Characteristics of incisor-premolar hypodontia in families

Features of Dental Anomaly Patterns in Finnish children as seen in panoramic radiographs at the late mixed stage

OBJECTIVE

To describe the prevalence of the developmental abnormalities involved in Dental Anomaly Patterns (DAP) and investigate their co-occurrence in an age cohort of children with late mixed dentition.

MATERIAL AND METHODS

Retrospective, register-based study focused on 1315 panoramic radiographs of children aged 8.5-10.5 years. The features examined were absent teeth, peg-shaped maxillary lateral incisor, delayed dental age, infraocclusion of primary molars, transposition and distal angulation of unerupted mandibular second premolar.

RESULTS

Feature involved in DAP was detected in 29.8% of the children, most common being infraocclusion of primary molars (17.5%), followed by absent teeth (8.4%), delayed dental age (7.6%), distal angulation of unerupted mandibular second premolar (7.3%), peg-shaped maxillary lateral incisor (2.4%) and transposition (0.5%). Two DAP features occurred together in 4.7% of children, while three occurred in 0.7%. Infraocclusion (p=.040) and absent teeth (p=.001) occurred more commonly in girls. Phenotypic variations in maxillary lateral incisor more often occurred together (p=.004). Absent teeth, peg-shaped maxillary lateral incisor and delayed dental age more often occurred together (p<.01) as did transposition and absent teeth (p=.016).

CONCLUSION

Almost third of the children had dental developmental abnormalities involved in DAP. Absent teeth, peg-shaped lateral incisors and delayed dental age more often occurred together.

Polymorphisms in hormonal-related genes might be associated with variations in permanent tooth crown size

BACKGROUND

The variability in tooth crown size (TCS) is influenced by genetic factors and might be regulated by the difference in hormonal response.

MATERIALS AND METHODS

This study aimed to evaluate the association between variations in TCS of permanent teeth with associated factors and genetic polymorphisms in hormonal-related genes (ESR1, ESR2 and PTH). This cross-sectional study involved dental casts from 86 individuals of both sexes. Dental casts were used to determine the maximum TCS of all fully erupted permanent teeth (except third molars) in the mesiodistal (MD) and buccolingual (BL) dimensions. Data such as sex, ethnicity, dental group (incisor, canine, premolar and molar), dental arch (upper and lower) and genetic polymorphisms of hormonal-related genes were used. The DNA from each patient was collected to evaluate the genetic polymorphisms in ESR1 (rs2234693 and rs9340799), ESR2 (rs1256049 and rs4986938) and PTH (rs694, rs6256 and rs307247) through real-time PCR. The data were submitted to statistical analysis with a significance level of 0.05.

RESULTS

In the MD dimension, the sex, dental group and dental arch were associated with variation in TCS (P < .05). In the BL dimension, the sex, dental group, dental arch and polymorphism in rs694 and rs307247 were associated with variation in TCS.

CONCLUSIONS

In short, this study suggests that genetic polymorphisms of PTH are associated with variations in the BL TCS of permanent human teeth.

Investigating the association between dental age and polymorphisms in genes encoding estrogen receptors

BACKGROUND

Genetic polymorphisms have been shown to influence several physiological traits, including dental and craniofacial characteristics. Understanding the clinical relevance of genetic polymorphisms in dental practice is crucial to personalize treatment plans and improve treatment outcomes.

OBJECTIVE

to evaluate the association between dental age and genetic polymorphisms in genes encoding estrogen receptors alpha and beta (ESR1 and ESR2, respectively) in a sample of Brazilian children.

METHODOLOGY

This retrospective cross-sectional study was performed with children undergoing orthodontic treatment. Patients with syndromes, congenital anomalies, craniofacial deformities, under hormonal or systemic treatment, and with a previous history of facial trauma were excluded. Panoramic radiographs were used to assess dental age according to the Demirjian, Goldstein, and Tanner method. A delta [dental age-chronological age (DA-CA)] was obtained, which shows whether the patient tends to have a normal, delayed (negative values), or advanced (positive values) dental age. DNA isolated from buccal cells was used to genotype four genetic polymorphisms: rs9340799 (A>G) and rs2234693 (C>T), located in ESR1; and rs1256049 (C>T) and rs4986938 (C>T), located in ESR2. A statistical analysis was performed and values of p<0.05 indicated statistical difference.

RESULTS

A total of 79 patients were included, 44 (55.70%) girls and 35 (44.30%) boys. The Demirjian, Goldstein, and Tanner method, in general, overestimated patients' age by 0.75 years. There was no difference in the delta of dental age between the sexes (p>0.05). Genetic polymorphisms in ESR1 and ESR2 were not associated with dental age (p>0.05).

CONCLUSION

The studied genetic polymorphisms in ESR1 and ESR2 were not associated with dental age in Brazilian children.

Genetic Factors of Teeth Impaction: Polymorphic and Haplotype Variants of PAX9, MSX1, AXIN2, and IRF6 Genes

In recent research, there has been a growing awareness of the role of genetic factors in the positioning and eruption of teeth in the maxilla and mandible. This study aimed to evaluate the potential of specific polymorphic markers of single nucleotide polymorphisms (SNPs) located within the PAX9, MSX1, AXIN2, and IRF6 genes to determine the predisposition to tooth impaction. The study participants were divided into two groups: the first group consisted of individuals with at least one impacted secondary tooth. In contrast, the second group (control group) had no impacted teeth in their jaws. To analyze the genes, real-time PCR (polymerase chain reaction) and TaqMan probes were utilized to detect the selected polymorphisms. The findings suggest that disruptions in the structure and function of the mentioned genetic factors such as polymorphic and haplotype variants of PAX9, MSX1, AXIN2, and IRF6 genes, which play a direct role in tooth and periodontal tissue development, might be significant factors in tooth impaction in individuals with genetic variations. Therefore, it is reasonable to hypothesize that tooth impaction may be influenced, at least in part, by the presence of specific genetic markers, including different allelic variants of the PAX9, AXIN2, and IRF6 genes, and especially MSX1.

