Root Resorption After Orthodontic Treatment Part Ii Literature Review
Paring Res J (Isfahan). 2022 January-Feb; 12(i): one–13.
Congenitally missing teeth (hypodontia): A review of the literature apropos the etiology, prevalence, hazard factors, patterns and handling
Vahid Rakhshan
1Iranian Tissue Banking company and Research Centre, Tehran University of Medical Sciences, Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad Academy, Tehran, Islamic republic of iran
Received 2013 Oct; Accepted 2022 Feb.
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 os growth, reduced chewing ability, inarticulate pronunciation and other bug. Handling might be unremarkably expensive and multidisciplinary. This highly frequent and yet expensive anomaly is of interest to numerous clinical, basic science and public wellness fields such every bit 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 information technology tends to occur more than in the maxilla or mandible and also in the anterior versus posterior segments. It can accompany diverse complications and should exist attended past skillful teams every bit presently every bit possible.
Keywords: Complications, etiology, hypodontia, prevalence, chance factors, tooth abnormalities, handling
INTRODUCTION
Oral health plays a crucial part in public health. Dental treatments are rather expensive wellness services and the combination of dissimilar modalities such equally orthodontic, prosthodontic and surgical treatments can put a heavy burden on the average family unit'south health upkeep. Some frequent dental anomalies need quite expensive treatments. One of them is congenitally missing teeth (CMT), built absence of teeth, congenital dental aplasia, or dental agenesis. It is one of the most common dental anomalies.[1,ii,3,4,5] It might negatively affect both the esthetics and role.[3,half-dozen,7,8] Esthetics itself is an important factor and its bug might affect patients' self-esteem, communication beliefs, professional functioning and quality of life.[9,10,11] Patients with missing permanent teeth may endure from complications such as malocclusion (which itself can pb to mastication bug),[12] periodontal damage, lack of alveolar os growth, reduced chewing ability, inarticulate pronunciation, changes in skeletal relationships and an unfavorable appearance,[9,12,13,14,15,xvi] almost of which need rather costly and challenging multidisciplinary treatments.[9,17,18,19]
ETIOLOGY OF DENTAL AGENESIS
CMT is a consequence of disturbances during the early stages of development[fifteen] and is suggested as a mild dysplastic expression of the ectoderm.[20,21,22,23] When a primary tooth is congenitally absent, its permanent analogue might besides exist missing.[22,24] Genetics plays a crucial office in congenital dental aplasia,[4] equally confirmed by studies on monozygotic twins.[22,25,26,27] Interestingly, the pattern of CMT tin differ between monozygotic twins, maybe pointing to additional underlying mechanisms,[25] such as epigenetic factors which might be implied by simultaneous occurrence of two anomalies.[4] This multifactorial etiology can include environmental factors besides, since a combination of environmental and genetic factors might contribute to the occurrence of dental agenesis.[4,8,fourteen,nineteen,28] These include infection, trauma and drugs, also as genes associated with virtually 120 syndromes,[ii,three,6,viii,19,22,29,30,31,32,33,34,35] such as cleft lip, cleft palate or both,[36] ectodermal dysplasia[9,27,37] and Down, Rieger and Book syndromes.[9,22] A possible full general caption is that except in hereditary cases, CMT has greater occurrence likelihood when the dental germ is developing afterwards the surrounding tissues take closed the space needed for the molar evolution.[3,38] Other investigations demonstrated that delays in tooth development and reductions in molar size correlate with advanced CMT.[three,39,xl,41] Both of these might accord with the concluding reduction theory.[3,42] Furthermore, information technology is suggested that anterior agenesis may depend more on genes while posterior missing might be sporadic.[23]
