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Duke A, Paterson M, P Ashley M, MacNab L. The genetic basis of hypodontia in dental development. Br Dent J 2023; 235:525-528. [PMID: 37828195 DOI: 10.1038/s41415-023-6384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 10/14/2023]
Abstract
Dental agenesis is one of the most common developmental anomalies in humans, characterised by the developmental absence of one or more teeth. It can present as an isolated condition (non-syndromic hypodontia) or associated with a syndrome (syndromic hypodontia). This paper aims to review the genetic basis of hypodontia with reference to aetiology, classification and the subsequent clinical features.Significant progress has been made to identify the developmental basis of tooth formation, though there is still a lack of knowledge within the literature of the aetiological basis of inherited tooth loss.Gene anomalies or mutations in WNT10A, MSX1, PAX9, AXIN2 and EDA appear to be most critical during tooth development, leading to various forms of tooth agenesis.
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Affiliation(s)
- Alice Duke
- Aberdeen Dental Hospital and Institute of Dentistry, Aberdeen, Scotland, UK.
| | - Michael Paterson
- James Cook University Hospital, South Tees Hospital NHS Foundation Trust, UK
| | | | - Lorna MacNab
- Glasgow Dental Hospital and School, Glasgow, Scotland, UK
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2
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Pace-Balzan A, Chatzipantelis A, J Dunn K, Charan G, P Ashley M. Restorative dentistry clinical decision-making for hypodontia: complex cases. Br Dent J 2023; 235:489-495. [PMID: 37828181 PMCID: PMC10570138 DOI: 10.1038/s41415-023-6324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 10/14/2023]
Abstract
Hypodontia is a relatively common condition and patients will be seen by both general dental practitioners and specialist dental colleagues. Although hypodontia can be described as mild, moderate and severe, this does not directly correlate with the complexity of treatment required to provide an acceptable outcome. In addition, the complexity of treatment provided by one colleague in the multidisciplinary team may not be the same as for other colleagues.When treatment planning and delivering dental care for these patients, especially those with severe hypodontia, it is useful to recognise the factors that make their care complex and also to follow principles for multidisciplinary treatment planning.
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Affiliation(s)
| | | | | | - Garima Charan
- Restorative Dentistry, Eastman Dental Hospital, London, UK
| | - Martin P Ashley
- Restorative Dentistry, University Dental Hospital of Manchester, UK.
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Fekonja A, Čretnik A. Comparison of craniofacial morphology in individuals with and without hypodontia with a special focus on the number of congenitally missing teeth. Front Public Health 2022; 10:1013862. [PMID: 36466493 PMCID: PMC9716192 DOI: 10.3389/fpubh.2022.1013862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background Hypodontia might negatively affect dental function and esthetics, what might affect patients' self-esteem, communication behavior, professional performance and thus quality of life. The aim of this study was to estimate the influence of number of congenital missing teeth on dentofacial features. Methods Lateral cephalograms of 60 individuals with hypodontia (study group) and 40 individuals without hypodontia (control group) were analyzed. Patients in the study group were divided into two subgroups according to the number of missing teeth (group A with hypodontia 1 to 4 teeth and group B with hypodontia 5 or more teeth). Cephalometric data were compared among the study and control groups and statistically analyzed. Results The results in the present study revealed a significantly shorter and more retrognathic maxilla, more prognathic chin position, more retruded incisors in both jaws, large interincisal angle, straighter facial convexity as well as more retruded upper and lower lips in the group B compared with the control group. In the group A only chin position was significantly more prognathic compared with the control group. Conclusions According to the results of present study impact of hypodontia on the craniofacial morphology and consequently on facial esthetics was found statistically significantly greater in patients with 5 or more congenitally missing teeth.
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Affiliation(s)
- Anita Fekonja
- Department of Orthodontics, Community Healthcare Centre Maribor, Maribor, Slovenia,Faculty of Medicine, University of Maribor, Maribor, Slovenia,*Correspondence: Anita Fekonja
| | - Andrej Čretnik
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Chen DDS, Cheng JHC, Hsu CSW. Relationship between craniofacial morphology and congenitally missing mandibular incisors. J Dent Sci 2022; 17:928-934. [PMID: 35756788 PMCID: PMC9201659 DOI: 10.1016/j.jds.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background/purpose Treatment of incisors‘ agenesis is challenging that arouses orthodontists’ interests. The purpose of this study was to compare the craniofacial pattern of individuals with or without congenitally missing mandibular incisors. Materials and methods This retrospective study included patients receiving orthodontic consultation between 1999 and 2019 at the Orthodontic Division of the Dental Department of Taipei Medical University Hospital. Cephalometric measurements were obtained through manual tracing and by using computer software. A total of 31 measurements were obtained to evaluate skeletal, dental and soft tissues, and chin morphology. A multivariate analysis of covariance, analysis of covariance, and Scheffé’s post hoc tests were used to analyze the differences among a group of patients with one congenitally missing mandibular incisor (M1), a group of patients with two congenitally missing mandibular incisors (M2), and the control group. Student's t-test was used to analyze the differences between the M1 or M2 group and the control group. Significance was set at P < 0.05. Results Significant differences were observed between the M and control groups in terms of lower incisor angulation and facial balance. Regarding chin morphology, significant differences were noted between the M and control groups and also among the M1, M2, and control groups. Conclusion The lower incisors of the M group are more retroclined than those of the control group, resulting in retrusive lower lips. Facial balance varies between the M and control groups. Congenitally missing mandibular incisors affect chin morphology, making the chin button prominent.
