fossa
 Periapical Abscess

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Static

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Hutchinson’s Incisors
 Are notched incisors or
sometimes called
screwdriver shaped.
 The shape of the
central incisors is
altered in 10% to 30%
of children with
congenital syphilis

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Hutchinson’s Incisors
 They resemble a screwdriver or may show notching
of the incisal edges.
 Maxillary centrals are most frequently involved but
the lateral incisors and the mandibular incisors may
also be affected.
 Deciduous dentition is not altered.
 The alteration in the shape of the teeth is due to
changes in the tooth germ during the stage of
morphodifferentiation.

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Hutchinson’s Incisors
 The molar counter part is called, mulberry molars.
 The shape of the 1st permanent molar is altered in
10% to 30% of the patients with congenital syphilis.
 The occlusal surface is much narrower than normal
and gives the crown a pinched appearance.
 The teeth also show hypoplasia of the enamel
 Pflüger molars are similar to mulberry molars
except they do not have hypoplasia present.

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Amelogenesis Imperfecta
 Is a developmental anomaly
related to hypocalcification.
 It is hereditary not acquired.
 Can affect permanent and
deciduous teeth, but sometimes
only the permanent teeth are
affected.
 The enamel is affected, not the
dentin or the root.
 It the enamel is present, it is
thin, is stained various shades
of yellow and brown and easily
fractures away.

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Amelogenesis Imperfecta

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Amelogenesis Imperfecta
 Etiology: Inherited, failure of the ameloblasts to lay
down enamel matrix properly
 Clinically: Teeth are pitted, yellow to brown color,
affects all the teeth, both dentitions
 Normal pulp and dentin, rough and thin enamel
 Treatment: Cosmetic surgery, such as restorations

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