Dental Anomalies III

Question 1

Treatment options for dentinogenesis imperfecta?

Answer 1

OHI and prophylaxis
Full crown coverage with composite - difficult and not most aesthetic, bond failure likely
Indirect composite for anteriors
Direct composite for posteriors
Can put gold onlays on posteriors
BUT all of the above depends on the pt case

Question 2

Clinical considerations for dentinogenesis imperfecta management?

Answer 2

Mask underlying discolouration
Reduced shear bond strength of resin composites
Orthodontic management
Life long maintenance of restorative interventions

Question 3

Amelogenesis imperfecta tx options?

Answer 3

OHI and prophylaxis
Scale under LA - teeth v sensitive, calculus helps with sensitivity
Full coverage crowns

Question 4

Management of tooth morphology anomalies?

Answer 4

Early diagnosis of dens in dente as subsequent RCT is difficult, aim to FS/occlude communicating channels or caries prone sites
Judicious grinding of talon cusps and duraphat applications after root formation is complete
Management of double teeth - very complex, seek specialist opinion (orthodontic assessment) management is dependent on pulp morphology

Question 5

What to look for when someone has a dental anomaly?

Answer 5

Look out for other anomalies as well

Question 6

Talon cusp issues?

Answer 6

Occlusal interferences may lead to displaced teeth, tmj dysfunction, acute apical periodontitis
Caries
Tongue irritation
Poor aesthetics
Attrition or fracture of cusp with pulpal exposure and ensuring pulp necrosis
Large talon cusps that project away from the tooth surface are most likely to contain pulpal tissue

Question 7

Treatment of talon cusps?

Answer 7

Early use of FS or composite to occlude caries prone fissures between talon cusp and tooth surfaces
Give appropriate OH instruction

Cusp reduction

• Be aware of possibility of pulp exposure
• Gradual cusp reduction with reparative dentine formation (and pulpal recession) e.g. 1-1.5mm at each visit
• Place F varnish after each visit to desensitise exposed dentine

Question 8

How to manage double teeth/germinated teeth?

Answer 8

Radiograph
Decide root morphology - if one tooth with shared root or separate roots

Accept
Fill in groove with composite or can you split tooth via raising a flap and separating the teeth
Section, remove portion, restore, align
Or extraction and partial denture

Question 9

What condition is hypodontia common in?

Answer 9

Anhydrotic ectodermal dysplasia

Question 10

What condition is hyperdontia common in?

Answer 10

Cleidocranial dysostosis

Question 11

Hypodontia clinical significance?

Answer 11

Poor aesthetics
Compromised function
Loss of vertical dimension

Question 12

Hypodontia management?

Answer 12

Ortho, paeds and restorative input
Maintain dentition - prevention
Ortho management of spacing
Partial dentures
Adhesive dentistry e.g. adhesive bridges
Implants

Question 13

Problems of hypodontia management?

Answer 13

Pt compliance e.g if pt young too much dentistry can put them off, parents input
Small crowns
Lack of undercuts
Lack of alveolar bone = difficult doing implants
Loss of vertical dimension

Question 14

Clinical significance of hyperdontia?

Answer 14

Poor aesthetics
Malocclusion - impediment to tooth eruption
Pathology associated with unerupted teeth - resorption of adjacent teeth; follicular changes

Question 15

Hyperdontia management?

Answer 15

Early diagnosis - appropriate radiographs
Ortho opinion regarding supplemental teeth
Referral for surgical removal if necessary
Space maintenance where necessary
Review of unerupted teeth

Question 16

Anomalies with tooth eruption?

Answer 16

Infraocclusion
Primary failure of eruption
Ectopic or failed eruption

Question 17

Clinical significance of infraocclusion?

Answer 17

Malocclusion

Caries/PD

Question 18

Management of infraocclusion?

Answer 18

Early diagnosis - regular review, photos, study models, usually monitoring is necessary, radiographs to see if permanents present underneath (if missing can extract infraoccluded tooth and permanent behind will move forward to close space)
Ortho opinion where successor is absent
Space maintenance where necessary, composite onlay over infraoccluded tooth to keep space, GIC, PMC, overdenture
Early extraction to avoid need for more complex surgery, care with ankylosis

Question 19

What is the problem with ectopic eruption of first permanent molars?

Answer 19

Pulp necrosis in Es where external resorption exposes pulp to oral microbes
Hold = tooth is not coming through - take E out to get 6 through
Jump = 6 comes down