Original Article

Tooth sizes in nonsyndromic hypodontia patients
Ahmet Yalcin Gungora; Hakan Turkkahramanb
ABSTRACT Objective: To evaluate and compare the sizes of teeth in mild and severe hypodontia patients with those of healthy controls. Materials and Methods: Dental casts of 154 patients with two or more congenitally missing teeth were obtained. Patients were divided into two groups according to severity of hypodontia. Group I (mild) consisted of 118 patients with two to five missing teeth. Group II (severe) consisted of 36 patients with six or more missing teeth. In addition, a control group was included, which consisted of 50 patients who had an Angle Class I jaw relationship and no missing teeth. Mesiodistal and labiolingual dimensions of the teeth were measured with a digital caliper on dental casts. The independent-samples t-test was used to evaluate the effect of gender on measurements. Intergroup differences for mesiodistal and labiolingual dimensions were evaluated with analysis of variance and post hoc Tukey tests. Results: Statistically significant differences were found between girls and boys with hypodontia in the mesiodistal dimension of the mandibular first premolar and the labiolingual dimension of the mandibular lateral incisor (P , .01). Mesiodistal and labiolingual width measurements of the teeth of hypodontia patients showed statistically significant differences compared with the control group (P , .05). Most teeth showed significant dimensional reductions in severe hypodontia compared with mild hypodontia (P , .05). Conclusions: The mesiodistal and labiolingual dimensions of teeth in both mild and severe hypodontia groups were smaller than those in control subjects. The reduction in size was more excessive in the severe hypodontia group. The teeth showing the greatest difference in tooth dimensions were the maxillary lateral incisor (in mesiodistal dimension) and the mandibular canine (labiolingual dimension). (Angle Orthod. 2013;83:16–21.) KEY WORDS: Hypodontia; Oligodontia; Tooth size; Dental cast

INTRODUCTION Hypodontia, defined as congenital absence of one or more teeth, is a dental disability that affects a patient’s function and aesthetics.1,2 It is one of the most common dental anomalies in the permanent dentition.3–5 To describe the phenomenon of congenitally missing teeth, hypodontia is the term most frequently used.6 Another term used to describe a reduced
a Assistant Professor, Department of Orthodontics, Faculty of Dentistry, University of Akdeniz, Antalya, Turkey. b Professor, Department of Orthodontics, Faculty of Dentistry, University of Suleyman Demirel, Isparta, Turkey. Corresponding author: Dr Ahmet Yalcin Gungor, Akdeniz ¨ niversitesi, Dishekimligi Fakultesi, Ortodonti A. D. Kampus, U Antalya, Turkey (e-mail: aygungor@gmail.com)

Accepted: March 2012. Submitted: January 2012. Published Online: May 7, 2012 G 2013 by The EH Angle Education and Research Foundation, Inc.
Angle Orthodontist, Vol 83, No 1, 2013 16

number of teeth is oligodontia. Oligodontia is defined as the condition in which six or more teeth are congenitally missing, excluding the third molars.7 The prevalence of hypodontia varies from 2.63% to 11.2%, depending on race.8–11 Mild hypodontia is relatively common (absence of one to five teeth), but severe hypodontia (oligodontia, the absence of six or more teeth) is rarer. The incidences of hypodontia and oligodontia in a Turkish population were reported as 2.63% and 0.13%, respectively.10 Hypodontia is the most common dental anomaly in the Turkish population.10 The etiology of hypodontia and oligodontia is unclear.12 In the literature, many theories for the etiology of missing teeth have been suggested. It might be the result of either environmental or genetic factors, or a combination of these.13–25 One of the determinants of successful orthodontic treatment with perfect occlusion is harmonious tooth size. Tooth size in relation to the mandibular and
DOI: 10.2319/011112-23.1

