Prevalence and patterns of tooth agenesis in Angle Class II Division 2 malocclusion in Japan

Treatment decisions of patients with Class II Division 2 malocclusion and severe tooth wear: a systematic review

BACKGROUND

The treatment strategy for patients with severe tooth wear associated with Class II Division 2 malocclusion remains a major challenge for dental practitioners.

OBJECTIVES

To systematically review and summarize the literature on treatment strategies, restoration procedures and clinical outcomes for Class II Division 2 malocclusion patients with severe tooth wear.

METHODS

A literature review was conducted using Pubmed, Embase, the Cochrane Library, and Web of Science to identify eligible articles. Publications until October 16th, 2023 were searched independently and cross-checked by two researchers.

RESULTS

Of 1513 articles screened, 10 reports detailed treatment processes, including six males and four females aged 34-68 years old. Four articles recorded pre-treatment freeway space (FWS) values ranging from 5 to 9 mm. All ten cases had significant occlusal vertical dimension (OVD) loss and the increase in OVD after treatment ranged from 1 to 7 mm. Pre-prosthetic orthodontic treatment was performed in two cases, in one of which only the maxillary region was orthodontically treated. The most common restorations provided were full coverage restorations. In most cases, temporary restorations were applied before the permanent restorations for eight weeks to six months. Four different sequences of final restoration were proposed. Follow-up ranged from four months to six years and included seven patients, one of them showed symptoms of temporomandibular disorder (TMD).

CONCLUSIONS

A multidisciplinary team (MDT) approach to treatment is recommended. Consideration of pre-prosthetic orthodontic treatment is essential. Commonly used cephalometric measurements for anterior teeth include the interincisal angle and collum angle. The increases in OVD ranging from 1 to 7 mm can be effectively accommodated. Temporary restorations are recommended to accommodate the OVD, and the transition periods of 8 weeks to 6 months help the patients adapted well. Four different sequences for final rehabilitation have demonstrated positive clinical outcomes. Full crown restorations have emerged as the preferred choice for the ultimate restoration of these patients.

Tooth agenesis: An overview of diagnosis, aetiology and management

Patients with one or more developmentally absent teeth are routinely encountered in dental practice. Tooth agenesis can be associated with significant functional, aesthetic and psycho-social problems. The present article provides an overview of the prevalence and aetiology of tooth agenesis, as well as the condition's clinical characteristics and management options with reference to the evidence base. A timely diagnosis can facilitate the appropriate planning and management which might not be straightforward, and patient care will likely require multi- and inter-disciplinary input. It is critical that dental care practitioners are aware of the clinical characteristics and management options for tooth agenesis.

Comprehensive Deciphering the Complexity of the Deep Bite: Insight from Animal Model to Human Subjects

Deep bite is a malocclusion phenotype, defined as the misalignment in the vertical dimension of teeth and jaws and characterized by excessive overlap of the upper front teeth over the lower front teeth. Numerous factors, including genetics, environmental factors, and behavioral ones, might contribute to deep bite. In this study, we discuss the current clinical treatment strategies for deep bite, summarize the already published findings of genetic analysis associated with this complex phenotype, and their constraints. Finally, we propose a comprehensive roadmap to facilitate investigations for determining the genetic bases of this complex phenotype development. Initially, human deep bite phenotype, genetics of human deep bite, the prevalence of human deep bite, diagnosis, and treatment of human deep bite were the search terms for published publications. Here, we discuss these findings and their limitations and our view on future strategies for studying the genetic bases of this complex phenotype. New preventative and treatment methods for this widespread dental issue can be developed with the help of an understanding of the genetic and epigenetic variables that influence malocclusion. Additionally, malocclusion treatment may benefit from technological developments like 3D printing and computer-aided design and manufacture (CAD/CAM). These technologies enable the development of personalized surgical and orthodontic guidelines, enhancing the accuracy and effectiveness of treatment. Overall, the most significant results for the patient can only be achieved with a customized treatment plan created by an experienced orthodontic professional. To design a plan that meets the patient's specific requirements and expectations, open communication between the patient and the orthodontist is essential. Here, we propose to conduct a genome-wide association study (GWAS), RNAseq analysis, integrating GWAS and expression quantitative trait loci (eQTL), micro and small RNA, and long noncoding RNA analysis in tissues associated with deep bite malocclusion in human, and complement it by the same approaches in the collaborative cross (CC) mouse model which offer a novel platform for identifying genetic factors as a cause of deep bite in mice, and subsequently can then be translated to humans. An additional direct outcome of this study is discovering novel genetic elements to advance our knowledge of how this malocclusion phenotype develops and open the venue for early identification of patients carrying the susceptible genetic factors so that we can offer early prevention and treatment strategies, a step towards applying a personalized medicine approach.

Ortho- perio- prosthetic interdisciplinary approach of an adult class II division 2 with multiple premolar agenesis: A case report

The aim of this case report is to illustrate the fixed orthodontic, surgical and periodontal implant management of a young adult with multiple agenesis associated with a class II division 2 malocclusion. The challenge here was the multidisciplinary synchronisation in order to achieve a coordinated treatment with the best possible aesthetic, prosthetic and functional prognosis. The patient suffered from a total of 10 agenesis including third molars and underwent implant replacement with bone grafting and periodontal planning of the 6 missing premolars. The orthodontic treatment lasted 22months and was followed by a period of just under a year for periodontal and implant prosthetic completion. The 3-year follow-up after the orthodontic phase showed an excellent prognosis in terms of aesthetics, function and stability.

