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Ana Lucia A, Capelozza; Roberta H. Abujamra; Izabel R.F.R Bullen. Faculdade de Odontologia de Bauru University Of São Paulo Brazil Signs and symptoms Delayed growth: short stature and deformity of extremities Breastbone projection Pain in the spine , pelvis and legs Muscle weakness Skeletal deformities Bowed legs Thickened wrists and ankles http://www.doctoryum.org/wp-content/uploads/2011/04/rickets.jpg Rickets disorder (affects the growing skeleton in infants and children) Osteomalacia ( affects the mature skeleton in adults) Occurs due to a genetic condition Skeletal deformities due to deficiency of vitamin D Radiographic features of the jaws Mandibular border or the walls of the mandibular canal thin Trabeculae: reduced in density, number and thickness Teeth: hypoplasia of the dental enamel erupted and unerupted teeth Lamina dura and cortical boundarry of tooth follicles may be thin or missing Pulp chambers: Large Bone loss around the teeth External root resorption Amelogênese imperfeita • Identification is made primarily by clinical examination • low or absent cusp • square shape of the crown • thin opaque layer of enamel Differential diagnosis Dentin Dysplasia (opalescent dentin) • altered color • occluded pulp chambers Dentinogenesis imperfecta • history of familial envolvment • bulbous crows • narrow roots • obliteration of pulp chambers and root canals Regional Odontodysplasia • enamel and dentin are hypoplastic and hypocacified • not hereditary • segment of the arch are affected Report of case • A 12 year old male patient was referred from Bauru School of dentistry due orthodontic evaluation. • The parents reported that the patient is one of triplets and at the birth were the biggest new born . • The diagnosis was made when he was 3 years old. Signs Symptoms Patient reports: bone pain in the hip region feets, ankles and back. Tooth pain Pus in the structures that surround the teeth Extraoral exploration : • lower limb bow, • frontal bulging bone, • short and orthopedic deformities of extremities. Intra-oral examination • spontaneous dental abscesses, • delay in teeth eruption. enlarged pulp chambers with pull horns extending up to dentin-enamel junction, presence of a radiolucent area along the lower incisors