|Year : 2013 | Volume
| Issue : 2 | Page : 86-89
Regional odontodysplasia: A classical case report
Ritika Malhotra1, Shilpy Singla1, ND Shashikiran1, Atul Verma2
1 Department of Pedodontics and Preventive Dentistry, People's College Of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Private Practitioner, Bhopal, Madhya Pradesh, India
|Date of Web Publication||22-Oct-2013|
Department of Pedodontics and Preventive Dentistry, People's College of Dental Sciences and Research Centre, Bhopal - 462 037, Madhya Pradesh
Regional odontodysplasia (RO) is an uncommon developmental anomaly affecting a localized area of the dentition; which presents with distinctive clinical and radiographical findings. Clinically, the affected teeth are often grossly hypoplastic with abnormal morphology. They often tend to develop abscess soon after eruption. Radiographically, they have a typical "ghost-like" appearance. Although extractions are often required, in some milder cases the teeth may be retained for a long period. The treatment plan should be based on the degree of involvement as well as functional and esthetic needs in each case. This article describes a classical report of a 3.5-year-old female with RO.
Keywords: Ghost teeth, localized arrested tooth development, regional odontodysplasia
|How to cite this article:|
Malhotra R, Singla S, Shashikiran N D, Verma A. Regional odontodysplasia: A classical case report. SRM J Res Dent Sci 2013;4:86-9
|How to cite this URL:|
Malhotra R, Singla S, Shashikiran N D, Verma A. Regional odontodysplasia: A classical case report. SRM J Res Dent Sci [serial online] 2013 [cited 2020 Jan 21];4:86-9. Available from: http://www.srmjrds.in/text.asp?2013/4/2/86/120186
| Introduction|| |
Regional odontodysplasia (RO) is an unusual, localized, nonhereditary developmental anomaly affecting the ectodermal and mesodermal dental components. The condition was first published by McCall et al., in 1947  under the name of "arrested tooth development"; and the term "odontodysplasia" was coined by Zegarelli et al., in 1963.  Since it is commonly found to be affecting only a segment of the jaw, it was prefixed with the word "regional" by Crawford  ; and thus, RO became an accepted terminology. The other terms which can interchangeably be used with this condition are "ghost teeth",  "odontogenesis imperfecta",  "localized arrested tooth development",  "unilateral dental malformation", "amelogenesis imperfecta",  "non-herediteria segmentalis", and "familial amelodentinal dysplasia". 
Although genetic predisposition has been reported,  but the precise etiology of the condition has not been explained. Suggested etiological factors include somatic mutations affecting the dental lamina, localized trauma during pregnancy, forceps delivery, vascular disorders, pharmacological treatments during pregnancy, local or systemic viral infection, local traumas, nutritional or metabolic deficits, radiation, hyperpyrexia, local ischemia, and Rh incompatibility. ,,,,,
Though both the jaws may be affected; there is a 2:1 predilection of maxilla over mandible.  It is usually unilateral, with common involvement of anterior region. The anomaly is seen to affect both primary and permanent dentitions, which is usually apparent in one of the jaw and mostly in one quadrant.
The condition presents with a classical clinical, radiographic, and histological findings. Clinically, the abnormality involves the dental hard tissues derived from both the epithelial (enamel) and mesenchymal (dentine and cementum) components of tooth forming apparatus. Owing to which, the tooth is hypoplastic and hypocalcified, giving a typical yellow or yellowish-brown appearance to the enamel, and an abnormal morphology.  A frequent finding of RO is the presence of gingival swelling, periapical infections, and abscesses even in the absence of caries. , Radiographically, a marked reduction in the radiodensity of the enamel and dentine can be seen, which leads to a poor contrast between them. Classically, a "ghost-like appearance"  (thus the name ghost teeth) of the teeth is observed. These teeth present with a shorter appearance, wide open apices, and a large pulp chamber. Histologically, the dental hard tissues are characterized as hypocalcified. Enamel prisms are irregularly distributed, with aprismatic and degenerative hypocalcified areas.  There is a marked reduction in the dentinal tubules, and areas of clefts can be seen within them. The pulp and dental follicle may contain calcifications of varying degrees. 
This paper reports a case of RO with its classical appearance clinically and radiographically.
| Case Report|| |
A 3.5-year-old female patient reported in the Department of Pedodontics and Preventive Dentistry, People's College of Dental Science, Bhopal with the chief complaint of pain and swelling in the left upper back tooth region since 10 days. History revealed that the patient was delivered preterm by a forceps delivery with a breech presentation. The patient had an uneventful medical history.
