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CASE REPORT
Year : 2012  |  Volume : 30  |  Issue : 2  |  Page : 176-178
 

Regional odontodysplasia: A case of progressive tooth development


Oral and Maxillofacial Radiology, Department General Dentistry, Tufts University School of Dental Medicine, Boston, MA, USA

Date of Web Publication23-Aug-2012

Correspondence Address:
R Ganguly
Oral and Maxillofacial Radiology, Department General Dentistry, Tufts University School of Dental Medicine, 1 Kneeland street, Boston, MA, 02111
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.100010

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   Abstract 

Regional odontodysplasia (RO) is considered a relatively rare dental anomaly despite increasing numbers of case reports in recent years. It usually presents as a localized anomaly in tooth development affecting a few adjacent teeth in a single maxillary or mandibular quadrant. The purpose of this paper is to describe an uncommon case of regional odotodysplasia involving noncontiguous mandibular teeth, crossing the midline in a male patient, and showing progressive normalization of tooth anatomy over a period of 6 years. Typically, teeth affected with RO become pulpally involved early on and are either extracted or endodontically treated. Such reports of automatic normalization over time in RO is supportive of a more conservative treatment approach.


Keywords: Ghost teeth; odontogenesis imperfecta; regional odontodysplasia.


How to cite this article:
Ganguly R, Ramesh A. Regional odontodysplasia: A case of progressive tooth development. J Indian Soc Pedod Prev Dent 2012;30:176-8

How to cite this URL:
Ganguly R, Ramesh A. Regional odontodysplasia: A case of progressive tooth development. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2019 Jul 22];30:176-8. Available from: http://www.jisppd.com/text.asp?2012/30/2/176/100010



   Introduction Top


Regional odontodysplasia (RO) is a relatively rare nonhereditary dental anomaly typically affecting one or several contiguous teeth in one quadrant of maxilla or mandible, not crossing the midline. [1],[2],[3],[4] The teeth affected may be either primary or permanent or both. [5] There is a slight female predilection (1.4:1). [5] The criteria for diagnosing RO are predominantly based on clinical and radiographic findings, although histopathological findings are distinctive. [5] Clinically, the affected teeth appear small and abnormally shaped, have a yellowish or brownish discoloration and mottled due to hypoplasia and hypocalcification of enamel and dentin, increasing the susceptibility to caries, pulpal, and periapical inflammation. [5],[6] Radiographically, the affected teeth have a "ghostlike" ("ghost teeth") appearance due to poor mineralization of enamel and dentin surrounding wide pulp chamber and root canal with wide apical foramen. [7],[8] Many local disturbances in tooth development are suggested as etilogical factors. [1],[3],[5],[7]


   Case Report Top


An 18-year-old white male was referred to the division of oral and maxillofacial radiology for radiographic assessment of asymptomatic, discolored teeth. On clinical examination, the mandibular left first and second molars, first and second premolars, right and left canines (Teeth #s 18-22, 27) appeared slightly discolored with irregular surfaces. The mandibular central left and lateral incisors were missing. The soft tissues showed normal color and texture. On periapical radiographs, the clinically discolored teeth appeared to have an irregular, hypoplastic occlusal enamel surface. The pulp chamber and root canals of the affected teeth appeared slightly larger compared to the rest of the dentition [Figure 1]. There were faint vertical radiolucent lines in the radicular dentin running parallel to the root canals in the affected teeth [Figure 1]. The radiographic distinction between the coronal enamel and dentin was minimal in the involved teeth.
Figure 1: Periapical radiographs of mandibular teeth showing reduction in width of the pulp and increased thickness of the mineralized tissue surrounding it compared to previous radiographs. Note the vertical radiolucent lines parallel to the pulp representing incremental line

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Comparisons were made with pre-existing radiographs taken 4 years ago in 2007 [Figure 2]. A prominent difference between these and current radiographs was the significantly larger pulp chambers and root canals with minimal circumpulpal dentin-enamel cover noted in the older radiographs, showing progressive normalization of anatomy of the affected teeth over a period of 4 years.
Figure 2: Periapical radiographs of mandibular teeth showing the hypoplastic and hypomineralized crown with wide pulp chamber and root canal

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   Discussion Top


The purpose of this paper is to describe an uncommon case of regional odontodysplasia involving noncontiguous mandibular teeth, crossing the midline. Most of the reported cases describe involvement of one quadrant, especially in maxilla. [5] This report presents a case with involvement of mandibular teeth in two quadrants and crossing the midline, a feature sparingly reported in literature. [3],[4] Pulp necrosis was not a feature in our reported case that resulted in retention of the involved teeth, permitting radiographic comparison over a period of 4 years.

