|Year : 2010 | Volume
| Issue : 4 | Page : 315-318
BV Thimma Reddy1, KK Vinay Reddy2, B Sunil3, R Pujita3, K Kiran3, KR Kranthi4
1 Professor and Head, Department of Pedodontics and Preventive Dentistry, Mamata Dental College and Hospital, Giri Prasad Nagar, Khammam, Andhra Pradesh, India
2 Professor and Head, Department of Oral Medicine and Radiology, Mamata Dental College and Hospital, Giri Prasad Nagar, Khammam, Andhra Pradesh, India
3 Senior Lecturer, Department of Pedodontics and Preventive Dentistry, Mamata Dental College and Hospital, Giri Prasad Nagar, Khammam, Andhra Pradesh, India
4 Post-Graduate Student, Department of Pedodontics and Preventive Dentistry, Mamata Dental College and Hospital, Giri Prasad Nagar, Khammam, Andhra Pradesh, India
|Date of Web Publication||25-Jan-2011|
B V Thimma Reddy
Department of Pedodontics and Preventive dentistry, Mamata Dental College and Hospital, Giri Prasad Nagar, Khammam - 507 002, Andhra Pradesh
| Abstract|| |
Regional odontodysplasia (ROD) is a rare developmental anomaly involving both mesodermal and ectodermal components in a group of contiguous teeth. It affects the primary and permanent dentitions in the maxilla and the mandible or both, however, the maxilla is frequently involved. Although the etiology of the ROD is uncertain, it has been suggested that numerous other factors play a role. The treatment plan should be based on the degree of involvement as well as the functional and esthetic needs in each case. This article reports the case of a 5-year-old boy presenting a rare anomaly on the right side of the maxillary arch. The treatment performed was rehabilitation with temporary partial acrylic denture and periodic checkups. The extraction was followed by rehabilitation with dental implants. The main aim of this article is to provide valuable information to pediatric dentists about the review and treatment alternatives for ROD.
Keywords: Ghost teeth, odontodysplasia, tooth autotransplantation
|How to cite this article:|
Thimma Reddy B V, Vinay Reddy K K, Sunil B, Pujita R, Kiran K, Kranthi K R. Regional odontodysplasia. J Indian Soc Pedod Prev Dent 2010;28:315-8
|How to cite this URL:|
Thimma Reddy B V, Vinay Reddy K K, Sunil B, Pujita R, Kiran K, Kranthi K R. Regional odontodysplasia. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2013 May 25];28:315-8. Available from: http://www.jisppd.com/text.asp?2010/28/4/315/76166
| Introduction|| |
Regional odontodysplasia (ROD) is a relatively rare nonhereditary developmental anomaly of the dental hard tissues of mesodermal and ectodermal origin with the specific clinical, radiographic, and histologic characteristics.  This condition was first described by Hitchin.  But the first report of this condition was published by McCall et al, in 1947, radiographically.  However, the term "Odontodysplasia" was coined by Zegarelli et al, in 1963, later Pindborg added the prefix "Regional" to it, as this anomaly has the tendency to affect only one quadrant. Since then many terms, such as Odontodysplasia, Ghost Teeth, Odontogenesis Imperfecta, Unilateral Dental Malformation, Familial Amelodentinal Dysplasia, Regional Odontodysplasia, Amelogenesis Imperfecta Nonhereditary Segmentalis, and Localized Arrested Tooth Development, have been used to describe it. ,,
The etiology of ROD is obscure. Many factors have been associated with it. Clinically the affected teeth demonstrate abnormal morphology, an irregular surface contour with pitting and grooved surface, yellowish or brown discoloration, hypoplastic or hypocalcified, and the teeth eruption may be delayed or completely failed.  The enamel is soft on probing and the affected teeth are more susceptible to caries and extremely friable fracturing at a slightest trauma.  Radiographically, the affected teeth show abnormal morphology and hypoplastic crowns.  There is lack of contrast between enamel and dentin when compared with the unaffected counterparts and there is little demarcation between enamel and dentin.  Additionally the enamel and dentin layers are very thin, giving the teeth a typical "Ghost-like" appearance. The pulp chambers are abnormally enlarged with open apices and enlarged follicles, and the teeth tend to be shorter, particularly the roots and shell-like crowns giving a dysmorphic appearance.
Histologically all the structures of the dental germ are affected.  Typically the affected teeth show hypoplasticity, hypomineralization, and matrix-enriched enamel of variable thickness. , Coronal dentin is fibrous, consisting of clefts and a reduced number of dentinal tubules. Pulpal radicular dentin is generally more normal in structure and calcification. Cementum is less affected. ,,
The present article reports the case of a 5-year-old boy presenting this rare anomaly affecting the right maxilla and its management.
| Case Report|| |
A 5-year-old boy was reported to the Department of Pedodontics and Preventive Dentistry, Mamata Dental College, Khammam, Andhra Pradesh, India, with the compliant of missing teeth in the right maxilla. His prenatal, birth, medical, and family history was unremarkable. According to his mother, her son's teeth erupted differently from others and were yellowish brown in color and were gradually destroyed after their eruption accompanied by pain. On extraoral examination, the patient exhibited bilaterally symmetrical face with mid-face deficiency.
