Generalised versus Regional Odontodysplasia: Diagnosis, Transitional Management, and Long-Term Followup—A Report of 2 Cases

Abstract

Background. Odontodysplasia is an uncommon condition. It can be localised or generalised, isolated or part of a syndrome. Case Report. We first report the case of an 8.5-year-old boy who presented with abnormally shaped teeth and multiple intraoral abscesses. Findings of clinical and radiographic examinations were consistent with those of generalised odontodysplasia. A 2-step, conservative treatment plan was executed with a 10-year followup. Step 1 was root canal treatment of nonvital teeth. Step 2 was crowning without preparation of new vital, erupted, and malformed teeth. The second case is that of a 12-year-old girl who presented with lack of teeth in the upper-left quadrant. The impacted teeth were exposed surgically, and fixed restoration was performed for temporary aesthetic improvement. Conclusion. Instead of tooth extraction, an approach previously used in similar cases, conservative management is feasible and offers better prosthetic treatment options for the future.

Mandibular Regional Odontodysplasia in an 8-year-old Boy showing Teeth Disorders, Gubernaculum Tracts, and Altered Bone Fractal Pattern

“…This case showed teeth with hypoplastic, hypocalcified crown, poor contrast between dental tissues demonstrated by a low radiodensity, shortened roots with wide open apices, pericoronal radiolucency representing an enlarged dental follicle, and large pulp chambers giving a “ghost teeth” appearance. 11 17 21 23 25 26 In addition, it was observed the absence of right permanent mandibular central and lateral incisors, an unusual finding according to Tervonen et al 24 These authors compiled epidemiological data of RO published in the international literature up to 2002 and found only 10.7% of missing teeth in the studied sample of 138 cases. Similarly to the present case, Ganguly and Ramesh 27 reported an unusual case of mandibular RO associated with the absence of left lower and lateral incisors which was observed on periapical radiographs.…”

Regional Odontodysplasia with Generalised Enamel Defect

“…However, there are few features which are rarely reported like radiographic evidence of a normally developing permanent successor (upper right first premolar) to follow affected primary predecessor (upper right first primary molar) [20] or the generalised enamel hypomineralization and hypoplasia affecting the other primary teeth which have not been reported in any case of regional odontodysplasia. The enamel defects seen in teeth with ROD are usually severe [13, 27]; however the remaining teeth usually have normal enamel and dentine [1].…”

“…Some authors have argued for maintaining the noninfected affected teeth to allow normal jaw development and reduce the risk of psychological trauma associated with premature tooth loss [24, 27]. Other treatment approaches in ROD include coverage restorations [25] and autotransplantation of teeth in the permanent dentition [20]. The management of ROD involves interventional dental care in both dentitions and it requires multidisciplinary care.…”

“…Affected teeth are usually in a continuous series, although it may skip a tooth or a group of teeth [12]. Primary teeth affected by this anomaly are usually followed by affected permanent successors; however it is very rare to find normal permanent teeth to follow affected primary ones [20]. Patients with regional odontodysplasia usually present with pain and dental abscess formation [21–23] which can be seen even in the absence of dental caries [24].…”

Familial oligodontia and regional odontodysplasia associated with a PAX9 initiation codon mutation

“…Iizava et al (2010) suggest retaining RO-affected teeth if possible [15]. Crowns, for instance, stainless steel crowns with ceramics not requiring preparation, have been shown to keep the teeth vital even for several years [16]. However, removing the infected, fragile teeth is often the only option for treatment and even that requires the skills of an experienced surgeon due to their eggshell-like consistency.…”