Craniofacial and dental features of Axenfeld-Rieger syndrome patients with PITX2 mutations

We aimed to characterize the genetic basis and craniofacial and dental features of Finnish patients with Axenfeld-Rieger syndrome (ARS). Mutational analyses of seven patients in five families were performed by sequencing or comparative genomic hybridization. Phenotypic analysis was based on both clinical and radiographic examinations, as well as on medical data. Lateral cephalometric radiographs of five patients were analysed using Viewbox 3.1-Cephalometric Software. The cephalometric values were compared to Finnish population-standard values of the same age and gender. Two frameshift mutations and three whole gene deletions were detected in five families. Class III skeletal relationship with retrognathic maxilla and mildly retrognathic mandible were detected in all five patients studied. Significant differences compared with the control values were in SNA (P = .0014), ANB (P = .0043) and SNB angles (P = .013). Five patients had anterior crossbite. Six patients showed tooth agenesis. The average number of missing teeth (third molars excluded) was 9 (range 0-15). The tooth agenesis rate was 52% in maxilla and 26% in mandible. Maxillary central and lateral permanent incisors were most often missing (rate 71% equally) while no one lacked canines or first molars in mandible. Two patients had a supernumerary mandibular permanent incisor. Six patients had either taurodontic and/or single-rooted molars. Our results suggest that class III skeletal relationship with maxillary and mandibular retrognathism, anterior crossbite, maxillary incisor agenesis and taurodontic, even pyramidal, roots are common determinants of ARS caused by PITX2 mutations.

Dental anomalies in non-syndromic orofacial clefts: a clinical approach

Orofacial clefts (OC) represent some of the most common congenital malformations and affect multiple structures in the craniofacial region. There are a wide range of morphological OC types within the spectrum of both non-syndromic OC (NSOC) and syndromic OC, including cleft lip (CL); cleft lip and palate (CLP) and cleft palate (CP). Here, we describe the most frequent dental anomalies seen in the permanent dentition of individuals with NSOC, comparing them between the three main cleft types (CL, CLP, CP). We present these findings from the perspective of prevalence relating to each anomaly, as well as the clinical characteristics and potential impact in the rehabilitation process. The investigation of dental anomalies associated with NSOC is important, helping to expand the phenotypic characterization of NSOC, improve initial diagnostics and establish appropriate rehabilitation and counseling.

Taurodontism in the first permanent molars in Van der Woude syndrome compared to isolated cleft palate

OBJECTIVES

To analyse prevalence, pattern, and severity of taurodontism in individuals with Van der Woude syndrome (VWS) exhibiting cleft palate and compare with aged-matched non-syndromic cleft palate (NSCP) and non-cleft controls.

MATERIALS AND METHODS

One hundred and seventy-eight dental panoramic tomographs (DPTs) (105 girls and 73 boys) consisting of 42 VWS patients (x¯=8.55±1.02 years), 42 NSCP patients (x¯=8.59±1.02 years), and 94 normative non-cleft children (x¯=8.79±1.16 years) were assessed and their first permanent molars evaluated. Measurement 3 of the taurodontism index developed by Shifman and Chanannel with the Tulensalo modification was used. Prevalence, pattern, and severity were compared between groups. Statistical differences were determined by one-way analysis of variance and Fisher test. Repeatability was calculated by Cohens Kappa test.

RESULTS

The prevalence of taurodontic molars was 59.5% in VWS, 45.2% in NSCP, and 26.6% in non-cleft controls. The prevalence and severity of taurodontism in VWS and NSCP were significantly higher than in non-cleft children in all first permanent molars. There was no significant difference in prevalence and severity between VWS and NSCP. The odds for having taurodontism in the VWS group was approximately double compared to the NSCP group. Most of the taurodontic molars showed hypotaurodontism and taurodontism occurred bilaterally more frequently than unilaterally.

CONCLUSION

This study shows a higher prevalence of taurodontism in VWS and NSCP. Most taurodontic molars are hypotaurodontic and most occur bilaterally.

Dental Anomalies' Characteristics

The aim of this study was to characterize dental anomalies. The pretreatment records (photographs and radiographs) of 2897 patients (41.4% males and 58.6% females) were utilized to detect dental anomalies. The dental anomalies studied were related to number, size and shape, position, and eruption. A Chi-square test was carried out to detect associations between dental anomalies, jaw, and sex. A total of 1041 (36%) of the subjects manifested at least one dental anomaly. The prevalence of all dental anomalies was jaw-dependent and greater in the maxilla, except for submerged and transmigrated teeth. The most frequently missing teeth were the maxillary lateral incisor (62.3%) and the mandibular second premolars (60.6%). The most frequent supernumerary teeth were the incisors in the maxilla (97%) and the first premolars in the mandible (43%). Dental anomalies are more frequent in the maxilla and mainly involve the anterior teeth; in the mandible, however, it is the posterior teeth. These differences can be attributed to the evolutionary history of the jaws and their diverse development patterns.

Dental age, agenesis, and morphological anomalies in individuals with Van der Woude syndrome and isolated cleft palate

OBJECTIVES

To analyse the differences between dental age and chronological age and dental anomalies in individuals with Van der Woude syndrome (VWS) and compare with non-syndromic cleft palate (NSCP) and non-cleft controls.

MATERIALS AND METHODS

In total, 204 oral panoramic radiographs (118 girls and 86 boys) consisting of 51 VWS patients (age x̅ = 8.17 ± 1.34 years), 51 NSCP patients (age x̅ = 8.09 ± 1.41 years), and 102 normative non-cleft children (age x̅ = 8.62 ± 1.24 years) were collected. Dental stages were assessed by the Demirjian method, with the local dental maturity index as reference. Dental anomalies including agenesis were investigated. Statistical differences were determined by One-way ANOVA and regression. Repeatability was calculated by an intra-class correlation test and 95% confidence interval.

