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PubMed This is a summary of 19 peer-reviewed journal articles Updated
Dentistry

Diagnosing DGI-II and Reading the X-rays

At a Glance

Dentinogenesis Imperfecta Type 2 (DGI-II) is primarily diagnosed using dental X-rays, which reveal characteristic signs like bell-shaped crowns, pinched gumlines, short roots, and vanishing nerve chambers (pulpal obliteration). Genetic testing for the DSPP gene confirms the exact diagnosis.

While a dentist can often suspect Dentinogenesis Imperfecta Type 2 (DGI-II) by looking at the color of the teeth, X-rays (radiographs) are the most important tool for confirming the diagnosis and planning care [1]. Because the condition affects how dentin is built, the “inside” of the tooth looks very different from a healthy tooth [2].

Common X-ray Findings

When a dentist looks at a panoramic X-ray (a 3D-like view of the entire mouth), they look for several features so specific that they almost always point to DGI-II [1][3].

  • Bulbous Crowns: The “top” part of the tooth (the crown) often looks unusually round or “bell-shaped” [4][1].
  • Cervical Constriction: This is a sharp narrowing or “pinching” of the tooth at the gumline [1][5]. This makes the crown above look even more bulbous by comparison.
  • Short, Blunt Roots: The roots of the teeth may be thinner, shorter, or more rounded at the tips than normal [1][3].

The Mystery of the Disappearing Nerve

In a healthy tooth, there is a hollow space in the center called the pulp chamber, which holds the nerves and blood vessels [2]. In DGI-II, this space often seems to “disappear” on X-rays [6].

This is called progressive pulpal obliteration [2]. Because the body is producing abnormal dentin at an accelerated, disorganized rate, it eventually fills in the hollow chamber entirely with solid tissue [2][7]. This process often begins shortly after the tooth first breaks through the gums (eruption) [6].

While “no nerves” might sound like it means “no pain,” it actually makes dental work more complex [8]. If a tooth with an obliterated pulp gets an infection, a standard root canal may be very difficult or even impossible because there is no clear “tunnel” for the dentist to follow [8][9].

Routine Monitoring: To catch hidden infections early, dentists often use specialized 3D X-rays, like a CBCT scan, to safely monitor the roots of these obliterated teeth [10][11].

Confirming with Genetic Testing

While X-rays are excellent for seeing the damage, genetic testing is becoming the standard for confirming the specific cause of the condition [12].

  • Targeting the DSPP Gene: Testing usually looks for mutations in the DSPP gene, which is the primary cause of DGI-II [12][13].
  • A “Tricky” Gene: Part of the DSPP gene (called Exon 5) is very repetitive and difficult for standard tests to read [14][15]. Doctors may use advanced “long-read sequencing” to get a clear picture of this specific area if standard tests are inconclusive [14].
  • Ruling Out Other Types: Genetic testing is also the most reliable way to ensure the condition is isolated DGI-II and not Type I, which would involve mutations in collagen genes related to bone health [16][17].

Confirming the diagnosis through genetics can help your dental team choose the right restorative materials and provide clarity for other family members who may be at risk of passing on the gene [18][19].

Common questions in this guide

How is Dentinogenesis Imperfecta Type 2 diagnosed?
Dentists typically diagnose DGI-II by examining the visible color of the teeth and taking dental X-rays to look for structural abnormalities. Genetic testing is also used to confirm the specific gene mutation responsible for the condition.
What do DGI-II teeth look like on an X-ray?
On an X-ray, teeth with DGI-II often show 'bulbous' or bell-shaped tops, narrow pinched bases near the gumline, and unusually short, blunt roots. The inner nerve chamber may also appear to be missing or filled in.
What does pulpal obliteration mean?
Pulpal obliteration means the hollow center of the tooth, which normally holds the nerves and blood vessels, fills up with abnormal solid dentin tissue. This process often starts shortly after the tooth comes through the gums.
Why is genetic testing recommended for DGI-II?
Genetic testing confirms if the condition is caused by a mutation in the DSPP gene. It helps rule out other genetic conditions linked to bone health and provides valuable information for family members who may carry the gene.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Can you show me on my child's X-ray where the 'bulbous crowns' and 'cervical constriction' are?
  2. 2.Are the pulp chambers already starting to 'disappear,' or is that a process we are still monitoring?
  3. 3.Do the X-rays show any signs of hidden infections (abscesses) at the tips of the roots?
  4. 4.If we decide on genetic testing, does the lab use 'long-read sequencing' to specifically look at the complex parts of the DSPP gene?
  5. 5.Based on the X-ray, are the roots long enough to support standard crowns, or will we need a different approach?

Questions For You

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References

References (19)
  1. 1

    Dentinogenesis imperfecta type II: A case report with 17 years of follow-up.

    Gama FJR, Corrêa IS, Valerio CS, et al.

    Imaging science in dentistry 2017; (47(2)):129-133 doi:10.5624/isd.2017.47.2.129.

    PMID: 28680850
  2. 2

    A novel approach to full-mouth rehabilitation of dentinogenesis imperfecta type II: Case series with review of literature.

    Zhang Y, Jin X, Zhang Z, et al.

