Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2012  |  Volume : 30  |  Issue : 2  |  Page : 176--178

Regional odontodysplasia: A case of progressive tooth development


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

Correspondence Address:
R Ganguly
Oral and Maxillofacial Radiology, Department General Dentistry, Tufts University School of Dental Medicine, 1 Kneeland street, Boston, MA, 02111
USA

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.



How to cite this article:
Ganguly R, Ramesh A. Regional odontodysplasia: A case of progressive tooth development.J Indian Soc Pedod Prev Dent 2012;30:176-178


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 2020 Nov 26 ];30:176-178
Available from: https://www.jisppd.com/text.asp?2012/30/2/176/100010


Full Text

 Introduction



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



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}

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}

 Discussion



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



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.

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