RESULTS

The difference between dental age and chronological age of the VWS group (0.12 years) and the NSCP group (0.09 years) was significantly lower than the non-cleft group (0.40 years) (P = 0.002). There was no significant difference between the VWS and NSCP groups (P = 0.885). Hypodontia was more prevalent in both the VWS group (37.25%, P = 0.0001) and the NSCP group (19.60%, P = 0.035) compared with the non-cleft group (5.88%). The odds for hypodontia in the VWS group were approximately double compared with the NSCP group. In VWS patients, the most commonly missing teeth were the permanent second premolars and the maxillary permanent laterals incisors. Peg-shaped teeth had a prevalence of 13.70% in VWS patients.

CONCLUSIONS

In VWS and NSCP patients compared with non-cleft children, the difference in dental age compared with chronological age decreased. Hypodontia occurs at a high prevalence in VWS and NSCP patients compared with non-cleft children.

Prevalence of congenitally missing upper lateral incisors in an orthodontic adolescent population

OBJECTIVE

To determine the frequency of congenitally missing maxillary lateral incisors (LIs) and to find out its variability in relation to gender.

MATERIALS AND METHODS

A retrospective study was carried out between January 2017 and December 2017. Orthopantomographs (OPGs) and lateral cephalographs record search of all orthodontic adolescent patients aged 12 to 18 years were taken from the archival records of the department. Orthopantomographs helped to diagnose the presence of unilateral/bilateral maxillary lateral incisors while the ANB angle was calculated from the lateral cephalographs to divide the subjects into various skeletal malocclusions.

STATISTICAL ANALYSIS USED

The statistical analysis was done using the Statistical Package for Social Sciences (SPSS version 17.0). The frequencies were compared with the help of the Chi-square test. P <0.05 was considered statistically significant.

RESULTS

The frequency of missing upper laterals among the male patients was 0.9%, however, 2.8% of the female patients were having missing maxillary lateral incisors. Based on gender, 62.16% had a bilateral expression of missing upper laterals, 16.21% had left unilateral expression, and 21.62% had right unilateral expression. Furthermore, skeletal class I malocclusion had a prevalence of 54.16% of bilateral missing lateral incisors in upper arch as compared to 40% of left unilateral expression and 37.5% of right unilateral expression whereas in skeletal class II malocclusion, the prevalence of right unilateral expression was 37.5% as compared to bilateral expression which was 33.33%. The left unilateral expression in skeletal class II malocclusion was found to be only 20%. The highest prevalence of missing laterals in skeletal class III malocclusion was left unilateral expression which was around 40%. The prevalence of right unilateral expression was 25% whereas the bilateral absence of upper laterals in skeletal class III malocclusion was 12.5%.

CONCLUSION

The prevalence rate for congenitally missing upper lateral incisors in the orthodontic adolescent population aged 12 to 18 years was found to be 3.77% in the present study while females were found to have a greater percentage of agenesis of the upper lateral incisors (2.8%) as compared to the males (0.9%).

Dental Age, Agenesis, and Morphology in Patients With Operated Single-Suture Craniosynostoses

OBJECTIVE

The aim of this study was to evaluate the dental age, agenesis, and morphology of children with surgically operated single-suture craniosynostoses from orthopantomographs.

DESIGN

A single-centered cross-sectional observational archival study.

PATIENTS

A sample of 196 Finnish patients with single-suture craniosynostosis without additional birth defects or syndromes (excluding Muenke syndrome) was included in this study.

MAIN OUTCOME MEASURES

Dental age was assessed using the method developed by Demirjian et al. and modified by Nyström et al. for the Finnish population. Methods described by Tulensalo et al. and Oehlers et al. were used to study taurodontism and dens invaginatus, respectively.

RESULTS

The study sample of 149 patients was divided into 3 groups: patients with sagittal synostosis (n = 103), coronal synostosis (n = 25), and metopic synostosis (n = 21). Orthopantomographs taken on average at ages 8.20 to 8.33 were used. The dental ages in different groups were on average 0.37, 0.60, and 0.66 years ahead of normative values, for sagittal, coronal, and metopic groups, respectively. Tooth agenesis, taurodontism, and invaginated teeth were found in all groups with invaginations having a high prevalence. Peg-shaped upper lateral incisors and one geminated lower lateral incisor were also found.

CONCLUSIONS

These descriptive data may help improve dental care in patients with single-suture craniosynostosis.

Genetic variants in tooth agenesis-related genes might be also involved in tooth size variations

OBJECTIVE

The present study aimed to evaluate if genetic variants in PAX9, MSX1, TGFα, FGF3, FGF10, FGF13, GLI2 and GLI3 are involved in TS of permanent teeth.

MATERIALS AND METHODS

Pretreatment dental records from orthodontic patients were assessed prior to recruitment. Patients with tooth agenesis and congenital anomalies (including oral cleft) and/or syndromes were excluded. Dental casts were used to measure the maximum crown dimensions of all fully erupted permanent teeth except second and third molars in mesiodistal direction. Teeth with caries, occlusal wear, mesiodistal restorations, and obvious deformities were not evaluated. Genomic DNA samples were used for genotyping. The allelic discrimination of 13 genetic variants was performed. The associations between TS and genotype were analyzed by linear regression, adjusted by gender at a significance level of p ≤ 0.05.

RESULTS

Genetic polymorphisms in the tooth agenesis-related genes studied here were associated with increased and decreased TS, in both maxilla and mandible (p < 0.05).

CONCLUSION

This study reported associations of novel tooth agenesis-related gene variants with permanent tooth size variations.

CLINICAL RELEVANCE

The presence of some genetic variants could allow the prediction of permanent tooth size.

Heritability of Craniofacial Characteristics in Twins - Cephalometric Study

Introduction:

The growth and development of the craniofacial complex are under the influence of genetic and environmental factors, which determine its morphological and functional characteristics. Twin studies provide significant insight into how many genetic and environmental factors determine dental and craniofacial characteristics.

Aim:

The aim of the study was to determine the genetic influence on craniofacial complex using a twin study model.

Methods:

The study sample comprised 52 pairs of twins who were referred to the Orthodontic Department, School of Dental medicine, University of Sarajevo. Informed consent was obtained by the parents of the children included in the study. Twenty pairs of twins were diagnosed as monozygotic while 32 pairs were diagnosed as dizygotic. Zygosity was diagnosed by physical characteristics similarity. Nineteen variables were measured: 10 dental variables, 9 cephalometric.

