Ismail, Ahmad Faisal

The International Islamic University Malaysia Repository

CERT I F I CATE  OF  APPREC IA T IOND R  A HMA D  F A I S A L  I S M A I LS M I L E  M A S T E R Y  S O L U T I O N S H E R E B Y  T H A N K SFOR PRESENTING A WEBINAR TITLED D R  T I V I Y A  R A T H A K R I S H N A NDirectorD R  S A N D I Y A  S U P R AM A N I A MDirectorP U R S U I N G  P A E D I A T R I C  D E N T A L  A N OMA L I E SON WEDNESDAY, THE 27TH OF JANUARY 202128-Jan-211DR AHMAD FAISAL ISMAILBDS(Malaya)  MDS(PaediatrDent)(Hong Kong)MPaedDent RCS(Edinburgh)  MPaedDent RCPS(Glasgow)AM(Malaysia) Introduction Classification of dental anomalies Managing common dental anomalies in children Principle management of unerupted teeth in children Anomalies of tooth development are relatively common and may occur as an isolated condition or in association with other anomalies/syndromes Disorders of the tooth development can be due to:- inheritance (genetic) - generalized- acquired (external exposure) – generalized/localized Primary dentition begins to form at approximately six weeks in utero and the permanent dentition continues through late adolescence. Developmental dental anomalies often exhibit patterns that reflect the stage of development during which the malformation occurs- hypodontia or supernumerary teeth  disruptions in tooth initiation - anomalies of size and shape  disruptions during morphodifferentiation- amelogenesis/dentinogenesis imperfecta  disruptions during mineralization Dental anomalies can have profound negative consequences for the affected individual and the family esthetic concerns, masticatory difficulties, tooth sensitivity, financial burdens, and complex dental treatment Causative factors- hereditary/genetic- amelogenesis imperfecta- dentinogenesis imperfecta- environmental/external- fluorosis- dilacerations of root*this classification is of less clinical significance28-Jan-212 Developmental stages- dental tissue- enamel (amelogenesis imperfecta)- dentine (dentinogenesis imperfecta, dentinal dysplasia)- tooth size- smaller (microdontia)- larger (macrodontia)- morphology- double teeth (fusion/gemination)- dens evaginatus/invaginatus- number of teeth- reduce number (hypodontia)- increase number (hyperdontia/supernumerary) Early diagnosis of dental anomalies should allow for more comprehensive treatment planning, proper prognosis and less extensive interception Previous reports in the literature suggest that the presence of a dental anomaly in the primary dentition may represent a risk factor for the recurrence of the anomaly in the permanent dentition However, the prevalence rate of the recurrence as well as the type of dental anomaly in the permanent dentition may vary 60.9% of sample subject had anomalies of the succedaneous permanent teethWhittingthon and Durward, 1996 In a Malaysian subjects, it was reported 100% of replication for hypodontia, 59% for double teeth, and 50% for hyperdontiaNik-Hussein and Abdul Majid, 1996 Almost identical prevalence rates were reported for hypodontia and double teeth in a sample of Croatian childrenSkrinjaric´ and Barac-Furtinovic, 1991 Hypodontia in the primary dentition is almost systematically represented itself in the permanent dentition Supernumerary teeth in the primary dentition are not a strong risk factor for hyperdontia in the permanent dentition A strong relationship was found between the presence of fusion of primary teeth and hypodontia in the permanent dentitionMarinelli et al., 2012 Psychosocial aspect of patient and families affected Patient’s cooperation and determination Causative factor ie environmental/genetic Underlying medical condition/associated syndromes Amelogenesis imperfecta Dentinogenesis imperfecta28-Jan-213 Amelogenesis imperfecta (AI) is a term used to describe a group of hereditary conditions that affect the structure and appearance of dental enamel Prevalence- 43:10,000 in Turkey- 14:10,000 in Sweden- 10:10,000 in Argentina- 1.25:10,000 in Israel These values suggests that the average global prevalence is <0.5% (<1 in 200).  