Distribution of Various Developmental Dental Anomalies in Uttar Pradesh: A Hospital Based Study.

Abstract

To investigate Developmental anomalies of teeth are clinically evident abnormalities. They may be the cause of various dental problems. Careful observation and appropriate investigations are required to diagnose the condition for appropriate treatment. Developmental dental anomalies are an important category of dental morphologic variations. All patients attending the outpatient department were screened for the presence of anomalies. A comprehensive clinical examination was carried out to identify the presence of microdontia, macrodontia, talon cusp, fusion, dens invaginatus, accessory cusp, transposition and supernumerary teeth. In the present study, A total of 130 patients were included in the group and the casts were prepared with informed content. Out of which total of 93 casts were of maxillary and 37 of mandibular. This group consists of 78 male and 52 female patients. Developmental dental anomalies are marked deviations from the normal color, contour, size, number, and degree of development of teeth. Local as well as systemic factors may be responsible for these developmental disturbances. Such influences may begin before or after birth, hence deciduous or permanent teeth may be affected.

Keywords

Developmental dental anomalies; microdontia; supernumerary teeth; accessory cusp; Anomalies.

Introduction

Developmental anomalies of teeth are clinically evident abnormalities. They may be the cause of various dental problems. Careful observation and appropriate investigations are required to diagnose the condition for appropriate treatment [1]. Developmental dental anomalies are an important category of dental morphologic variations [2]. They are marked by deviations from the normal color, contour, size, number and degree of development of teeth. Local as well as systemic factors are responsible for these developmental disturbances. Such influences may begin before or after birth, hence deciduous or permanent teeth may be affected [1]. Abnormalities in tooth size, shape, and structure result from disturbances during the morpho-differentiation stage of development, while ectopic eruption, rotation and impaction of teeth result from developmental disturbances in the eruption pattern of the permanent dentition [3].

Various studies reported the distribution of various dental anomalies in different populations, but the results are conflicting. The discrepancies in their results were attributed to racial differences, variable sampling techniques, and different diagnostic criteria [4,5,6,7].

The purpose of this study was to determine the distribution of selected developmental dental abnormalities in shape, structure, number and position of teeth in a population based on statistical analysis; these data are expected to contribute to the dental literature.

Subjects and Methods

The study was based on clinical examination and evaluation of dental casts of Uttar Pradesh, Indian subjects, who visited the outpatient department at KGMU, Lucknow between June, 2011- May, 2012, after obtaining their informed consent. All patients attending the outpatient department were screened for the presence of anomalies. A comprehensive clinical examination was carried out to identify the presence of microdontia, macrodontia, talon cusp, fusion, dens invaginatus, accessory cusp, transposition and supernumerary teeth.

Exclusion criteria were selected and only subjects of Indian origin were selected. A comprehensive clinical examination was carried out to identify the presence of selected anomalies. Dental impressions were taken using alginate. Casts were immediately processed with dental stone.

Exclusion criteria

The following groups were excluded from the study:

• Patients belonging to the pediatric age group (under the age of 14 years).

• Patients with history of extraction or orthodontic treatment

• Patients with syndromes such as Down’s syndrome, ectodermal dysplasia, etc.

• Patients having cleft lip and palate.

• Dental anomalies secondary to structure, i.e. hypoplasia secondary to amelogenesis imperfecta, dentinogenesis imperfecta, or dental fluorosis.

Results

A total of 130 patients were included in the group and the casts were prepared with informed content. Out of which total of 93 casts were of maxillary and 37 of mandibular. This group consists of 78 male and 52 female patients.

The distribution of various anomalies among male and female patients is outlined in Table 1.

Table 1: Sex Distribution

Figure 1: Sex Distribution Microdontia maxillary

Figure 2: Male and Female ratio in microdontia mandibular and maxillary

Table 2: list of various anomalies in maxillary dentition

Table 3: List of various anomalies in mandibular dentition

Figure 3: Frequency of various anomalies

Table 4: Frequency of various anomalies

Discussion

Developmental dental anomalies are marked deviations from the normal color, contour, size, number, and degree of development of teeth. Local as well as systemic factors may be responsible for these developmental disturbances. Such influences may begin before or after birth, hence deciduous or permanent teeth may be affected [1]. Dental anomalies of developmental origin reflect a change either in the number, size, shape, or location of teeth, or structural changes. Dental anomalies could appear as isolated, or related to various other syndromes. Dental anomalies can be congenital or acquired. The causes of these anomalies are shown in table 5 [8].

Table 5: Causes of developmental dental anomalies

Our study includes 130 cases of dental anomalies (Table 1, figure 1). The most common dental anomalies found in the group were as follows: 52.3% microdontia, 14.6% fusion, 9.2% talon cusp, 6.9% malposition, 5.4% extra cusp, 5.4 % transposition, 3.8% macrodontia and 2.3 % supernumerary which included both maxillary as well as mandibular dentition.