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Siddiqui HP, Sennimalai K, Samrit VD, Duggal R, Yadav R. Adjunctive orthodontic therapy for prosthetic rehabilitation in a growing child with Axenfeld-Rieger syndrome: A case report. Spec Care Dentist 2021; 41:423-430. [PMID: 33719126 DOI: 10.1111/scd.12579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
AIM The congenital oligodontia impeding the development of the alveolar process resulting in disproportionate jaw growth has been previously reported. This case report describes the interdisciplinary management of an 11-year-old girl with Axenfeld-Rieger syndrome exhibiting oligodontia and maxillary hypoplasia. METHODS AND RESULTS An adjunctive orthodontic therapy was performed by taking advantage of bone-anchored maxillary protraction (BAMP) therapy using miniplates and 24-hour traction by intermaxillary Class III elastics. After 6 months of active treatment, the maxilla advanced by approximately 5 mm and upper lip relation improved by 3 mm without any significant changes in vertical relations. All the changes were maintained at 15th-month follow-up. A temporary removable prosthesis was given for immediate esthetics, and the definitive management is discussed. CONCLUSION The BAMP therapy can be a befitting alternative in cases exhibiting complex presentation involving skeletal and dentoalveolar components. An appreciable profile improvement without any dentoalveolar side effects can be achieved with BAMP therapy.
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Affiliation(s)
- Hamza Parvez Siddiqui
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Karthik Sennimalai
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vilas D Samrit
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Duggal
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Division of Oral and Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Canigur Bavbek N, Arslan Avan B. Morphometric evaluation of cranial base and sella turcica in patients with bilateral agenesis of maxillary lateral incisors. Odontology 2021; 109:701-709. [PMID: 33608796 DOI: 10.1007/s10266-021-00593-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/28/2021] [Indexed: 11/26/2022]
Abstract
The aim of this paper is to evaluate the dimensions and morphology of cranial base and sella turcica in patients with bilateral agenesis of maxillary lateral incisors (BMLI). This retrospective study was conducted on lateral cephalometric radiographs of 34 female patients with BMLI (17.69 ± 2.96 years) and 34 female patients with complete dentation and skeletal Class 1 relationship serving as a control group (17.22 ± 2.2 years). Basicranial and maxillomandibular variables together with linear dimensions and morphology of sella turcica were evaluated. Differences between groups were analyzed by Student's t test for parametric variables and Mann-Whitney U test for nonparametric variables. Chi-square test followed by post hoc test with Bonferroni correction was used for categoric variables (p < 0.05). When compared to control group, N-S-Se angle was less negative, dimensions between Ba-Se, N-Ba, and N-Ar were larger, and SNA angle was smaller in BMLI group. There were no significant differences between groups regarding the linear dimensions of sella turcica. However, variations in sella turcica morphology were more frequent in BMLI group (n = 17; 50%) when compared to control group (n = 2; 5.8%). The most common morphologic variations in BMLI group were oblique anterior wall (20.6%) and irregularity (notching) in the posterior part of sella turcica (14.7%). The present study showed a statistically significant relationship between the presence of BMLI with some craniofacial parameters and morphological variations of sella turcica. This information may be useful as an additional and early diagnostic tool for BMLI and to highlight the possible links to its development.
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Affiliation(s)
- Nehir Canigur Bavbek
- Department of Orthodontics, Faculty of Dentistry, Gazi University, 82nd Road No: 2 06510 Emek, Cankaya, Ankara, Turkey.