The most supported etiological theory suggests a polygenic way of inheritance, with epistatic genes and environmental factors exerting some influence on the phenotypic expression of the genes involved,[29,43,44] which this can disturb the molar germ during the initial stages of formation, i.eastward., the initiation and proliferation.[22] The exact genetic mechanism is not known.[3,7,9,21] Separate mechanisms might as well account for missing of each tooth.[3]
CMT can class in isolation as well. Isolated cases are more mutual than syndromic type[17] and might be familiar or sporadic.[22] The isolated condition can follow autosomal dominant,[45,46,47] autosomal recessive[48,49] or X-linked[50] patterns of inheritance, with remarkable variation in both penetrance and expressivity.[17,20,22,51] Different subphenotypes of dental agenesis might be probably caused by various genes.[52,53,54,55,56,57] Mutations in genes such as MSX, PAX9 or TGFA might cause CMT in different racial groups.[ix,14,30,31,47,56,58,59,60] Amid the homeobox genes, MSX1 and MSX2 play an important role in mediating direct epithelial-mesenchymal interactions during craniofacial bone and tooth development.[fourteen,17,61] The autosomal-ascendant CMT might be correlated with a mutation in the MSX1 and PAX9 genes.[9,17,31,47,58,59,62] MSX1 mutations affect predominantly the second premolars and 3rd molars, sometimes in combination with other types of teeth similar the get-go molars.[17] On the other mitt, in more than common cases of incisor-premolar type of dental agenesis, MSX1 is less likely to play a role equally the causative locus for this type of CMT.[17,53] In add-on, PAX9 and TGFA are associated with built missing by interacting between MSX1 and PAX9.[14,56] A recent written report showed a novel mutation in MSX1 gene responsible for CMT of the second premolars and third molars merely.[63]
DIAGNOSIS AND CLASSIFICATION OF CONGENITALLY MISSING TEETH
Dental aplasia is classified based on the number of missing teeth.[22,35,64] Mild and moderate cases accept usually less than three and less than vi teeth missing, respectively.[35] The definitions of hypodontia, oligodontia and anodontia differ in the number of missing teeth, on which there is no clear agreement.[three,15,22,31,64] This tin can account for some of the variation observed.[64] An ideal CMT diagnosis requires radiographic, clinical and dental cast examinations,[65] just in any case, radiographic examination is a must.[3,8,66] Since radiographic testify of tooth germs needs certain level of calcification to appear, inclusion of besides young individuals might enter insufficiently calcified molar buds into the sample, which can be mistakenly diagnosed as missing teeth on the radiograph.[64] Information technology can be of a greater business organization for the mandibular premolars[3,7,34,67,68] and boys, both with more delayed eruption odds.[8,65,69,seventy,71] Therefore scientists should take into consideration the late evolution of the lower 2nd premolars in boys; and should not include subjects without the canines and premolars neither erupting nor fully erupted,[65] or at least nether half-dozen.[iii] Some authors have recommended the exclusion of children younger than nine or 10 or even 12 years sometime.[8,34,60,64,69,70,71,72] The third molar bud calcification begins at the age of most 7.5 merely in very few people; yet, the boilerplate age for the initiation of its calcification is nearly the age 9.v.[73,74] Therefore, by including patients younger than 9, or even 11 (as the 85th percentile for initiation of calcification),[74] researchers might considerably overestimate the third molar missing rate. This might explain the very high prevalence reported past some studies (34.8%).[60] It should be noted that even the initiation of calcification does non guarantee well detection in radiographs; and older ages might be needed for some cases, in gild to brand sure calcification has reached a detectable minimum.