Microdontia

It is considered to exist if one, or more teeth are smaller than those considered to\ be within normal range; that is, they are outside the usual limits of variation [9]. Teeth commonly affected are maxillary lateral incisors and third molars. The prevalence of this condition ranges from 0.8% to 8.4% in various populations [10]. In present study we found 53 cases of microdontia in maxillary dentition and 15 in mandibular dentition. Over all 52.3 % of microdontia was found in our study. When lateral incisors are affected, there is a reduction in mesiodistal diameter and convergence towards the incisal edge and this is referred to as peg shaped incisors. The condition is largely of genetic origin. In the present study, microdontia constituted of total anomalies with a majority of peg shaped lateral incisors & third molar.

Talon Cusp

Talon cusps are morphologically well delineated and extend at least half the distance from the cemento-enamel junction to the incisal edge of the primary teeth. This dental anomaly was firstly described as a process of horn-like shape curving from the base to the cutting edge on the palatal surfaces of the incisors [11]. In the present study, talon cusp constituted 9.2% of all of the anomalies, in which purely 12 cases were seen in maxillary teeth. Its prevalence ranges from less than 1% to 8% of the population [12] with a higher frequency in males than females Hattab et al classified [13] anomalous cusps into three types based on the degree of cusp formation and extension:

Talon

A morphologically well-delineated additional cusp that prominently projects from the palatal surface of a primary or permanent anterior tooth and extends at least half the distance from the CEJ to the incisal edge.

Semi talon

An additional cusp of 1 mm or more, but extending less than half the distance from the CEJ to the incisal edge. It may blend with the palatal surface or stand away from the rest of the crown.

Trace talon

Enlarged or prominent cingula in any of its variants (i.e. conical, bifid or tubercle-like) originating from the cervical third of the root

Extra Cusp/ Accessory Cusp

They are the common variations of tooth morphology that are occasionally seen clinically [14]. The most commonly reported variations of accessory cusps are of 3 types: the Carrabelli cusps of the molars, Talon cusps of the incisors and Leong’s tubercle of the premolar [15].

Presence of these additional extensions of tooth structure may pose various dental problems to clinicians such as caries in the pits or deep developmental grooves between the accessory cusp and the tooth [16] sensitivity or devitalisation of tooth due to fracture or attrition of the protruded portion of the cusp that has pulpal extension [17,18]. In the present study, accessory cusps are more commonly seen in maxillary teeth then the mandibular teeth.

Transposition

A dental transposition (or transmigration) occurs when teeth emerge in the wrong sequences in the dental arch, and the most common is when maxillary canine emerges distal to the first premolar [19]. Such teeth have been confused with supernumerary teeth but in reality, patients exhibit an increase prevalence hypodontia, not hyperdontia [10].

The etiology of canine ectopia and canine-premolar transposition is not known, but is assumed to be associated with multifactorial disorders involving genetic factors [20,21]. In the present study, transposition is also seen between canine premolar and found to be seen maximum in maxillary teeth then mandibular teeth i.e. out of 7 cases transposition, 6 cases were seen in maxillary dentition.

Fusion

Fusion may be partial or complete and may present with two independent root canals or less often, a single root and one or two pulp chambers [22]. In the present study, fusion accounted 14.6% of all of the dental anomalies and out of 19 cases of fusion, marked 13 cases were seen in mandibular teeth. Fusion was observed to occur unilaterally in accordance with other studies.23Mandibular teeth were affect-ed more than maxillary. Fusion can be suspected when the number of teeth in the arch is found to be reduced and/or two roots are seen radiographically [10].

Macrodontia

In present study only 3.8% of macrodontia were seen. Macrodontia, megalodontia, megadontia or gigantism occurs when a tooth, or teeth are larger than those considered to be within normal range; that is, they are outside the usual limits of variation. Macrodontia can be classified as true generalized, relative generalized and localized macrodontia in a manner similar to microdontia [24].

True generalized macrodontia, the condition in which all or at least the majority of the teeth are larger than normal. Relative generalized macrodontia, which is slightly more common, is the result of the presence of normal or slightly larger than normal teeth in relatively small jaws. Localized macrodontia is when a single tooth exhibits normal crown, root and pulp morphology except for the size [2].

Supernumerary teeth

Extra, or supernumerary, teeth in the dentition most probably result from continued proliferation of the permanent or primary denial lamina to form a third tooth germ. Supernumerary teeth are found more often in the permanent dentition than in the primary dentition and are much more commonly seen in the maxilla than in the mandible (10 to 1) [25].

Supernumerary teeth closely resemble the teeth of the group to which it belongs, i.e. molars, premolars or anterior teeth. Prevalence of supernumerary teeth was reported to be 0.8 % in primary dentition and 2.1% in permanent dentitions. Multiple supernumerary teeth are rare in individuals with no other associated disease or syndrome [24].

In our study only 2.3% cases are reported in present study and no supernumerary teeth were seen in permanent mandibular teeth.

Conclusion

The present study attempts to evaluate the frequency of occurrence of various developmental dental anomalies in a non-syndromic adult Indian population. It was duly recorded and noted that anomalies were more frequent in male patients than in females. Hyperdontia, fusion, peg shaped laterals (microdontia), and hypodontia were more frequent compared to other anomalies of size and shape. Developmental anomalies of teeth are clinically evident abnormalities. They may lead to various dental deformities. Careful observation and appropriate investigations are required to diagnose the condition and institute appropriate treatment. Early diagnosis can lead to early interception and thus treatment.

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