    Medicine 2024; (103(4)):e36882 doi:10.1097/MD.0000000000036882.

    PMID: 38277536
  3. 3

    Indirect adhesive rehabilitation by cementation under pressure of a case of Dentinogenesis Imperfecta type II: follow-up after 13 years.

    Campanella V, Di Taranto V, Libonati A, et al.

    European journal of paediatric dentistry 2018; (19(4)):303-306 doi:10.23804/ejpd.2018.19.04.10.

    PMID: 30567448
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    Dentinogenesis imperfecta type II: Diagnosis, functional and esthetic rehabilitation in mixed dentition.

    Kaur R, Karadwal A, Sharma D, Sandhu MK

    Journal of oral and maxillofacial pathology : JOMFP 2021; (25(Suppl 1)):S76-S80 doi:10.4103/jomfp.JOMFP_172_20.

    PMID: 34083977
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    Personalized Bonding Approach for Full-Mouth Adhesive Rehabilitation in Dentinogenesis Imperfecta.

    Clark C, Kérourédan O, Massé L

    Clinical case reports 2025; (13(6)):e70552 doi:10.1002/ccr3.70552.

    PMID: 40469120
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    Dentinogenesis imperfecta type 2: a case report.

    Mohan KR, Narayanan M, Ravikumar PT

    General dentistry 2021; (69(6)):74-76.

    PMID: 34678748
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    Early Rehabilitation of Incisors with Dentinogenesis Imperfecta Type II - Case Report.

    Beltrame AP, Rosa MM, Noschang RA, Almeida IC

    The Journal of clinical pediatric dentistry 2017; (41(2)):112-115 doi:10.17796/1053-4628-41.2.112.

    PMID: 28288297
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    Regenerative Endodontic Treatment in Dentinogenesis Imperfecta-Induced Apical Periodontitis.

    Liao Y, Pan T, Xing X

    Case reports in dentistry 2024; (2024()):5128588 doi:10.1155/2024/5128588.

    PMID: 38223911
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    Regenerative Endodontic Procedures in Immature Teeth Affected by Regional Odontodysplasia.

    Chebath-Taub D, Slutzky-Goldberg I

    Journal of endodontics 2024; (50(7)):1017-1021 doi:10.1016/j.joen.2024.04.006.

    PMID: 38626857
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    Guided Endodontics in Managing Root Canal Treatment for Anomalous Teeth-A Narrative Review.

    Sabanik P, Samiei M, Avval ST, Cavalcanti B

    Australian endodontic journal : the journal of the Australian Society of Endodontology Inc 2025; (51(3)):836-848 doi:10.1111/aej.70007.

    PMID: 40792425
  11. 11

    Cone-Beam Computed Tomography (CBCT)-Guided Non-surgical Management of Type II Dens Invaginatus in Maxillary Lateral Incisors Using Calcium Silicate-Based Materials: A Case Series.

    Priya P

    Cureus 2026; (18(1)):e101205 doi:10.7759/cureus.101205.

    PMID: 41669597
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    Isolated dentinogenesis imperfecta: Novel DSPP variants and insights on genetic counselling.

    Hassib NF, Mehrez M, Mostafa MI, Abdel-Hamid MS

    Clinical oral investigations 2024; (28(5)):254 doi:10.1007/s00784-024-05636-z.

    PMID: 38630328
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    A Novel DSPP Mutation in Dentinogenesis Imperfecta Shields Type II: Clinical, Genetic and Stem Cell Perspectives.

    Gao Q, Deng Z, Yang L, et al.

    International dental journal 2025; (75(5)):100937 doi:10.1016/j.identj.2025.100937.

    PMID: 40763686
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    Diagnosis complexity of dentinogenesis imperfecta involving DSPP genetic variants.

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    Journal of medical genetics 2026; doi:10.1136/jmg-2025-111345.

    PMID: 41819808
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    The dentin phosphoprotein repeat region and inherited defects of dentin.

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    Molecular genetics & genomic medicine 2016; (4(1)):28-38 doi:10.1002/mgg3.176.

    PMID: 26788535
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    Dentinogenesis imperfecta type II in Swedish children and adolescents.

    Andersson K, Malmgren B, Åström E, Dahllöf G

    Orphanet journal of rare diseases 2018; (13(1)):145 doi:10.1186/s13023-018-0887-2.

    PMID: 30134932
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    Non-Syndromic Dentinogenesis Imperfecta Caused by Mild Mutations in COL1A2.

    Lee Y, Kim YJ, Hyun HK, et al.

    Journal of personalized medicine 2021; (11(6)) doi:10.3390/jpm11060526.

    PMID: 34201399
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    Dentinogenesis Imperfecta Type II in Children: A Scoping Review.

    Garrocho-Rangel A, Dávila-Zapata I, Martínez-Rider R, et al.

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    Interdisciplinary Management of a Patient with Dentinogenesis Imperfecta Type II Using a Combination of CAD-CAM and Analog Techniques: A Clinical Report.

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This page explains DGI-II diagnosis and dental X-ray terminology for educational purposes only. Always consult a qualified dentist or genetic counselor for an accurate diagnosis and personalized care plan.

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