THE PREVALENCE OF DENTAL AGENESIS
In the primary dentition, the CMT is non frequent, existence between 0.1% and 2.4%.[30,33,35,75,76] However, primary dental aplasia is commonly followed by permanent tooth missing.[8,19,34] The prevalence of CMT in the permanent dentition excluding the third molars ranges between 0.fifteen% and 16.ii% [Tabular array 1] in studies varying in size from most 200 subjects to most +100,000 ones.[1,3,iv,5,7,8,9,fourteen,15,17,22,23,29,32,34,38,42,51,57,lx,64,65,66,67,68,69,seventy,71,72,75,77,78,79,eighty,81,82,83,84,85,86,87,88,89,ninety,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156] Japanese people showed the highest rates both in deciduous and permanent dentitions.[17,30,35,64] The CMT prevalence was plant to differ betwixt continents and races, but unlikely over time.[34] The CMT prevalence in third molars has been reported over a rather broad range, between 5% and 37%.[22] For example, Ghaznawi et al.[134] reported 5.5% of wisdom tooth missing in Kingdom of saudi arabia, while Varela et al.[29] observed that 11.5% of a population from Kingdom of spain had missing of tertiary molars. Other rates might exist much greater. For instance, Afify and Zawawi[155] and Silva Meza[141] reported 24% third molar absenteeism rates in Kingdom of saudi arabia and Mexicans, respectively. Sheikhi et al.[60] have reported 34.8% missing prevalence of Iranians' third molars. Australian aborigines and maybe African Blacks might take a depression chance of dental agenesis.[8,19] Indians have shown very small prevalence rates, as two out of three studies in Republic of india had rates less than 1% and the other one had well-nigh 4% prevalence.[77,151,152] The different rates reported could exist explained by different measurement approaches or other methodologies[ii,3,eight,34,70] and ethnic backgrounds.[four,8,15,19,33,34,115] In dissimilarity, Ten-ray is a carcinogen factor and cannot be prescribed without any treatment needs.[1,8,64,157,158,159] Thus, researchers need to use previously taken radiographic images. In very rare cases, such images have been taken from randomly selected subjects (epidemiological samples such as patients attending mandatory public health protocols that oblige periodic dental radiographs be taken from salubrious people).[148] However, in almost all contempo assessments, dental radiographs take been taken from dental patients. It is possible, however, that dental patients include more than cases of dental anomalies which might bias the result.[64]
Table 1
The minimum and maximum prevalence of congenitally missing teeth/hypodontia in unlike continents
The CMT prevalence may be increasing, peradventure due to evolutionary changes,[2,8,15,lxx,160,161,162] or because of increases in the diagnosis,[2,viii,163] not necessarily the evolution.[65,163] Nevertheless, some authors suggest that it might be evolutionary[one,152,161] to suit with the gradually shrinking size of the jaws.[1,152,161] Some researchers state that evolution needs much more time to happen;[163] whereas some account for the rapid environmental changes as the causes of CMT.[160,163] However meta-analyses take non confirmed such an increment in the previous decades.[34,64,163]
THE ASSOCIATION OF CMT WITH OTHER DENTAL ANOMALIES
CMT can accompany other conditions such as delayed eruption of other teeth, reductions in coronal or radical dimensions, retained main teeth, ectopic canine eruption and aberrant dental morphologies such as taurodontism and peg-shaped maxillary lateral incisors.[2,3,4,8,fourteen,20,31,32,33] While some researchers have reported that the size of teeth and the width of the dental arch are not related to dental agenesis,[68] some others reported conflicting results indicating that CMT is associated with dental anomalies such every bit microdontia and decreases in the size of the incisors and canines equally well as conical or tapered teeth such as peg lateral.[14,28,31,164,165] Still, some investigators did not find a link between molar agenesis and microdontia just with peg laterals.[14] They concluded that CMT was not associated with changes in the overall tooth size, while changes in tooth morphology especially in the maxillary lateral incisors might withal be possible.[14] This might be in line with other studies finding correlations between astringent CMT and taurodontism[57,166] especially in boys,[166] or between CMT and taurodontism;[31] It might likewise be in agreement with studies that could not associate CMT with microdontia of contralateral teeth.[57] Some authors found links between CMT with size anomalies and taurodontism.[31] Therefore, the literature is not conclusive. Both CMT and taurodontism seem to be a part of syndromes characterized by decreased mitotic cellular activeness which might also touch on dental germ development.[iv] On the other hand, some other studies found clear associations between both mild and severe CMT and reduced molar size,[21,32,160,165,167] peculiarly in the upper laterals (in the mesiodistal dimension) and the lower canines (the labiolingual dimension).[165] The latter agrees with the synergism and allelism of major genes possibly affecting CMT.[21]
ASSOCIATIONS WITH SKELETAL CHANGES IN THE HORIZONTAL Plane