Results:

Based on the findings of this study, t-test showed significant genetic effect on the length of cranial base (p = 0.03), corpus of maxilla (p = 0.02) and mandibular length (p = 0.03), and also for B-angle (p = 0.04). Environmental factors are more involved in determining dental traits (e.g., the inclination of the incisors).

Conclusion:

There is a significant genetic effect on the linear cephalometric variables: the length of the cranial base, maxillary length and mandibular length.

Patterns of congenitally missing teeth of non-syndromic and syndromic patients treated at a single-center over the past thirty years

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 2^nd 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.

The restorative management of microdontia

Microdontia is a dental abnormality that will often present to the dental practitioner due to the aesthetic concerns of the patient. Treatment is therefore aimed at addressing the aesthetics issue of the patient and this can present a number of challenges which may require a multidisciplinary approach in its management. This article presents the restorative management of localised and generalised microdontia.

Prevalence of dental developmental anomalies of permanent teeth in children and their influence on esthetics

OBJECTIVE

The aim of this study was to determine the prevalence of dental developmental anomalies in permanent teeth and their influence on esthetics.

MATERIALS AND METHODS

The records of 473 subjects, which comprised of orthopantomograms, clinical examination, and anamnestic data, were explored for dental developmental anomalies. Subjects with dental anomalies completed the modified questionnaire. Data on reasons for seeking the treatment as well as factors affecting the patients' satisfaction were collected. The data were processed using the Chi-square test.

RESULTS

It was found that 79 subjects (16.7%) had at least 1 dental developmental anomaly. The most common anomalies were hypodontia (7.2%), followed by talon cusps (3.4%), and microdontia (2.5%). Hypodontia, microdontia, and talon cusps were found more prevalent in females than males, whereas hyperdontia and macrodontia were more common in males. The reason for dissatisfaction with their smile in most cases was due to missing teeth or spacing between anterior teeth (excess space 2.9 mm ± 1.1 mm), followed by crowding of anterior teeth (lack of space 3.1 mm ± 0.8mm), difficulty maintaining oral hygiene and midline asymmetry (1.8 mm ± 0.9 mm). All subjects were treated using a fixed orthodontic appliance and 30 (37.9%) of them had additional dental specialists included to achieve good esthetics and function. Overall, 92.4% of subjects were satisfied with their resulting appearance after treatment.

CONCLUSIONS

Dental developmental anomalies are clinically evident abnormalities. They may be the cause of various dental problems and can influence esthetics and the development of orthodontic problems.

CLINICAL SIGNIFICANCE

This paper evaluates the distribution of dental developmental anomalies and their influence on esthetics and function. Careful observation and appropriate investigation are required to diagnose the condition and institute treatment. The therapeutic approach to some dental anomalies should be interdisciplinary.

Patterns of non-syndromic permanent tooth agenesis in a large orthodontic population

OBJECTIVE

The aim of this study is to explore patterns of non-syndromic permanent tooth agenesis in a large orthodontic patient group.

DESIGN

A record review was performed in various orthodontic clinics to identify white patients with non-syndromic permanent tooth agenesis, excluding 3rd molars. Four hundred and fourteen subjects fulfilled the inclusion criteria.

RESULTS

In the 414 subjects with tooth agenesis, approximately 70% presented 1-2 missing teeth. Symmetric agenesis patterns were often observed in the sample (by jaw, by side, or crossed quadrants), with prevalence approaching 30% for cases with contralateral tooth agenesis within a jaw. In cases with 1 or 2 missing teeth, from the total number of potential tooth agenesis patterns in the sample, a certain part was evident, limiting the variation to 27.8% (44/158). In the entire sample, both in the maxilla and the mandible a certain incisor/premolar agenesis phenotype was observed in 59.0% of cases in isolated form.

CONCLUSIONS

Although there was variation in the tooth agenesis patterns, our findings suggest the involvement of particular genetic, epigenetic, and/or environmental factors in the formation of the entire dentition, which often lead to specific tooth agenesis phenotypes in cases where this process is disrupted. The present study provides a comprehensive categorization of orthodontic cases with tooth agenesis and can assist in planning future epidemiological and genetic studies.

Nonsyndromic oligodontia : Does the Tooth Agenesis Code (TAC) enable prediction of the causative mutation?

OBJECTIVES

The literature suggests an association between phenotype and causative mutation in nonsyndromic oligodontia. Thus, the present study was designed to verify this hypothesis in a consecutive cohort of patients.

METHODS

All patients with nonsyndromic oligodontia who had been treated at the study center (Department of Orthodontics, University of Giessen, Germany) over the period 1986-2013 were contacted. Candidates were included only if at least one more family member had hypo- or oligodontia (i.e., without regard to the number of congenitally missing teeth). A total of 20 patients were included. After evaluating the dental status of each participant, the Tooth Agenesis Code (TAC) was applied. On this basis, a tentative diagnosis was made to predict which gene (MSX1, AXIN2, EDA, or PAX9) was likely to show mutation. Afterwards this hypothesis was confirmed or rejected by analyzing a saliva sample for mutation of the predicted gene. If confirmed, any available family members were also genetically analyzed.

RESULTS

Based on their TAC scores and sums, gene mutations were predicted for MXS1 in 11, AXIN2 in 3, EDA in 6, and PAX9 in none of the patients. The evaluation of MSX1 yielded variants in 4 of 11 cases, all of which were classified as nonpathogenic since they were not considered as functional mutations. The evaluation of EDA yielded a pathogenic exon-7 mutation in 2 of 6 patients, both being brothers with different TAC scores; the same mutation, which represents a novel missense mutation, was also found in other members of the same family. The evaluation of AXIN2 yielded variants in 3 of 3 cases, all of which were classified as nonpathogenic.

CONCLUSIONS

Our findings obtained in consecutive patients with nonsyndromic oligodontia did not reveal any clinically relevant associations between oligodontia phenotype (based on TAC) and causative mutations for nonsyndromic oligodontia.

