*Clinical Concepts and Practical Management Techniques in Dentistry*

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Enamel pearl or ectopic enamel.

9.What other names have they acquired?

Enamel droplet, enamel globules, enamel nodules, etc. as stated in the introductory section of article on the subject, above.

10. In which teeth are they most commonly found?

Maxillary and mandibular molars.

11.Can multiple teeth be involved?

Yes?

12.Give three (3) differential diagnosis

1.Pulp stone.

	- 1.Can lead to chronic localized or generalized periodontitis,

2.Can obscure a furcation involvement.

14. Is there a role for cone beam CT Imaging modalities?

Yes, a confirmatory role.

Point at the developmental dental defects in the periapical radiographs shown above (**Figure 27**).


*The Radiology of Developmental Dental Defects Demystified: An e-Based Learning System DOI: http://dx.doi.org/10.5772/intechopen.101435*

**Figure 27.**

*Periapical radiograph showing multiple enamel pearls (these can be easily misdiagnosed on radiograph as pulp stones. (See arrows).*

Concrescence, because the roots appears to be joined, the entire resultant tooth structure is big and the structure has two distinct pulp separated by a tooth tissue with the radiodensity of the dentine.

	- 1.Fusion,
	- 2.Germination,
	- 3.Double teeth,
	- 4.Twinning.

In actual fact, double teeth and twinning can be used to express fusion, germination, and concrescence.

7.What is the clinical significance of this developmental dental defect?

1.Difficulty in confirmatory diagnosis until extraction or CBCT is done.

2.Difficulty in extraction.

3.Difficulty in effecting a root canal treatment.

4.Unnecessary spacing of the teeth.

5.Likely oro-antral communication following non-surgical extraction.

8.What advantage does it have and why is it so?

Because it is extremely rare in occurrence and its presentation is very unique, it has a positive role in identification of the deceased, thus giving it a forensic significance and use. It is as such called a *Unique, non coincidental forensic finding* in the antemortem and postmortem correlations and evaluation (**Figure 28**) [2–4].

**Figure 28.** *Periapical radiograph showing concrescence of the maxillary molars (see arrows).*


Proceed with the blue arrow to point at the main developmental dental defect.

8.Utilize a red arrow to point at the third molar.

Proceed with the red arrow to point at the third molar.

9.Utilize a green arrow to point at the second molar.

Proceed with the green arrow to point at the second molar.

10.Utilize a brown arrow to point at the distomolar.

Proceed with the brown arrow to point at the distomolar.

11.Use these four arrows to deduce an etiology for this condition (at least in this case).

The mesial root of the second molar seems to be fused with the distal roots of the first molar with an obscured root canal of the joined roots. Since a

developing third molar is present and a distomolar is present, a diagnosis of concrescence of the first and second molar teeth can be made.

Diagnosis: Concrescences of the first and second molars. It could, however, be fusion, but it is not germination.

12. Is your deduced etiology consistent with the literature?

Yes (**Figure 29**) [2–4].


The main radiographic finding is a larger than normal lower incisor, which has a coronal pit (upper arrow) to simulate two crowns joined together (bifid crown); however, the tooth has one root, which is larger than that of the other incisors (see the lower arrow). The pulp cavity of this large tooth is also larger than the other pulp (see the middle arrow). A count of the teeth shows only the normal number (four incisors). Since this patient has never removed a tooth before, it is reasonable to say that the central and lateral incisors on the left side have fused together during dentinogenesis.

Diagnosis: Fusion of the central and lateral incisors on the left side of the lower jaw.

Differential diagnosis:


A and B are periapical radiographs of the upper anterior teeth. Very obvious is the presence of a miniature tooth or tooth-like structure, erupting in the opposite direction (i.e., inverted).

6.What is your diagnosis?

Inverted mesiodens.

7.What is the main difference in the two cases?

The mesiodens in B is not only creating pressure effect on the roots of one of the upper centrals, but it is also responsible for the rotation of one of the developing lateral incisors and it is responsible for the creation of the diastema seen.

8.Advice the dentist on the treatment or management.

Both mesiodens must be removed surgically by raising a flap and skillfully drilling out the surrounding bone before elevation so as not to damage the

#### **Figure 30.**

*Periapical radiograph showing double teeth which is consistent with fusion of the lower central and lateral incisors.*

roots and crowns of the central incisors. Additionally, the situation in B may warrant endodontic treatment of upper central incisor on the right and also orthodontic treatment to correct anterior crowding and the elimination of the diastema (**Figure 31**).

1.Utilize the three radiographs to arrive at just one diagnosis

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This patient has cleiodocranial dysostosis.

	- 1.Extremely short/almost absent clavicle (hypoplasia or aplasia of the clavicle).
	- 2.Bossing of the forehead (the head actually looks big because of frontal and parietal bossing).
	- 3.Multiple unerupted supernumerary teeth.
	- 4.Premature fusion of the coronal suture (brachycephaly).

**Figure 31.** *Periapical radiographs showing inverted mesiodens of the upper jaw.*

7.What type of developmental dental defect is this

Syndrome-associated DDD (**Figure 32**) [2].

The clinical picture above is that of a 27-year old radiographer who presented for the surgical removal of the impacted third molars and also all the four parapremolars (supernumerary teeth) shown.

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See arrow pointing at the carious lesion on the first premolar on the right side.

#### **Figure 32.**

*Chest radiograph, lateral skull view radiograph and DPT showing, absence of clavicle, bossing of the cranial bones and multiple unerupted supernumerary teeth respectively in a patient with cleodocranial dysostosis.*

*The Radiology of Developmental Dental Defects Demystified: An e-Based Learning System DOI: http://dx.doi.org/10.5772/intechopen.101435*

5.Would you consider any form of radiography?

Yes.

6.List the possible radiographic investigations to be done:


There are no parapremolars seen on this radiograph.

The following are a list of radiographic changes of suspicion:

1.Loss of the radiolucency of the mental foramen.

2. Increased uniformed radiopacification of the crowns of all the presumed normal premolars when compared with all the other teeth in the jaw, without the presence of a radiopaque restoration.

#### **Figure 34.**

*DPT of a the patient shown in Figure 33 above, showing increased radiopacification of the first and second premolar bilaterally as the only radiographic finding to justify the clinical presentation shown in Figure 33.*

(a)

**Figure 35.** *DPT of a patient with regional odontodysplasia (both DPT'S)*

*The Radiology of Developmental Dental Defects Demystified: An e-Based Learning System DOI: http://dx.doi.org/10.5772/intechopen.101435*

> 3.The absence of the large carious lesion seen clinically on the first premolar on right side on the radiograph (**Figure 34**) [2–4].

This condition is exceedingly rare in occurrence (**Figure 35a** and **b**). It is a DDD which has no hereditary attribute. There is no sex predilection, but females seem to be more affected by regional odontoplasia. The literature is replete of the clinical, radiological and histological information on regional odontoplasia [5].

Now, read the article below and utilize the information obtained to present a power point presentation on the following: The Investigation of Regional Odontoplasia against the background of the following:

1.Accurate diagnosis of regional odontoplasia.

2.Long-term management and follow-up.

3.Reason for histopathology [1].
