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International Journal of Medical and Dental Case Reports (2014), Article ID 231014, 3 Pages
CASE REPORT
Enamel hypoplasia: A rare case report involving all
permanent canines
Hamsini Gottipati1, Santosh Hunasgi2, Anila Koneru2, Vanishree M2
1
General Dentist, Raichur, Karnataka, India, 2Department of Oral and Maxillofacial Pathology, Navodaya Dental College, Raichur, Karnataka, India
Correspondence
Dr. Hamsini Gottipati, General Dentist,
Raichur - 584 103, Karnataka, India.
Phone: +91-9739696167,
Email: [email protected]
Received 01.09.2014;
Accepted 24.10.2014
Abstract
Enamel hypoplasia (EH) is restricted to ectodermal disturbance, associated to
alterations in the organic enamel matrix which can source the white flecks, narrow
horizontal bands, lines of pits, grooves and discoloration of the teeth altering from
yellow to dark brown. Enamel defects have been connected with a broad spectrum
of etiologies together with genetic and epigenetic factors such as local, systemic and
environmental factors. In our case EH involves all the permanent canines, which are
found to be uncommon. Hence, we report a rare case of enamel hypoplasia.
Doi: 10.15713/ins.ijmdcr.10
Keywords: Ameloblasts, enamel hypoplasia, permanent canines, pitted type
How to cite this article:
Gottipati H, Hunasgi S, Koneru A, Vanishree M. Enamel
hypoplasia: A rare case report involving all permanent
canines. Int J Med Dent Case Rep 2014:1-3.
on the patient. Timing of ameloblastic damage has a great effect
on location and appearance of the defect in the enamel.[5]
In our case, EH involves all the permanent canines which are
found to be rare. Hence, we are reporting a rare case of EH.
Introduction
Enamel formation is a complex and extremely regulated process.
Enamel is the covering of the tooth and is greatly mineralized
tissue in the body. It consists of 96% inorganic hydroxyapatite
crystallites. Cells responsible for the development of the enamel
are called ameloblasts. They cover the whole surface of the
enamel as it forms, but are lost as the tooth emerges. Partial or
imperfect development of the organic enamel matrix of teeth
associated with hypocalcification and hypomineralization of
enamel is defined as enamel hypoplasia (EH).[1]
EH is restricted to ectodermal disturbance, associated to
alterations in the organic enamel matrix which can source the
white flecks, narrow horizontal bands, lines of pits, grooves and
discoloration of the teeth altering from yellow to dark brown.[2]
Tooth enamel is unique in that, remodeling does not occur after
initial formation. Therefore, abnormalities in enamel formation
are etched permanently on the tooth surface.
Hypoplasia marks merely if the injury occurs at some stage in
enamel development. Just the once the enamel has calcified no
such defect can be formed.[3]
Enamel defects have been connected with a broad spectrum
of etiologies together with genetic and epigenetic factors such as
local, systemic and environmental factors.[4] Generally causes of
EH is difficult to determine. Since the ameloblast is a sensitive
type of cell and easily damaged, it is likely that in cases in which
the etiology cannot be determined, the causative agent may be
some illness or systemic disturbance that has made no impression
Case Report
A 14-year-old patient who is female reported to the dental clinic
with a chief complaint of pain in the upper left back region of her
mouth.
On intra-oral examination deep carious lesion was associated
with 26. On further examination, all the permanent canines 13,
23, 33 and 43 were associated with two brown pitted spots on the
incisal 1/3rd of labial surface one on the mesial and the other on
the distal half [Figures 1 and 2]. Radiographic examination of all
canines through intraoral periapical showed two localized small
radiolucencies in the incisal third of the tooth [Figures 3 and 4].
Patient was attended to the chief complaint and treated
with root canal treatment followed by crown fixation. Clinical
diagnosis for these canines was given as “EH,” pitted variety.
Patient had no significant medical history.
Discussion
EH was first used by Zigmondy in 1894. Hypoplasia is preferable
to the old term “enamel atrophy” because the condition is
characterized by an underdevelopment of the enamel, whereas
1
Gottipati, et al.