99 0.92 0.99 0.97 0.99 0.98 0.99 0. who Table 1. overbite. The null hypothesis to be tested was that there was no difference between hypodontia groups and the control group in any dimensions of the teeth.96 0.95 0.97 Control Group 0.TOOTH SIZES IN NONSYNDROMIC HYPODONTIA 17 had an Angle Class I jaw relationship with no missing teeth (excluding third molars). The mesiodistal and labiolingual dimensions of the teeth were measured on dental casts with a digital caliper (Guilin Measuring and Cutting Tool Works. Dental casts of 154 patients (98 girls. Measurements were obtained systematically under standardized conditions. Angle Orthodontist. Intraclass Correlations of the Measurements Hypodontia Group 0. Vol 83. MATERIALS AND METHODS This prospective study was performed with two hypodontia patient groups (mild and severe) and a control group with all teeth other than the third molars present. unexplained previous loss of teeth. and discrepancies in the sizes of teeth in different arches determine buccal interdigitation. overjet. Therefore. this study sought to evaluate and compare the mesiodistal and labiolingual tooth sizes of mild to severe hypodontia patients with those of healthy controls. Hypodontia was diagnosed by radiographic and clinical observations.99 0.98 0. unerupted or partially erupted teeth. Prior to participation in the study.92 0.96 0.96 0. The labiolingual distance was measured as the greatest distance between the labial and lingual surfaces of the tooth crown in a plane perpendicular to that in which the mesiodistal distance was measured.26 6 1.26.98 0.99 Measurementa MD max1 MD max2 MD max3 MD max4 MD max5 MD max6 MD mand1 MD mand2 MD mand3 MD mand4 MD mand5 MD mand6 LL max1 LL max2 LL max3 LL max4 LL max5 LL max6 LL mand1 LL mand2 LL mand3 LL mand4 LL mand5 LL mand6 a MD indicates mesiodistal. and the results were averaged.95 0.94 0. 19 boys) with a mean age of 14. mandible. all subjects gave their informed consent after receiving an explanation of the aim of this study. Teeth were measured on both sides of each dental arch.13. Group III consisted of 50 patients (31 girls.99 0.94 0.93 0.96 0. 56 boys) (mean age. LL. 40 boys) with two to five missing teeth.96 0.96 0.96 0. 16 boys) with six or more missing teeth.93 0. Three months later.95 0. The control group (group III) included a selection of patients from the University of Suleyman Demirel.95 0.90 years.94 0.90 (Table 1).28 6 3. All hypodontia patients were white and Turkish and examined in Suleyman Demirel University.01 mm.92 0. Faculty of Dentistry. with the calipers held parallel to the occlusal and buccal surfaces.97 0.7. The study protocol was approved by the ethical committee of the University of Suleyman Demirel. The correlation values did not reveal any systematic measurement error (P . Group I (mild) consisted of 118 patients (78 girls. labiolingual.98 0. The mesiodistal distance was measured as the greatest distance between the contact points on the approximal surfaces of the tooth crown.92 years) with two or more congenitally missing teeth (excluding the third molars) were obtained.96 0. Department of Orthodontics.97 0. 13. 30 of the 154 dental casts of hypodontia patients and 50 of the control group casts were randomly selected. or had undergone previous orthodontic treatment. and measurements were repeated to estimate the repeatability of the measurement technique. these studies did not take into account the severity of hypodontia. Reproducibility coefficients of the all measurements were greater than 0. and mand. The inclusion criterion was the congenital absence of two or more teeth.98 0.97 0. 2013 .92 0. Guilin. . Department of Orthodontics. Faculty of Medicine. Persons were excluded if they had any associated syndrome.96 0.98 0. China) to the nearest 0.13. Group II (severe) consisted of 36 patients (20 girls. maxilla.05). No 1. between 2005 and 2009 by the same examiner.93 0. caries or restorations on the mesial or distal surfaces of the examined teeth.30 However.99 0.99 0.99 0.98 0.26 Many studies have found that the teeth of patients with congenitally missing teeth have smaller mesiodistal dimensions than normal populations. Faculty of Dentistry. The patients were divided into two groups according to the severity of hypodontia. max. and center line discrepancies.93 0.26–32 but to our knowledge only a few studies have compared the mesiodistal and labiolingual dimensions of the teeth of hypodontia patients.96 0.94 0. maxillary arches determines whether the dentition is spaced or crowded.