The results pertaining to skeletal changes are controversial. Some authors did non detect a pregnant correlation between malocclusions and CMT prevalence, although suggested a link between CMT and Class Two division two.[65] While according to others, there could be significant links. CMT might accompany reduced intercanine and intermolar widths.[147] Inductive missing can accompany retrognathic maxillae, prognathic mandibles and smaller lengths of posterior cranial base of operations.[16] It as well might be more common in the skeletal Class Iii malocclusion due to smaller or retrognathic maxillae.[fourteen,22,thirty,71,168,169] In some studies, Class 3 was associated only with severe CMT.[169,170] CMT might be too significantly less frequent in Course II cases,[147] although a study reported non-significant results for this subtract (maybe due to small sample of Class II cases).[65] On the contrary, Cua-Benward et al.[128] found the greatest prevalence of CMT in Form II patients and observed a meaning number of missing maxillary teeth in Class III patients. Even so, it might depend on the about common missing teeth, as it appears that the missing tooth affects its own jaw. A study by Hirukawa et al.[135] concluded that Form Iii might be the most mutual malocclusion observed among the subjects who had missing teeth just in the maxilla, while when teeth were missing only in the mandible, it was frequently associated with Form II malocclusion.[135] Perhaps the tendency towards a Class III relationship is acquired by decreased maxillary and mandibular angular prognathism and the issue might exist greater on the maxilla than on the mandible.[170]
ASSOCIATIONS WITH VERTICAL SKELETAL CHANGES
Co-ordinate to some studies, dental aplasia is not correlated with the vertical relationship of the jaws.[xiv,147] All the same some investigators have found significant associations between the CMT ocurrence with reduced anterior lower facial height[16,30,168,171] and increased overbite,[22] which intensifies past increasing the severity of CMT,[169,170] or less severe deep bite in CMT patients[135] and decreased maxillary-to-mandibular-planes angle, which was clinically relevant only in severe CMT.[170] Furthermore inductive CMT might have a meaning event on the vertical skeletal relationships with increasing severity of CMT.[170] It also might contribute to a more acute mandibular angle and flatter mentum.[16]
Sexual activity DIMORPHISM
Gender might human activity as a dental agenesis risk cistron.[viii,33,34] Women are usually more than affected[7,15,22,34,67,141,160] and the male-to-female person ratio is about 2:3.[8,29,33,34,172] Some authors studied the teeth individually and plant meaning gender dimorphism only for certain teeth,[seventy,104,141] such equally the upper incisors and upper offset premolars, all on the right side only.[seventy] Of these teeth, only the missing of the upper right primal incisor was more prevalent in males and the other ones were more prevalent in females. Silva Meza[141] accept reported meaning intersex differences simply for the lateral incisors and third molars (without indicating the predominant gender). Eidelman et al.[104] reported significant differences merely for the lateral incisor missing cases, being more common in females. Some studies found a non-significant predominance of CMT in males.[29,seventy,148,151] A very large report on six districts of Turkey showed that in five regions, females had a significantly higher CMT prevalence, while in one of them males had a significantly greater prevalence.[15] Male-to-female ratios were previously summarized as 1:ane.37 and 1:i.four in literature reviews.[eight,33,34] The higher rates observed in females might be associated with biological differences such as smaller jaws which might trigger ecology factors. This might be confirmed past the suggestion that teeth might be absent also when the evolution of dental germs is delayed and thus the needed space has been compromised by the surrounding tissues.[78] As well, another gene can contribute to the higher rates of CMT in females: The existence of a probable higher orthodontic treatment need in females with the tooth missing due to their higher concern regarding the advent[viii] and the higher value that lodge gives to esthetics in females.[29] However, the latter might not be the case, since most of studies on schoolchildren besides showed a higher rate in females. Moreover, some other studies did not find such a difference in orthodontic patients,[viii,14] or even reported higher prevalence rates in male orthodontic patients[69,70] and male patients of the public health services.[148] Furthermore, since males tend to have lower rates of CMT, studies enrolling more males, might show lower total CMT prevalence rates.[64]
A possible reason for the controversies is that different teeth might vary in terms of sex activity dimorphism. Küchler et al.[57] showed that the M:F ratio of incisor agenesis was 1.four:1, while in the case of the upper lateral incisors, this ratio was 2:ane and for the lower incisors, the M:F ratio was 1:ane. On the other hand, the M:F ratio of premolar missing was 0.5:ane (0.3:1 for the upper second premolar ratio and 0.v:1 for the lower 2nd premolar ratio).[57] Thus a combination of various M:F ratios for dissimilar teeth tin disallow to easily identify significant differences in the whole dentition. Based on the differences in sex ratios depending on the specific tooth types affected, Küchler et al.[57] suggested a continuous variable, "liability," with a threshold value, across which individuals might be affected. This system is called multifactorial because both genetics and environmental factors determine liability.[57] Based on this concept, they concluded two possibilities: Either the same genetic model might accept dissimilar thresholds for males and females, or each gender is influenced by an independent genetic model, each having its own threshold.[57] Another factor contributing to the controversy might be the ethnicity.
