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2016 02 Lateral Incisor Official Version PDF
2016 02 Lateral Incisor Official Version PDF
Supported, in part, by the American Association of Orthodontists and American Association of Orthodontists Foundation (to J.A.B.). This article is based on the
Master’s thesis (J.W.) presented in 2011 in partial fulfilment of requirements for the degree of Master of Science, Marquette University School of Dentistry, 2011.
a
Adjunct Professor, Department of Developmental Sciences, Marquette University School of Dentistry, Milwaukee, Wis.
b
Associate Professor, Department of Orthodontics, Rutgers School of Dental Medicine, Newark, N.J.
c
Assistant Professor, Department of Oral Health and Rehabilitation, University of Louisville School of Dentistry, Louisville, Ky.
d
Research Associate I, Department of Institutional Assessment and Quality Improvement, Rutgers School of Dental Medicine, Newark, N.J.
the maxillary lateral incisor have the same sized teeth in the
Clinical Implications maxilla and mandible as those in a matched control sample.
Because maxillary and mandibular teeth are smaller The secondary hypothesis was that sex, arch, and tooth type
affect tooth size in the missing lateral incisor group.
than normal in patients missing one or both
maxillary lateral incisors, the space created or
MATERIAL AND METHODS
remaining for the definitive restorations may be
smaller than ideal. Thus, clinicians should plan This research was approved by the Institutional Review
accordingly. Board. Forty sets of dental casts (21 women, 19 men,
mean 15.9 years of age), with missing maxillary lateral
incisors (22 unilateral, 18 bilateral) (Fig. 1), were collected
significant variable affecting tooth size arch size from local orthodontic practices. For comparison, an
discrepancy compared with the mesiodistal and bucco- equal number of dental casts were collected from the
lingual dimensions of other teeth.10 Graduate Orthodontics program at the Marquette Uni-
Research has demonstrated that genetic factors may versity School of Dentistry to form a control group
contribute to agenesis and tooth size discrepancies.12-19 matched for ethnicity, age, and sex. Inclusion criteria for
Specifically, MSX1 and PAX9 mutations have been asso- the test population were: white individuals with unilat-
ciated with tooth agenesis.12,15 PAX9 gene mutation has eral or bilateral agenesis of the maxillary lateral incisors,
also been associated with smaller than normal teeth.19 with the other permanent teeth (except for third molars)
Although individuals of different ethnic origins in both arches fully erupted; and with no evidence of
experience dental agenesis, those of European origin are extreme wear, breakdown, or interproximal reduction of
more often missing maxillary lateral incisors, with a any teeth. Pretreatment and post-treatment dental casts
higher incidence in women.16,20,21 Men generally have were used for measurement. Post-treatment dental casts
larger teeth than women within any given ethnicity. To were examined only to confirm that no interproximal
minimize ethnic variations within the sample population, enamel reduction or enameloplasty had been conducted
this study focused on the agenesis of maxillary lateral during treatment. Dental casts with crowns or mesio-
incisors of individuals of European origin. distal restored teeth were rejected because of the modi-
Few studies have discussed the relationship between fication of tooth structure and size.
tooth size and agenesis.22-26 However, some studies have The mean age for the test group was 15.9 years
suggested that newer implants require smaller spaces for (SD=7.12), ranging from 11 to 47 years of age, and the
implant placement, leading to size reduction in tooth mean age for the control group was 15.9 years (SD=6.7).
replacement.27-30 Thus, the purpose of this study was to The orthodontic program’s computerized charting system
evaluate whether tooth size discrepancy is observed in (axiUm; Exan Group) was used to search for the matching
white orthodontic patients with agenesis of one or both sample. Mesiodistal widths of each tooth were measured
maxillary lateral incisors. The null hypothesis was that or- with a high-precision digital caliper (Digital Calipers; Masel,
thodontic patients with unilateral or bilateral agenesis of Henry Schein Orthodontics), with measurements rounded
Figure 1. A, Patient cast showing unilateral agenesis of left maxillary lateral incisor, retained left primary canine, left permanent canine in position of
lateral incisor, and peg-shaped right lateral incisor. B, Cast of patient with agenesis of both maxillary lateral incisors. Maxillary canines moved mesially
into lateral incisor space.
lateral incisor was a strong predictor for reduced overall would indicate the discrepancy, nor has the study found
tooth size. On average, that study showed that the dif- significant differences between specific teeth (central
ference in mesiodistal width of the maxillary central incisor incisor, canines, first and second premolar or molars) in
was 0.47 mm and that of the mandibular incisors was 0.43 the control and sample test.