Dracula tooth: A very rare case report of peg-shaped mandibular incisors

Microdontia is a term used to describe teeth which are smaller than normal. Peg-shaped teeth are type of microdontia, a developmental disturbances of teeth mainly due to congenital reasons. Most commonly affecting single teeth, that is maxillary lateral incisors. Incidence of peg shaped tooth in maxillary laterals are usually seen and reported. But in mandibular arch it is very rare. Present case, it affected all the incisors of mandibular arch and also the laterals of maxillary arch which is rarest of condition. This case report presents a non syndromic, peg shaped mandibular incisors in a 11 year old male patient.

Radiographic Study of the Prevalence and Distribution of Hypodontia Associated with Unilateral and Bilateral Clef Lip and Palate in a Hungarian Population

Background

Cleft defects are one of the most frequent birth-deformities of the orofacial region and they are commonly associated with anomalies of the tooth structure, size, shape, formation, eruption, and tooth number. The aim of our study was to evaluate the prevalence, distribution, and potential association of combined hypodontia in cleft-affected patients with regard to all types of teeth in both jaws in the permanent dentition.

Material/Methods

This retrospective radiographic analysis included patients with various types of clefts treated orthodontically in the Department of Orofacial Orthopedics and Orthodontics at Heim Pàl Children’s Hospital, Budapest. There were 150 patients (84 males, 66 females) with non-syndromic unilateral (UCLP; n=120 patients) or bilateral (BCLP; n=30 patients) cleft formation (lip, alveolus and palate) who met the inclusion criteria. Statistical analysis was performed using the chi-square test and Fisher’s exact test (significance level p<0.05).

Results

Hypodontia was significantly more frequent in patients with cleft-sided lateral incisor (104 patients, 69%), with a total of 235 missing teeth, followed by the second premolars of the upper and lower jaw. A significant correlation of congenital missing teeth was observed in left-sided clefts between the upper and lower second premolar in the cleft area.

Conclusions

Hypodontia inside and outside the cleft area was frequently observed. This should affect the therapy plans, especially if the cleft-sided premolar is also absent. Further comprehensive research including numerous random samples is necessary for better estimating other possible associations.

Tooth Size in Patients with Mild, Moderate and Severe Hypodontia and a Control Group

Objectives:

To compare tooth size between subjects with mild, moderate and severe hypodontia and a control group.

Material and Methods:

The study comprised 120 patients with hypodontia divided into three groups of 40 mild (≤2 teeth congenitally missing), 40 moderate (3-5 teeth congenitally missing) and 40 severe (≥6 teeth congenitally missing) hypodontia; and 40 age and sex matched controls. Tooth size was recorded by measuring the mesiodistal and buccolingual dimensions of all fully erupted teeth on study models using digital callipers and compared between all hypodontia and control groups using Two-way ANOVA and Post Hoc Tests of subgroup comparison.

Results:

Two-way ANOVA revealed patients with hypodontia had significantly smaller mesiodistal and buccolingual tooth dimensions compared with controls (p<0.05). Furthermore patients with more severe hypodontia demonstrated significantly smaller tooth dimensions than those in the mild and moderate hypodontia subgroups (p<0.05). The most affected tooth in terms of tooth size reduction was the maxillary lateral incisor and the least affected tooth was the mandibular first molar.

Conclusion:

Patients with hypodontia have smaller tooth dimensions than control. Tooth size appears to be affected by the degree of hypodontia, with severe hypodontia having a greater effect on tooth size reduction. The findings of this study may contribute to understanding the aetiology of hypodontia and aid the multidisciplinary management of this complex condition.

Mutation of KREMEN1, a modulator of Wnt signaling, is responsible for ectodermal dysplasia including oligodontia in Palestinian families

Tooth development is controlled by the same processes that regulate formation of other ectodermal structures. Mutations in the genes underlying these processes may cause ectodermal dysplasia, including severe absence of primary or permanent teeth. Four consanguineous Palestinian families presented with oligodontia and hair and skin features of ectodermal dysplasia. Appearance of ectodermal dysplasia was consistent with autosomal recessive inheritance. Exome sequencing followed by genotyping of 56 informative relatives in the 4 families suggests that the phenotype is due to homozygosity for KREMEN1 p.F209S (c.626 T>C) on chromosome 22 at g.29,521,399 (hg19). The variant occurs in the highly conserved extracellular WSC domain of KREMEN1, which is known to be a high affinity receptor of Dickkopf-1, a component of the Dickkopf-Kremen-LRP6 complex, and a potent regulator of Wnt signaling. The Wnt signaling pathway is critical to development of ectodermal structures. Mutations in WNT10A, LRP6, EDA, and other genes in this pathway lead to tooth agenesis with or without other ectodermal anomalies. Our results implicate KREMEN1 for the first time in a human disorder and provide additional details on the role of the Wnt signaling in ectodermal and dental development.

The prevalence and distribution of hypodontia in a sample of Qatari patients

OBJECTIVE

The aims of this study were to determine the prevalence of hypodontia in the permanent dentition in a sample of Qatari patients attending a dental center and to compare the results with the reported findings of other populations.

MATERIALS AND METHODS

Orthodontic files including orthopantomographs of 1000 patients (655 females and 345 males, 11-36-year-old) were examined and inspected for evidence of hypodontia.

RESULTS

The prevalence of hypodontia in the present Qatari sample was 7.8%; 6.9% was in males and 8.2% in females. Hypodontia was found more frequently in the maxilla than in the mandible. The distribution of missing teeth was noticed in the left side more than the right side. The most frequently missing teeth were the maxillary lateral incisors followed by the mandibular second premolars, maxillary second premolars, and mandibular left lateral incisor. The majority of patients with hypodontia had one or two teeth missing, but rarely more than four teeth were missing in the same patient. Bilateral missing teeth in the current study was commonly seen in the maxillary lateral incisor (14.1%) followed by mandibular second premolar (12.8%) and maxillary second premolar (6.4%).

CONCLUSIONS

The prevalence of hypodontia in a sample of Qatari individuals was within the range reported in the literature for other populations. The incidence of hypodontia in the anterior segment requires multidisciplinary team approach (orthodontic and prosthodontic) to restore the esthetic and function and improve patient self-esteem.