07 0.47 5.77 6.15 0.10 0.10 0.09 0.10 0.60 6.01) in boys than in girls and the labiolingual width of the mandibular lateral incisor was significantly greater (P .01) and second (P .90% in the mesiodistal dimension and from 0. RESULTS The mesiodistal and labiolingual width measurements of the teeth according to gender are shown in Table 2.29 7.05 7. maxilla.09 0.16% to 17.49 7.001) and first molar (P .01) in girls than in boys.21 7.55 8.15 10. .07 0. .12 0.06 0.01) incisors.38 8. Vol 83.66 0.95 5.05). The independent-samples t-test was used to evaluate the effect of gender on measurements.38 8.01).06 0. The threshold for significance was set at P .05) and that of the mandibular lateral incisor (P .26 6. 2013 Table 3.69% in the labiolingual dimension (Table 4).09 0. .33 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 0.66 6.93 6. .0 (SPSS Inc.21% in the labiolingual dimension.13 0. version 16. .07 0. n-s indicates nonsignificant. .08 0. .39 8. and SD.68% to 14. parametric tests were used.01) and of the mandibular lateral incisor (P .33% to 6. .07 0. The mesiodistal dimensions of the maxillary lateral incisor (P . Mesiodistal and Labiolingual Width Measurements of the Teeth According to Gender Boys Measurement MD max1 MD max2 MD max3 MD max4 MD max5 MD max6 MD mand1 MD mand2 MD mand3 MD mand4 MD mand5 MD mand6 LL max1 LL max2 LL max3 LL max4 LL max5 LL max6 LL mand1 LL mand2 LL mand3 LL mand4 LL mand5 LL mand6 a a GUNGOR. .01) and second premolar (P .71 5. mand.09 0. max. The percentage reduction in the tooth dimensions of the severe hypodontia patients ranged from 2.11 0.38 7.78 5.54 6. The labiolingual dimension of the maxillary first (P .05 0.74 6.28 8.50 9.30 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 0. . The Kolmogorov-Smirnov test was used to see whether the sample was normally distributed.08 0. . Mesiodistal and labiolingual measurements of the teeth according to severity of hypodontia are shown in Angle Orthodontist.09 0. canine (P . Intergroup differences for mesiodistal and labiolingual dimensions were evaluated using analysis of variance and post hoc Tukey tests.07 0.05) showed significant reductions in severe hypodontia compared with mild hypodontia.07 10. .06 n 88 41 67 72 43 88 73 82 76 72 38 49 88 41 67 72 43 88 73 82 76 72 38 49 Significance n-s n-s n-s n-s n-s n-s n-s n-s n-s ** n-s n-s n-s n-s n-s n-s n-s n-s n-s ** n-s n-s n-s n-s (Mean 6 SD) 8.32 6. Chicago.97 10.30 7.54% in the mesiodistal dimension and from 3.17 0. but the reduction in size was more excessive in the severe hypodontia group.35 5. and first premolar (P .01.14 0. No 1. Ill).66 6. The percentage reduction in the tooth dimensions of the mild hypodontia patients ranged from 3. LL.08 0.06 0.06 0.08 0.06% to 6.10 0.10 0.14 0.62 7. . TURKKAHRAMAN Girls n 51 28 35 34 24 49 38 45 38 36 11 89 51 28 35 34 24 49 38 45 38 36 11 89 (Mean 6 SD) 8.62 5. standard deviation. Therefore.92 5. .06 0.99 7. MD indicates mesiodistal. .54 6.09 0.86 6.85 10.07 ** P .34 6.05) showed significant reductions in severe hypodontia compared with mild hypodontia.08 0.12 0. The mesiodistal width of the mandibular first premolar was significantly greater (P .61 5.49 7. The values indicated that the data were normally distributed (P .08 0.95 10.08 0. Both hypodontia groups showed smaller teeth than the control subjects.06 0.06 0.98 10. canine (P . mandible. . labiolingual.10 0.12 0.18 Table 2.47 9.69 6.58 6.05. The teeth that showed the greatest difference in dimensions were the maxillary first premolar in mild hypodontia and the maxillary lateral incisor in severe hypodontia for the mesiodistal dimension.05 0.001) and first premolar (P . .23 6.12 0.06 0.001).54 5.09 0. Statistical Methods All recorded data were statistically analyzed and compared among the groups with SPSS software.