| | - Basak Arslan Avan
- Department of Orthodontics, Faculty of Dentistry, Gazi University, 82nd Road No: 2 06510 Emek, Cankaya, Ankara, Turkey
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Nikolov Borić D, Radalj Miličić Z, Kranjčević Bubica A, Meštrović S. Prevalence and Pattern of Hypodontia among Croatian Orthodontic Patients. Acta Stomatol Croat 2020; 54:155-160. [PMID: 32801374 PMCID: PMC7362730 DOI: 10.15644/asc54/2/5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of this retrospective study was to assess the prevalence of hypodontia in the permanent dentition among Croatian orthodontic patients. The occurrence was evaluated concerning gender, specific missing teeth, the location, pattern of distribution in the maxillary and mandibular arches and sagittal and vertical skeletal pattern. Material and Methods The sample consisted of 194 patients (75 males and 119 females) from the Department of Orthodontics, Dental Clinic, Clinical Hospital Center Zagreb. Based on the severity of hypodontia the sample was divided into mild (1-2 missing teeth), moderate (3-5 missing teeth) and severe groups (6 or more missing teeth). The location of missing teeth was used to further divide the sample into anterior (intercanine region), posterior (premolars and molars) and anteroposterior groups. In addition, jaw localization of hypodontia was also considered. Results Permanent dentition hypodontia among Croatian orthodontic patients was found to be generally mild (80%), and a distribution was similar in the maxilla (39%) and the mandible (41%), as well as in the anterior and posterior segments of dental arch (44%). The number of missing teeth per person ranged from 1 to 12, with no significant difference between genders. The severity and location of hypodontia did not differ significantly between the genders, as well as in between the categories of sagittal and vertical skeletal patterns. Conclusion Present results suggest that the treatment plan for patients with hypodontia in permanent dentition should be individualized and adjusted for each case.
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Affiliation(s)
- Daša Nikolov Borić
- Postgraduate student, School of Dental Medicine, University of Zagreb, Croatia
| | | | | | - Senka Meštrović
- Department of Orthodontics, School of Dental Medicine, University of Zagreb, Croatia
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Gallone M, Robiony M, Bordonali D, Bruno G, De Stefani A, Gracco A. Multidisciplinary treatment with a customized lingual appliance for an adult patient with severe Class III malocclusion and multiple missing teeth. Am J Orthod Dentofacial Orthop 2019; 156:401-411. [DOI: 10.1016/j.ajodo.2019.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/16/2022]
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Marañón-Vásquez GA, Dantas B, Kirschneck C, Arid J, Cunha A, Ramos AGC, Omori MA, Rodrigues AS, Teixeira EC, Levy SC, Schroeder A, Matsumoto MAN, Proff P, Antunes LAA, Vieira AR, Antunes LS, Küchler EC. Tooth agenesis-related GLI2 and GLI3 genes may contribute to craniofacial skeletal morphology in humans. Arch Oral Biol 2019; 103:12-8. [PMID: 31112935 DOI: 10.1016/j.archoralbio.2019.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The present cross-sectional, multi-centre, genetic study aimed to determine, whether single nucleotide polymorphisms (SNPs) in tooth agenesis (TA)-associated GLI2 and GLI3 genes contribute to the development of craniofacial skeletal morphology in humans. DESIGN Orthodontic patients from an ethnically heterogeneous population were selected for the present study (n = 594). The presence or absence of TA was determined by analysis of panoramic radiography and dental records. The subjects were classified according to their skeletal malocclusion and facial growth pattern by means of digital cephalometric analysis. Genomic DNA was extracted from squamous epithelial cells of the buccal mucosa and SNPs in GLI2 (rs3738880, rs2278741) and GLI3 (rs929387, rs846266) were analysed by polymerase chain reaction using TaqMan chemistry and end-point analysis. RESULTS Class II skeletal malocclusion presented a significantly lower frequency of TA (P < 0.05). Subjects without TA showed significantly higher ANB angles (P < 0.05). Genotype and/or allele distributions of the SNPs in GLI2 (rs3738880, rs2278741) and GLI3 (rs846266) were associated with the presence of TA (P < 0.05). The SNPs rs3738880, rs2278741 and rs929387 were also associated with some type of skeletal malocclusion (P < 0.05), but not with the facial growth pattern (P > 0.05). The G allele for TA-related GLI2 rs3738880 was strongly linked to the presence of Class III skeletal malocclusion (OR = 2.03; 95% CI = 1.37-3.03; P<3125 × 10-6). GLI2 rs2278741 C allele was overrepresented in individuals without TA, suggesting it as a protective factor for this dental phenotype (OR = 0.43; 95% CI = 0.24-0.78; P<625 × 10-5). CONCLUSION The present study suggests that SNPs in TA-associated GLI2 and GLI3 genes may also play a role in the development of skeletal malocclusions. rs3738880 and rs2278741 in GLI2 seems to contribute to the genetic background for skeletal Class III and TA, respectively. TA could be an additional predictor of craniofacial morphology in some cases. Further research replicating the reported associations should be performed.
