Improperly Formed Maxillary Teeth

Abstract

A general dentist referred a 14-year-old boy to an oral surgeon (J.S.S.) because he was missing multiple maxillary left teeth. The patient was otherwise asymptomatic, and the principal concern was the missing teeth. The patient was healthy and had undergone surgery to correct hypospadias (congenital malformation of the penis in which the urethral opening is on the underside) at 3 years of age. The results of an extraoral examination revealed normal facial symmetry. The results of an intraoral clinical examination showed hypoplasia of the left posterior maxillary alveolar process but normal occlusion. The left maxillary premolars were absent (Figure 1). The patient had retained his left maxillary primary canine, which had been extracted two weeks before the oral surgeon examined him. The maxillary lateral incisors had been peg shaped and had received dental veneers. Eruption of tooth no. 27 was delayed. No masses were palpable, and the overlying mucosa and gingiva appeared normal. The involved teeth had no history of caries or trauma. The patient’s oral hygiene was excellent. We obtained a computed tomographic scan of the patient. It revealed segmental deformity or dysplasia of the left maxillary alveolar ridge with associated deformity in the position or development of the maxillary left canine and first and second premolars. We detected no other skeletal abnormalities. We also noted these defective maxillary teeth on the panoramic and periapical radiographs (Figures 2 and 3). The maxillary left first and second molars appear to be normal in position and appearance, and the mandibular teeth were normal in appearance. The oral surgeon surgically removed the defective teeth and submitted them to oral pathologists (I.B., D.M.C.) for microscopic examination. Histopathological examination of the decalcified hard tissue revealed anomalous toothlike structures associated with spherical droplets of cementumlike material. We noted aggregates of calcified abnormal dental hard tissue in the defective teeth (Figure 4).