Lecture 2 , disorders of development 2 ( script )

8/4/2019 Lecture 2 , disorders of development 2 ( script )

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oral pathology lecture #2

Wednesday 28/9/2011

Done by: Bayan Al-shaikh, shorooq alalmeh

Colleagues :) just sorry for not adding any pictures, but. Youknow Dr.reema use PowerPoint as read only .

Review for the first lectureIn the last lecture we start talking about developmentalchanges & alteration affecting the oral & maxillofacial

regions specifically in the oral cavity, we talked aboutdevelopmental changes affect the teeth, like number,size, shape.

The changes affecting the number either: hypodontia,supernumerary (hyperdontia) . changes affecting thesize :microdontia, or macrodontia. Then we start talkingabout the changes affecting the shape : dilacerations,taurodontism,dense in dente.

Dense in dente varies in severity , it may vary from asimple small pit on the cingulum to a dilated Odentonwhich is the most severe form of dense invaginatus . wetalked about cusp of carabelli as an extra cusp affectingthe shape of teeth (dense evaginatus) ;which is a cuspusually on the maxillary first molars. Talon cusp is anextra cusp on the anterior teeth. Also we talked aboutgiminatiom & fusion ,the difference between two is mainly

clinical by counting the teeth but the pathogenesis of bothof them is mainly different.

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The causes of hypercementosis are several , includinghypofunction or hyperfunction of the tooth.

abnormal location of enamel including cervical enamelprojection or extension, we said that in the cervical

enamel extension there will be lost of PDL insertion, sothere may be pocketing & progression of the periodontaldisease. Enamel pearl which is a small rounded mass on

the furcation area of the molar.

Todaywe are going to talk about the alterationofthe structure of teeth , as you know structure of theteeth includes enamel & dentine ,the causes of changes

in the structure of the teeth could be : hereditary orenvironmental.

hereditary cause; for example if the father has aproblem in the structure of enamel or dentine ,then someof his children will have a problem in the structure ofenamel or dentine ,maybe you have encountered somepeople like this ,children has abnormal teeth in the color ,

shape...etc. this is called hereditary.

environmental causes related to environmentalchanges, like high fever, trauma, calcium deficiency.these environmental changes will affect teeth at specificperiod of time (the time of defect or change) ; y3ne thepatient is havening a high fever ,the changes in the teethwill be in the time period of fever, so the changes doesn'toccur after 2 years of ending of the fever .. logically !! Soit will be chronological related to time & we can evenknow approximately when the patient had the disease by

going back to the chart that we took in dental anatomy.

e.g. if a disease affecting the incisal edges ,we go backto see when the incisal edges form & then we can knowwhen the patient had the environmental changes thataffected the teeth ,general view of the environmental

causes.Environmental causes maybe bacterial, viral & nutritional.

Bacterial like congenital syphilis infection which affectsthe mother & then go to the developing embryo affecting

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the developing tooth germs. Nutritional deficiencies,Chemical injuries ,to the teeth & trauma all of these areenvironmental, the defect maybe focal according to thetrauma ,focal trauma leads to focal defect.

if the change is general like nutritional deficiencies wemay have more generalized defect.

The defect in environmental causes could be eitherdeciduous or permanent ; because usually the defectoccurs at specific period of time which affect the teethdeveloping at that period of time ,not all of the patientlife. y3ne it will be at the time at which the deciduousteeth is developing & at the time at which the permanentteeth is developing both of them. and this point will

differentiate between hereditary & environmentalcauses ;in the hereditary causes the genetic defectaffect deciduous & permanent teeth. But, in theenvironmental causes will affect only one set ofteeth either deciduous or permanent . in theenvironmental it affects both types of hard tissues;y3ne when the defect occur supposed we are talkingabout fever, the defect in the incisal third edge formation,the enamel & dentine & whatever is forming at that time

will be affected that limited portion of the tooth. But, inthe hereditary causes it's usually affect either enamel ordentine ; it's a genetic defect .for example, genetic defectin formation of enamel but dentine isn't involved ,orgenetic defect in dentine , in this case enamel isn't

involved.

we have said that we have localized & generalizedenvironmental causes.

localized causes:

1* -turner tooth2* -enamel opacities

localized cause e.g. turner tooth .you will talk about itin details in pediatric , turner tooth is a permanent tooth.