Association between teeth agenesis and Angle's classes in an Italian population

BACKGROUND

Teeth agenesis or hypodontia consists of the developmental absence of one or more teeth. Many studies confirm that this condition is almost frequent in general population; the prevalence reported is between 2.7% and 11.3%. This condition shows a multifactorial etiology: genetic factors, hereditary factors, environmental factors, local or general infective processes, radiations, drugs and traumas. The aim of this observational study was to evaluate the prevalence of tooth agenesis in a sample of orthodontic healthy patients considering each Angle malocclusion.

METHODS

Nine hundred patients from a University clinic and three private practices were analyzed through intra and extra oral photographs, orthodontic study casts, panoramic radiographs and lateral cephalograms. The following inclusion criteria were applied: non-syndromic patients, without previous orthodontic, prosthetic treatment or extractions. Patients' clinical data consisted in general and dental anamnesis, intra and extra oral photographs, orthodontic study casts, digital panoramic radiographs and lateral cephalograms. The whole sample was divided into four groups (A-B-C-D) in relation with Angle's malocclusion and dental agenesis registered.

RESULTS

The whole sample presented a mean prevalence of the condition of 8.80%. Class II/2 is the most affected malocclusion with 20.37% of the patients affected by the condition, followed by class III (11.19%), class II/2 (8.05%) and class I (6.62%). The χ² test demonstrated a statistically significant different distribution of the condition between the four groups (P value =0.0059). The four groups presented also different patterns of missing teeth.

CONCLUSIONS

We found a significantly different distribution of the condition in the different malocclusions with class II/2 presenting the higher prevalence of tooth agenesis (20.37%). The most frequent teeth affected by agenesis in the entire sample are respectively: mandibular second premolars (32.40%), followed by the maxillary lateral incisors (27.70%) and the maxillary second premolars (15.50%).

Sexual dimorphism of tooth agenesis patterns in non-syndromic oligodontia in Japanese patients

OBJECTIVE

Wide individual variation observed in tooth agenesis patterns in patients with non-syndromic oligodontia could be affected by sexual dimorphism. Therefore, the present study investigated sex-associated differences in tooth agenesis patterns in patients with non-syndromic oligodontia.

DESIGN

Subjects were 108 male (ages 7-46 years) and 184 female (ages 7-43 years) orthodontic patients missing ≥6 permanent teeth, excluding third molars. The number of agenetic teeth per patient, excluding third molars, and the prevalence of agenesis of each tooth type were evaluated using panoramic radiographic images. Rankings of the most common tooth agenesis patterns in the maxillary and mandibular arches were calculated. The number of agenetic teeth per patient was compared between sexes using the Mann-Whitney test. The prevalence of tooth agenesis for each tooth type was compared between sexes using the χ² and Fisher's exact tests with Bonferroni correction.

RESULTS

No significant sex difference in the distribution of the number of agenetic teeth was observed. The prevalence of agenesis of the maxillary second premolars was significantly higher in females (P < 0.007) and the prevalence of agenesis of the mandibular central incisors was significantly higher in males (P < 0.007). Sexual dimorphism was observed in the highly ranked tooth agenesis patterns.

CONCLUSIONS

No significant difference in the severity of tooth agenesis was observed between sexes; however, sexual dimorphism was observed in the tooth agenesis patterns of patients with non-syndromic oligodontia. Although various tooth agenesis patterns were identified, sex-specific tendencies suggest that categories can be utilized in future epidemiologic research and planning.

Tooth agenesis-related GLI2 and GLI3 genes may contribute to craniofacial skeletal morphology in humans

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.

The Relationship between Agenesis of Third Molar and Craniofacial Morphology in Orthodontic Patients

Aims and Objectives:

The aim of this study was to evaluate the association between third molar agenesis and craniofacial morphology in a group of Iranian orthodontic patients.

Materials and Methods:

A total of 164 high-quality lateral cephalograms and panoramic radiographs were included in the study. Eighty-two radiographs with the absence of at least one-third molar were assigned to agenesis group and other 82 radiographic records were served as control group. Cephalometric analysis was performed, and the results were compared between the two groups using Independent Samples Student's t-test.

Results:

Significant differences were found in SNA, ANB, sum of posterior angles, and lower gonial angle between the study groups. All of them were smaller in the agenesis group.

Conclusion:

Third molar agenesis in this group of Iranian subjects is associated with deficient maxillary development and brachyfacial and hypodivergent skeletal pattern.

Association between Tooth Agenesis and Skeletal Malocclusions

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.

Symmetrical agenesis of the mandibular third molars and agenesis of other teeth in a Japanese orthodontic population

This study was conducted to investigate the association between symmetrical agenesis of the mandibular third molars and agenesis of other teeth in Japanese orthodontic patients. A sample of 64 patients with symmetrical agenesis of the mandibular third molars and without agenesis of the maxillary third molars was selected as the third molar agenesis group. In addition, 585 patients with all 4 third molars were selected as controls. The main materials examined for diagnosis of tooth agenesis were panoramic radiographs. The prevalence rate of tooth agenesis was compared between the groups using the chi-squared or Fisher's test, and the odds ratio. Significantly increased occurrence of overall agenesis of the maxillary lateral incisors, and overall and symmetrical agenesis of other teeth including the maxillary and mandibular second premolars and mandibular first molars were observed in the patients with symmetrical agenesis of the mandibular third molars and without agenesis of the maxillary third molars. Irrespective of the presence or absence of symmetrical agenesis of the mandibular third molars, no significant differences in the prevalence rates of overall or symmetrical agenesis of other teeth and specific teeth were noted between the sexes or between the right and left sides of the jaws in the patients without maxillary third molar agenesis. (J Oral Sci 58, 171-176, 2016).