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Heuberer S, Ulm C, Zechner W, Laky B, Watzak G. Patterns of congenitally missing teeth of non-syndromic and syndromic patients treated at a single-center over the past thirty years. Arch Oral Biol 2019; 98:140-7. [PMID: 30496934 DOI: 10.1016/j.archoralbio.2018.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Literature regarding congenitally-missing-teeth (CMT) is lacking especially on CMT-patterns. Thus, the aim of this study was to present an in-depth analysis of 843 patients with CMT treated at a single-center over the past thirty years. DESIGN Age, date-of-birth-year, gender, medical- and family-history, CMT-types, -numbers, -severity, -region, -symmetry, -patterns using the tooth agenesis code (TAC), and -growth types of all clinically and radiographically diagnosed CMT-patients were collected. Age and occurrence of syndromes were used to divide CMT-patients into non-syndromic patients older than nine years (group1) and syndromic CMT-patients (group2). Groups were compared especially regarding gender and CMT-severity. RESULTS The average CMT-number per patient was 5.5 (group1, n = 816, 59.9% female) and 15.1 (group2, n = 27, 29.6% female). There were significant less male (40.1% vs. 70.4%, respectively; P = 0.002) as well as significantly less male-oligodontia (44.8% vs. 73.9%, respectively; P = 0.009) in group1 than in group2. Group1 resulted in decreased prevalence of similar CMT-patterns with severity; the most prevalent CMT was the 2nd premolar; there were no significant differences between the right and left side, whereas more CMT affected the maxilla; the majority of patients presented with bilateral-CMT (82.8%); females were more affected by CMT but more males had severer forms; certain single CMT differed by gender, and CMT was related to first-grade-relatives. CONCLUSION The majority of CMT-patients presented with hypodontia. Furthermore, same CMT-patterns seem more like to be present in patients with milder forms of tooth agenesis. Gender-specific association regarding CMT-number, severity groups, and single CMT were detected.
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Taju W, Sherriff M, Bister D, Shah S. Association between severity of hypodontia and cephalometric skeletal patterns: a retrospective study. Eur J Orthod 2018; 40:200-205. [PMID: 29016739 DOI: 10.1093/ejo/cjx049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective To assess if severity of hypodontia is related to a specific skeletal pattern. Study design Lateral cephalometric radiographs and dental panoramic tomographs of 182 hypodontia patients were analysed. The severity of hypodontia was recorded and the sample was divided into groups with mild (n = 71), moderate (n = 56) and severe (n = 55) hypodontia. According to ethnicity, the sample was further subdivided into White Caucasians, African-British, and Arabian/Indian subgroups. Cephalometric measurements were used to quantify the skeletal discrepancy and vertical facial dimensions. Mean and standard deviation for each group were obtained for comparison and an analysis of variance (ANOVA) was carried out to assess the level of significance between the means of the readings in different severity groups. Results In the white Caucasian group, increased severity of hypodontia, was related to a retrusive maxilla with concomitant reduction of A point, Nasion, B point (ANB), reduced mandibular plane angle and anterior lower facial height (P value: 0.0935-0.9371). For the Black-British and Arabian/Indian groups' findings were inconsistent, with no specific pattern as the number of missing teeth increased. Conclusion The white Caucasian group followed a pattern that has previously been reported in other studies. For Black-British and Arabian/Indian groups' findings were inconsistent and no specific pattern emerged for different degrees of hypodontia.
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Affiliation(s)
- Waleed Taju
- Department of Orthodontics, Umm Al-Qura University College of Dentistry, Al Abedyah Campus, Makkah, Saudi Arabia
| | - Martyn Sherriff
- School of Oral & Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol, UK
| | - Dirk Bister
- Department of Orthodontics, Dental Institute, Kings College London, London, UK
| | - Sophia Shah
- Department of Orthodontics, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
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Vucic S, Dhamo B, Kuijpers MA, Jaddoe VW, Hofman A, Wolvius EB, Ongkosuwito EM. Craniofacial characteristics of children with mild hypodontia. Am J Orthod Dentofacial Orthop 2016; 150:611-9. [PMID: 27692418 DOI: 10.1016/j.ajodo.2016.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of our study was to evaluate the craniofacial characteristics of children with mild hypodontia using conventional and principal component (PC) analysis. METHODS We used radiographic images of 124 children (8-12 years old) with up to 4 missing teeth (55 boys, 69 girls) and of 676 reference children (365 boys, 311 girls) from the Rotterdam Generation R Study and the Nijmegen Growth Study in The Netherlands. Fifteen cephalometric measurements of children with hypodontia were compared with those of the reference children. Moreover, cephalometric parameters were combined into standardized PC scores using PC analysis, and the components were compared between the 2 groups. RESULTS PC analysis showed common dental characteristics for all types of hypodontia: a significant increase of the interincisal angle, and decreases of the maxillary and mandibular incisor angles. Other findings were consistent when both methods were applied: (1) anterior hypodontia was significantly associated with the high-angle (hyperdivergent) craniofacial pattern, (2) the tendency toward a Class III malocclusion was identified in maxillary hypodontia, and (3) we observed a significant reduction of lower posterior facial height in children with posterior and mandibular hypodontia. CONCLUSIONS Our findings suggest that children with mild hypodontia have distinctive skeletal and dental features.
