Head And Neck Anatomy

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Dentin Dysplasia

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Dentin dysplasia type I (rootless teeth);

Dentin dysplasia type II (coronal dentin dysplasia); thistle tube shape of pulp chamber

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attrition

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loss of tooth structure due to tooth-to-tooth contact from mastication and occlusion (normal wear and tear)

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attrition accelerated by

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accelerated by poor quality or absent enamel, premature edge-to-edge occlusion, intraoral abrasives, erosion, and grinding habits

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Internal resorption is caused by

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cells located in dental pulp. Rare, usually follows injury to pulpal tissues.
dentin is eatin away (dentinoplasts)

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External resorption is caused by

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cells in the periodontal ligament. Most patients are likely to have root resorption on one or more teeth

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Visible environmental enamel defects can be classified into one of three patterns:

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1. Enamel hypoplasia
2. Diffuse opacities of enamel
3. Demarcated opacities (spotty) of enamel

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Enamel hypoplasia

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pits, grooves, or larger areas of missing enamel

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Diffuse opacities of enamel

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variations in translucency or normal thickness; increased white opacity with no clear boundary with adjacent normal enamel

Book: the affected enamel is of normal thickness

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Demarcated opacities (spotty) of enamel

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areas of decreased translucence, increased opacity, and a sharp boundary with adjacent enamel; normal thickness

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common pattern of enamel loss due to high fever (measels, chicken pox, scarlet fever)

age 2

age 4

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age 2: Horizontal rows of pits or diminished enamel are present on the anterior teeth and first molars. The enamel loss is bilaterally symmetric, and the location of the defects correlates well with the developmental stage of the affected teeth
age 4 : cuspids, bicuspids and 2nd molars are affected in similiar way

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turner's hypoplasia

caused by two different things

most frequently affects

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1. caused by periapical inflammatory disease of the overlying deciduous tooth. The altered tooth is called a Turner's tooth

it can also be caused by trauma to decidious teeth causing dilaceration (a bend in the tooth root)or disorganization of the bud resembling a complex odontoma

2. perm bicuspids due to caries in the primary molars

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hypoplasia casued by antineoplastic therapy (radiation or chemo)
severity related to

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-age at treatment
-form of therapy
-dose (.72 grey all that is needed 10X less than normal)
-field of radiation

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antineoplastic therapy defects include
affects both enamel and dentin

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-hypodontia (less teeth)
-microdontia (small teeth)
-radicular (root) hypoplasia
-enamel hypoplasia

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Mulberry molars

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constricted occlusal tables with disorganized surface anatomy resembling surface of a mulberry

Caused by syphilitic hypoplasia

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hutchinson's incisors

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crowns that are shaped like straight-edge screwdrivers,

incisal edge has a notch

casued by syphilitic hypoplasia

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Visible environmental enamel defects can be classified into one of three patterns:

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1. Enamel hypoplasia
2. Diffuse opacities of enamel
3. Demarcated opacities (spotty) of enamel

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attrition

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Loss of tooth structure caused by tooth-to-tooth contact during occlusion and mastication

Interproximal contact points also affected
Over time, interproximal loss can result in shortening of arch length

accelerated by poor enamel quality and grinding

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4 causes of postdevelopmental loss of tooth structure

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1. attrition
2. abrasion
3. erosion
4. abfraction

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Enamel hypoplasia

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pits, grooves, or larger areas of missing enamel

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abrasion

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Pathologic loss of tooth structure caused by an external agent

toothbrush is #1 contributer
also can cause notches by pipes and toothpicks

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Diffuse opacities of enamel

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variations in translucency or normal thickness; increased white opacity with no clear boundary with adjacent normal enamel

Book: the affected enamel is of normal thickness

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Demarcated opacities (spotty) of enamel

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areas of decreased translucence, increased opacity, and a sharp boundary with adjacent enamel; normal thickness

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erosion

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Loss of tooth structure by chemical reaction, not that associated with bacteria (caries)

dietary or external (usually acidic in nature)

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perimolysis

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Erosion from dental exposure to gastric secretions

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common pattern of enamel loss due to high fever (measels, chicken pox, scarlet fever)

age 2

age 4

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age 2: Horizontal rows of pits or diminished enamel are present on the anterior teeth and first molars. The enamel loss is bilaterally symmetric, and the location of the defects correlates well with the developmental stage of the affected teeth
age 4 : cuspids, bicuspids and 2nd molars are affected in similiar way

