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Developmental anomalies of teeth - by variyta

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Developmental anomalies of teeth - by variyta

  1. 1. Developmental disturbances means an abnormality where the pathology starts in the embryonic stage of human life , before the formation of the dentition
  2. 2.  SIZE OF TEETH  SHAPE OF TEETH  NUMBER OF TEETH  STRUCTURE OF TEETH  GROWTH (ERUPTION) OF TEETH
  3. 3.  MICRODONTIA  MACRODONTIA
  4. 4. MICRODONTIA
  5. 5.  THIS TERM IS USED TO DESCRIBE TEETH WHICH ARE SMALLER THAN NORMAL ,i.e. OUTSIDE USUAL LIMITS OF VARIATION  TYPES :  True generalized microdontia  Relative generalized microdontia  Microdontia involving single tooth
  6. 6.  ALL TEETH smaller than normal  Rare  Well formed teeth, merely small  Associated with PITUITARY DWARFISM
  7. 7.  NORMAL OR SLIGHTLY SMALLER than normal TEETH are present in JAWS that are LARGER than normal.  Illusion of true microdontia  Role of HEREDITARY FACTORS
  8. 8.  COMMON condition  SITE : maxillary lateral incisor & 3rd molar  Supernumerary teeth are frequently small in size ‘PEG LATERAL’: in maxillary lateral incisors ,instead of exhibiting parallel or diverging mesial & distal surfaces ,the sides converge or taper together incisally ,forming a peg shaped or cone shaped crown.
  9. 9. MACRODONTIA
  10. 10.  Teeth that are LARGER than normal  Opposite of microdontia  TYPES : 1. True generalized macrodontia 2. Relative generalized macrodontia 3. Macrodontia of single tooth
  11. 11.  ALL TEETH ARE LARGER than normal  RARE  Associated with PITUITARY GIGANTISM
  12. 12.  More common  PRESENCE OF NORMAL OR SLIGHTLY LARGER THAN NORMAL TEETH IN SMALL JAWS  Illusion of macrodontia  Role of HEREDITARY FACTORS
  13. 13.  Uncommon  Unknown etiology  TOOTH MAY APPEAR NORMAL IN EVERY RESPECT EXCEPT FOR ITS SIZE  Not to be confused with fusion of teeth
  14. 14.  GEMINATION  FUSION  CONCRESCENCE  DILACERATION  TALON CUSP  DENS IN DENTE  DENS EVAGINATUS  TAURODONTISM
  15. 15.  Attempt of DIVISION OF SINGLE TOOTH GERM BY INVAGINATION  Incomplete formation of teeth  Usually one with two completely or incompletely separated crowns that have single root and root canal  Exhibit a hereditary tendency  Tooth count is normal  Unknown cause; trauma may be possible cause
  16. 16.  Fused teeth arise THROUGH UNION OF TWO NORMALLY SEPARATED TOOTH GERMS  Physical force or pressure produces contact  Depending upon stage of development of teeth, fusion may be 1. COMPLETE 2. INCOMPLETE  If this contact occurs early, at least before calcification begins,2 teeth may be completely united to form a single larger tooth
  17. 17.  Seen in deciduous as well as permanent dentition  Higher frequency in anterior and maxillary region  It is not always possible to differentiate between gemination and fusion between a normal tooth & supernumerary tooth  The term ‘TWINNING’ is used to designate the production of equivalent structures by division resulting in one normal & one supernumerary teeth
  18. 18.  Fusion which occurs after root formation has been completed  Teeth are UNITED BY CEMENTUM ONLY  Arise as a result of traumatic injury or crowding of teeth with resorption of interdental bone so that the 2 roots are in approximate contact and become fused by deposition of cementum between them  It may occur before/after teeth have erupted