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Costa AMG, Trevizan M, Matsumoto MAN, da Silva RAB, da Silva LAB, Horta KC, Romano FL, Nelson-Filho P, Küchler EC. Association between Tooth Agenesis and Skeletal Malocclusions. J Oral Maxillofac Res 2017; 8:e3. [PMID: 28791079 PMCID: PMC5541988 DOI: 10.5037/jomr.2017.8203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 06/26/2017] [Indexed: 12/22/2022]
Abstract
Objectives The aim of this study was to evaluate the association between tooth agenesis and skeletal malocclusions in Brazilian non-syndromic orthodontic patients. Material and Methods Pretreatment orthodontic records of 348 patients of both genders and with various skeletal malocclusions were examined. Tooth agenesis was evaluated in panoramic radiographs. Angular measurements were taken from lateral cephalometric radiographs to classify the patient’s malocclusion as skeletal Class I, Class II and Class III. Subjects were divided into 2 groups, “with tooth agenesis” and “without tooth agenesis”. Chi-square or Fisher exact test was used to compare categorical data. ANOVA with Tukey’s post-test was used for means comparisons. An alpha of 5% was established. Results From 348 analysed patients, 28 presented tooth agenesis. There was no difference between genders (P = 0.27) nor mean age (P = 0.16). The most prevalent skeletal malocclusion was Class I (63.11%), followed by Class II (25.94%), and Class III (10.95%). The mean of congenitally missing teeth was 1.3 (SD 0.13). Thirteen subjects had premolar agenesis, 13 upper lateral incisor agenesis, 4 lower incisor agenesis and 2 molars agenesis. The group with tooth agenesis presented A point-nasion-B point (ANB) angle smaller (1.66 [SD 2.52]) than the group without tooth agenesis (2.86 [SD 2.49]) (P = 0.01). ANB angle had a negative correlation with the number of congenitally missing teeth (P = 0.039; r = -0.39). Conclusions Tooth agenesis is associated with a smaller A point-nasion-B point angle and is negatively correlated with the number of congenitally missing teeth.
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Affiliation(s)
- Ana Maria Guerra Costa
- Department of Pediatric Dentistry, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, São PauloBrazil
| | - Mariana Trevizan
- Department of Pediatric Dentistry, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, São PauloBrazil
| | - Mírian Aiko Nakane Matsumoto
- Department of Pediatric Dentistry, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, São PauloBrazil
| | - Raquel Assed Bezerra da Silva
- Department of Pediatric Dentistry, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, São PauloBrazil
| | - Lea Assed Bezerra da Silva
- Department of Pediatric Dentistry, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, São PauloBrazil
| | - Karla Carpio Horta
- Department of Pediatric Dentistry, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, São PauloBrazil
| | - Fabio Lourenço Romano
- Department of Pediatric Dentistry, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, São PauloBrazil
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, São PauloBrazil
| | - Erika Calvano Küchler
- Department of Pediatric Dentistry, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, São PauloBrazil
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Breeze J, Dover MS, Williams RW. Contemporary surgical management of hypodontia. Br J Oral Maxillofac Surg 2017; 55:454-60. [PMID: 28410841 DOI: 10.1016/j.bjoms.2017.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/21/2017] [Indexed: 11/24/2022]
Abstract
Hypodontia is the term most commonly applied to the condition in which teeth congenitally fail to develop. Such cases differ from teeth that have been lost early or that have failed to erupt, although their initial presentation may be similar and therefore not recognised. The range of missing teeth and their physical and psychological results is large, and the difference in complexity in the management of a patient with isolated hypodontia compared with one with oligodontia or anodontia together with skeletal and orthognathic discrepancies should not be underestimated. Surgical interventions primarily involve augmentation of bone before placement of an implant, but may include techniques such as distraction osteogenesis and orthognathic surgery. These patients are best managed by a multidisciplinary team, and in this review our aim has been to describe the role of oral and maxillofacial surgeons within it.
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Al-Ani AH, Antoun JS, Thomson WM, Merriman TR, Farella M. Hypodontia: An Update on Its Etiology, Classification, and Clinical Management. Biomed Res Int 2017; 2017:9378325. [PMID: 28401166 PMCID: PMC5376450 DOI: 10.1155/2017/9378325] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/14/2017] [Accepted: 02/19/2017] [Indexed: 11/28/2022]
Abstract
Hypodontia, or tooth agenesis, is the most prevalent craniofacial malformation in humans. It may occur as part of a recognised genetic syndrome or as a nonsyndromic isolated trait. Excluding third molars, the reported prevalence of hypodontia ranges from 1.6 to 6.9%, depending on the population studied. Most affected individuals lack only one or two teeth, with permanent second premolars and upper lateral incisors the most likely to be missing. Both environmental and genetic factors are involved in the aetiology of hypodontia, with the latter playing a more significant role. Hypodontia individuals often present a significant clinical challenge for orthodontists because, in a number of cases, the treatment time is prolonged and the treatment outcome may be compromised. Hence, the identification of genetic and environmental factors may be particularly useful in the early prediction of this condition and the development of prevention strategies and novel treatments in the future.
