Abnormality in the Morphogenesis of Tooth Development and Relationship with Orthodontic Deformities and Treatment Approaches

In the process of odontogenesis, a disturbance in the formation of the epithelium and mesenchyme can be observed and this can be manifested by atypical forms of dental development. Such biological phenomena with altered morphology are as follows: dens invaginatus (DI), dens evaginatus (DE), talon cusps, and double teeth (DT) or connate teeth (fusion and gemination). Patients with orthodontic anomalies who also exhibit teeth with morphogenetic disorders are presented in this article. Dens evaginatus and talon cusps pose orthodontic challenges in the treatment finishing phase. These reduce the possibility of achieving maximum intercuspidation between the lower and upper front teeth as well as poor incisor guidance. Other orthodontic challenges are as follows: the risk of occlusal trauma and periodontal loading of the antagonists and the possibility of accessory cusps to play the role of the inclined plane and lead to deviations in the closure of the lower jaw. The fused teeth can cause aesthetic and occlusal disturbances in the anterior segment. Furthermore, double teeth can lead to ectopic eruption or noneruption of adjacent teeth due to their increased crown size as is the case with one of the presented patients. This is because a double tooth occupies more space in the dental arch. If not diagnosed early, impaction of the adjacent tooth, violation of the occlusal ratios (Bolton/anterior), and exacerbation of the orthodontic deformity can be observed. The modern CBCT imaging is the best diagnostic method for identifying problems related to tooth positions or tooth germs.

BILATERAL FUSION OF PRIMARY MANDIBULAR CANINE AND FIRST MOLAR: A RARE OCCURRENCE

Objective: Fusion is a developmental anomaly of the teeth. It is dened as the union of two independently developing primary or permanent teeth. Aberrations in morpho differentiation stage of tooth development leads to abnormal forms and sizes of teeth. This paper reports a rare case of bilateral fusion of mandibular primary rst molar and canine. A 10 year old boy reported with the chief complaint of difculty in chewing due to mobility of teeth in lower back teeth region. Intraoral, radiographic and histopathological examinations indicated fusion of mandibular deciduous canine and deciduous rst molar on both sides. According to the treatment plan, the fused teeth were extracted. Fusion of teeth is caused by various etiological factors, can be diagnosed by amalgamation of clinical, radiological and histopathological examinations and can be treated by multidisciplinary approach. Accurate diagnosis of dental anomalies helps in prompt treatment, which in turn avoids future orthodontic complications and better prognosis.

Fusion or Gemination? Diagnosis and Management in Primary Teeth: A Report of Two Cases

Primary double teeth (PDT), referring to either gemination or fusion, are one of the most important and frequent developmental dental anomalies that can affect children’s oral health. Many clinical complications are correlated with these anomalies, such as dental caries, malocclusions, periodontal problems, and dental anomalies in permanent dentition. The aim of this report was to describe, through two cases, a case of gemination and another of fusion, the clinical management, the consequent effects, and the possible repercussions of these two developmental abnormalities on permanent successors. The first case involved gemination of the primary maxillary left central incisor (#61) in a 6-year-old boy. The patient presented with dental caries in the geminated tooth and its contiguous primary left lateral incisor (#62). The radiological examination revealed a slight developmental delay in the permanent left lateral incisor (#22). The treatment plan involved performing a pulpotomy and restoring the dental crowns of the affected teeth. The second clinical case describes a 6-year-old girl with unilateral fusion between a primary mandibular lateral incisor (#72) and a supernumerary tooth (#72’). The treatment included restoration of the deep grooves of the fused teeth using flowable composite and coronal restoration of the contiguous left primary canine (#73). Clinical and radiological follow-ups were performed every 3 months to monitor the development of teeth. No clinical and radiological symptoms were noted during the follow-up visits. PDT may require a multidisciplinary treatment. They should be diagnosed early to avoid and treat any possible complications in both the primary teeth and their permanent successors.

Fused teeth in the primary dentition: clinical case report

ABSTRACT Fused teeth are a developmental anomaly involving the union of two dental germs at the crown, root or pulp. This type of anomaly occurs during intraosseous development, resulting in a morphologically irregular tooth that can affect both the primary and permanent dentition. Clinical problems involving esthetics, a lack of space and greater susceptibility to caries are often associated with fused teeth. This type of anomaly is easily confused with dental twinning, which has similar clinical features but emerges from a single dental germ. The aim of the present study was to report a clinical case of the fusion of two deciduous mandibular incisors, describe prospects for treating this anomaly and discuss its repercussions during the development of the dentition. Extraction of the fused tooth was performed and orthodontic treatment was recommended for esthetic and functional improvements. Integrated planning involving both Pediatric Dentistry and Orthodontics provided a better treatment option.

