Dental Anomaly

drg. Siska yumira

Pengetahuan umum anomali gigi

• Anomali Ketidaknormalan• Anomali gigi lebih sering dijumpai pada

gigi permanen daripada decidui, RA>>RB• Diagnosa anomali Klinis & Radiografis• Etiologi :

1.Herediter2.Gangguan pd masa pertumbuhan

dan perkembangan gigi3.Gangguan metabolisme tubuh

(sistemik)

Dibedakan berdasarkan :

1. Jumlah2. Ukuran3. Bentuk : Mahkota & Akar4. Posisi & Erupsi5. Reaksi jejas6. Defect enamel, dentin,

pulpa, cementum

Anomali jumlahBerkurang jumlahnya

Bertambah jumlahnya

•Supernumerary teeth•Supplemental teeth

Anodontia oligodontia

hipodonsia

urutan gigi yg sering hilang :

M3 RAI2 RAP2 RBI1/i1 RB

Supernumerary : gigi yang memiliki bentuk anatomis yang tidak normal;

kadang gigi ini berukuran lebih kecil dari normal.• Pada gigi sulung dan permanen• Dpt terjadi px yg menderita syndrome cleidocranial

dysplasia dan Gardner’s syndrome.• 90% di RA• Paling sering I1 RA atau M3 RA• Macamnya : Mesiodens, Paramolar, Distomolar / distodens,

Peridens with Tuberkel.

Mesiodens :• Bentuk conus, berada di antara insisive central atau

mesial dari kedua insisive 1 (midline mesiodens)

• keabnormalan terjadi pd tahap inisiasi, faktor etiloginya herediter.

• Erupsi –> terlihat, Tidak erupsi –> menyebabkan diastema

mesiodens

Paramolar

distomolar

Anomali Ukuran

Macrodontia

• Disebut juga megadontia• Berukuran lebih besar dr normal• Bisa single atau keseluruhan (pituitary

gigantism)• Pada hemifacial hypertrophy : megadontia 1

sisi

Microdontia

• Lebih kecil dari ukuran normal• Lebih sering pd gigi I2 dan M3• Bentuk : peg-shaped• Keadaan yg tersering dgn microdontia :

pituitary dwarfism

macrodontia

Microdontia*panah birupegshape

Anomali Bentuk

1. Geminasi2. Fusion / synodontia3. Hutchinson’s triad (etiologi : syphilis kongenital)4. Cups Tambahan / tuberkel

Mahkota

1. Dilaceration2. Flexion3. Dens in dente4. Concresense5. Segmented root6. Dwarfed root7. Hypersementosis8. Akar tambahan

Akar

Anomali- bentuk mahkota

1. Gemination/skizodontia 1 benih membelah jd 2• decidui >> permanen, Sering pd I & P• Ro: Sal. Akar 1 gigi, mahkota tmpak trbelah

spt 2 gigi2. Fusion / Synodontia / kembar dempet : 2 benih

bersatu• decidui >>permanen, RA > RB• Tbentuk tekanan saat pmbentukn akar• Ro : sal. Akar 2 gigi, mahkotanya menyatu

Fusion

Fusiongemination

gemination

Anomali - bentuk mahkota

3. hutchinson triad a common pattern of presentation for congenital syphilis. It consists of: 1. Hutchinson’s teeth :

• mengenai gigi insisive RA & RB decidui / permanen• Ciri : servical lebar, insisal sempit dengan notch

pd incisal edge screwdriver2. Mulberry molars : gigi molar murbei

pada Molar 1 permk. Oklusal dgn cusp spt buah murbei, banyak tuberkel kecil-kecil ganda.

3. interstitial keratitis

Hutchinson’s teeth & mulberry molar

Anomali – bentuk mahkota

4. Taurodontism5. Tubercle / cusp tambahan

A. Enamel pearls (enameloma)B. Talon CuspC. Dens evaginatusD. Tuberculum intermediumE. Tuberculum sextum

Taurodontism / taurodontia• ukuran dan bentuk mahkota normal namun bentuk

kamar pulpa memanjang (apico-occlusal), tidak mengecil pd CEJ dan akar memendek

• >>populasi Eskimo, indian america.• Tidak tampak scr klinis harus dental Rӧ• Bisanya berkaitan dgn kondisi :

Amelogenesis imperfectaTricho-dento-osseous syndromeKlinefelter’s syndrome

taurodontism

Enamel pearl (enameloma) a condition of teeth where enamel is found on

locations where enamel is not supposed to be, such as on a root surface di area furkasi

• Molar RA >> Molar RB

Talon cusp

• tonjolan kecil enamel pd singulum gigi anterior RA / RB.