Etiology of maxillary canine impaction: a review

This article is a review that enumerates the causes of impaction of the maxillary permanent canines, including hard tissue obstructions, soft tissue lesions, and anomalies of neighboring teeth, and discusses the much-argued relationship between environmental and genetic factors. These phenomena have been shown in many investigations to accompany the diagnosis of canine impaction and have been presented as unrelated anomalous features, each of which is etiologically construed as genetic, including the aberrant canine itself. While in general the influence of genetics pervades the wider picture, a guidance theory proposes an alternative etiologic line of reasoning and interpretation of these studies, in which the same genetically determined anomalous features provide an abnormal milieu in which the canine is reared and from which it is guided in its misdirected and often abortive path of eruption.

Prevalence of hypodontia and associated factors: a systematic review and meta-analysis

OBJECTIVES

To determine the prevalence and factors associated with hypotonia.

DESIGN

Systematic review and meta-analysis.

DATA SOURCE

A search strategy was developed along with inclusion criteria and run in MEDLINE and EMBASE (published from 2002 to August 2012) databases to reveal all studies on the prevalence of hypodontia or associated factors. A hand search of reference lists and a Google search aimed to improve the sensitivity of the literature search.

SELECTION CRITERIA

All studies on the prevalence of hypodontia or associated factors published from 2002 onwards were included. Abstracts of non-English papers were also analyzed.

DATA SELECTION AND EXTRACTION

All potential articles were checked against the inclusion criteria independently, and in duplicate by two investigators. A checklist was used to assess the quality of selected studies.

MAIN OUTCOME

Prevalence of hypodontia, excluding third molars.

RESULTS

The overall prevalence of hypodontia was found to be 6.4% (95% CI: 5.7, 7.2). There was a statistically significant difference in the prevalence of hypodontia by continent (Q = 34.18, P<0.001). Prevalence of hypodontia was the highest in Africa: 13.4% (95% CI: 9.7, 18.0), followed by Europe (7% CI: 6.0-8.0%), Asia (6.3% CI: 4.4, 9.1) and Australia (6.3% CI: 5.3, 7.4) with a lower prevalence in North America (5.0% CI: 4.1-5.9) and Latin America and Caribbean (4.4% CI: 3.2-6.1). Females were found to have a higher prevalence than males (combined OR 1.22; 95% CI: 1.14, 1.30). The most commonly affected teeth were mandibular second premolars followed by maxillary lateral incisors and maxillary second premolars. The prevalence of mild, moderate and severe hypodontia was found to be 81.6, 14.3 and 3.1% respectively.

CONCLUSIONS

There was a high variation in the prevalence of hypodontia between the studies. African populations were found to have a higher risk for tooth agenesis and there was an increased risk for females to have hypodontia than males.

Genetic variations in MMP9 and MMP13 contribute to tooth agenesis in a Brazilian population

We investigated the association between polymorphisms in the MMP2 (rs243865), MMP9 (rs17576), and MMP13 (rs2252070) genes with tooth agenesis in humans. Two hundred eighty-five unrelated individuals (202 controls without tooth agenesis and 83 cases with tooth agenesis) were evaluated in a cross-sectional single-center study. The study participants were recruited through the Pediatric Dental Clinics of the Federal University of Rio de Janeiro, Brazil. Genotyping of the selected polymorphisms for MMPs was carried out by real-time PCR using the Taqman assay method from genomic DNA isolated from buccal epithelial cells of all the studied individuals. There was no significant association of MMP2 genotype or allele distribution with tooth agenesis or its absence. For MMP9, a significant difference in allele frequency was evident between the two groups (P = 0.05). With regard to the affected side, there was a significant difference between unilateral tooth agenesis and the control group in the distribution of MMP9 (P = 0.05). Also, there was a significant difference in MMP9 distribution between tooth agenesis in the maxilla and control individuals (P = 0.03). The genotype distribution of MMP13 differed significantly between the group with unilateral tooth agenesis and the controls (P = 0.01). Our findings provide evidence that MMP9 and MMP13 may be involved in tooth agenesis.

Dental anomalies in first-degree relatives of transposed canine probands

The aim of this study was to investigate and compare the inheritance pattern and prevalence of inheritable dental anomalies in a sample of patients with maxillary canine—first premolar transposition and their first-degree relatives with a sample of palatally displaced canine families. Thirty-five consecutive maxillary canine—first premolar transposition probands and 111 first-degree relatives were matched to 35 consecutive palatally displaced canine probands and 115 first-degree relatives. These were assessed for palatally displaced canines and incisor-premolar hypodontia. Parental age at birth of the proband was also noted. The results revealed that (i) there is no difference in the overall prevalence of palatally displaced canine or incisor-premolar hypodontia between the groups of relatives; (ii) first-degree relatives of bilateral palatally displaced canine probands have a higher prevalence of palatally displaced canine and incisor-premolar hypodontia than those with unilateral palatally displaced canine; and (iii) maternal age at birth of the maxillary canine—first premolar transposition probands was significantly higher than that of the palatally displaced canine probands. The results suggest that maxillary canine—first premolar transposition and palatally displaced canine are unlikely to be different genetic entities and also indicate environmental or epigenetic influences on dental development.

Congenitally missing teeth (hypodontia): A review of the literature concerning the etiology, prevalence, risk factors, patterns and treatment

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.

Ectopia or concomitant hypohyperdontia? A case report

This report describes the unusual appearance seen on a panoramic radiograph of an orthodontic patient which the authors argue may represent ectopia or concomitant hypohyperdontia of the mandibular premolar teeth. A literature review describes the frequency of such anomalies in this area from previous studies. The presenting features of the patient and the differential diagnoses are explored. Treatment planning is discussed and treatment carried out in this particular case is detailed. The unusual symmetrical bilateral anomalies in this patient may point to a genetic determinant of tooth germ position and/or movement.

Prevalence of hypodontia in a sample of Sudanese orthodontic patients

Objective:

The aims of this study were to determine the prevalence of hypodontia in the permanent dentition in a sample of Sudanese patients who sought orthodontic treatment and to compare the results with the reported findings of other populations.