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Affiliation(s)
- Azza Husam Al-Ani
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Joseph Safwat Antoun
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - William Murray Thomson
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Tony Raymond Merriman
- Department of Biochemistry, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Mauro Farella
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Antonarakis GS, Fisher DM. Permanent Tooth Agenesis and Maxillary Hypoplasia in Patients with Unilateral Cleft Lip and Palate. Plast Reconstr Surg 2015; 136:648e-656e. [DOI: 10.1097/prs.0000000000001694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Durey K, Cook P, Chan M. The management of severe hypodontia. Part 1: Considerations and conventional restorative options. Br Dent J 2015; 216:25-9. [PMID: 24413116 DOI: 10.1038/sj.bdj.2013.1236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2013] [Indexed: 11/09/2022]
Abstract
Severe hypodontia is the absence of six or more permanent teeth and is relatively uncommon (estimated prevalence of 0.1-0.2%). This condition may have considerable functional, aesthetic and psychological implications for the patient, as well as presenting a significant challenge for the restorative dentist. There are a number of additional dental and craniofacial features that are seen frequently in patients with severe hypodontia that may complicate the provision of restorative treatment. These patients typically present at a young age and are likely to require lifelong support from the dental team. Initially this may be limited to oral health education and delivery of effective preventative regimes in childhood. Where required, missing teeth may be replaced using conventional removable and fixed prosthodontics as well as implant retained restorations. This article, part one of a two-part series, deals with the assessment of patients and factors to consider when treatment planning for the provision of conventional restorative solutions in severe hypodontia.
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Affiliation(s)
- K Durey
- SpR in Restorative Dentistry, Clarendon Way, Leeds, LS2 9LU
| | - P Cook
- Consultant in Orthodontics, Clarendon Way, Leeds, LS2 9LU
| | - M Chan
- Consultant in Restorative Dentistry, Leeds Dental Institute, Clarendon Way, Leeds, LS2 9LU
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Rakhshan V. Congenitally missing teeth (hypodontia): A review of the literature concerning the etiology, prevalence, risk factors, patterns and treatment. Dent Res J (Isfahan) 2015; 12:1-13. [PMID: 25709668 PMCID: PMC4336964 DOI: 10.4103/1735-3327.150286] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Congenitally missing teeth (CMT), or as usually called hypodontia, is a highly prevalent and costly dental anomaly. Besides an unfavorable appearance, patients with missing teeth may suffer from malocclusion, periodontal damage, insufficient alveolar bone growth, reduced chewing ability, inarticulate pronunciation and other problems. Treatment might be usually expensive and multidisciplinary. This highly frequent and yet expensive anomaly is of interest to numerous clinical, basic science and public health fields such as orthodontics, pediatric dentistry, prosthodontics, periodontics, maxillofacial surgery, anatomy, anthropology and even the insurance industry. This essay reviews the findings on the etiology, prevalence, risk factors, occurrence patterns, skeletal changes and treatments of congenitally missing teeth. It seems that CMT usually appears in females and in the permanent dentition. It is not conclusive whether it tends to occur more in the maxilla or mandible and also in the anterior versus posterior segments. It can accompany various complications and should be attended by expert teams as soon as possible.
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Affiliation(s)
- Vahid Rakhshan
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad University, Tehran, Iran
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Abstract
OBJECTIVE To evaluate the effects of severity and location of nonsyndromic hypodontia on craniofacial morphology. MATERIALS AND METHODS A total of 154 patients with at least two or more congenitally missing teeth were selected and divided into two groups (group I [mild]: patients with two to five missing teeth; group II [severe]: patients with six or more missing teeth). The patients with hypodontia were divided into three groups according to the location of missing teeth in the dental arches (anterior, posterior, and both anterior and posterior) and location of missing teeth between the jaws (maxilla, mandible, and both maxilla and mandible). Fifty Class I patients without any missing teeth served as the control group. Twenty-one measurements were performed on lateral cephalograms. Intergroup differences for the severity and location of hypodontia were analyzed using analysis of variance (ANOVA) and post-hoc Tukey tests. RESULTS Significant decreases were found in mandibular plane angles (P < .05), upper and lower incisor measurements (P < .05), anterior (P < .001) and posterior (P < .05) face heights, and ramus height (P < .01), as well as a significant increase in the soft tissue convexity angle (P < .05) among the hypodontia groups and control group. These differences were more excessive in the severe hypodontia group. Upper lip-E plane measurements were significantly longer in the mandible group than in the maxilla group (P < .01). CONCLUSIONS Patients with congenitally missing teeth have different craniofacial morphologies. The severity and location of missing teeth have a significant effect.
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Affiliation(s)
- Ahmet Yalcin Gungor
- Department of Orthodontics, Faculty of Dentistry, University of Akdeniz, Antalya, Turkey.