• Sering bertanduk pulpa

Dens evaginatusHasil pertumbuhan enamel organ ke bagian luar gigi.

Tuberculum intermedian : cups tambahan yg letaknya pd area antar cusp lingual (sering pd gigi molar RB)

Tuberculum sextum : cusp tambahan yg letaknya pd marginal ridge antar cusp distal dan cusp distolingual (sering pd M 1 RB - cusp ke-6).

Bukan Anomali Sesungguhnya• Insisive atas berbentuk sekop kelainan biologis pada

ras anatomi bagian palatal, cingulum dan marginal ridge yang menonjol membentuk seperti sekop.

• >>> ras Asian, Mongolian, Eskimo dan Indian Amerika. .

Anomali – Bentuk Akar

A. Dilaceration : sudut 45º - lebih dr 90ºB. Flexion : < 90º atau memutarC. Dens in Dente (Dens invaginatus)D. Concrescence : fusion akar (sementum)E. Segmented root : akar terpisah jd 2F. Dwarfed root : akar pendekG. Hypercementosis : jar.sementrum >>>H. Akar tambahan

Dilaceration & Flexion

• Dilaceration a severe bend in the long axis of the tooth.it located at the junction between the crown and the rootcan be as much as 90 degrees.

• usually results from trauma to the unfinished tooth when development is in progress.

• Flexion a deviation or bend restricted just to the root portion of the tooth the bend is less than 90 degrees.

• tmay be a result of trauma to the developing tooth.

Dilaceration & Flexion

Dens invaginatus/dens in dente

hasil dari invaginasi permukaan enamel ke bagian dalam gigi.

Invaginasi area cingulum (dens invaginatus), tepi insisal (dens in dente) mahkota atau pada akar selama perkembangan gigi.

• mrpkn keabnormalan gigi yg terjadi pada cap stage

• faktor etiologiherediter.• Sering : I2

Dens in dente ( dens invaginatus)

Concrescence• akar dari dua atau lebih gigi baik gigi permanen maupun

gigi desidui berfusi pada sementum.• keabnormalan gigi terjadi pada tahap aposisi dan maturasi,

etiologinya injuri traumatic atau gigi yang crowded.• Biasanya gigi dengan akar concrescence akan kesulitan

erupsi atau kadang gagal• Sering pada M2dan M3 RA juga antara gigi dan

supernumerary• Rӧ : sulit membedakan concrescence dgn superimposed

Concrescence

Hypercementosis

• Terlihat secara radiografi seme ntum menebal di seluruh atau sebagian akar gigi

• Biasanya terkait dengan inflamasi periapikal, gigi yg tidak berkontak

• Secara umum, dapat menyertai kondisi :Paget’s diseaseAcromegalyPituitary gigantism

Anomali posisi & erupsi • Submerged teeth : retained deciduous tooth• Transposed teeth – misplaced : Permanent

teeth• Ankylosed teeth• Rotasi• Ectopic eruption• Eruption cyst• Eruption hematoma• Impacted teeth

ANOMALI GIGI

Vestibular deflection Supra & infra

occlusion Diastema Mesiodistal shift of

dents Oral inclination

Anomali karena jejashilangnya / berkurangnya struktur gigi

ATRISI

• e/ physiologic

• Co: bruxism, kunyah tobaco, kebiasaan mengunyah

ABRASI

• e/ mechanical

• Co : pipe smoking, menyikat gigi yg salah, gigit kuku

EROSI• e/ chemical• Co :

makanan asam, soft drinks, vomiting, bulimia

ABFRAKSI• Mikro- fraktur email

ANOMALI GIGI

Anomali – defect email, dentin, pulpa, cementum• Email : Enamel dysplasia : Environmental

enamel hypoplasia, Localized enamel hypoplasia, AI

• Dentin : DI, DD, Odonto Dysplasia• Pulpa : Resorption, Calsification• Cementum : Hypophostasia

ANOMALI GIGI

Enamel dysplasia

• Pekembangan enamel yg abnormal• Disebut Enamel Hypoplasia ggn pd ameloblast

ketika pembentukan enamel matrix• Disebut Enamel hypocalcification ggn pd saat

enamel matrix masak• Penyebab enamel dysplasia : herediter, sistemik,

ggn lokal (trauma, infeksi)• Variasi warna : putih – kuning – coklat• Variasi morfologi : berlubang, kasar

