|Year : 2011 | Volume
| Issue : 4 | Page : 323-326
DN Mehta, D Bailoor, B Patel
Department of Oral Medicine and Radiology, Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat, India
|Date of Web Publication||21-Oct-2011|
D N Mehta
23, Sunita society, Beh. C. N. Vidhyalaya, Bhuadharpur Road, Ambawadi, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Regional odontodysplasia is an unusual developmental anomaly in which ectodermal and mesodermal tooth components are affected. We present a rare case of a developmental anomaly called regional odontodysplasia or 'ghost teeth' in a 12-year-old Indian girl. The anomaly affected right maxillary permanent teeth. The mandibular teeth were unaffected. The clinical, radiographic and histological features are reviewed. The management of affected patients is discussed.
Keywords: Ghost teeth, hypoplastic permanent teeth, odontodysplasia
|How to cite this article:|
Mehta D N, Bailoor D, Patel B. Regional odontodysplasia. J Indian Soc Pedod Prev Dent 2011;29:323-6
| Introduction|| |
Regional odontodysplasia (ROD) is an uncommon nonhereditary developmental anomaly affecting localized area of dental hard tissue derived from both the ectoderm and mesoderm. 
ROD was first reported by Hitchin in 1934, ascribed by Crawford. , McCall and Wald were credited for publishing the first report of odontodysplasia in 1947, and termed the condition 'arrested tooth development'. , In 1954, Rushton introduced the term 'shell teeth' to describe radiographic finding. , In 1963, Zegarelli et al. were the first to suggest the term 'odontodysplasia'. ,, Pindborg added the prefix 'regional' as the condition affects a group of several adjacent teeth in a particular segment of jaw. 
| Case Report|| |
A 12-year-old girl came to Department of Oral Medicine and Radiology, Karnavati School of Dentistry, Uvarsad, Gujarat with chief complaint of missing or unerupted permanent maxillary right teeth since 5 years. Both parents reported no previous history of dental anomalies on either side of family. Her prenatal, natal and medical history was unremarkable. Patient was not giving any history of previous extraction of any permanent teeth. Deciduous teeth were normal and exfoliated timely as reported by patient's mother.
Patient had history of tobacco chewing, two packets/day.
On examination, permanent teeth were present in all segments except maxillary right in which tips of lateral incisor, second premolar were present along with fully erupted right maxillary canine and partially erupted teeth- right maxillary first premolar and right maxillary second molar. Clinically right maxillary central incisor and maxillary first molar were missing. No deciduous teeth were present in patient. All the teeth in right maxillary region showed abnormal morphology, irregular surface, yellowish brown color, and no carious involvement [Figure 1] and [Figure 2].
|Figure 1: Multiple discolored hypoplastic teeth along with multiple unerupted teeth in right maxillary segment|
Click here to view
Periapical, panaromic, and occlusal radiographs were made. [Figure 3], [Figure 4] and [Figure 5] Radiograph showed abnormally formed teeth-right maxillary teeth-central incisor, canine, first premolar with short roots. Periapical radiolucency was present in relation with right maxillary first and second premolar teeth. In right maxillary segment, except right second molar, no clear demarcation was present between enamel and dentin giving "ghost like" appearance to all present teeth. Right maxillary first molar was missing. In all other segments, all permanent teeth were present with normal radiodensity of enamel and dentine. On the basis of clinical and radiographic features diagnosis of regional odontodysplasia affecting right maxillary segment was made.
|Figure 3: OPG showing "ghost like" teeth in right maxillary segment. Missing right maxillary first molar|
Click here to view
|Figure 4: Maxillary occlusal radiograph showing "ghost like" teeth in right maxillary segment|
Click here to view
|Figure 5: IOPA showing "ghost like" teeth with short roots. Periapical radiolucency present in relation with maxillary right first and second premolar|
Click here to view
As affected teeth in right maxillary segment were abnormally formed with short and slender roots, orthodontic eruption was not possible. Patient was advised for extraction of right maxillary canine, surgical removal right maxillary central and lateral incisor, both right maxillary premolars followed by a removable heat cure acrylic partial denture two months postoperatively. [Figure 5]
| Discussion|| |
Regional odontodysplasia affects histologic elements of dental organ in a localized area of dentition while other teeth in the same individual are normal.  The condition is characterized by deficient and abnormal formation of both dentin and enamel. 
Regional odontodysplasia exhibits no racial predilection. Females are more commonly affected than males. The maxilla is involved twice commonly than mandible. It is usually unilateral and rarely crosses the midline. It affects both primary and permanent dentition and appears to be more common in the anterior segment. ,,,
The etiology of this dental anomaly is uncertain, although several factors, such as local trauma or infection, teratogenic drugs, local circulatory disorders, Rh-incompatibility, irradiation, neural damage, hyperpyrexia, metabolic and nutritional disorders, vitamin deficiency, activation of latent viruses residing in odontogenic epithelium, hereditary and somatic mutation and neural damage. , In our case, no identifiable etiology for ROD was present.