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Kreczi A, Proff P, Reicheneder C, Faltermeier A. Effects of hypodontia on craniofacial structures and mandibular growth pattern. Head Face Med 2011; 7:23. [PMID: 22142280 PMCID: PMC3248361 DOI: 10.1186/1746-160x-7-23] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 12/06/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction This study was performed to examine craniofacial structures in persons with hypodontia and to reveal any differences, that may occur, when agenetic teeth are only found in the maxilla, the mandible or in both jaws. The groups consistent of 50 children (33 girls, 17 boys) aged between 9 and 13.5 years were analyzed and assigned to three subgroups. Group 1 = upper jaw hypodontia. Group 2 = lower jaw hypodontia. Group 3 = hypodontia in both jaws. Materials and methods Eleven angular and three index measurements from lateral encephalographs and two linear measurements from dental blaster casts were calculated. All data was statistically analyzed, parameters with p < 5% were investigated for each subgroup respectively. Results In comparison with standards the study group showed bimaxillary retrognathism and a reduction of the lower anterior facial height. Moreover both overbite and overjet significantly increased. Other values laid within the normal ranges. Evaluating results of the subgroups, differences in the means of SNA, SNB and overjet between the groups were observed. Analysis of the mandibular growth pattern revealed, that neither vertical nor horizontal patterns are dominant in hypodontia patients. Conclusions In certain dentofacial parameters differences between persons with hypodontia and such with full dentition exist. According to our findings agenetic teeth may have a negative influence on the saggital development of a jaw and the lower face and may be responsible for increased overbites. This should receive attention in orthodontic treatment of hypodontia patients.
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Affiliation(s)
- Amelia Kreczi
- Department of Orthodontics, University Clinics, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany
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Al-Nimri KS, Bsoul E. Maxillary palatal canine impaction displacement in subjects with congenitally missing maxillary lateral incisors. Am J Orthod Dentofacial Orthop 2011; 140:81-6. [PMID: 21724091 DOI: 10.1016/j.ajodo.2009.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 11/01/2009] [Accepted: 11/01/2009] [Indexed: 10/14/2022]
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Acharya PN, Jones SP, Moles D, Gill D, Hunt NP. A cephalometric study to investigate the skeletal relationships in patients with increasing severity of hypodontia. Angle Orthod 2010; 80:511-8. [PMID: 20482356 DOI: 10.2319/072309-411.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To determine the skeletal relationships in patients with hypodontia and analyze the effects of severity and pattern. MATERIALS AND METHODS Pretreatment lateral cephalograms from 277 patients with hypodontia, categorized by the number of missing teeth as mild (1-2), moderate (3-5), or severe (> or =6), were digitized recording angular measurements and ratios and compared with published norms matched for age and gender. Pattern was determined as mandibular, maxillary, bimaxillary, bilateral, anterior, posterior, and anteroposterior. Linear regression models assessed relationships between number of missing teeth and cephalometric parameters, controlling for the pattern of hypodontia. RESULTS For every additional missing tooth, SNA, SNB, and ANB decreased 0.3 degrees , 0.1 degrees , and 0.2 degrees , respectively; this was clinically significant for >4, >10, and >5 missing teeth, respectively. Mandibular to cranial base ratio decreased 0.3% for every additional missing tooth; this was clinically significant for >10 missing teeth. The MMPA decreased 0.3 degrees for every additional missing tooth; this was clinically significant for >7 missing teeth. Percentage LAFH decreased 0.2% for every additional missing tooth; this was significant for >7 missing teeth. Jarabak ratio increased 0.2% for each additional missing tooth; this was clinically significant for >10 missing teeth. Anterior hypodontia significantly decreased most cephalometric parameters. CONCLUSIONS Patients with hypodontia demonstrated a tendency toward a Class III relationship, caused by decreased maxillary and mandibular angular prognathism and MnCB ratio, though the effect was greater on the maxilla than the mandible. Clinical significance was only associated with severe hypodontia. Vertically, there was a tendency toward decreased MMPA and %LAFH; this was clinically relevant only with severe hypodontia. Anterior hypodontia had a significant effect on skeletal relationship.
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Sclar AG, Kannikal J, Ferreira CF, Kaltman SI, Parker WB. Treatment planning and surgical considerations in implant therapy for patients with agenesis, oligodontia, and ectodermal dysplasia: review and case presentation. J Oral Maxillofac Surg 2009; 67:2-12. [PMID: 19835745 DOI: 10.1016/j.joms.2009.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 06/25/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Anthony G Sclar
- Department of Oral and Maxillofacial Surgery, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, FL 33328, USA.