But, it has enamel hypoplasia ,it's abnormal in shape ,ithas a rough surface , a problem in the structure of the

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tooth due to a cause related to the deciduous tooth in thatarea. y3ne the deciduous lower anterior may have atrauma or periapical infection, that will affect thedeveloping permanent central incisor. So the developing

permanent central incisor will have a defect in the enamel& this defect is localized to the anterior region becausethe problem was infection of the lower anterior deciduousteeth.

this localized turner tooth changes will varies in severityfrom just yellow to brown color , forms grooves & pits &rough surface .this is turner tooth which is a permanenttooth that has defect in dental structure or enamel due toproblem to the deciduous teeth .so it's not a primary

tooth.

enamel opacity which is very common .people havewhite chalky spot on just on one or two tooth ,notgeneralized maybe the upper central or lower central .(usually affect central incisor & it's very common).so it'slocalized defect of the environmental group of causes, if

it's generalized then it's called fluorosis.Turner tooth maybe infection in the deciduous canine

,affecting the development permanent canine, or traumato the deciduous canine causing localized defect here inthe permanent canine .but, most of the time turner tooth

is usually lower central incisor.

Generalized causes:

chronological hypoplasia

chronological it's time related to disease , or defecthappening over a certain period of time, affecting acertain area or number of teeth, which were developing at

that time.look here pic slide (39) we have a band or a defect of themiddle third of the labial surface of the upper anteriorteeth , then incisal edge here & maybe the canine tip, thelower canine & the middle surface of the lower anteriorteeth, so this defect here is generalized .here in 7 teeth

defect(several teeth involved ) we can related to timerelated cause , bands of pits & grooves ,and their

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distribution depend on the enamel developing at time ofthe disease.

What causes generalized hypoplasia?

Generalized environmental hypoplasia caused bynutritional deficiencies like hypocalcimea , you knowthat calcium is very important for teeth structure .ameloblast are one of the most the sensitive cells in the

body for nutritional changes.there is neonatal line, it's an interesting changemicroscopically ,it's seen affecting deciduous teeth which

are developing at the time of birth; y3ne process of birthis a trauma to the developing teeth and neonatal line

change in the structure of enamel happened.dental fluorosis ,as you took in oral histology increased

in fluoride concentration, the fluoride ion will beincorporated in the structure of the tooth, this is abnormal,it will give us different appearance of the teeth, theadvantage of dental fluorosis that these teeth are cariesresistant but the patient doesn't like them for aesthetic

reasons. there is arrange of changes in dental fluorosis ,somethingmild ;just changes in the color of teeth , something more

severe hypoplasia & change in the structure themselves.hypominralization or hypoplastic this is the sever form offluorosis .you know teeth affecting by dental fluorosisdarken in color with time specially the anterior teethbecause they are exposed to light . if a patient come toyour clinic suffer from generalized fluorosis ,you will notice

that his upper anterior teeth are brown, because they areexposed to light, while the rest of the teeth just havingwhite flakes.

This is summary of how dental fluorosis works,interferance with ameloblast function ,white flakes ordiscoloration could happened .in severe case enamel willbe soft . if the dr bring a question in exam : enamel willbe soft in dental fluorosis correct or white opacities withfluorosis both are correct .dental flurosis is generalized

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cause includes generalized changes in enamel not justone tooth.

it's important to know the differences between hypoplasia

& hypomineralization.

what is hypoplsia ? in general pathology,hyperplasia increase number of cells . hypoplasiadecrease number of cells. hypoplasia in enamel decrease

the amount of matrix produced.

How does the enamel form?

Matrix formation which are protein followed bymineralization .matrix formation which will give the shapeof the tooth ,then mineralization will give the hardness ofthe tooth .y3ne shape of the tooth depend on the amountof matrix formed .if the amount of matrix wasdecreased ;y3ne hypoplastic the result abnormal contourwhich appear clinically in ranges ;could be pits or grooves

enter & exit decrease in the amount of matrix, or smoothhomogenous decrease in the size of the tooth.

refer to slide (43 )to understand this paragraph

you see pits or grooves this is hypoplastic forget abouthardness we aren't talking about hardness. here we have

smooth contour but the thickness of enamel isn't normal.

we have variant hypoplastic , here this having the normalcontour, the normal thickness of enamel ,but it's soft sothis hypomineralized.

this is normal enamel it's having normal thickness &normal calcification, the color here is important, the darkyellow is the normally calcified enamel & this is thenormal thickness of enamel .in the hypocalcified variantwe have normal thickness of enamel.but, white colormeans not enuogh mineralized ,it's not well calcified, ifyou go to hypoplastic mineralization , it isn't affected, it'sdark yellow we have a lot of minerals .but, the thickness is

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abnormal in the hypoplastic generalized smooth pattern,normal minaralizzed .but ,the thickness is abnormal lookhere in the hypomaturation there is hypoplasia decreasein the amount of matrix & hypocalcification, again in

hypomaturation there is a range of changes ..in all ofthem actually.