mm. However, they had no control for race and sex.26 Ballard8 discovered that 90% of teeth in his sample
The results of the present study, where race, sex, were not symmetrically sized between right and left sides,
and age were controlled, also demonstrated that the with differences as much as 0.25 mm. In the present study,
mandibular and maxillary teeth of patients with agenesis no statistical differences were found between teeth on the
of one of both maxillary lateral incisors were smaller than right and left sides. Therefore, the teeth were grouped
those who had all permanent teeth. However, this study together, and an average size was created for each tooth.
could not find a specific tooth or group of teeth that Because one or both maxillary lateral incisors were missing
incisor. This could lead the orthodontic clinician to prepare 4. Bolton WA. Disharmony in tooth size and its relation to the analysis and
treatment of malocclusion. Angle Orthod 1958;28:113-30.
an incorrect amount of space for the implant and crown 5. Kokich VG. Maxillary lateral incisor implants: planning with the aid of or-
restoration. thodontics. J Oral Maxillofac Surg 2004;62(suppl 2):48-56.
6. Kinzer GA, Kokich VO Jr. Managing congenitally missing lateral incisors.
Results that are statistically significant may not be Part III: Single-tooth implants. J Esthet Restor Dent 2005;17:202-10.
clinically significant. A tooth size discrepancy of 1.5 to 2 7. Bolton WA. The clinical application of a tooth-size analysis. Am J Orthod
1962;48:504-29.
mm within an arch (0.75 to 1 mm/side) is deemed clin- 8. Ballard ML. Asymmetry in tooth size: a factor in the etiology, diagnosis and
ically significant. Othman and Harradine30 used the treatment to malocclusion. Angle Orthod 1944;14:67-70.
9. Uysal T, Sari Z, Basciftci FA, Memili B. Intermaxillary tooth size discrepancy
Bolton analysis to determine this clinical significance. The and malocclusion: is there a relation? Angle Orthod 2005;75:208-13.
study was conducted with a sample of orthodontic pa- 10. Agenter MK, Harris EF, Blair RN. Influence of tooth crown size on maloc-
clusion. Am J Orthod Dentofacial Orthop 2009;136:795-804.
tients with a full complement of teeth, making it harder 11. Basdra EK, Kiokpasoglou MN, Komposch G. Congenital tooth anomalies and
to compare it with the present study of participants with malocclusions: a genetic link? Europ J Orthod 2001;23:145-51.
12. Vastardis H, Karimbux N, Guthua SW, Seidman JG, Seidman CE. A human
agenesis. Because the present study did not calculate the MSX1 homeodomain missense mutation causes selective tooth agenesis. Nat
tooth size discrepancy per participant (as with the Bolton Genet 1996;13:417-21.
13. Garib DG, Alencar BM, Lauris JR, Baccetti T. Agenesis of maxillary lateral
analysis), it is difficult to determine whether the results incisors and associated dental anomalies. Am J Orthod Dentofacial Orthop
from this sample are clinically significant. These tooth 2010;137:732. e1-6.
14. McKeown HF, Robinson DL, Elcock C, al-Sharood M, Brook AH. Tooth di-
size reductions may be clinically significant for some mensions in hypodontia patients, their unaffected relatives and a control group
patients but not for others. measured by a new image analysis system. Eur J Orthod 2002;24:131-41.
15. Stockton DW, Das P, Goldberg M, D’Souza RN, Patel PI. Mutation of PAX9
The present study found significantly smaller teeth in is associated with oligodontia. Nat Genet 2000;24:18-9.
patients with agenesis of one or both maxillary lateral 16. Bailit HL. Dental variation among populations. An anthropologic view. Dent
Clin North Am 1975;19:125-39.
incisor. However, these findings were not specific and may 17. Dempsey PG, Townsend GC. Genetic and environmental contributions to
have varied among individuals as well as being dependent variation in human tooth size. Heredity 2001;86:685-93.
18. Brook AH, Elcock C, al-Sharood MH, McKeown HF, Khalaf K, Smith RN.
on specific clinical situations. It is thus advisable to Further studies of a model for the etiology of anomalies of tooth number and
approach patients with maxillary lateral incisor agenesis on size in humans. Connect Tissue Res 2002;43:289-95.