Enamel hypoplasia of canines
Figure 1: Right maxillary and mandibular permanent canines
associated with two brown pitted spots on the incisal 1/3rd of labial
surface
Figure 2: Left maxillary and mandibular permanent canines associated
with two brown pitted spots on the incisal 1/3rd of labial surface
the word “atrophy” indicates a wasting or reduction in size of a
fully developed tissue or organ.[6]
EH can be defined as a partial or imperfect development of the
enamel matrix of teeth. Two fundamental types of EH subsist:[1,6]
1. EH caused by environmental factors
2. EH caused by hereditary defects (amelogenesis imperfecta).
Almost all visible environmental enamel defects can be
classified into one of the three patterns:[6]
1. Hypoplasia
2. Diffuse opacities
3. Demarcated opacities.
Classification of enamel defects recorded in the study done
by Littleton and Townsend based on the developmental defects
of enamel:[7]
Figure 3: Radiographic examination of permanent maxillary right
and left canines showed two localized small radiolucencies in the
incisal third of the tooth
Types of defects (hypoplasia only)
Pits
Grooves: Horizontal
Grooves: Vertical
Missing enamel
Number and demarcation
Single
Multiple
Diffuse: Fine white lines
Diffuse: Patchy
Environmental EH can be caused by a number of different
factors each capable of producing injury to the ameloblasts
which include: Nutritional insufficiency (vitamins A, B, C
and D); Exanthematous diseases (e.g.: Measles, chicken pox,
scarlet fever); birth injury; congenital syphilis; hypocalcemia;
prematurity, Rh hemolytic disease; local infection or trauma and
Ingestion of fluorides.[1]
Figure 4: Radiographic examination of permanent mandibular
right and left canines showed two localized small radiolucencies in
the incisal third of the tooth
Hypoplasia marks barely if the damage occurs throughout the
time the teeth are developing, or more in particular, during the
formative stage of enamel maturity. Formerly if the enamel has
2
Enamel hypoplasia of canines
Gottipati, et al.
been calcified, no such defect can be formed. The timing of the
ameloblastic damage has a great effect on the location and appearance
of the defect in the enamel. The site of coronal damage correlates
with the area of ameloblastic activity at the time of the injury; the
affected enamel is restricted to the areas in which secretory activity
or active maturation of the enamel was occurring.[1,3]
If the interference takes place in the 1st year (called the
infancy period), the permanent teeth affected are the first
molars, the incisors (except the maxillary lateral incisors), and
the canine teeth. It is striking that the maxillary lateral incisors
mineralize after the central incisors and canines, approximately
after the age of 10 months. If the interference takes place in early
childhood (approximately 13-34 months) the maxillary lateral
incisors and premolars which begin to calcify during this period
are also affected.[6]
In mild environmental hypoplasia, there might be simply a few
minute grooves, pits or fissures on top of the enamel surface. If
the condition is further severe, the enamel may show evidence of
rows of deep pits arranged horizontally diagonally on the surface
of the tooth. Sometimes there might be only a single row of such
pits or several rows signifying a sequence of injuries.[1,6] Thus, the
present case is of mild environmental hypoplasia involving only
permanent canines with two pits on the labial surface.
The treatment of dental problems of patients with EH presents
an interesting challenge to the dental surgeon. Management of
patients with EH should start with early diagnosis to prevent
restorative problems at a later stage. The esthetic treatment of
EH is limited to the removal of surface.[2]
Conclusion
EH is quantitative enamel defect associated with a broad
spectrum of etiologies. Most defects in enamel are cosmetic
rather than functional dental problems. The main clinical
characteristic is extensive loss of tooth tissue, carious lesions,
tooth sensitivity and poor aesthetics. Appropriate interventions
and early dental treatment may help prevent destruction and loss
of the dentition.
References
1. Rajendran A, Sundharam S. Shafer’s Textbook of Oral Pathology.
5th ed. India: Elsevier; 2006.
2. Shah P, Shah M, Parikh K, Khan F. Enamel hypoplasia:
The multidisciplinary approach - 3 case reports. J Dent Sci
2012;2:48-50.
3. Neville DD, Damm BW Oral and Maxillofacial Pathology.
2nd ed. Philadelphia: Elsevier; 2009. p. 51-5.
4. Musale PK, Yadav T, Ahmed BJ. Clinical management of an
epigenetic enamel hypoplasia- A case report. Int J Clin Dent Sci
2010;1:77-80.
5. Slootweg PJ. Dental Pathology- A Practical Introduction. 1st ed.
New York: Springer 2007. p. 21.
6. Paranjpe A, Risbud M, Kshar A. Environmental enamel
hypoplasia: A case report. J Res Adv Dent 2013;2:65-8.
7. Littleton J, Townsend GC. Linear enamel hypoplasia and
historical change in a central Australian community. Aust Dent
J 2005;50:101-7.
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