Hereditary causes:

Amelogenises imperfecta

hereditary causes of developmental alteration ofstructure .. Question in the exam: one of the following isa cause of developmental alteration of structure teethwithout specified environmental or hereditary ;then therewill be many correct choices. But, if we asked, one of thefollowing statement is correct regarding hereditarydevelopmental alteration in structure of teeth ? sowe talked about hereditary only not aboutenvironmental .you should be attention during reading ofthe question !! Don't focus on the developmentalalteration in structural of teeth only , look for the

important word which is environmental or hereditary

amelogenises impefecta*it's hereditary , it will affect deciduous & permanent y3neit will affect either enamel or dentine , from its name ,amelogenises it affects enamel.

from picture we have 3 types ofamelogenisesimperfecta .hypoplastic type , hypocalcified ,

hypomaturation.in the hypoplastic types we have subtypes one

smooth(generalized )& other is pitted variant.

amelogenises imperfect 3 major types:**

hypoplastic typehypocalcifid

hypomaturation

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we have talked that in enamel hypoplasia there are pits &grooves or reduction in thickness so we will go over itquickly , if we have defective in mineralization then wewill have normal thickness of enamel but abnormal color &

abnormal density, so if you bring a probe you can pierceit , it's very soft & it will be lost easily later on.hypoplastic type could be generalized; of pits ,groove ,scattered all over the teeth , could be localized rise justlines of pits over localized surface of the tooth .butaffecting all the teeth ;y3ne could be the middle third ofthe teeth may have pits , grooves and all the teeth willhave that not one or two teeth or just three or only from

canine to canine all the teeth will be affected with pits &grooves in the middle third or all the surface of the teethwill have pits & groove& all of the teeth.

e.g. on localized middle of the buccal surfaces butaffecting all the teeth, it will affect deciduous &permanent teeth.

look at the pic (slide 47) here we have some pits not onthe incisal third nor on the cervical third they are on the

middle third only .but, all of the teeth are affected(central, lateral , canine , molars ) . why only on themiddle third ? we don't know it's idiopathic (it's geneticchange ;it's impossible to memorize, wide numbers ofgenetic mutations & alteration in amelogensisimperfecta ) also in each mutation amelogenisesimperfect will have many different manifestations .(onceour Dr faced a patient with a mild form of amelogenisesimperfecta, there were a few numbers of pits ) we as a

dentist we know about amelogenises imperfecta so weknow it's genetic defect.

when we say amelogenises imperfect , it has to beobvious that it's generalized on all of the teeth ,it'sgenetic disease affect both deciduous & permanent &affecting all the teeth . variant in amelogenesis imperfectlike mild form on permanent & deciduous only on themiddle third so it's localized relatively to one tooth not toall of the teeth . smooth pattern is a mild form and it's not

very bad esthetically.look at the pic(slide 50. (

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slide (48,49)you can see that all of the tooth surfaces areinvoloved so it's not localized & not smooth it's rough . sowhen we say rough' it means that we have hypoplasia ;there is a defect ,there a decrease in the amount of matrix

produced, so this is hypoplastic rough type. amelogenisisimperfecta in this picture here we have smooth type ,whywe call it hypoplastic ?because the thickness of enamel isless than normal, look at the radiograph slide (50) just athin layer of enamel, the one which is very opaque ; thewhite opaque line represent the thickness of enamel,which left at the end.

this variant is smooth hypoplastic & this is rough , ofcourse the pigment get adsorption & sticked on the

surface and become brown.

a student asked : could we differentiate thesmooth pattern clinically without radiograph?

yes, we can. There will be an open contacts & all of theteeth will be tapered with no normal size. Even theincisors wil be tapered there will be no divergent on the

incisal edge. and the posterior teeth will be tapered , ifyou didn't notice these changes and take a radiograph ,

they will be very clear.usually in oral diagnosis , we make radiograph even if

the patient is healthy to see class II caries & other defects.

so radiographically to distinguish smooth pattern. we willhave decrease in thickness of enamel , in hypoplastictype radiodensity of enamel will be normal so we see

enamel more opaque than dentine y3ne more calcifiedcompared to dentine ,but in hypocalcification theradiodensity less than dentine . in hypomaturation a

middle form the radiodensity almost equal to dentine.