It affects all or nearly all of the teeth in both the primary and permanent dentitions The most widely accepted classification:- hypocalcified- hypoplastic pitted- hypoplastic generalized- hypomaturation The variability of the appearance of the different types of AI makes identification difficult Clinicians treating children and adolescents with AI must address the clinical and emotional demands of these disorders with sensitivity It is important to establish good rapport with the child and family early Early identification and preventive interventions are critical Regular periodic examinations can identify teeth needing care as they erupt Fluoride applications and desensitizing agents may diminish tooth sensitivity The appearance, quality, and amount of affected enamel and dentin will dictate the type of restorations necessary to achieve esthetic, masticatory, and functional health When the enamel is intact but discolored, bleaching and/or microabrasion may be used to enhance the appearance If the enamel is hypocalcified, composite resin or porcelain veneers may be able to be retained with bonding If the enamel or dentin cannot be bonded, full coverage restorations will be required During the primary dentition, it is important to restore the teeth for adequate function and to maintain adequate arch parameters The permanent dentition usually involves a complex treatment plan with specialists from multiple disciplines The fabrication of an occlusal splint is advocated to reestablish vertical dimension when full mouth rehabilitation is necessary28-Jan-214 Primary dentition- treatment provided reflects the degree of symptoms- glass ionomer or composite direct veneers of anterior teeth to address aesthetics- stainless steel crowns (SSC) for primary molars Permanent dentition- premolars and permanent canines  minimal intervention is the ideal treatment plan- full coronal coverage restoration28-Jan-215 Dentinogenesis imperfecta (DI) is a hereditary developmental disturbance of the dentin originating during the histodifferentiation stage of tooth development. Shields 1973- DI type I (with osteogenesis imperfecta)- DI type II- DI type III Children with unexplained bone fracturing should be evaluated for DI as a possible indicator of an undiagnosed case of OI28-Jan-216 Clinically, the teeth have a variable blue-gray to yellow-brown discoloration that appears opalescent Due to the defective, abnormally-colored dentin shining through the translucent enamel Due to the lack of support of the poorly mineralized dentin, enamel frequently fractures from the teeth leading to rapid wear and attrition of the teeth Radiographically:- bulbous crowns- cervical constriction- thin roots- early obliteration of the root canal and pulp chambers Periapical abscess, radiolucencies and root fractures are common Dental approach for managing DI will vary depending on the severity of the clinical expression Early identification and preventive interventions are critical Fluoride applications and desen-sitizing agents may diminish tooth sensitivity Routine restorative techniques often can be used effectively to treat mild to moderate DI. In more severe cases with significant enamel fracturing and rapid dental wear, the treatment of choice is full coverage restorations in both the primary and permanent dentitions Restorative stabilization of the dentition should be completed before excessive wear and loss of vertical dimension occur Because of pulpal obliteration, apical surgery may be required to maintain the abscessed teeth Attempting to negotiate and instrument obliterated canals in DI teeth can result in lateral perforation due to the poorly mineralized dentin28-Jan-217 Type I DI (Shields 1973) Radiographically, the teeth have short, constricted roots and dentine hypertrophy leading to pulpal obliteration The teeth of both dentitions are typically amber and translucent and show significant attrition OI – prone to fracture- blue sclera28-Jan-218 Fusion Gemination Dens invaginatus Dens evaginatus Tannenbaum and Alling in 1963 determined gemination as the formation of equivalent of two teeth from the same follicle Geminated teeth arise from a single tooth germ by invagination, resulting as  a single tooth with two completely separated crowns The anomalous tooth has an enlargement in mesial-distal diameter than normal and is counted as one. Thus, total number of teeth in dental arch is normal Preventive – fissure sealant and monitoring Endodontic therapy Hemisection + endodontic therapy Restorative camouflage28-Jan-219 Pindborg defined fusion as the combination of two or more separate developing