  19. 19.  Dilaceration refers to AN ANGULATION,OR A SHARP BEND OR A CURVE ,IN ROOT OR CROWN OF FORMED TEETH  Due to trauma in the period in which the tooth is forming  Position of calcified portion of tooth is changed & the remainder of tooth is formed at an angle  The curve or bend may occur anywhere along length of tooth depending upon amount of root formed when injury occurred
  20. 20. DILACERATION
  21. 21.  An anomalous structure RESEMBLING AN EAGLE’S TALON  Projects lingually from the cingulum of maxillary /mandibular permanent incisor  This cusp bends smoothly with tooth except that there is a deep developmental groove  It is composed of normal enamel and dentin & contains a horn of pulp tissue …
  22. 22.  ASSOCIATED WITH RUBINSTEIN TAYBI SYNDROME: 1. DEVELOPMENTAL RETARDATION 2. BROAD THUMBS & GREAT TOES 3. CHARACTERISTIC FACIAL FEATURES 4. DELAYED OR INCOMPLETE DESCENT OF TESTES IN MALES  TREATMENT: PROPHYLACTICALLY RESTORING GROOVE TO PREVENT CARIES
  23. 23.  ALSO KNOWN AS ‘DENS INVAGINATUS , DILATED COMPOSITE ODONTOME’  Invagination in surface of tooth crown before calcification has occurred  CAUSES: 1. increased localized external pressure 2. focal growth retardation/stimulation
  24. 24. CORONAL 3 types – TYPE 1 TYPE 2 TYPE 3
  25. 25. TYPE 1: •Confined to the crown TYPE 2 : • Extends below CEJ • Ends in a blind sac • May or may not communicate with adjacent dental pulp TYPE 3 : • Extends through the root • Perforates in the apical or lateral radicular area without any immediate communication with pulp
  26. 26.  CLINICAL FEATURES: 1. Maxillary lateral incisors 2. Bilateral 3. Majority represent simply an accentuation on lingual pit RADICULAR VARIETY :  DISCUSSED BY ‘BHATT & DHOLAKIA’  Radicular invagination usually results from an infolding of HERS & takes its origin within the root after development is complete TREATMENT :  TOOTH PROPHYLACTICALLY RESTORED  IN TEETH WITH OPEN APICES,APEXIFICATION WITH Ca(OH)2
  27. 27.  ALSO KNOWN AS ‘OCCLUSAL TUBERCULATED PREMOLAR , LEONG’S PREMOLAR , EVAGINATED ODONTOME , OCCLUSAL ENAMEL PEARL’  Appears as accessory cusp or globule of enamel on occlusal surface between the buccal and lingual cusp of premolars  Proliferation and evagination of an area of inner enamel epithelium during tooth development  Unilateral/bilateral  Rarely on molars , cuspids , laterals
  28. 28.  A PECULIAR DENTAL ANOMALY IN WHICH THE BODY OF TOOTH IS ENLARGED AT EXPENSE OF ROOTS  CLASSIFIED INTO- 1. Hypotaurodont 2. Mesotaurodont 3. Hypertaurodont
  29. 29.  CAUSES: 1. A SPECIALIZED OR RETROGRADE CHARACTER 2. A PRIMITIVE PATTERN 3. A MENDELIAN RECESSIVE TRAIT 4. AN ATAVISTIC FEATURE 5. A MUTATION RESULTING FROM ODONTOBLASTIC DEFICIENCY DURING DENTINOGENESIS OF ROOT  Hammer & his associates believe that the taurodont is caused by failure of HERS to invaginate at proper horizontal level  Goldstein & gottlieb stated that condition appears to be genetically controlled & familial in nature  CLINICAL FEATURES: 1. DECIDUOUS 2. PERMANENT (COMMON) 3. MOLARS 4. CLEFT LIP & CLEFT PALATE
  30. 30.  RADIOGRAPHIC FEATURES: 1. RECTANGULAR IN SHAPE 2. PULP CHAMBER : LARGE 3. LACKS CONSTRICTION 4. ROOTS ARE EXCEEDINGLY SHORT 5. BIFURCATION OR TRIFURCATION – FEW mm
  31. 31.  Enamel in unusual location  DROPLETS OF ECTOPIC ENAMEL  Hemispheric structure  Most project from the surface of root  A localized bulging of odontoblastic layer