What's the maturation of enamel?

calcification occur .but, the last step of maturation of

enamel which is removal of some of the proteins &replacement them by minerals doesn't occur so there is

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some calcification we can see dentine like calcification.but, it's not like normal enamel ,while in thehypocalcification we see the radiodensity is less than

dentine.

if the dr bring this picture (slide 51 )in exam you can'tdecide if it's

hypocalcification or hypomineralization rough type , it'srough generalized , unless dr give you radiograph whereyou can see the enmel ,you see something even lessopaque compared to the surrounding tissue so this is nothypoplatic type at all; if it's hypoplastic type I should see

normal radioopaity of enamel.

How does the enamel looks on the radiograph?

enamel looks white .dentine white & the pulp chamber isblack. Why black ? because there is a space in the middleof the tooth & this space contains soft tissues bloodvessels , nerves . **why it's not totally black ? becausefrom buccal & lingual sides there are layer of dentine; sorelatively the pulp will be black in color compared toenamel and dentine both enamel & dentine are white but

enamel is whiter it's chalky white like chalks.back to hypocalcification slide (52) where is enamel ?it'snot exist so it's hypo calcification .sometimes it's difficultto distinguish hypocalcification from hypomaturation in

radiograph.

student asked a Question about medication ,sorry Icouldn't hear clearly.

medications always given over a certain period oftime, y3ne if a child take a medication at 8-9 years ,whatare the teeth that forms at this age those will be affected,it will not involve teeth from centrals to 3rd molar , it willnot involve primary & secondary ,that's in case we have

history .if we don't have history in amelogenises imperfect

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all of the teeth are affected & the radiograph will confirmthat.

another question , what is the differencebetween hypomineralization & hypocalcification?

There is no different , hypomineralization more specificword from hypocalcification, because hypocalcificationrefers to calcium & the minerals in the tooth not onlycalcium so to be more accurate we usehypomineralization but the meaning of hypocalcificationor hypomineralization is the same.

hypomaturation could be white opaque to yellowdiscoloration radiographically density is similar to dentine,there might be different pattern like pigmented pattern or

snow caped pattern.1st pic(slide 55) pigmented pattern .y3ne something brown,something white spread , like drawing spots on the toothwith brush , look at the teeth it's not due to medication,because central ,lateral canine molar all are affected

upper & lower , primary or permanent are all affected too.density of enamel isn't like normal, it's like dentine so lostof will n't as fast as the hypocalcified type.

This the snow capped pattern which is specialslide (56),there will be a question in the exam about snow capped

pattern & pigmented pattern.snow capped pattern which is hypomaturation type

of amelogeneisis imperfecta , you see white spot on thecentrals also on the laterals , canines , premolars ,

molars ..etc. and these white spot looks like enamelopacity .but, they aren't enamel opacities they are locatedon the incisal & occlusal surfaces, for this reason they arecalled snow capped pattern. as if you hold the arch & dipit in the snow or white paint a little pit , only the incisaledges& occlusal sufaces will be painted by white area.

This is hypomaturation again slide (57) the dr confess thispic isn't clear because it's scanned.

enamel whitish area if it's on one tooth enamel opacity

which is idiopathic , unknown cause & occurs on one ortwo teeth only

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look here all the tooth have this whitish spots.

Dentinogenesis imperfecta-:

Dentinogenesis is another hereditary (genetic) diseaseaffecting teeth structure and the affected part of thetooth is Dentin.

Dentinogenesis imperfecta has many types ; type Iassociated with osteogenesis imperfecta ( this disease

affecting the structure of bone and it may associated withchanges in the structure of dentin ) we will talk about itlater enshallah.Type II ;when the teeth are affected without the bone.

Type III ;the same as type II, but it affects rare racialisolates in USA ,it has specific genetic and clinicalpattern ,and it associated with multiple pulpal exposure.