The findings in the older radiographs revealed a typical presentation of regional odontodysplasia with wide pulp chambers and root canals, thin enamel-dentin layers, and pitted irregular occlusal enamel. The current radiographs show similar findings; however, with a much reduced width of the pulp chambers and root canals in the involved teeth. The most interesting and unusual radiographic feature was the presence of faint vertical radiolucent lines parallel to the root canals extending almost the entire length of the root in the involved teeth, resulting in progressive normalization of tooth anatomy. This narrowing of the pulp chambers and root canals is most likely a result of a pulpal response with gradual deposition of circumpulpal dentin. The ability of the odontoblasts to respond to injury such as caries or cavity preparation, and up-regulate their secretory activity leading to deposition of reactionary dentin is well-established. [9],[10] The irregular and thin layer of mineralized tissue covering the occlusal surfaces of teeth observed in the presented case could have served as a relatively mild stimulus, resulting in the formation of tertiary dentin, specifically reactionary dentin. Also the vertical radiolucent line noted in the radiographs taken after root completion [Figure 1] is suggestive of an incremental formation of mineralized tissue and has been referred to as the calcio-traumatic line, that delineates the dentin matrix secreted pre- and postinjury by other authors. [9]

Reports of such normalization of tooth anatomy in RO is sparce in the literature. [1],[3],[11],[12],[13] The paucity is most probably because of the fact that the typical treatment choice for the affected teeth is extraction. [3]

Since the clinical and radiographic features of RO are characteristic, the diagnosis is usually straight forward. The greater challenge lies in treatment planning and management of individual cases. Typically, teeth affected with RO become pulpally involved early on and are either extracted or endodontically treated. Such reports of automatic normalization over time in RO is supportive of a more conservative treatment approach. The treatment of choice obviously depends on the degree of dental development and functional or esthetic needs of each patient with RO. The reparative nature observed in this case, might suggest radiographic follow up for 1-2 years after root completion, in asymptomatic patients and in the absence of periapical changes in radiographs, as an interim conservative option in RO.


   Conclusion Top


The case report adds rarely reported features that could be observed in regional odontodysplasia, including involvement of teeth crossing the midline, noncontiguous mandibular teeth. More interestingly the reparative nature that has been observed in the case is very unusual, which could alter the treatment modality chosen for the patient.

This report presents radiographic follow up, in the absence of clinical signs and symptoms of pulpal or periapical inflammation, as a conservative approach to monitoring tooth development for a few years after eruption/root completion in patients with RO.

 
   References Top

1.Marques AC, Castro WH, do Carmo MA. Regional odontodysplasia: An unusual case with a conservative approach. Br Dent J 1999;186:522-4.  Back to cited text no. 1
[PUBMED]    
2.Ansari G, Reid JS, Fung DE, Creanor SL. Regional odontodysplasia: Report of four cases. Int J Paediatr Dent 1997;7:107-13.  Back to cited text no. 2
[PUBMED]    
3.Cabral LA, Carvalho YR, Moraes E, Nogueira Tde O, Cavalcante AS, de Moraes LC. Regional odontodysplasia: A report of three cases. Quintessence Int 1994;25:141-5.  Back to cited text no. 3
[PUBMED]    
4.Guzman R, Elliott MA, Rossie KM. Odontodysplasia in a pediatric patient: Literature review and case report. Pediatr Dent 1990;12:45-8.  Back to cited text no. 4
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5.Melamed Y, Harnik J, Becker A, Shapira J. Conservative multidisciplinary treatment approach in an unusual odontodysplasia. ASDC J Dent Child 1994;61:119-24.  Back to cited text no. 5
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6.Kerebel B, Kerebel LM. Structural, ultrastructural, microradiographic, and electron-probe studies of an unusual case of regional odontodysplasia. J Dent Res 1982;61:1056-62.  Back to cited text no. 6
[PUBMED]    
7.van der Wal JE, Rittersma J, Baart JA, van der Waal I. Regional odontodysplasia: Report of three cases. Int J Oral Maxillofac Surg 1993;22:356-8.  Back to cited text no. 7
[PUBMED]    
8.Kinirons MJ, O'Brien FV, Gregg TA. Regional odontodysplasia:An evaluation of three cases based on clinical, microradiographic and histological findings. Br Dent J 1988;165:136-9.  Back to cited text no. 8
[PUBMED]    
9.Goldberg M, Smith AJ. Cells and extracellular matrices of dentin and pulp: A biological basis for repair and tissue engineering. Crit Rev Oral Biol Med 2004;15:13-27.  Back to cited text no. 9
[PUBMED]    
10.Smith AJ, Cassidy N, Perry H, Be'gue-Kirn C, Ruch JV, Lesot H. Reactionary dentinogenesis. Int J Dev Biol 1995;39:273-80.  Back to cited text no. 10
    
11.Crawford PJ, Aldred MJ. Regional odontodysplasia: A bibliography. J Oral Pathol Med 1989;18:251-63.  Back to cited text no. 11
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12.Spini TH, Sargenti-Neto S, Cardoso SV, Souza KC, de Souza SO, de faria PR, et al. Progressive dental development in regional odontodysplasia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e40-5.   Back to cited text no. 12
[PUBMED]    
13.Gerlach RF, Jorge J Jr, de Almmeida OP, Colletta RD, Zaia AA. Regional odontodysplasia. Report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:308-13.  Back to cited text no. 13
    


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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
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