Front 36

turner's hypoplasia

caused by two different things

most frequently affects

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1. caused by periapical inflammatory disease of the overlying deciduous tooth. The altered tooth is called a Turner's tooth

it can also be caused by trauma to decidious teeth causing dilaceration (a bend in the tooth root)or disorganization of the bud resembling a complex odontoma

2. perm bicuspids due to caries in the primary molars

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hypoplasia casued by antineoplastic therapy (radiation or chemo)
severity related to

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-age at treatment
-form of therapy
-dose (.72 grey all that is needed 10X less than normal)
-field of radiation

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antineoplastic therapy defects include
affects both enamel and dentin

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-hypodontia (less teeth)
-microdontia (small teeth)
-radicular (root) hypoplasia
-enamel hypoplasia

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Mulberry molars

Back 39

constricted occlusal tables with disorganized surface anatomy resembling surface of a mulberry

Caused by syphilitic hypoplasia

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hutchinson's incisors

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crowns that are shaped like straight-edge screwdrivers,

incisal edge has a notch

casued by syphilitic hypoplasia

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attrition

Back 41

Loss of tooth structure caused by tooth-to-tooth contact during occlusion and mastication

Interproximal contact points also affected
Over time, interproximal loss can result in shortening of arch length

accelerated by poor enamel quality and grinding

Front 42

4 causes of postdevelopmental loss of tooth structure

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1. attrition
2. abrasion
3. erosion
4. abfraction

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abrasion

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Pathologic loss of tooth structure caused by an external agent

toothbrush is #1 contributer
also can cause notches by pipes and toothpicks

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erosion

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Loss of tooth structure by chemical reaction, not that associated with bacteria (caries)

dietary or external (usually acidic in nature)

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perimolysis

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Erosion from dental exposure to gastric secretions

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abfraction

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the loss of tooth structure that results from repeated tooth flexure caused by occlusal stresses

narrow V shaped wedges most often on mandible in cervical area

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Internal resorption

what is it when it affects crown

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caused by cells located in dental pulp. Rare, usually follows injury to pulpal tissues.

When it affects the coronal pulp, crown can display pink discoloration (pink tooth of Mummery)

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External resorption

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caused by cells in the periodontal ligament

is very common in the form of root resorption

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extrinsic discoloration

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Arise from surface accumulation of exogenous pigment (color from outside source)

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intrinsic discoloration

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Something incorporated into tooth structure (underlying dentin)

Secondary to endogenous factors that discolor underlying dentin

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Congenital erythropoietic porphyria (Günther’s disease)

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an AR disorder of metabolism that results in increased synthesis and excretion of porphyrins
-an intrinsic discoloration problem

the teeth are red!

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Eruption

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the continuous process of movement of a tooth from developmental location to functional location

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Impacted

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teeth that cease to erupt due to physical obstruction

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Embedded

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teeth that cease to erupt due to lack of eruptive force

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Ankylosis

peak time frame

most common tooth

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teeth that cease to erupt due to anatomic fusion of tooth with alveolar bone after emergence
-peak time is 7-8 yrs old
-most common is primary 1st molar

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angles of impacted teeth

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mesioangular, distoangular, vertical, horizontal and inverted

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Anodontia

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total lack of tooth development. Rare;
most cases occur in hereditary hypohidrotic ectodermal dysplasia

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Hypodontia

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-lack of development of one or more teeth
-More common in permanent teeth, third molars most affected
-More frequent in females than males

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Oligodontia

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lack of development of six or more teeth.

More than 5

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Hyperdontia

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-development of increased number of teeth.
-supernumeraries
-Prevalence 1-3% of pop.
-More common in males and usually develops by age 20.
-more common in maxilla

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mesiodens

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extra incisor in midline
(supernumerary)

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ectodermal dysplasia causes what

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-results is hypodontia
-teeth are made of ectodermal tissue

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Paramolar

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posterior supernumerary tooth situated lingually or buccally to a molar tooth

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Dental transposition

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normal teeth erupted in an inappropriate pattern

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Natal teeth

what disease can be associated with natal teeth

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teeth present in newborns
(85% mandibular incisor region)
-Riga-Fede disease (ulceration of ventral tongue associated with breast-feeding)

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Microdontia

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small teeth
-More common in females
-peg lateral
-Increased in Down’s, pituitary dwarfism
-can be associated with hypodontia

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Macrodontia

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large teeth
-more common in males
-can be associated with hyperdontia

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Double teeth

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two separate teeth exhibiting union by dentin and sometimes pulps (fusion).