There is no consistent finding as to which sex is predominant in regard to having more than missing teeth per child.[iv,5,7,8,15,51,67,68,69,72,81,93,94,95,99,100,106,109,110,113,173] In one enquiry, each male had an average of missing teeth per person college than that of each female person (2.32 compared to ane.twoscore).[viii] However, in another one, the average numbers of missing per person dentition were near similar for both genders with a slight increase in boys (2.v for boys, 2.4 for girls)[5] and in some others, girls had a higher chance for having more missing teeth per person.[15,23,68,109] From data reported in a study on Swedish schoolchildren,[four] these ratios were calculated and showed 1.46 missing teeth in each boy in comparison to 1.74/girl. Evaluation of vi regions of Turkey showed that in five of them, females had a significantly greater chance of having more missing teeth per individual and in one of them, males had a greater take chances of having more missing teeth in each person.[15] Some other studies as well showed that females might take oligodontia much more likely than males might do.[144,147,148] However, some other study found the opposite[71] and another one found similarity between the two.[9]
THE MOST FREQUENTLY MISSING TEETH
Clinicians could exist assisted by knowing the CMT risk factors and its pattern of occurrence.[vi,8,141] As a general rule, if but a few teeth are missing, the absent-minded tooth would be the nigh distal molar of any given type.[8,22,70,162,174] This applies to the maxillary laterals and the mandibular 2nd premolars. On the other hand, it is suggested that the permanent maxillary first premolars, canines and first molars, which are probable to be more stable, accept a relatively greater rate of CMT in children with 5 or more teeth missing.[5,146]
UNILATERAL VERSUS BILATERAL DENTAL AGENESIS
Well-nigh authors observed predominance of bilateral CMT to extents such as about every bit twice as unilateral missing[1,4,v,8,xv,51,67,69,81,95,99,110,112,141,144,161] or fifty-fifty every bit trice every bit unilateral missing.[1,3,141] Even Endo et al.[5] have reported that in 89% of patients, the teeth were bilaterally missing. Notwithstanding, few studies failed to notice a pregnant divergence[fourteen,100,112,115,140] or reported non-meaning[60] or significant predominance of unilateral missing.[threescore] In studies on Koreans and Iranians, these were almost similar.[65,146] However, a careful examination of presented information past Kim[65] unsaid that that commodity has compared "patients" with bilateral or unilateral missing teeth, not the number of missing teeth. This author further evaluated the values and it was implied that many patients had more than merely a pair of bilaterally missing teeth and that if the number of teeth was to be compared, bilateral missing would exist as double as unilateral missing in their written report. In some other Korean study, 70.9% of sample had unilateral missing.[14] On this subject area, a review shows that overall, unilateral missing is more than common, just bilateral missing is seen mostly in the maxillary lateral incisors.[34] Furthermore, it is suggested that unilateral agenesis might be more common in the instance of the upper and lower second premolars, whereas, bilateral missing might be more common in the maxillary laterals.[fifteen] Except for the beginning molars in both jaws and the maxillary centrals, bilateral agenesis was significantly more mutual than unilateral aplasia.[15]
WHICH TEETH ARE Mostly SYMMETRICALLY MISSING?
This question is non assessed thoroughly. Medina[172] stated that while symmetrical dental missing affects the maxilla, the mandible shows generally unilateral agenesis. According to another reports, the most common symmetric missing tooth could exist the mandibular second premolar agenesis, followed by the absence of the maxillary second premolar or maxillary lateral incisor.[5,51,85,101,161] According to a meta-analysis, the maxillary lateral incisor might exist the nearly common bilateral missing tooth.[34,60] Endo et al.[5] found a like design in children other than those with 2 missing teeth. However, in children with two missing teeth, the mandibular lateral incisor agenesis had a college prevalence rate.[v]
THE RIGHT VERSUS THE LEFT SIDES
No studies so far have found a significant divergence between missing teeth located in the left and correct sides.[5,8,22,57,60,seventy,78,130,141,142,147,175,176] For example, Sisman et al.[70] did not observe whatever significant right-left differences for the whole CMT prevalence and for whatever of teeth assessed individually. Even a study on more than 100,000 dental patients showed that the number of missing teeth on the left and right sides was almost identical (1574 vs. 1573).[15] According to Fekonja,[22] the missing teeth were more normally absent on the right side (26 teeth, 54.2%) than on the left side (22, 45.8%). However, their comparing was not statistically substantiated. Statistical comparison was carried out by this writer using the Chi-foursquare goodness-of-fit examination, which did not detect a meaning difference (P = 0.564).