The main changes happen in dentinogenesis imperfecta is

that we have abnormal Dentin and abnormal EDJ, weall know that the EDJ in normal cases is scallop in shape itis not flat , but in dentinogenesis imperfecta we have flatEDJ so the EDJ is weak , as a result of that enamel will belost easily ( why ? because the supporting dentin isabnormal and the EDJ is flat.(

Another point you should know about dentinogenesisimperfecta is that the dentinal tubules are obliterated andthey are tortuous they have abnormal pattern (notstraight and opened but obliterated and tortuous ) andbecause of this pattern we dont have increase risk ofdental caries because we dont have opened tubules , thethird point , we all know that the pulp is surrounded bydentin and this dentin in dentinogenesis imperfecta isabnormal, because of that the pulp chamber and thecanals are obliterated as a result of dentin depositioninside it.

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So if you doubt whether this case is dentinogenesisimperfecta or amelogenesis imperfecta directly take aradiograph and look to the pulp, if the pulp canals areobliterated and abnormal so directly this is dentinogenesis

imperfecta but if the pulp looks ok this is amelogenesisimperfecta.

Slide 58:So clinically> some teeth arebulbous (bulbous crown )and some has lost their enameland either their dentin , so we can see excessive wearingof the teeth.

*so in dentinogenesis imperfecta enamel is losteasily and also dentin is soft and lost easily.

Slide 59:Radiographically , enamel has chalky white appearance indentinogenesis imperfecta (very radio opaque ) which isnormal ( unless there is wear of enamel) , this appearancefor enamel is altered and not seen this way inamelogenesis imperfecta it is hypoplastic or

hypocalcified.(So again in this radiograph enamel is normal and not lostyet ,but look at the pulp (pulp chamber and the rootcanals) they are obliterated and we can not recognize itbecause of the dentin deposition inside it , and in somecases the pulp may appear as a thin layer or a thin thread

in the radiograph.

Slide 60:Here we have excessive wearing of teeth (everything is

lost. (

Slide 61:Here this picture has been taken before the wearing ofteeth , so enamel is still there no lost in teeth structures ,

but the color and the appearance of the teeth are

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abnormal since dentin is abnormal because we all knowthat dentin is responsible to give the teeth their color sothe color of the teeth is actually the color of dentin seenthrough enamel and in dentinogenesis imperfecta dentin

is abnormal so the color will be abnormal.

Question on slide # 61 , sorry I couldnt hear it , but theDr answer was:

Here in this slide the size of the teeth , the contour andthe smoothness are normal but the problem is with thecolor of the ,and if you are wondering why this is notrelated to medications ? because taking medications incertain period will affect teeth structures formed in thatperiod but not the whole teeth , but here in this slide wesee generalized structure alteration , so medications arenot the reason.

*so in dentinogensis imperfecta enamel is normal(but because of dentin abnormality the enamel islost easily but its normal in hardness and thickness

no hypoplasia no hypocalcification) , EDJ isabnormal , dentin is abnormal.

another question about dentinogenesis imperfectaand the answer was : the teeth with dentinogenesisimperfecta are resistant to caries because of theobliterated dentinal tubules ,but the structures will be losteasily without caries.

Slide 62:Dental manifestations in dentinogenesis imperfecta:

Shell teeth:In Shell teeth dentin is extremely thin (like a shell) and thepulp chamber is very large (ya3ni the pulp occupying thewhole volume of the tooth.(

This type occurs especially in deciduous dentition.

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Slide 63:

Regarding the histopathology you need to know that thedentinal tubules are abnormal (short and misshapen )thats all.

*in the textbook you will find more details abouthistopathology you dont need it.

Hala2 again what are the differences between

amelogenesis imperfecta and dentinogenesisimperfecta?

)1(amelogenesis imperfecta affects enamel whiledentinogenesis imperfecta affects dentin.

)2(the pulp chamber and canals are obliterated indentinogenesis imperfecta while in amelogenesisimperfecta the pulp is normal and not affected.

)3(the shape of the crown is bulbous in dentinogenesisimperfecta.

)4(the dentinal tubules in dentinogenesis imperfecta areabnormal (tortuous and closed) while the tubules arenormal in amelogenesis imperfecta.

)5(the EDJ in dentinogenesis imperfecta is flat (abnormal)but its normal in amelogenesis imperfecta.

another question : if the patient could have

amelogenesis imperfecta and dentinogenesis imperfectaat the same time.