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Concrescence

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union of two teeth by cementum without confluence of dentin.

requires no therapy unless interfering with eruption

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Gemination

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single enlarged tooth or joined (double) tooth in which tooth count is normal when this tooth is counted as one.

Is hard to separate from double teeth

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Fusion

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single enlarged tooth or joined (double) tooth in which the tooth count is short one when this tooth is counted as one.

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Talon cusp (anterior dens evaginatus)

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additional cusp located on surface of anterior tooth -extending at least half the distance from the cemento-enamel junction to the incisal edge
-Usually projects from the lingual surface.

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Dens evaginatus

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on posterior teeth
-cusp-like elevation of enamel located in central groove or lingual ridge of buccal cusp of permanent premolar or molar teeth

rare in whites
more common in asians

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Dens Invaginatus

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Deep surface invagination of crown or root that is lined by enamel

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Radicular dens invaginatus

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altered enamel forms a surface invagination into dental papilla

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Ectopic enamel

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presence of enamel in unusual places

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Enamel pearls

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hemispheric structures projecting from the surface of the root,

found mostly on the roots of maxillary molars.

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Cervical enamel extensions

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on buccal surface of root overlying bifurcation.

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Buccal bifurcation cyst

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inflammatory cyst developed along buccal surface over the bifurcation

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Taurodontism

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Enlargement of body and pulp chamber of multirooted tooth

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Hypercementosis

what does it look like on x-ray

factors of formation

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-Non-neoplastic deposition of excessive cementum continuous with the normal radicular cementum
-Thickness or blunting of root radiographically, localized or generalized
-Local or systemic factors; loss of antagonist tooth, occlusal trauma, inflammation, Paget’s disease

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Dilaceration

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Abnormal angulation or bend in root (or commonly the crown)

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Amelogeneis Imperfecta

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Group of conditions that demonstrate developmental alterations in enamel structure in the absence of a systemic disorder

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4 main subtypes of amelogenesis imperfecta

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Type I hypoplastic form; generalized/localized, smooth/pitted/rough, AD, AR. X-linked

Type II hypomaturation form; pigmented/non-pigmented, diffuse/snow capped; AD, AR, X-linked

Type III Hypocalcified form: diffuse AD/AR

Type IV Hypomaturation-hypoplastic or hypoplastic-hypomaturation with taurodontism; AD

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Hypoplastic Amelogenesis Imperfecta

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Inadequate deposition of enamel matrix

Generalized pattern – pinpoint sized pits scattered across surface of teeth

Localized pattern – horizontal rows of pits, linear depression or one large area of hypoplastic enamel

Autosomal dominant smooth pattern – smooth surface, enamel is thin, hard, and glossy

X-linked dominant smooth pattern – alternating zones of normal and abnormal enamel related to active X chromosomes

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Hypomaturation Amelogenesis Imperfecta

3 patterns

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Enamel matrix laid down appropriately and begins to mineralize, but there is defective maturation of enamel’s crystal structure; normal shape but abnormal mottled, opaque white-brown color

Pigmented pattern (AR) – surface enamel is mottled and brown

X-linked pattern – deciduous are opaque white; permanent are yellow-white that darken with age

Snow-capped pattern – zone of white opaque enamel on incisal or occlusal surface of the crown

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Hypocalcified Amelogenesis Imperfecta

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Enamel matrix laid down appropriately but no significant mineralization occurs (very soft enamel)

Teeth yellow-brown to orange

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Hypomaturation/hypoplastic Amelogenesis Imperfecta

2 types

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Enamel hypoplasia combined with hypomaturation.

Hypomaturation-hypoplastic pattern – primary defect is enamel hypomaturation; mottled yellow-white to yellow-brown.

Hypoplastic-hypomaturation pattern – primary defect is enamel hypoplasia (thin enamel).

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Dentinogenesis Imperfecta

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-Hereditary developmental abnormality of the dentin
-All teeth in both dentitions affected
-Shell teeth normal thickness enamel, extremely thin dentin, enlarged pulps

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Dentin Dysplasia

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-Dentin dysplasia type I (rootless teeth)
-Dentin dysplasia type II (coronal dentin dysplasia); thistle tube shape of pulp chamber

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Regional Odontodysplasia (Ghost Teeth)

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-not genetic
-Extremely thin enamel and dentin surrounding an enlarged radiolucent pulp