Clinical examination revealed that all the deciduous teeth were present except for the maxillary right quadrant where there were soft friable spicules of teeth in the incisor and molar regions by the time the patient reported to us [Figure 1]. Dental caries was present in the left maxillary and mandibular first and second primary molars and the left maxillary central incisor [Figure 1],[Figure 2],[Figure 3]. Occlusion was normal on the left side but on the right side the mandibular molars were supraerupted in such a way that the second molar was touching the upper alveolar ridge. Radiographically, the succedaneous permanent teeth germs showed very thin enamel and dentin layers with lack of differentiation between them and with enlarged pulp chambers, giving them a typical "Ghost-like" appearance. Radiopaque masses were found in the incisor and molar regions of the right maxilla, which were the remnants of primary teeth [Figure 4]. A diagnosis of ROD was made based on these findings.
|Figure 1 :Maxillary right quadrant where the soft friable spicules of teeth in the incisor and molar regions are evident|
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|Figure 2 :Dental caries was present in left maxillary first and second primary molars and left maxillary central incisor|
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|Figure 3 :Dental caries was present in left mandibular first and second primary molars|
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|Figure 4 :Radiographically the succedaneous permanent teeth germs showed very thin enamel and dentin layers with enlarged pulp chambers giving them a typical "Ghost-like" appearance|
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Since the involved teeth cannot be restored effectively, it was planned for removal of affected deciduous teeth and rehabilitated with a temporary maxillary acrylic removable partial denture with heat-cure acrylic resin incorporating central incisor, lateral incisor, canine, and first molar. A "C" clasp was given on the maxillary left second molar for retention [Figure 5]. Labial flange was avoided in the partial denture except for a thin acrylic representing marginal gingival for the esthetic reasons. However, it was incorporated in the second molar region for the purpose of retention. The patient was instructed to report as soon as he feels the denture loose or if any permanent tooth erupts [Figure 6].
|Figure 5 :Heat-cure acrylic removable partial denture incorporating central incisor, lateral incisor, canine, and first molar. A "C" clasp was given on the maxillary left second molar for retention|
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|Figure 6 :Restored maxillary left primary central incisor with removable partial denture|
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The patient will continue to be seen regularly for the alteration or remake of the denture as the succedaneous teeth erupt until the skeletal growth stops so that the permanent, ultimate treatment in the form of fixed prosthesis or implant prosthesis can be done. Oral hygiene instructions, dietary analysis, and advice were given and have been followed-up periodically to monitor the growth and development of the maxillary and mandibular arches.
| Discussion|| |
According to International Statistical Classification of Diseases and Related Health Problems (10th Revision Version for 2007), ROD is classified as K00.4. This is a sporadic (not inherited) developmental defect involving only a few teeth in a small region of the jaw. 
In a child with ROD, conservative treatment should be applied to preserve the affected teeth for as long as possible to provide normal jaw development.  Several reports state that if abscessed teeth are present, they should be extracted and edentulous areas should be restored with acrylic removable appliances to
- Maintain esthetic and masticatory functions;
- Avoid overeruption of opposing teeth;
- achieve space preservation and normal vertical dimension; and
- Lessen the psychological effects of premature tooth loss.
As the bone itself is not affected by ROD, autotransplantation offers a good alternative if suitable donor teeth are available. , Autotransplantation is an accepted therapeutic option in dentistry. A risk of ankylosis in autotransplanted teeth has been previously reported. Other alternative is the prosthetic treatment with implants will be considered once the patient's craniofacial growth is completed.
Although in the present case the child and her mother are satisfied with treatment, the rehabilitation in this case cannot be considered ideal because the patient's oral esthetic and function were not totally restored. For the time being, the patient is under control visits to observe the growth and the development of the maxilla and the mandible. During the appointments, the appliance has been adjusted or changed for a new one.
The permanent teeth will probably not erupt or will have altered eruption pattern. The noninfected permanent teeth will not be extracted before eruption because these teeth help maintaining the alveolar bone. The presence of teeth is important during the skeletal growth phase. However, the prognosis of the affected permanent teeth is poor. Because of this, in the future, the extraction of permanent teeth and the rehabilitation with dental implants must be evaluated.  The therapeutic considerations in cases of ROD are illustrated in [Figure 7].
|Figure 7 :Therapeutic considerations in cases of regional odontodysplasia|
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]