THE OCCURRENCE OF CMT Across THE Inductive/POSTERIOR REGIONS
Few studies accept evaluated the difference betwixt CMT rates in the anterior and posterior segments[v,eight,69,147] and this should be considered in futurity studies. Nearly studies showed higher prevalence in the anterior segment[8,71,147] and the few remaining researches found no significant differences.[5] Some investigators suggest that in mild cases of CMT, the anterior segment might be more involved while the posterior segment might be predominant in astringent cases.[5] Many studies did not summate or report the anterior versus posterior missing and many of them did not present raw data.[3,four,5,viii,9,22,31,57,66,70,71,144,146,148,149,150,176,177] Their raw data were recovered from their tables, graphs and/or texts. The anterior/posterior occurrence was calculated and statistically analyzed using the Chi-square goodness-of-fit examination, after making certain that the tertiary molars were excluded. Some of these differences analyzed by this writer were statistically significant (P < 0.01,[70] P < 0.01,[177] P < 0.01,[148] P < 0.01,[71] P < 0.01,[150] P < 0.01,[9] P = 0.000,[8] P = 0.003,[176] P = 0.000[4]) and some were not-significant (P > 0.05).[22,31,57,66,144,146,149] Galluccio and Pilotto[23] investigated the family copse of CMT patients. They identified two groups: Nine families exhibited dental missing seemingly equally a role of autosomal dominant genetic transmission. In these families, CMT mainly involved the maxillary lateral incisors. Since other dental anomalies were present, CMT seemed one of the manifestations of an bibelot of the dental lamina. Half-dozen families had CMT as a desultory condition. In this group, CMT was seen only in orthodontic patients and it nearly oft involved the second molars and 2nd premolars.[23]
THE OCCURRENCE OF CMT Across THE ARCHES
The results equally which arch is predominant are not conclusive.[5,8,34] Some investigators found that built tooth agenesis was more common in the maxilla,[8,15,22,70,147] and some others reported a higher rate of missing teeth in the mandible.[4,14,65,79,161] The following studies did not analyze/written report maxillary/mandibular missing. However, their data were recovered and analyzed by this writer. Some studies showed significant differences (P = 0.09,[66] P = 0.063,[146] P = 0.054,[31] which were only marginally pregnant, P = 0.000,[71] P = 0.000,[144] P = 0.003,[65] P = 0.000,[4] P = 0.000[70]) and some did not demonstrate significant or marginally significant differences (P > 0.1).[66,148,149,150,176]
TREATMENT OF CONGENITALLY MISSING TEETH
CMT has direct clinical implications. The handling is comprehensive and expensive,[nine] costing in some countries from about $3000 to $fifteen,000/patient for minor prosthodontic interventions similar a stock-still partial denture in mild cases with only one or two missing permanent teeth, to $sixty,000 for comprehensive interdisciplinary treatments.[9,18] The handling would be ordinarily difficult.[137] It might stand for an interdisciplinary challenge for specialists in oral and maxillofacial surgery, operative dentistry, pediatric dentistry, orthodontics and prosthodontics.[9,22,65,171,178,179,180,181] General or pediatric dentists tin can facilitate multidisciplinary treatments by diagnosing built absenteeism of main teeth and so through early on referrals of patients; every bit the absenteeism of primary teeth highly associates with missing of permanent successors.[8,19,34] They might also ensure the retention of reduced number of teeth,[viii,19] in cases such every bit palatal impaction of the maxillary canines caused by the missing laterals, in which early extraction of deciduous canines might guide the eruption of the permanent ones into the correct position.[8,182] This necessitates the early evaluation of the number of missing teeth and the consideration of the CMT chance factors, as well as the size and number of teeth remaining in both arches in planning and managing treatment.[3,19,22] The type of malocclusion, severity of crowding and facial profile are of major business organisation in determining the final handling plan.[22] Os volume is related to facial esthetics such equally smile, and should be considered in treatment planning equally well.[65,183] During treatment planning, possible changes in the craniofacial morphology associated with CMT should be too borne in listen.[14]
Another therapeutic challenge is the demand to carry out handling in the growing young patient.[nine,179] While handling should be initiated during adolescence,[9] interim treatment should begin in around 7-9 years of age before the affected children realize they are different from other children.[ix,19,179]