teeth Fusion can be complete or incomplete depending on level of development If fusion starts before calcification stage, the teeth unite completely and the crown incorporates enamel, dentin, cementum and pulp of both the teeth Incomplete fusion happens at a later level and resultant tooth may exhibitive separate crowns and limited to root alone with combined or separate pulp canals Treatment options:- preventive- endodontic therapy- surgical hemisection- extraction of anomalous tooth28-Jan-2110 Dens in dente Consequence of an invagination on the external surface area of the tooth crown before calcification The invagination ranges from a short pit limited to the crown to a deep invagination into the root Most of the cases are encountered in maxilla with the maxillary lateral incisors being mostly affected, followed by central incisors, premolars, canines and molars The classical radiographic appearance is a pear-shaped invagination of enamel and dentin with a narrow structure at the opening on the surface area of the tooth The invagination acts as a channel for entrance of irritants and microorganisms; and lead to development of dental caries and abscess The endodontic treatment of invaginated teeth may be challenging because of:- difficulties in accessing the root canals- complex variations of internal morphology Developmental aberration of a tooth resulting in formation of one accessory cusp Clinically presented as abnormal tubercle, elevation, protuberance, excrescence, extrusion or a bulge Tubercle commonly contains pulp tissue; occasionally having slender pulp horn Tubercle may have fracture or be abraded as soon as the tooth comes into occlusion, exposing the pulp28-Jan-2111 Early diagnosis and management are necessary to prevent occlusal interference, compromised aesthetics, carious developmental grooves, or irritation of the tongue while speech and mastication Management:- composite restoration to protect tubercle- selective grinding of tubercle- coronal pulpotomy Microdontia Macrodontia Refers to teeth that appear larger than normal size Reported prevalence is around 0.03-1.9% Isolated macrodontia can result from twinning abnormalities during proliferation phase Generalized macrodontia usually associated with Klinefeltersyndrome and pituitary gigantism One or more teeth appear dimensionally smaller outside usual limit of variations Classification of microdontia:- single tooth microdontia- relative generalized microdontia- true generalized microdontia True generalized microdontia is rare, and usually associated with systemic upset or syndromes Treatment options (may be in combination of hypodontia):- orthodontic treatment for space distribution- restorative treatment- extraction- combination28-Jan-211228-Jan-211328-Jan-2114 Hypodontia (less number of tooth) Hyperdontia (increase number of tooth) Congenital absence of one or more teeth Oligodontia – more than 6 teeth missing Anodontia – absence of primary and/or permanent dentition Prevalence of missing teeth- primary dentition – maxillary lateral incisor- permanent dentition – 3rd molar > mandibular second premolar > maxillary lateral incisor > maxillary second premolar prevalence of hypodontia ranges from 1% in African and Australian aborigines to 30% in Japanese people Missing permanent teeth are seen in 40%-50% of patients who have missing primary teeth Aetiology – genetic and environmental Hypodontia usually associated with microdontia Hypodontia usually requires extensive and complex treatments, ranging from single restoration to surgery, multiple restorations, with lifelong maintenance Treatment depends on:- pattern of tooth absence- residual spacing- underlying malocclusion- patient’s attitudes Often require multidisciplinary intervention Composite restoration is strongly advised in masking conical-shaped tooth Anodontia – full dentures are required and possibility of early implant placement Communication with orthodontist – to open or close spaces28-Jan-211528-Jan-2116 Characterized by thin, sparse hair, dry skin, oligodontia and absence of sweat glands Heat intolerance  unable to cool themselves  hyperthermia Tooth agenesis is common in many different type of EDs, can affect the growth of the jaws Genetic association – EDA, EDAR, WNT10A Multidisciplinary team management Coordinated preventive strategies Minimize