Anomali : Ketidaknormalan

Anomali gigi lebih sering dijumpai pada gigi permanen daripada decidui

Kejadian anomali gigi pada RA lebih banyak dari RB

Diagnosa anomali : Klinis & Radiografis

Etiologi (secara umum) antara lain :

1. Herediter

2. Gangguan pd masa pertumbuhan dan perkembangan gigi

3. Gangguan metabolisme tubuh (sistemik)

1. Jumlah

2. Ukuran

3. Bentuk : Mahkota & Akar

4. Posisi & Erupsi

5. Reaksi jejas

6. Defect enamel, dentin, pulpa, cementum

Lengkap Anodontia

< 6 Hypodontia

> 6 Oligodontia

Berkurang jumlahnya

Supernumerary teeth

Supplemental teeth

Berlebih jumlahnya

ANOMALI GIGI

Anodontia & oligodontia

M3 RA I2 RA P2 RB I1/i1 RB

Terjadi pada 0,3% - 3,8% penduduk

Pada gigi decidui dan permanen

90% di RA

Paling sering di daerah I1 RA atau regio M3 RA

Bisa tunggal atau ganda

Macam2nya : Mesiodens, Paramolar, Distomolar / distodens, Peridens, Tuberkel.

Gigi yang berada diantara insisive central atau mesial dari kedua insisive 1 (midline mesiodens)

Erupsi terlihat

Tidak erupsi menyebabkan diastema

Peg-shaped

Jarang terletak antara ins sentral & lat / ins lat & C

mesiodens

Radiography mesiodens

Paramolar tuberkel

Distomolar tuberkel

Paramolar

Macrodontia

Disebut juga megadontia

Berukuran lebih besar dr normal

Bisa single atau keseluruhan (pituitary gigantism)

Pada hemifacial hypertrophy : megadontia 1 sisi

Microdontia

Lebih kecil dari ukuran normal

Lebih sering pd gigi I2 dan M3

Bentuk : peg-shaped

Keadaan yg tersering dgn microdontia : pituitary dwarfism

ANOMALI GIGI

macrodontia

1. I2

2. P2

3. M3

4. Geminasi

5. Fusion / synodontia

6. Hutchinsons triad (etiologi : syphilis kongenital)

7. Cups Tambahan / tuberkel

Mahkot

a 1. Dilaceration

2. Flexion

3. Dens in dente

4. Concresense

5. Segmented root

6. Dwarfed root

7. Hypersementosis

8. Akar tambahan

Akar

ANOMALI GIGI

Anomali- bentuk mahkota

1. Insisive 2 RA : gigi anterior yg paling sering mengalami anomali peg shaped

2. Premolar 2 RB : morfologi oklusal variasi : lingual cusp : 1/3, bentuk groove & fossa berubah, akar kadang ada 2 MD

3. Molar 3 RA : variasi bentuk mahkota; biasanya peg shaped, kadang ada yg menyerupai M1/M2.

Peg-shaped I2

Anomali- bentuk mahkota

4. Gemination/Skizodonsia : 1 benih membelah jd 2

Sering pd decidui drpd permanen Sering pd regio I & P

5. Fusion / Synodontia / kembar dempet : 2 benih bersatu

Sering pd decidui drpd permanen RA > RB terbentuk karena tekanan pd waktu

pembentukan akar

Gemination ? Fusion ?

Anomali - bentuk mahkota

6. Etiologi Syphilis kongenital, hutchinson triad : 1. Hutchinsons teeth :

mengenai gigi insisive RA & RB decidui / permanen

Ciri : servical lebar, insisal sempit dengan notch pd incisal edge screwdriver

2. Mulberry molars : gigi molar murbei

pada Molar 1 permk. Oklusal dgn cusp spt buah murbei, banyak tuberkel kecil-kecil ganda.

3. interstitial keratitis

Hutchinsons teeth & mulberry molar

Anomali bentuk mahkota

7. Tubercle / cusp tambahan

A. Enamel pearls (enameloma)

B. Taurodontism

C. Talon Cusp

D. Dens evaginatus

E. Tuberculum intermedium

F. Tuberculum sextum

Enamel pearl (enameloma)

Massa enamel ektopik (bulat) yang berada pd permukaan akar gigi

Sering pada area furkasi

Molar RA >> Molar RB

Taurodontism / taurodontia

Gigi taurodont memiliki ukuran dan bentuk mahkota yg normal namun bentuk kamar pulpa memanjang (apico-occlusal) dan tidak mengecil pd CEJ. Akar memendek

Sering pada populasi Eskimo, indian america.