The criteria for diagnosis of regional odontodysplasia are primarily clinical and radiographic, sometimes supplemented by histologic findings.  Clinically affected teeth have an abnormal morphology, irregular contour with pitting and grooves. The teeth appear to be discolored hypoplastic and hypocalcified, discolored, yellow or yellowish brown. , The thin enamel is soft on probing and more susceptible to caries and is extremely friable at slightest trauma. , Tooth eruption is delayed or does not occur.  The most frequent clinical symptoms after eruption of teeth with regional odontodysplasia are gingival swelling periapical infection or abscess formation in absence of caries.  Although dentinal dysplasia, amelogenesis and dentinogenesis imperfecta show some similarities to ROD, these conditions affect the entire dentition in contrast to the segmental involvement seen in ROD. , In the present case, hypoplastic, discolored, multiple partially erupted/unerupted teeth were present in right maxillary segment.
Radiographically, a demarcation between hypo-mineralized enamel and hypomineralized dentin is not visible. The affected teeth show a "ghost like" appearance due to reduced thickness and radiodensity of enamel and dentin.  The teeth tend to be shorter, have short roots with wide open apices and abnormally wide pulp chambers and canals.  In the present case, teeth in right maxillary segment showed typical ghost like appearance with short roots and right maxillary first - second premolar teeth showed periapical radiolucency.
Histologically, enamel characterized as hypoplastic and hypocalcified with variable thickness. The dentin layer is reduced and presented a decreased quantity of tubules that are also irregularly distributed, extensive interglobular and amorphous dentin areas, predentin layer enlargement and clefts that could establish communication between the pulp and oral cavity. ,
Patient affected with ROD should be treated with multidisciplinary approach. It is somewhat controversial too. Majority of clinicians suggest removal of affected teeth while others recommend preserving the affected teeth as long as possible. Treatment should be based on the consideration of the age of the patient, previous dental experience, the number of affected teeth, and the attitude and wishes of the child and parents alike. In our case teeth were impacted and having abnormal structure and short, slender root. So surgical removal and extraction of affected teeth was the only appropriate option.  Orthodontic traction was not possible due to short roots. Prosthetic replacement was done to improve esthetics and function.
| Conclusions|| |
Various clinical and radiographic features of regional odontodysplaisa are discussed here. This helps dentist to diagnose this condition at an early age. The treatment plan should be based on the age of the patient, degree of anomaly, the functional and esthetical needs of individual case.
| References|| |
|1.||Gondim JO, Pretel H, Ramalho LT, Santos-Pinto LA, Giro EM. Regional odontodysplasia in early childhood: A clinical and histological study. J Indian Soc Pedod Prev Dent 2009;27:175-8. |
|2.||Cahuana A, González Y, Palma C. Clinical management of regional odontodysplasia. Pediatr Dent 2005;27:34-9. |
|3.||Kappadi D, Ramasetty P, Rai K, Rahim AM. Regional odontodysplasia: An unusual case report. J Oral Maxillofac Pathol 2009;13:62-6. |
|4.||Magalhães AC, Pessan JP, Cunha RF, Delbem AC. Regional odontodysplasia: Case report. J Appl Oral Sci 2007;15:465-9. |
|5.||Gunduz K, Zengin Z, Celenk P, Ozden B, Kurt M, Gunhan O. Regional odontodysplasia of the deciduous and permanent teeth associated with eruption disorders: A case report. Med Oral Patol Oral Cir Bucal 2008;13:E563-6. |
|6.||Iizawa F, Kinjoh N, Taguchi Y. Regional odontodysplasia: Long- term observation of a case on the mandibular left side. Pediatr Dent J 2010;20:103-9. |
|7.||Guzman R, Elliott MA, Rossie KM. Odontodysplasia in a pediatric patient: Literature review and case report. Pediatr Dent 1990;12:45-8. |
|8.||Marques AC, Castro WH, do Carmo MA. Regional odontodysplasia: An unusual case with a conservative approach. Br Dent J 1999;186:522-4. |
|9.||Cho SY. Conservative Management of Regional Odontodysplasia: Case Report. J Can Dent Assoc 2006;72:735-8. |
|10.||Thimma Reddy BV, Vinay Reddy KK, Sunil B, Pujita R, Kiran K, Kranthi KR. Regional odontodysplasia. J Indian Soc Pedod Prev Dent 2010;28:315-8. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]