19. Brook AH, Elcock C, Aggarwal M, Lath DL, Russell JM, Patel PI, Smith RN.
a case-by-case basis, keeping in mind that these patients Tooth dimensions in hypodontia with a known PAX9 mutation. Arch Oral
can have varying patterns of smaller than normal teeth. Biol 2009;54(suppl 1):S57-62.
20. Polder BJ, Van’t Hof MA, Van der Linden FP, Kuijpers-Jagtman AM. A meta-
This study was limited to white orthodontic patients, analysis of the prevalence of dental agenesis of permanent teeth. Community
so generalizing tooth size discrepancy patterns across Dent Oral Epidemiol 2004;32:217-26.
21. Bishara SE, Fernandez Garcia A, Jakobsen JR, Fahl JA. Mesiodistal crown
races may not be prudent. The main finding of the pre- dimensions in Mexico and the United States. Angle Orthod 1986;56:315-23.
sent sample from a white population showed patients 22. Salmon D, Le Bot P. Congenital defects of the upper lateral incisors: multi-
variate analysis of measurements of the other teeth, the superior arch, head
missing one or both maxillary lateral incisors to have and face. Am J Phys Anthropol 1977;46:245-51.
smaller tooth size than patients with all teeth present. 23. Sofaer JA, Chung CS, Niswander JD, Runck DW. Developmental interaction, size
and agenesis among permanent maxillary incisors. Hum Biol 1971;43:36-45.
However, possibly because the reduced sample size, this 24. Baidas L, Hashim H. An anterior tooth size comparison in unilateral and
study could not find any specific tooth or group of teeth bilateral congenitally absent maxillary lateral incisors. J Contemp Dent Pract
2005;6:56-63.
responsible for the difference. The sample size should be 25. Yaqoob O, DiBiase AT, Garvey T, Fleming PS. Relationship between bilateral
increased in future studies. Furthermore, people of Afri- congenital absence of maxillary lateral incisors and anterior tooth width. Am J
Orthod Dentofacial Orthop 2011;139:e229-33.
can, Hispanic, or Asian descent with agenesis of the 26. Mirabella AD, Kokich VG, Rosa M. Analysis of crown widths in subjects
maxillary lateral incisor(s) may show different tooth size with congenitally missing maxillary lateral incisors. Eur J Orthod 2012;34:
783-7.
discrepancies or none at all. Future studies are recom- 27. Elian N, Bloom M, Dard M, Cho SC, Trushkowsky RD, Tarnow D. Effect of
mended to evaluate these populations. interimplant distance (2 and 3 mm) on the height of interimplant bone crest:
a histomorphometric evaluation. J Periodontol 2011;82:1749-56.
28. Jung RE, Jones AA, Higginbottom FL, Wilson TG, Schoolfield J, Buser D,
CONCLUSIONS et al. The influence of non-matching implant and abutment diameters on
radiographic crestal bone levels in dogs. J Periodontol 2008;79:260-70.
Orthodontic patients with unilateral or bilateral agenesis of 29. Vela X, Méndez V, Rodríguez X, Segalá M, Tarnow DP. Crestal bone
changes on platform-switched implants and adjacent teeth when the
the maxillary lateral incisor have smaller than average teeth tooth-implant distance is less than 1.5 mm. Int J Periodontics Restor Dent
when compared with a control-matched group. The 2012;32:149-55.
30. Othman S, Harradine N. Tooth size discrepancies in an orthodontic popu-
maxillary arch has larger tooth size differences between the lation. Angle Orthod 2007;77:668-74.
control and test groups than the mandibular arch. Clini- Corresponding author:
cians should consider the findings of this study when Dr Jose A. Bosio
preparing maxillary lateral incisor sites for restorations. Rutgers School of Dental Medicine
110 Bergen Street, Rm C780
Newark, NJ 07103
REFERENCES Email: jose.bosio@gmail.com
1. Kinzer GA, Kokich VO Jr. Managing congenitally missing lateral incisors. Acknowledgments
Part II: Tooth-supported restorations. J Esthet Restor Dent 2005;17:76-84. The authors thank Drs William Lobb, Gerard T. Bradley, and Dawei Liu, Mar-
2. Woolf CM. Missing maxillary lateral incisors: a genetic study. Am J Human quette University School of Dentistry, for advice and suggestions; and Jessica
Genetics 1971;23:289-96. Pruszynski and Dr Raphael Benoliel for statistical analysis.
3. Lombardi RE. The principles of visual perception and their application to
dental esthetics. J Prosthet Dent 1973;29:358-82. Copyright © 2016 by the Editorial Council for The Journal of Prosthetic Dentistry.