Clinically, the child presented with a complete set of deciduous dentition [Figure 1], with the affected left maxillary primary first molar, associated with a gingival swelling. The deciduous molars were fractured, because of its hypoplastic and hypocalcified nature [Figure 2]. The deciduous left lateral incisor and canine were partially erupted, while the left deciduous central incisor appeared hypocalcified [Figure 1] and [Figure 2]. The teeth in the adjacent arches showed normal morphological features.
|Figure 1: Clinical aspect of regional odontodysplasia case showing hypomineralized left deciduous central incisor, and partially erupted lateral incisor and canine|
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Panoramic [Figure 3] and periapical radiographs [Figure 4] and [Figure 5] showed longitudinal shortened teeth with lack of contrast between enamel and dentine. The affected teeth had wide pulp chambers with open apices and were smaller than normal in overall size. The main radiographic feature was a 'ghost' appearance. The succedaneous tooth germs appeared as initial hypocalcified clefts; suggesting the permanent tooth involvement. Other than the left maxillary hemiarch, other radiographic features showed normal appearance.
|Figure 3: Panoramic view, showing initial hypocalcified crypts of the succedaneous permanent tooth germs|
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|Figure 4: Intraoral periapical radiograph of posterior region showing typical ghost appearance|
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|Figure 5: Intraoral periapical radiograph of anterior region showing typical ghost appearance|
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Proper parent counseling was done, and only symptomatic treatment was given to the patient. After administration of systemic antibiotics, the primary first molar was extracted under local anesthesia.
Based upon the clinical and radiographical findings, the diagnosis of RO was made. Because of uncertain prognosis, the patient is kept on long-term follow-ups, to maintain the teeth in the arch, until full growth of jaw.
| Discussion|| |
RO is a relatively uncommon, localized, nonhereditary developmental anomaly affecting the tooth morphogenesis by targeting the ectodermal and mesodermal components of the dental hard tissues.  It is often confused with other developmental anomalies affecting the tooth development like dentinal dysplasia, shell teeth, hypophosphotasia, dentinogenesis imperfecta, or amelogenesis imperfecta; but these disorders tend to affect the entire dentition, which is contradictory to RO.
The condition can involve both sets of the dentition. If the primary dentition is affected, most likely the permanent set of dentition is also affected.  The patient in the present report has an affected deciduous and permanent dentition which is visible radiographically. Since, there was no family history; the genetic predisposition in the present case can be ruled. Thus, the possible etiology could be local trauma due to forceps delivery. The present case can be described is a classic case of RO.
The literature reveals a female predilection (1.4:1) ,, and a left maxillary arch involvement over mandibular arch (2:1), which does not crosses the midline. ,, This is consistent with the findings of the present case; however, bilateral involvement  can also be seen. Although more commonly anterior region is affected, in the present case, all the teeth of the affected arch were equally affected. The affected teeth most often occur as a continuous series, although occasionally the anomaly will "skip" a tooth or group of teeth. 
The classical clinical presentation of partially erupted teeth with yellowish brown hypoplastic pitted appearance ,,, supports the previous reports. The tooth is thin, friable, and susceptible to trauma; which is attributable to its hypomineralization. Typically, gingival swelling is seen even in the absence of caries , which is consistent with the present report.
Radiographically, the affected teeth showed a classical "ghost-like" appearance, with hypomineralized enamel and dentin, and the absence of clear demarcation between them. , The teeth presented with a shorter appearance and a wide open apices with a large pulp chamber. This is in accordance with the previous published reports of the condition. ,, The succedaneous dental germs were also seen affected, suggesting the involvement of the permanent dentition.
The management of affected tooth in RO still remains controversial.  These cases require a continuous and a multidisciplinary approach. Some suggest the removal of the tooth with periapical pathologies followed by suitable prosthesis to restore function and esthetics, while other professionals suggest a restorative treatment wherever possible. Cahuna et al.,  proposed autotransplantation as a treatment option in RO patients; however it is limited because of availability of an appropriate donor. Bulut et al.,  suggested the use of endosseous implant for oral rehabilitation in patients with odontodysplasia, however, this treatment can be done at a later stage of life. Since there is no specific treatment projected for this condition, the treatment should be considered based upon the patient's age, compliance, attitude towards the dental treatment, and the degree of odontodysplasia.
In the present report, the conservative approach was not possible because of loss of the tooth structure and an open wide chamber, so we opted for removal of the involved tooth following the systemic administration of the antibiotics. The aim was to retain the anomalous teeth until skeletal growth was complete; so that the patient could be reassessed for dental implants and other rehabilitation methods.
| Conclusions|| |
A case of classical presentation of RO is presented, with typical features and a possible etiology of local trauma caused by forceps delivery. As seen in this case, affected teeth showed different degrees of malformation. Although the tooth with periapical infection was extracted, others that were free from infection can be retained. The treatment plan should be based on degree of involvement as well as functional and esthetic needs in individual cases.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]