Tidak tampak scr klinis harus dental R

Bisanya berkaitan dgn kondisi :

Amelogenesis imperfecta

Tricho-dento-osseous syndrome

Klinefelters syndrome

taurodontism

Talon cusp

tonjolan kecil enamel pd singulum gigi anterior RA / RB.

Sering bertanduk pulpa

Dens evaginatus

tonjolan enamel pd permukaan oklusal gigi premolar, biasanya RB.

Sering memiliki dentin & pulpa sendiri.

Ras Asia >>>

Anomali bentuk mahkota

E. Tuberculum intermedian : cups tambahan yg letaknya pd area antar cusp lingual (sering pd gigi molar RB)

F. Tuberculum sextum : cusp tambahan yg letaknya pd marginal ridge antar cusp distal dan cusp distolingual (sering pd M 1 RB - cusp ke-6).

Bukan Anomali Sesungguhnya

Insisive atas berbentuk sekop : kelainan biologis pada ras Asian, Mongolian, Eskimo dan Indian America.

Bentuk gigi menyerupai sekop : palatal, singulum dan marginal ridge menonjol membentuk spt sekop.

Anomali Bentuk Akar

A. Dilaceration : sudut 45 - lebih dr 90

B. Flexion : < 90 atau memutar

C. Dens in Dente (Dens invaginatus)

D. Concrescence : fusion akar (sementum)

E. Segmented root : akar terpisah jd 2

F. Dwarfed root : akar pendek

G. Hypercementosis : jar.sementrum >>>

H. Akar tambahan

Dilaceration & Flexion

Dens in dente ( dens invaginatus)

Tooth within a tooth

Etiologi : gangguan saat pembentukan gigi, dimana terjadi invaginasi epitel dalam perkembangan mahkota gigi yang seharusnya menjadi ruang pulpa

Terlihat melalui dental r

Sering : I2

Concrescence

Fusi akar yang terjadi setelah akar selesai terbentuk, akibat persatuan cementum

Biasanya gigi dengan akar concrescence akan kesulitan erupsi atau kadang gagal

Sering pada M2dan M3 RA juga antara gigi dan supernumerary

R : sulit membedakan concrescence dgn superimposed

Concrescence

Hypercementosis

Terlihat secara radiograph bahwa sementum menebal diseluruh atau sebagian akar gigi

Biasanya terkait dengan inflamasi periapikal, gigi yg tidak berkontak

Secara umum, dapat menyertai kondisi :

Pagets disease

Acromegaly

Pituitary gigantism

Submerged teeth : retained deciduous tooth

Transposed teeth misplaced : Permanent teeth

Ankylosed teeth

Rotasi

Ectopic eruption

Eruption cyst

Eruption hematoma

Impacted teeth

ANOMALI GIGI

Vestibular deflection

Supra & infra occlusion

Diastema

Mesiodistal shift of dents

Oral inclination

ATRISI

e/ physiologic

Co: bruxism, kunyah tobaco, kebiasaan mengunyah

ABRASI

e/ mechanical

Co : pipe smoking, menyikat gigi yg salah, gigit kuku

EROSI

e/ chemical

Co : makanan asam, soft drinks, vomiting, bulimia

ABFRAKSI Mikro- fraktur email

ANOMALI GIGI

Email : Enamel dysplasia : Environmental enamel hypoplasia, Localized enamel hypoplasia

- AI

Dentin : DI, DD, OD

Pulpa : Resorption, Calsification

Cementum : Hypophostasia

ANOMALI GIGI

Enamel dysplasia

Pekembangan enamel yg abnormal

Disebut Enamel Hypoplasia ggn pd ameloblast ketika pembentukan enamel matrix

Disebut Enamel hypocalcification ggn pd saat enamel matrix masak

Penyebab enamel dysplasia : herediter, sistemik, ggn lokal (trauma, infeksi)