Materials and Methods:

Orthodontic files including orthopantomographs of 1069 patients (760 females and 309 males - more than 8 years old) were examined and inspected for evidence of hypodontia.

Results:

The prevalence of hypodontia of the present sample was 5.1%. Hypodontia was found considerably more frequently in the mandible than in the maxilla. The distribution of missing teeth was noticed in the left side more than in the right side. The most frequently missing teeth were the maxillary lateral incisors, followed by the mandibular second premolars, maxillary second premolars and mandibular left lateral incisor. The majority of patients had two or three teeth missing, but rarely more than 5 teeth missing.

Conclusions:

The prevalence of hypodontia of this study was within the range of that reported in the literature. The incidence of hypodontia in the anterior segment requires great need for orthodontic and prosthodontic treatment. With early detection of hypodontia, alternative treatment modalities can be planned and performed with a multidisciplinary team approach restoring the esthetic and function.

Assessing the association of taurodontism with numeric dentition anomalies in an adult central Indian population

AIM

To study the association between taurodontism and numeric anomalies in adult population.

MATERIALS AND METHODS

Out of 1,012; 946 panoramic radiographs and dental records were retrospectively assessed to determine the presence of dental agenesis and supernumerary and taurodont teeth.

RESULTS

Taurodontism of one or more teeth was observed in 164 cases (97 females and 67 males). Hypodontia was observed in 148 patients (84 females and 64 males) with 62 patients having associated taurodontism (38 females, 24 males), oligodontia in 12 patients (five females and seven males) of whom nine patients also had taurodontism of one or more teeth (five females and four males). Forty-five patients (32 females and 13 males) presented with 57 supernumerary teeth (ST) with 12 patients having simultaneous presence of taurodontic tooth (seven females and five males).

CONCLUSION

Our study suggests a preferential association between tooth agenesis and taurodontism; however, such association was not observed in individuals with hyperdontia. Understanding the nature of this preferential association may be of importance in determining the etiology of both conditions. This association may also define a subphenotype for future genetic studies on dental development. Further molecular studies are necessary to verify the etiology and mechanism of taurodontism associated with tooth agenesis.

Transposition of mandibular lateral incisor-canine (mn.i2.C) associated with hypodontia: a review and rare clinical case

Transposition is a unique and extreme form of ectopic eruption in which a permanent tooth develops and erupts in the position which is normally occupied by other permanent teeth. Tooth transpositions are rare and they can be complete or incomplete. The aetiology of transposition is still obscure. Various populations have been studied, to determine the prevalence of tooth transpositions. 20% of the transpositions which occur on the maxillary arch involve the canine and the lateral incisor. Although they are rare, transpositions may involve the maxillary lateral and central incisors. Among all transpositions, Mandibular Lateral Incisor-Canine (Mn.I2.C) is the rarest, with a prevalence rate of 0.03%. Although various reports have been published on tooth transpositions, very few have noted the agenesis of teeth, particularly Mn.I2.C and its management. We are reporting a rare clinical case with associated hypodontia.

Identification of Genetic Risk Factors for Maxillary Lateral Incisor Agenesis

Tooth agenesis affects 20% of the world population, and maxillary lateral incisors agenesis (MLIA) is one of the most frequent subtypes, characterized by the absence of formation of deciduous or permanent lateral incisors. Odontogenesis is a complex mechanism regulated by sequential and reciprocal epithelial-mesenchymal interactions, controlled by activators and inhibitors involved in several pathways. Disturbances in these signaling cascades can lead to abnormalities in odontogenesis, resulting in alterations in the formation of the normal teeth number. Our aim was to study a large number of genes encoding either transcription factors or key components in signaling pathways shown to be involved in tooth odontogenesis. We selected 8 genes— MSX1, PAX9, AXIN2, EDA, SPRY2, TGFA, SPRY4, and WNT10A—and performed one of the largest case-control studies taking into account the number of genes and variants assessed, aiming at the identification of MLIA susceptibility factors. We show the involvement of PAX9, EDA, SPRY2, SPRY4, and WNT10A as risk factors for MLIA. Additionally, we uncovered 3 strong synergistic interactions between MLIA liability and MSX1- TGFA, AXIN2- TGFA, and SPRY2- SPRY4 gene pairs. We report the first evidence of the involvement of sprouty genes in MLIA susceptibility. This large study results in a better understanding of the genetic components and mechanisms underlying this trait.

The genetic basis of dental anomalies and its relation to orthodontics

The interruption of odontogenesis by any etiological factor may result in dental anomalies. Apart from the environmental factors, the impact of genetics in dental anomalies was found to be a factor in different levels. Many authors had questioned a common genetic defect resulting in different phenotypic conditions such as absent, malformed, malposed or ectopic teeth. Because the multidisciplinary treatment of these dental anomalies such as hypodontia, impaction etc., involves orthodontic intervention, orthodontists must be aware of the etiology and possible correlative conditions with dental anomalies.

Candidate gene analysis of tooth agenesis identifies novel mutations in six genes and suggests significant role for WNT and EDA signaling and allele combinations

Failure to develop complete dentition, tooth agenesis, is a common developmental anomaly manifested most often as isolated but also as associated with many developmental syndromes. It typically affects third molars or one or few other permanent teeth but severe agenesis is also relatively prevalent. Here we report mutational analyses of seven candidate genes in a cohort of 127 probands with non-syndromic tooth agenesis. 82 lacked more than five permanent teeth excluding third molars, called as oligodontia. We identified 28 mutations, 17 of which were novel. Together with our previous reports, we have identified two mutations in MSX1, AXIN2 and EDARADD, five in PAX9, four in EDA and EDAR, and nine in WNT10A. They were observed in 58 probands (44%), with a mean number of missing teeth of 11.7 (range 4 to 34). Almost all of these probands had severe agenesis. Only few of the probands but several relatives with heterozygous genotypes of WNT10A or EDAR conformed to the common type of non-syndromic tooth agenesis, incisor-premolar hypodontia. Mutations in MSX1 and PAX9 affected predominantly posterior teeth, whereas both deciduous and permanent incisors were especially sensitive to mutations in EDA and EDAR. Many mutations in EDAR, EDARADD and WNT10A were present in several families. Biallelic or heterozygous genotypes of WNT10A were observed in 32 and hemizygous or heterozygous genotypes of EDA, EDAR or EDARADD in 22 probands. An EDARADD variant were in seven probands present together with variants in EDAR or WNT10A, suggesting combined phenotypic effects of alleles in distinct genes.