The edentulous space can be either left open for prosthetic restoration, or airtight by orthodontic ways.[13,14,164] Other treatment modalities might include autotransplantation[fourteen,184] or protraction[14,185] of the third molars, which are otherwise extracted, in order to substitute for the edentulous region or to increment the number of occluding teeth.[fourteen] In prosthodontic treatments, transplantation is a better choice than implanting, since osseointegrated implants are contraindicated in the growing alveolar bone.[22] Successful autotransplantation of teeth ensures the stability of alveolar os volume due to physiological stimulation of the periodontal ligament.[22] Implant treatment is postponed until the jaws have stopped growing in adolescence.[22,186,187,188] It is besides possible to close the lateral space in crowded maxillae and recontour the canine into the lateral'southward shape. In an aligned maxillary arch, the distributed excess space tin can be localized then restored using prosthetic approaches.[22] Absent lower incisors demand esthetic and functional camouflage regarding the relationship betwixt the maxillary and mandibular inductive teeth.[65] In crowded jaws, the missing premolar spaces can be used every bit one of the extraction spaces for arch alignment.[22] In uncrowded jaws with missing permanent premolars, the primary 2nd molar might be left in situ. Still, since, there is the chance of infra-occlusion or progressive root resorption, it might be somewhen extracted and replaced with an implant or and autotransplanted tooth.[22] The treatment of severe cases is complex and should be performed in centers such as "Hypodontia Clinics"[65,189] with admission to pediatric dentistry, orthodontics, prosthodontics and oral and maxillofacial surgery.[9,22,171,180,181] Information technology should be noted that orthodontic/prosthodontic treatments might compromise esthetics and periodontal wellness.[22,190,191]
Determination
CMT is a prevalent multifactorial dental bibelot, usually actualization in females and in the permanent dentition. It is non conclusive whether it tends to occur more in the maxilla or mandible and likewise in the anterior versus posterior segments. Information technology can accompany diverse dentoskeletal deformities, anomalies, or just complications. Thus it should be attended by expert teams at the earliest possibility.
Although the CMT prevalence has been investigated thoroughly, no or few quasi-experimental (instance-control or accomplice) studies have assessed CMT chance factors. Besides, the number of studies assessing the severity of CMT is very small equally well. It is recommended to evaluate inside quasi-experimental designs the effect of gender on the prevalence of CMT and too its event on the severity of CMT. Some other problem which should be avoided in future research is the lack of proper study of every finding in many studies. Time to come studies are recommended to report non only the prevalence of CMT, but likewise the prevalence of cases with different numbers of missing teeth (for example how many subjects had two, three, or more missing teeth? etc.). This is valuable, since definitions of hypodontia might differ from report to report.[3,15,31,64] This approach would allow the standardization of the results. Another proffer might exist a global consensus on the definitions. Furthermore, it would be helpful if each written report clearly defines hypodontia. Many studies have used the term hypodontia to refer to congenitally absent teeth in general. Maybe it would be better to distinguish CMT and hypodontia in each written report, by clearly defining the hypodontia (for case congenital missing of six teeth or more) or oligodontia terminologies (for example congenital missing of 10 teeth or more) in each study. Some other limitation of about previous studies is that they have not reported the number of the affected patients with bilateral CMT, unilateral CMT and both simultaneously.[64]
Time to come studies are warranted to country the severity of CMT in both genders, both arches, both sides (left/right) and across other possible variable levels. The data tin can exist simply summarized within a couple of tables and/or figures. Therefore, it is highly recommended to state all the numbers of all the missing teeth according to tooth types, jaws and sides, etc., in each study.
Footnotes
Source of Back up: Zip.
Conflict of Involvement: None declared.
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