Variasi warna : putih kuning coklat

Variasi morfologi : berlubang, kasar

Environmental enamel hypoplasia

Nutritional deficiencies in Vitamin A, C, D, calcium and phosphorus

Severe infections such as Rubella, Syphillis, and high fever

Neurologic defects such as Cerebral palsy and Sturge-Weber Syndrome

Prematurity and birth injuries

Radiation

Fluorosis (excessive ingestion of fluoride)

Tetracycline induced hypoplasia and discoloration

Environmental enamel hypoplasia

Localized enamel hypoplasia

Infection of primary teeth affecting the developing permanent tooth

Trauma to primary tooth disturbing the permanent tooth bud

Turners teeth

Amelogenesis Imperfecta

Group of hereditary defects of enamel unassociated with any other generalized effect

Entirely an ectodermal disturbance

Incidence = 1 in 14, 000 (Witkop, 1957)

Both primary and permanent dentition affected

Classified into three major categories :

Tipe I : Hypoplastic AI

Tipe II : Hypomaturation AI

Tipe III : Hypocalcified AI

Type I : hypoplastic AI

This defect occurs during the histodifferentiation stage.

Enamel is not formed to full thickness because ameloblasts fail to lay down sufficient matrix.

The resulting disorder may include a localized defect, localized pitting, or generalized dimunition of enamel formation.

Affected teeth appear small with open contacts due to very thin or nonexistent enamel causing thermal sensitivity.

AI type I

Type II : Hypomaturation AI

This defect occurs during matrix apposition.

Enamel is softer and chips from the underlying dentin.

Enamel has a mottled brown-yellow-white color.

Contact points present as enamel is of normal thickness.

Radiographically enamel approaches the radiodensity of dentin.

AI type II

Type III : Hypocalcified AI

Defect occurs during the calcification stage.

Most common type of amelogenesis imperfecta.

Enamel is of normal thickness but soft, friable, and easily lost by attrition.

Enamel appears dull, lustrous, honey colored and stains easily.

AI type III

Dentinogenesis imperfecta

An inherited dentin defect originating during the histodifferentiation stage

Frequency of occurrence is 1: 8000

Defect of predentin resulting in amorphic, disorganized and circumpulpal dentin

Shields Type I

(associated with Osteogenesis Imperfecta)

Shields Type II

(Hereditary Opalescent Dentin)

Shields Type III

(Brandywine Type)

Klasifikasi DI

Shields Type I (associated with Osteogenesis Imperfecta)

- Inherited defect in collagen formation resulting in osteoporotic brittle bones.

- Primary teeth more affected than permanent teeth.

- Other features include periapical radiolucencies, bulbous crowns, obliteration of pulp chambers, root fractures and amber translucent tooth color.

Shields Type II (Hereditary Opalescent Dentin)

- Primary and permanent dentition are equally affected.

- Features are same as Shields Type I apart from Osteogenesis Imperfecta.

Shields Type III (Brandywine Type)

- Teeth have a shell-like appearance with bell-shaped crowns.

- Occurs exclusively in a isolated group in Maryland called Brandywine population.

DI

Dentin dysplasia

Dentin dysplasia is a genetic disorder of teeth, commonly exhibiting an autosomal dominant inheritance.

It is characterized by presence of normal enamel but atypical dentin with abnormal pulpal morphology.

Cause: Dentin dysplasia is an inherited disorder.

Types of Dentin dysplasia

There are two types: Type I is the radicular type, and Type II is the coronal type.

With Type I , the roots of teeth are shorter than normal and the pulp chamber may be nearly gone. The pulp chamber is sometimes described as having a "crescent shaped" appearance.

With Type II , the pulps are enlarged and are described as having a "thistle tube" appearance, in permanent dentition. In the deciduous dentition, coronal dentin dysplasia bears a resemblance to Dentinogenesis Imperfecta type II.

DD

ODONTODYSPLASIA

Localized arrest in tooth development due to regional vascular developmental anomaly

Ghost-like appearance with short roots and shell-like crowns

Large diffusely calcified pulp chamber

Ghost teeth

Anomalies in cementum : Hypophostasia

Kadar serum alkaline phosphatase rendah

Osteoporosis, bone fragility

Gagal membentuk cementum yang mengarah pada premature loss insisive decidui

hypophostasia

ANOMALI GIGI