An observational study of dental abnormalities in the primary teeth

Pregnancy and early childhood are the most critical phases with regard to biological, cognitive, emotional, and social development. Adverse events in these periods of life may be related to alterations in dental development, including alterations in size, shape and mineralization. Objective: To evaluate the frequency of dental abnormalities and the factors associated with the developmental defects of the enamel in primary teeth. Material and methods: Information about family income, maternal education level, preterm birth, and hospitalization history up to 11 months of age were collected from the dental records of 544 children. Clinical examination of the children was performed to investigate abnormalities of tooth number, form, size, and developmental defects of the enamel (DDE). Data were analyzed using χ2 test and Poisson regression. Results: In all, 544 children were evaluated. Sixty children (11.0%) presented some alterations in the primary teeth; and 7.5% showed DDE. Children born preterm were 3.17 times more likely to develop DDE in primary teeth (prevalence ratio – PR = 3.17, 95% confidence interval – 95%CI 1.26–7.98, p = 0.014). Among the alterations of number, 1.7% was hypodontia, and among the abnormalities of shape, 1.7% was fused teeth. Conclusion: The prevalence of dental anomalies in this sample was, in general, expressive. Children born preterm were more vulnerable to present developmental defects of the enamel.

An observational study of dental abnormalities in the primary teeth

Introduction: Pregnancy and early childhood are the most critical phases with regard to biological, cognitive, emotional, and social development. Adverse events in these periods of life may be related to alterations in dental development, including alterations in size, shape and mineralization. Objective: To evaluate the frequency of dental abnormalities and the factors associated with the developmental defects of the enamel in primary teeth. Material and methods: Information about family income, maternal education level, pretermbirth, and hospitalization history up to 11 months of age were collected from the dental records of 544 children. Clinical examination of the children was performed to investigate abnormalities of tooth number, form, size, and developmental defects of the enamel (DDE). Data were analyzed using χ2 test and Poisson regression. Results: In all, 544 children were evaluated. Sixty children (11.0%) presented some alterations in the primary teeth; and 7.5% showed DDE. Children born preterm were 3.17 times more likely to develop DDE in primary teeth (prevalence ratio – PR = 3.17, 95% confidence interval– 95%CI 1.26–7.98, p = 0.014). Among the alterations of number, 1.7% was hypodontia, and among the abnormalities of shape, 1.7% was fused teeth. Conclusion: The prevalence of dental anomalies in this sample was, in general, expressive. Children born preterm were more vulnerable to present developmental defects of the enamel.

Joined supernumerary mandibular teeth in the premolar region: Report of a Hungarian archeological case

Supernumerary teeth are those that are additional to the normal complement. They may occur in any region of the dental arch and have been reported in both the primary and the permanent dentitions. The etiology of supernumerary teeth is still not clearly understood, but several theories have been suggested for their occurrence. The investigated material were the remains from the Bácsalmás-Óalmás burial site (from the 16th-17th centuries), where 472 skeletons were excavated from 1993 to 2003. For the purpose of this study, the dentitions of 164 adult individuals were examined. The examination was carried out using macromorphological methods, radiographic analysis and a dial caliper were applied. This paper describes a supernumerary tooth of an adult female skeleton. On the labial surface of the first mandibular premolar an extra tooth was observed.Radiographic examination of the fused teeth indicated that the crown of the premolar had fused incompletely with the crown of the extra tooth. The position of the extra tooth could have been the result of gemination of the tooth germ or the elaboration of the buccal cingulum. The cranium of the examined individual showed some mongoloid morphologic features, too. Our presumption about the formation of the supernumerary tooth may have contributed to the theories of the occurrence of supernumeraries. The sporadic occurrence of this anomaly was reported in recent and archaeological skeletal collections. This study showed that multiple permanent dental formation was present in past Hungarian populations, representing a contribution to the history of dental anomalies.

Primary Fused Teeth and Findings in Permanent Dentition

Objective: The aim of this study was to investigate the characteristics of primary fused teeth (PFT) and their effect on permanent dentition in a group of Turkish children. Subjects and Methods: Dental records of 13,450 pediatric patients who attended the Pediatric Dental Clinic in northern Turkey between 2015 and 2017 were reviewed. Forty patients had been diagnosed with PFT and were included in the study. Clinical and radiographic examinations were conducted, and the distribution of PFT was calculated by type, sex, affected jaw, associated dental anomalies, and clinical complications. Data analysis involved descriptive statistics. Results: A total of 50 PFT were detected in the 40 patients. The mean age of patients was 6.7 ± 0.3 years (range 3–10 years). The most common PFT were the mandibular lateral incisors and canines (34, 68%). The most prevalent type of PFT was type III (20, 40%). Of the 40 patients with PFT, 34 (85%) also ex­hibited other dental anomalies such as tooth aplasia, peg-shaped incisors, talon cusps, ectopic eruption, and delayed eruption in both related and unrelated areas. The most common complications of PFT were fusion-related tooth aplasia (n = 26 [76%]) and caries formation in the affected teeth (24 [48%]). Conclusion: In this study, PFT were frequently observed in the mandibular anterior region. Caries formation and dental anomalies, especially permanent tooth aplasia, were often encountered in areas where PFT were seen. Hence, parents should be informed about possible dental problems associated with PFT and be encouraged to schedule regular follow-up appointments.