The dr said she is not sure if this could happen.

A question from the previous lecture:

If the deciduous teeth are absent is it necessary for thepermanent teeth to be absent?

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A student answered 30% of the cases no not necessary,the permanent may appear if we have teeth germs , butmost of the cases the permanent will be absent.

Slide 64:Dentin dysplasia:

Its hereditary , in dentin dysplasia we have abnormaldentin and abnormal pulp morphology ( so theabnormality in the pulp not in its content ya3ne not in theblood vessels or the nerves or the fibrous tissue no , but in

the morphology of the pulp.(

We have two major types of dentin dysplasia:

Type I radicular dentine dysplasia or rootless teeth (theteeth have short roots.(

Type II coronal dentin dysplasia ( normal root length ), inthis type the deciduous dentition has many featuressimilar to dentinogenesis imperfecta but the permanent

are not.

Slide 65:

Here in this slide we can see the normal tooth has well-calcified enamel in normal thikness (yellow in color ),dentin (white ) ,and the pulp (red.(

Hala2, in dentinogenesis imperfecta enamel is there itshaving its normal thickness and calcification , but the pulpchambers and canals are obliterated , also notice that the

root has its normal length (which is important.(

But see dentin dysplasia type I we have obliteratedpulp canals and short roots (rootless tooth) ,look to thepulp chambers it is just like a slit (chevron shaped pulp)

extends horizontally.

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Remember in dentin dysplasia type I short root & obliterated root canals.While in dentinogensis imperfecta normal root length &obliterated root canals.


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now ,type II dentin dysplasia we find normal rootlength ,normal enamel , but abnormal pulp shape(pattern),there is a division in the pulp chamber and it has two

calcified areas (stones.(

Slide 66:

Dentin dysplasia type I:*Again its hereditary (genetically determined) affecting all

teeth (all teeth in both dentitions are affected. (

*dentin dysplasia type I is far more common than type II.

*in dentin dysplasia type I patients ,there is an increase inteeth mobility (so the patient might have good ,notcarious teeth ,all his teeth are OK but they are mobile)

,when you take a radiograph and you find short roots puton your mind that there is sth called dentin dysplasia typeI.

*also in this type we have variable decrease in the rootlength (very short root to intermediate) , the enamel andthe coronal dentin in this type are normal so clinically youdont see anything abnormal on the patient , enamel and

coronal dentin are OK ,see slide 69& 70.

Slide 67:

Again in dentin dysplasia type I we have short blunt roots ,and obliterated pulp (almost all the pulp canals areobliterated) so ,why do we have periapical region ? itsnot really clear but they say that may be a thin layer ofthe pulp still present there , goes to the apical region andinduce it , see slide 67&68.

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Periapical radiolucency resembling abscesses ,granulomas, and cysts ( we will talk about all these later on

enshallah.(You need to know that the deciduous teeth exhibit

obliterated pulp chambers too.

Slide 68:

In this slide we have variable decrease in root length , youmay not notice this decrease in some teeth but look at theroot canals they are obliterated and the pulp appears asslit like spaces ( horizontal bands ) having the pulp inside

it ,( so the pulp is not vertically oriented as canals but itextends horizontally as bands.(

And look periapically there is periapical radiolucency ,soits dentin dysplasia type I.

Slides 69& 70:Clinically the teeth look normal but may be they aremobile.

Slide 71:Dentin dysplasia type II:Affects both dentitions , according to the clinicalappearance the deciduous differs from the permanent.

In permanent teeth:

We have normal root length but abnormal large pulpchambers with abnormal radicular extension " calledflame shaped root pulp"

Back to slide (65) dentin dysplasia type II ; these twowhite areas in the pulp called pulp stones (here in thechamber we have two calcified pulp stones appear as two

radiopaque areas look like dentine.(So in dentin dysplasia type II in permanent teeth wehave pulp stones within the pulp and the pulp extends

abnormally because it may go more in the pulpchambers , because normally the pulp extends in the pulp

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chambers and the pulp canals butin dentin dysplasia type II the pulp chamber may go down

in to the root which is abnormal.

And thats everything for this lecture.

Done by:

Bayan Al-shaikh

Shorouq Alalmeh

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Lecture 2 , disorders of development 2 ( script )

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