Asyndromic hypodontia associated with tooth morphology alteration: A rare case report

Clinicians frequently encounter hypodontia in their practice. It can be associated with any syndrome or more commonly it is asyndromic. This asyndromic form is commonly familial and can be followed in heredity of the patient. The patient referred in this report presented with a rare anomaly of hypodontia with altered morphology where the patient had all the teeth single rooted and single canalled. Studies have indicated several genes that affect the tooth morphology and number. A genetic correlation of hypodontia with altered permanent teeth morphology may be explored further in studies.

Earliest evidence for social endogamy in the 9,000-year-old-population of Basta, Jordan

The transition from mobile to sedentary life was one of the greatest social challenges of the human past. Yet little is known about the impact of this fundamental change on social interactions amongst early Neolithic communities, which are best recorded in the Near East. The importance of social processes associated with these economic and ecological changes has long been underestimated. However, ethnographic observations demonstrate that generalized reciprocity – such as open access to resources and land – had to be reduced to a circumscribed group before regular farming and herding could be successfully established. Our aim was thus to investigate the role of familial relationships as one possible factor within this process of segregation as recorded directly in the skeletal remains, rather than based on hypothetical correlations such as house types and social units. Here we present the revealing results of the systematically recorded epigenetic characteristics of teeth and skulls of the late Pre-Pottery Neolithic community of Basta in Southern Jordan (Figure S1). Additionally, mobility was reconstructed via a systematic strontium (Sr) isotope analysis of tooth enamel of the Basta individuals. The frequency of congenitally missing maxillary lateral incisors in the 9,000-year-old community of Basta is exceptionally high (35.7%). Genetic studies and a worldwide comparison of the general rate of this dental anomaly in modern and historic populations show that the enhanced frequency can only be explained by close familial relationships akin to endogamy. This is supported by strontium isotope analyses of teeth, indicating a local origin of almost all investigated individuals. Yet, the accompanying archaeological finds document far-reaching economic exchange with neighboring groups and a population density hitherto unparalleled. We thus conclude that endogamy in the early Neolithic village of Basta was not due to geographic isolation or a lack of exogamous mating partners but a socio-cultural choice.

Phenotype characterization and sequence analysis of BMP2 and BMP4 variants in two Mexican families with oligodontia

Both BMP2 and BMP4 are involved in tooth development. We examined phenotypes and BMP2 and BMP4 gene variations in two Mexican oligodontia families. Physical and oral examinations and panoramic radiographs were performed on affected and unaffected members in these two families. The affected members lacked six or more teeth. DNA sequencing was performed to detect BMP2 and BMP4 gene variations. Three single nucleotide polymorphisms (SNPs) in BMP2 and BMP4 genes were identified in the two families, including one synonymous and two missense SNPs: BMP2 c261A>G, pS87S, BMP2 c570A>T, pR190S, and BMP4 c455T>C, pV152A. Among the six affected patients, 67% carried "GG" or "AG" genotype in BMP2 c261A>G and four were "TT" or "AT" genotype in BMP2 c570A>T (pR190S). Polymorphism of BMP4 c455T>C resulted in amino acid changes of Val/Ala (pV152A). BMP2 c261A>G and BMP4 c455T>C affect mRNA stability. This was the first time that BMP2 and BMP4 SNPs were observed in Mexican oligodontia families.

Agenesis of premolar associated with submerged primary molar and a supernumerary premolar: An unusual case report

The combination of submerged primary molar, agenesis of permanent successor with a supernumerary in the same place is very rare. The purpose of this article is to report a case of submerged mandibular left second primary molar with supernumerary tooth in the same region along with agenesis of second premolar in an 11-year-old girl, its possible etiological factors, and a brief discussion on treatment options.

Polymorphism in the MSX1 gene in a family with upper lateral incisor agenesis

OBJECTIVE

The MSX1 gene plays a key role in odontogenesis regulation, particularly during early stages. Since only a few genetic variants have thus far been associated with non-syndromic tooth agenesis, we screened for mutations in this gene, aiming to detect a relationship between genotype and phenotype.

DESIGN

The sample consisted of one proband with non-syndromic hypodontia involving upper lateral incisors, three relatives and ten unaffected controls. The proband and two affected relatives showed the same phenotype. DNA was extracted from buccal epithelial cells, and direct sequencing was performed. The two exons of MSX1 were first sequenced in the proband. When an alteration was detected, his relatives were investigated by the same method.

RESULTS

We identified the known polymorphism *6C>T in the homozygous state in all three affected family members. The unaffected father was heterozygous and ten control samples were negative for the *6C>T polymorphism.

CONCLUSIONS

The *6C>T polymorphism, when homozygous, may contribute to agenesis of upper lateral incisors. However, since the *6C>T polymorphism is quite common, additional genes must be involved in this phenotype.

Management Missing Later Incisor in Monozygotic Twins: Two Case Reports

Tooth loss of anterior region is the result of congenital anomaly or of a traumatic event. Maxillary lateral incisor is very important in masticatory function because permit lateral protrusion movement of mandible and is a key point in aesthetic of smile. Tooth agenesis is one of the most common developmental anomalies in man and it often is a feature of syndromes. Tooth developmental results by interactions of genetic and environmental factors, in particular mutations in MSX1, PAX9 contribute tooth agenesis, but also radiotherapy, chemotherapy, maternal systemic diseases aid genetic aberrations. Upper lateral incisor is in a unfavorable anatomical position because it's in fusion area of facial processes for this it's the most common tooth loss in oral cleft. The management of these patients is complex and it includes an orthodontic, prosthetic and surgical analysis This report addresses the fundamental considerations related to replacement of congenitally missing lateral incisors by a team approach.