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Créton M, Cune MS, de Putter C, Ruijter JM, Kuijpers-Jagtman AM. Dentofacial characteristics of patients with hypodontia. Clin Oral Investig 2010; 14:467-77. [PMID: 19590908 DOI: 10.1007/s00784-009-0308-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022]
Abstract
This study aims to identify distinctive dentofacial characteristics of hypodontia patients. For this purpose, 189 young hypodontia patients (cases) were divided into subgroups, based on criteria from literature. Normalised differences between cases and controls were calculated for various parameters of dentofacial form. Subsequently, cluster analysis was applied to disclose subsets of hypodontia patients with distinctive dentofacial features. The ANB angle, interincisal angle and lower anterior face height were consistently significantly different amongst the subsets. Four clusters of patients with an increasing number of missing teeth and distinctive dentofacial characteristics could be identified. Patients in cluster 1 display a high-angle facial pattern. Patients in clusters 2 and 3 exhibit markable dentoalveolar characteristics (a relatively small and a large interincisal angle, respectively). Patients in cluster 4 exhibited notable sagittal-skeletal discriminative features predominantly because of a retrognathic maxilla. The smallest nasolabial angle and lower anterior face height were seen in this cluster. It is concluded that the anterior-posterior relationship between the jaws, the interincisal angle and the lower anterior face height are discriminative parameters of dentofacial form in hypodontia patients. Patients with hypodontia can be clustered in four groups, each with distinctive vertical-skeletal, dentoalveolar and sagittal-skeletal characteristics. This categorisation of patients with hypodontia into meaningful groups may be useful for treatment planning, interdisciplinary communication and as a means of identifying groups of patients that qualify for reimbursement of costs. Other dental factors should be appreciated as well during restorative clinical decision making in patients with hypodontia.
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Stahl E, Keilig L, Abdelgader I, Jäger A, Bourauel C. Numerical Analyses of Biomechanical Behavior of Various Orthodontic Anchorage Implants. J Orofac Orthop 2009; 70:115-27. [DOI: 10.1007/s00056-009-0817-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 02/06/2009] [Indexed: 11/24/2022]
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Abstract
The association between craniofacial morphology and congenitally missing teeth is at present unclear. The aims of this study were to investigate whether hypodontia is associated with changes in the sagittal skeletal profile and to identify putative relationships between the skeletal profile and the severity of hypodontia. In a cross-sectional analytical study, the craniofacial structure and profile based on two-dimensional lateral cephalograms of Southern Chinese hypodontia patients (n = 49, 24 males, 25 females, mean age 16.4 years) and a comparison group without hypodontia (n = 41, 15 males, 26 females, mean age 16.7 years) were compared. The hypodontia patients were divided into three subgroups according to the severity of hypodontia (mild: < or =5, moderate: 6-9, and severe: > or =10 congenitally missing permanent teeth). All hypodontia patients had a significantly reduced mandibular plane, ANB, and face height compared with the control group (P < 0.05). A significant increase in chin thickness was also observed in the hypodontia patients (P < 0.05). As the severity of hypodontia increased from moderate to severe, a tendency to develop a retrognathic maxilla and a Class III skeletal relationship was noted in addition to the above features, making the already thick chin even more prominent. Statistically significant correlations (Pearson's correlation coefficient) were found between the number of missing teeth and SNA, NAFH, and ANB angles, the mandibular plane, chin thickness, and face height. In Southern Chinese subjects, hypodontia was associated with a shorter face, a flatter mandibular plane, a more pronounced chin, and a Class III skeletal profile. In severe hypodontia subjects, the maxilla was more retrognathic with a greater predilection to a Class III skeletal relationship.
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Affiliation(s)
- Doreen W S Chan
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR
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27
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Affiliation(s)
- Robert P Carmichael
- Bloorview Kids Rehab, Suite 2E-285, 150 Kilgour Road, Toronto, Ontario M4G 1R8, Canada.
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Yip HK, Smales RJ. Prosthodontic management of older severe hypodontia patients in general dental practice: A case series. Special Care in Dentistry 2004; 24:260-3. [PMID: 15552344 DOI: 10.1111/j.1754-4505.2004.tb01703.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although a detailed understanding of the etiology of hypodontia is lacking, there is a need for awareness among dental professionals of the social and psychological consequences of severe hypodontia, as well as knowledge of those affected by hypodontia have ongoing dental treatment needs. Although, there may be a need for immediate referral of children to different specialists for optimal multidisciplinary treatment planning, most older patients with severe hypodontia can be treated by general practitioners. Practitioners therefore need to be aware of the ramifications of the condition and be capable of providing adequate oral health care for these patients and referring them for additional services when necessary. A case-report series is used to illustrate routine prosthodontic treatments that can be offered to older patients in general dental practice.
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Affiliation(s)
- H K Yip
- Oral Diagnosis and Family Practice, Prince Philip Dental Hospital, 34 Hospital Rd., Hong Kong SAR, PR China.
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Affiliation(s)
- N E Carter
- School of Dental Sciences, Framlington Place, Newcastle upon Tyne NE2 4BW.
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