Environmental enamel hypoplasia

• Nutritional deficiencies in Vitamin A, C, D, calcium and phosphorus

• Severe infections such as Rubella, Syphillis, and high fever

• Neurologic defects such as Cerebral palsy and Sturge-Weber Syndrome

• Prematurity and birth injuries• Radiation• Fluorosis (excessive ingestion of fluoride)• Tetracycline induced hypoplasia and discoloration

Environmental enamel hypoplasia

Localized enamel hypoplasia• Infection of primary teeth affecting the

developing permanent tooth• Trauma to primary tooth disturbing the

permanent tooth bud• Turner’s teeth

Amelogenesis Imperfecta• Group of hereditary defects of enamel unassociated

with any other generalized effect• Entirely an ectodermal disturbance• Incidence = 1 in 14, 000 (Witkop, 1957)• Both primary and permanent dentition affected• Classified into four major categories :

Tipe I : Hypoplastic AITipe II : Hypomaturation AITipe III : Hypocalcified AITipe IV : Hypomaturation-hypoplastic with

taurodontism

Type I : hypoplastic AI

• This defect occurs during the histodifferentiation stage.

• Enamel is not formed to full thickness because ameloblasts fail to lay down sufficient matrix.

• The resulting disorder may include a localized defect, localized pitting, or generalized dimunition of enamel formation.

• Affected teeth appear small with open contacts due to very thin or nonexistent enamel causing thermal sensitivity.

AI type I

Type II : Hypomaturation AI

• This defect occurs during matrix apposition. • Enamel is softer and chips from the underlying

dentin. • Enamel has a mottled brown-yellow-white color. • Contact points present as enamel is of normal

thickness. • Radiographically enamel approaches the

radiodensity of dentin.

AI type II

Type III : Hypocalcified AI

• Defect occurs during the calcification stage. • Most common type of amelogenesis imperfecta. • Enamel is of normal thickness but soft, friable, and

easily lost by attrition.• Enamel appears dull, lustrous, honey colored and

stains easily.

AI type III

Dentinogenesis imperfecta

• An inherited dentin defect originating during the histodifferentiation stage

• Frequency of occurrence is 1: 8000• Defect of predentin resulting in amorphic,

disorganized and circumpulpal dentin

Klasifikasi DI• Shields Type I

(associated with Osteogenesis Imperfecta)

• Shields Type II (Hereditary Opalescent Dentin)

• Shields Type III(Brandywine Type)

Klasifikasi DI• Shields Type I (associated with Osteogenesis Imperfecta) -

Inherited defect in collagen formation resulting in osteoporotic brittle bones. Primary teeth more affected than permanent teeth. Other features include periapical radiolucencies, bulbous crowns, obliteration of pulp chambers, root fractures and amber translucent tooth color.

• Shields Type II (Hereditary Opalescent Dentin) - Primary and permanent dentition are equally affected. Features are same as Shields Type I apart from Osteogenesis Imperfecta.

• Shields Type III (Brandywine Type) - Teeth have a shell-like appearance with bell-shaped crowns. Occurs exclusively in a isolated group in Maryland called Brandywine population.

DI

Dentin dysplasia

• Dentin dysplasia is a genetic disorder of teeth, commonly exhibiting an autosomal dominant inheritance. It is characterized by presence of normal enamel but atypical dentin with abnormal pulpal morphology.

• Cause: Dentin dysplasia is an inherited disorder.

Types of Dentin dysplasia• There are two types: Type I is the radicular type, and Type

II is the coronal type. • With Type I , the roots of teeth are shorter than normal and

the pulp chamber may be nearly gone. The pulp chamber is sometimes described as having a "crescent shaped" appearance.

• With Type II , the pulps are enlarged and are described as having a "thistle tube" appearance, in permanent dentition. In the deciduous dentition, coronal dentin dysplasia bears a resemblance to Dentinogenesis Imperfecta type II.

DD

ODONTODYSPLASIA

• Localized arrest in tooth development due to regional vascular developmental anomaly

• Ghost-like appearance with short roots and shell-like crowns

• Large diffusely calcified pulp chamber

Ghost teeth

Anomalies in cementum : Hypophostasia

• Kadar serum alkaline phosphatase rendah• Osteoporosis, bone fragility• Gagal membentuk cementum yang mengarah

pada premature loss insisive decidui

hypophostasia

Unusual dentitionANOMALI GIGI