of inappropriate treatment May consider early implant placement Genetic counseling28-Jan-2117 Mesiodens is the most common supernumerary tooth, with a reported prevalence between 0.15 to 1.9 % Most common sequelae of mesiodentes are impaction (26–52 %) and ectopic eruption (28–82 %) of the uneruptedpermanent central incisors Patients with multiple mesiodentes typically have an associated craniofacial disorder; such as Gardner syndrome, cleidocranialdysplasia (CCD), or cleft-lip and/or cleft palate Sufficient arch space has to be ensured or orthodonticallycreated Early surgical extraction of a mesiodens or mesiodentes(ideally before 7 years of age) Re-evaluation after 2–3 months to assess for any natural eruption of the permanent tooth Application of orthodontic traction in the event of non-eruption28-Jan-2118 Supernumerary teeth are considered to be a numerical anomaly, characterised by an excessive number of teeth May appear as an isolated finding, or associated with different syndromes such as Gardner’s syndrome, cleido-cranial dysosthosis Prevalence ranges between:- 0.5 to 3.8% in patients with permanent teeth- 0.35 to 0.6% in patients with primary dentition This anomaly is usually detected in routine exams and 90% of the cases are located in the anterior region of the maxilla Complications associated with unerupted supernumerary:- delayed/unerupted permanent tooth- displacement/crowding- incomplete closure during orthodontic treatment- resorption of adjacent root Localization and identification of possible complications If teeth are causing no complications and are not likely to interfere with tooth movement, they can be monitored with yearly radiographic review If supernumerary teeth are associated with complications, it is usual to extract such teeth, which usually involves a surgical procedure28-Jan-2119Surgical removal of supernumeray teeth GA.MOV28-Jan-2120Surgical removal of unerupted supernumerary tooth_Trim.mp4 The maxillary incisor is considered unerupted when:- there is no history of previous extraction- eruption of contralateral incisor has occurred 6 months earlier- both maxillary incisors are unerupted but the lower incisors have erupted one year previously- deviation from the normal sequence of eruption such as lateral incisors erupt before the central incisors Aetiologies:- congenital (odontomes, ectopic position)- environmental (retained deciduous, previous trauma, scar tissue) Can be prevented with proper treatment timing and early diagnosis at ages 6 to 8 years The earlier removal of the causative factor, the better is the prognosis Teeth that have not erupted 6 months after normal eruption time should be investigated radiographically Retained deciduous teeth should be removed if the incisor is close to eruption When space is created for eruption, 75% will erupt spontaneously Obstructions should be removed as early as possible Presence of supernumerary teeth --> 54%-74% will erupt spontaneously within 16 months provided sufficient space is available Create/maintain space Removal of physical obstruction (if any) Monitor eruption / orthodontic tractionIf the tooth still does not erupted  surgical intervention28-Jan-212128-Jan-212228-Jan-212328-Jan-212428-Jan-2125 Do I have sound knowledge/understanding of the anomaly? Is there any underlying conditions? Does patient and parents have the favorable behavior? Will patient benefit/require comprehensive management? Am I comfortable to do the procedure? Does my clinic have the necessary equipment? Common things occurs commonly Dentist may be the first to recognize anomalies Presence of generalized dental anomaly may be associated with underlying condition Anomaly in primary dentition may be associated with anomaly in permanent dentition28-Jan-2126You don’t have to rely on textbook. Write your own.- Dr Frances AndreasenYou cannot stop learning. Being a specialist means you need to learn throughout your career.- Prof Mark HectorYou have to love your job to be great- Prof Piranit KantaputraofficialahmadfaisalAhmad Faisaldrfaisal@iium.edu.my

Pursuing paediatric dental anomalies

http://irep.iium.edu.my/88190/1/88190_Pursuing%20paediatric%20dental%20anomalies_new.pdf

Pursuing paediatric dental anomalies

Abstract

Similar works

Full text

Available Versions

The International Islamic University Malaysia Repository