  32. 32.  CLINICAL FEATURES: 1. Roots of maxillary molar (common) 2. Mandibular molar 3. Deciduous molar is not rare 4. 1.1-9.7% highest in Asians  SITE- on roots of furcation area  RADIOGRAPHICALLY-well defined radio opaque nodule
  33. 33.  ANODONTIA  HYPERDONTIA  SUPERNUMERARY TEETH  PRE – DECIDUOUS DENTITION  POST – PERMANENT DENTITION
  34. 34.  CONGENITAL ABSENCE OF TEETH  3 TYPES: 1. TRUE -TOTAL -PARTIAL 2. FALSE (EXTRACTION) 3. PSEUDO (UNERUPTED)
  35. 35.  All teeth missing  May involve both primary & secondary dentition  Rare  Associated with : HEREDITARY ECTODERMAL DYSPLASIA
  36. 36.  HYPODONTIA - 1 or more teeth  OLIGODONTIA - 6 or more teeth  common condition  MISSING- 3rd molar, lateral incisor, maxillary & mandibular 2nd premolar  Congenitally missing deciduous teeth– uncommon – lateral incisor  ETIOLOGY – unknown,familial tendency
  37. 37.  Increase in no. of teeth - SUPERNUMERARY TEETH  Closely resemble in size or shape with which associated  ETIOLOGY-Supernumerary teeth develop from splitting of permanent bud HYPERACTIVITY THEORY-As a result of local , independent , hyperactivity of dental lamina  In some cases, hereditary tendency
  38. 38.  CONDITION : 1. CLEFT LIP & PALATE 2. CLEIDOCRANIAL DYSPLASIA 3. GARDENER SYNDROME  CLASSIFICATION : ACCORDING TO MORPHOLOGY & LOCATION –  CONICAL : MESIODENS  TUBERCULATE – >1 CUSP/TUBERCLE (barrel shaped ; may be invaginated)  SUPPLEMENTAL / DUPLICATION  ODONTOME-(hamartomatous malformation rather than a neoplasm) *COMPOSITE (composed of >1 type of tissue) -COMPLEX (diffuse mass of dental tissue i.e., totally disorganized) -COMPOUND (malformation which bears some superficial anatomic similarity to a normal tooth)
  39. 39. MESIODENS : Most common supernumerary tooth Situated between maxillary central incisors Occurs as : -single or paired ; - erupted or impacted or inverted
  40. 40. FOURTH MOLAR :  2nd most common supernumerary tooth  Situated distal to the 3rd molar  Usually small , rudimentary tooth but may be of normal size  Maxillary 4th molar is more common than mandibular 4th molar  An accessory 4th molar is called Distomolar or DISTODENS
  41. 41.  The epithelial structures in the mouth of the infant before the eruption of the primary teeth • Arising from, – An accessory bud of the dental lamina ahead of the deciduous tooth bud. – The bud of accessory dental lamina.  Described as hornified, epithelial structures without roots. Occurs in the gingiva over the crest of the ridge , may be easily removed.  Differentiated from true deciduous teeth or natal teeth  described by Massler – which erupts at the time of birth.  Some consider it as a misinterpretation of dental lamina cysts of new born, – Projects above the crest of the ridge. – White in color. - Packed within keratin , so that it appears hornified - Can be easily removed
  42. 42.  The rare appearance of supernumerary teeth after loss of permanent teeth; most teeth that appear after extraction of permanent teeth are due to eruption of previously impacted teeth particularly after insertion of complete denture.  Majority is due to delayed eruption of retained or embedded teeth.  Some may represent post‐permanent or third dentition.  But they are actually, multiple supernumerary unerupted teeth.  It probably develops from a bud of the dental lamina beyond the permanent tooth germ.
  43. 43. 1. AMELOGENESIS IMPERFECTA 2. ENVIRONMENTAL ENAMEL HYPOPLASIA 3. DENTINOGENESIS IMPERFECTA 4. DENTIN DYSPLASIA 5. REGIONAL ODONTODYSPLASIA 6. DENTIN HYPOCALCIFICATION
  44. 44.  SYNONYMS – HEREDITARY ENAMEL DYSPLASIA ; HEREDITARY BROWN ENAMEL ; HEREDITARY BROWN OPALESCENT TEETH  A STRUCTURAL DEFECT OF THE TOOTH ENAMEL WITH COMPLEX INHERITANCE PATTERN  Developmental of normal enamel occurs in 3 stages –  FORMATIVE  CALCIFICATION  MATURATIVE
  45. 45.  3 BASIC TYPES ARE-  Hypoplastic  Hypocalcification  Hypomaturation CLASSIFICATION : CLASSIFICATION OF AMELOGENESIS IMPERFECTA GIVEN BY – WITKOP (1989) TYPES - TYPE 1 TYPE 2 TYPE 3 TYPE 4
  46. 46. TYPE 1 TYPE 2 TYPE 3 TYPE 4  HYPOPLASTIC • 1A : Hypoplastic , pitted autosomal dominant • 1B : Hypoplastic , local autosomal dominant • 1C : Hypoplastic , local autosomal recessive • 1D : Hypoplastic, smooth autosomal dominant • 1E : Hypoplastic , smooth X linked dominant • 1F : Hypoplastic , rough autosomal dominant • 1G : Enamel agenesis , autosomal recessive  HYPOMATURATION • 2A: hypomaturation,pigmented autosomal recessive • 2B: hypomaturation,X linked recessive • 2C : snow capped , autosomal dominant  HYPOCALCIFIED • 3A : autosomal dominant • 3B : autosomal recessive  HYPOMATURATION-HYPOPLASTIC WITH TAURODONTISM , AUTOSOMAL DOMINANT • HYPOMATURATION-HYPOPLASTIC WITH TAURODONTISM,AD • HYPOPLASTIC-HYPOMATURATION WITH TAURODONTISM,AD
  47. 47.  CLINICAL & RADIOGRAPHIC FEATURES : • Inadequate deposition of enamel matrix • Any matrix present will mineralize appropriately • Absence of enamel thickness • Open contact points • Radiographically,a thin peripheral outline of radio opaque enamel
  48. 48.  CLINICAL & RADIOGRAPHIC FEATURES : • Enamel matrix is laid appropriately, there is a defect in maturation of enamel crystal structure • Mottled , opaque white brown yellow discoloration • Enamel surface tends to chip • Radiographically , radio density similar to dentin
  49. 49.  CLINICAL & RADIOGRAPHIC FEATURES : • No significant mineralization • Enamel very soft & easily lost • Occlusal surface more irregular • Radiographically , radio density of enamel & dentin are similar • Yellow to brown in color
  50. 50.  Main problem is aesthetics , sensitivity & loss of vertical dimension  The type which exhibits thin enamel (hypocalcification-hypomaturation )-full coverage crown  Patterns without significant crown length : full dentures  Less rapid hypo plastic tooth loss : aesthetics is the prime consideration – full crown; facial veneers
  51. 51.  DEFINITION- incomplete or defective formation of organic enamel matrix of teeth  TYPES-I. Hereditary type-both dentition II. Type caused by environmental factors-only single tooth  CLINICAL FEATURES-I. Mild cases few grooves , pits & fissures II. Severe rows of deep pits III. Most severe forms- considerable portion of enamel may be absent
  52. 52.  CAUSES :  LOCAL INFECTION OR TRAUMA – TURNERS TEETH-condition is called TURNERS HYPOPLASIA any infection to 1º teeth that leads to periapical area where ameloblasts of 2º teeth (tooth buds are present)  CONGENITAL SYPHILIS – non pitting type maxillary & mandibular 2º incisors & 1st molars • HUTCHINSON’S INCISORS • MOON’S MOLAR/FOURNIER MOLAR/MULBERRY MOLAR  NUTRITIONAL DEFICIENCY-Incisors, canines & 1st molar  BIRTH INJURIES  ERYTHROBLASTOSIS FOETALIS  NEONATAL LINES OR RINGS MULBERRY
  53. 53.  CHEMICALS : Eg.Tetracycline Mechanism – a chelate of calcium & tetracycline forms. at high concentration, in both ameloblast & odontoblast , protein synthesis is impaired ,this results in hypoplasia of enamel & dentin matrix CRITICAL PERIOD – TEETH IU (months) Deciduous incisors 4 Deciduous canines 5 Permanent incisors & canines 3-5  FLUOROSIS : PATHOGENESIS – disturbance of ameloblasts during the formative stage of tooth development resulting in defective or deficient enamel matrix GRADE CLINICAL APPEARANCE Very mild, questionable white, opaque,<25% Mild white , opaque,</=50% Moderate white , opaque, brownish Severe opaque,pitted,brown,brittle
  54. 54.  Affected teeth are gray to yellowish brown & have ‘TULIP SHAPE’  Radiographically,the teeth appear solid, lacking pulp chamber & root canals  CLASSIFICATION :associated with osteogenesis imperfecta was listed TYPE 1 I. DENTINOGENESIS IMPERFECTA 1 – D.I. without osteogenesis imperfecta (opalescent dentin) II. DENTINOGENESIS IMPERFECTA 2 - Brandywine type D.I.  D.I. TYPE 1: FREQUENCY -1 in 6000-8000 children BLUE GRAY OR AMBER BROWN & OPALESCENT RADIOGRAPHICALLY ; teeth have bulbous crowns & obliterated pulp chambers  D.I. TYPE 2 : brandywine triracial isolate in southern Maryland Multiple pulp exposures may occur Dentin is amber colored & smooth Radio graphically , deciduous- large pulp chambers & root canals Permanent – completely obliterated
  55. 55.  HISTOLOGICAL FEATURES : • Irregular tubules , with large areas of uncalcified matrix • Tubules are larger in diameter • Dentinal tubules in D.I. are disoriented  PHYSICAL AND CHEMICAL FEATURES : • water content increased 60 % • hardness - low  TREATMENT : • Full coverage : crowns & roots close to normal shape • Overlay dentures placed on teeth covered with fluoride releasing GIC • Vertical dimension rebuilt-metal castings • Newer composite combined with dentin bonding agent – occlusal wear
  56. 56.  ATYPICAL DENTIN FORMATION WITH ABNORMAL PULP MORPHOLOGY  SHIELDS & HIS ASSOCIATES separated it into – TYPE 1 – DENTIN DYSPLASIA TYPE 2 – ANOMALOUS DYSPLASIA OF DENTIN  WITKOP referred as – RADICULAR – TYPE 1 CORONAL - TYPE 2
  57. 57.  TYPE 1 (RADICULAR) Slight amber translucency Exfoliated prematurely or after only minor trauma Radio graphically ; Deciduous – pulp completely obliterated Permanent – crescent shaped  TYPE 2 (CORONAL) Yellow brown or bluish gray opalescent Clinical appearance of permanent dentition is normal Radio graphically , Deciduous – pulp chamber obliterated Permanent – thistle tube shaped
  58. 58.  HISTOLOGICAL FEATURES : • TYPE 1 (RADICULAR) - lava flowing around boulders • TYPE 2 (CORONAL) – DECIDUOUS : amorphous & atubular dentin in radicular portion PERMANENT : multiple pulp stones or denticles  TREATMENT : • Preventive care • Meticulous oral hygiene • Shallow restorations – pulpal necrosis • Periapical inflammatory lesions : therapeutic choice guided by root lengths  SYSTEMIC DS. ASSOCIATED WITH DENTIN DYSPLASIA  CALCINOSIS UNIVERSALIS  RHEUMATOID ARTHRITIS & VITAMINOSIS  SCLEROTIC BONE & SKELETAL ABNORMALITIES  TUMOR CALCINOSIS
  59. 59.  Odontogenic Dysplasia  Odontogenesis Imperfecta  Ghost Teeth Also known as :  ETIOLOGY : 1. Abnormal migration of neural crest cells 2. Latent virus 3. Local circulatory deficiency 4. Local trauma or infection 5. Hyperpyrexia 6. Malnutrition 7. Medication 8. Radiation therapy 9. Somatic mutation 10. Alteration in vascular supply
  60. 60.  CLINICAL FEATURES : a. BIMODAL PEAK b. FOCAL AREA c. MAXILLARY PREDOMINANCE d. SURROUNDING BONE – LOWER DENSITY e. ERUPTED TEETH – IRREGULAR, ROUGH, YELLOW TO BROWN IN COLOR  SIGNS & SYMPTOMS : a. DELAYED/FAILURE OF ERUPTION b. EARLY EXFOLIATION c. ABSCESS FORMATION d. MALFORMED TEETH e. NON INFLAMMATORY GINGIVAL ENLARGEMENT  RADIOGRAPHIC FEATURES : a. THIN ENAMEL & DENTIN – GHOST TEETH b. LACK OF CONTRAST c. PULP STONES
  61. 61.  HISTOLOGIC FEATURES : • ENAMEL : PRISM STRUCTURE – IRREGULAR • DENTIN : GLOBULAR AREAS –POORLY ORGANIZED TUBULAR DENTIN • PULP : PULP STONES  TREATMENT : • RETENTION • NON VITAL – ENDODONTIC THERAPY • TOOTH PREPARATION CONTRAINDICATED • SEVERELY INFECTED / AFFECTED TEETH - EXTRACTION
  62. 62.  Caused by environmental factors affecting mineralization  There is failure in the fusion of calcium globules , during mineralization , leaving interglobular areas of uncalcified matrix  Globular dentin can be easily detected in ground & decalcified sections  Hypocalcified dentin is softer
  63. 63.  PREMATURE ERUPTION  DELAYED ERUPTION  ERUPTION SEQUESTRUM  MULTIPLE UNERUPTED TEETH  EMBEDDED AND IMPACTED TEETH  ANKYLOSED & DECIDUOUS TEETH
  64. 64.  Reason is unknown.  Hormonal influences like hyperthyroidism, adrenal glands and gonadism, for tooth eruption are also considered.(e.g., in ADRENOGENITAL SYNDROME)  These teeth are often well formed, normal in all aspects but may exhibit mobility.  It should be retained though nursing difficulties may be experienced.  Permanent teeth erupt prematurely as a sequel to the premature loss of deciduous teeth.  Seen when only a single deciduous teeth is lost with subsequent eruption of the succedaneous tooth.
  65. 65.  In deciduous and permanent teeth, it is difficult to assess unless a gross variation is present.  Caused by,  Systemic conditions like rickets, cretinism, cleidocranial dysplasia.  Local factors like fibromatosis gingivae (Because of dense connective tissue which delays eruption).  Treatment of the primary condition may lead to eruption of the teeth.
  66. 66.  Anomaly associated with tooth eruption in children.  Described by Starkey and Shafer.  It is a tiny, irregular spicule of bone overlying the crown of an erupting permanent molar, found just prior to or immediately following the emergence of the tip of the cusps through the oral mucosa.  Etiology :  As the molar teeth erupt through the bone, they can separate a small osseous fragment from the surrounding bone similar to a cork screw.  In most cases, the fragment undergoes complete resorption before eruption.  If the bony spicule is large or the eruption is rapid, complete resorption cannot occur and hence, it is observed.
  67. 67.  Clinical features :  The child may complain of slight soreness in the area during function.  The spicule directly overlies the central occlusal fossa but is within the soft tissue.  It may be seen lying in a tiny depression over the crest of the ridge.  As the tooth erupts, the fragment of bone completely sequesters through the mucosa and is lost.  Radiographic features :  It can be recognized even before the tooth eruption.  Seen as a tiny, irregular opacity overlying the central occlusal fossa but separated from the tooth itself.
  68. 68.  Uncommon condition with delayed eruption of teeth. – Deciduous teeth may be retained or – Deciduous teeth would be shed but the permanent teeth would have failed to erupt (Pseudo‐anodontia).  Radiographs may be normal but the eruptive forces would be lacking.  In association with cleidocranial dysplasia
  69. 69.  Embedded teeth are individual teeth which are unerupted usually because of a lack of eruptive force.  Impacted teeth are prevented from eruption by some physical barrier in the eruption path like, – Lack of space – crowding, premature loss of deciduous teeth. – Rotation of tooth buds.  Any tooth may be impacted – usually mandibular third molars (22%), maxillary third molars (18%) and maxillary cuspids (0.9%), premolars and supernumerary teeth.  Mandibular teeth are more severely impacted than maxillary teeth.
  70. 70.  Also called Submerged teeth, Infraocclusion, Secondary retention, Submergence, Reimpaction and Reinclusion.  Usually deciduous mandibular second molars with variable degree of root resorption can become ankylosed to bone.  This prevents exfoliation and subsequent replacement by permanent teeth.  After the eruption of adjacent teeth, these ankylosed teeth appears to be submerged from the level of occlusion.  The submerged appearance could be due to – Continued growth of the alveolar process – Crown height of deciduous tooth is less than that of adjacent permanent teeth.  It has a solid sound on percussion when compared to the dull, cushioned sound of normal teeth.  Teeth lack mobility , root resorption is far advanced.  Radio graphically , partial absence of PDL , with areas of apparent bending between tooth root & bone
  71. 71.  Books  Cawson, R.A: Cawson’s Essentials of Oral › Oral Pathology and Oral Medicine, › 8th Edition • (pages 24-36)  Neville, et al: Oral and Maxillofacial Pathology › 3rd Edition • (pages 77-113)  Shafer, et al: A textbook of Oral Pathology, › 3rd Edition • (pages 37-69)

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