96 10.26–33 and labiolingual13.06 n 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 Significance .000 . *** P .24 7.07 0. This difference might be caused by different etiologies (genetic or environmental) of the missing teeth. n-s indicates nonsignificant.TOOTH SIZES IN NONSYNDROMIC HYPODONTIA Table 3.06 0.000 . and group III.97 10.06 0.14 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 0.21 7.98 7.06 0. It is the later developing teeth in each morphological class that are most frequently absent.000 .000 . standard deviation. According to the present findings.08 0.75 6.05 0.000 .000 .104 .05 * P . maxilla. 2013 .20 reported that the different prevalence of hypodontia at different tooth sites may be associated with developmental timing.05 0.06 0. group I. .43 6.37 10. mandible.07 0.63 6.07 0.40 6.18 0.64 6.08 0. and this is likely not clinically significant.15 9.10 0. MD indicates mesiodistal.08 0.10 10.7. labiolingual. They concluded that the reasons for this trend were unclear at present.51 10.71 5.7 concluded that oligodontia is not an isolated phenomenon but is related to a complex of other dental anomalies.10 0.3 mm for both teeth. We found significant reductions in almost all of the teeth of hypodontia patients in the mesiodistal and labiolingual dimensions. the mean difference was only 0.82 7.07 6.000 .12 0.09 n 34 11 20 14 8 32 20 26 26 22 11 32 34 11 20 14 8 32 20 26 26 22 11 32 Group III (Mean 6 SD) 8.90 6.21 6.05 0. Many authors have reported that patients with congenitally missing teeth had smaller teeth than normal populations in the mesiodistal7.67 9.017 .06 5. ** P .07 0.33 0.05 0.13 0.000 .08 0.33 reported that female hypodontia patients showed less difference in the size of their canines relative to normal controls than male hypodontia patients.000 .06 0.07 0.38 8.98 6.05 0.84 6.06 0. the tooth showing the greatest difference in tooth dimensions in both mild and severe hypodontia was the mandibular canine. .18 7. SD.06 0.02 5.10 0.26.09 0.07 0.108 .06 0.50 10.02 10.07 0.06 0.52 6.12 0.30 6.70 7.08 0.001.10 0.36 10.08 0. Diastemas are frequently seen in patients with congenitally missing teeth.61 6.10 0.34 6.41 5.000 .08 0.000 .07 0.22 9.22 0. Most authors have reported no difference in tooth sizes between girls and boys.64 5.06 0.18 0.68 6.05.08 0.011 . Additionally.69 9.18 0.35 5.05 0.05 0.13.08 0.30 dimensions. second Angle Orthodontist.39 5.000 .43 5.000 I-II n-s *** n-s n-s n-s ** n-s ** n-s n-s * n-s ** * *** * n-s n-s n-s ** *** * n-s n-s Post Hoc Tests I-III *** * *** *** *** ** n-s *** *** ** * * * n-s n-s *** n-s *** n-s * *** ** n-s ** II-III *** *** *** ** *** *** n-s *** *** *** *** *** *** * *** *** n-s *** n-s *** *** *** * *** (Mean 6 SD) 8.75 8.85 7.36 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 0. severe hypodontia.12 0. Vol 83.07 6.04 10.90 7.06 0.25 5. .45 7.34 6.06 0.000 .06 0.57 8. DISCUSSION The aim of this study was to evaluate and compare tooth sizes in mild and severe hypodontia with the tooth sizes in normal subjects.000 .12 0.78 6. LL.84 7.66 8. eg. Clinicians should take this finding into account when planning orthodontic treatment.73 6. mand.01.06 0. The results of this study were in accordance with these studies.05 0.10 0.000 .76 5.55 6.000 .13 0.25 6.07 0.64 7. Comparison of Mesiodistal and Labiolingual Width Measurements of the Teeth According to Severity of Hypodontia Group I Measurement MD max1 MD max2 MD max3 MD max4 MD max5 MD max6 MD mand1 MD mand2 MD mand3 MD mand4 MD mand5 MD mand6 LL max1 LL max2 LL max3 LL max4 LL max5 LL max6 LL mand1 LL mand2 LL mand3 LL mand4 LL mand5 LL mand6 a a 19 Group II n 105 58 82 92 59 105 91 101 88 82 38 106 105 58 82 92 59 105 91 101 88 82 38 106 (Mean 6 SD) 8.06 0. especially considering the dimensional accuracy of the plaster models from which the measurements were taken. and male patients generally showed a greater percentage difference in labiolingual dimensions in the anterior dentition and in mesiodistal dimensions in the posterior dentition.13. group II.70 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 0.96 0.10 0.15 7. No 1. Schalk-van der Weide et al.06 0. max. normal controls.07 0.11 0. Larmour et al.05 0.000 .118 .31 0.10 0. Although a statistically significant difference was reported.26–32 Brook et al.17 0.16 7.38 5. The dimensions of the teeth did not differ according to gender except for the mesiodistal width of the mandibular first premolar and the labiolingual width of the mandibular lateral incisor. we observed smaller mesiodistal and labiolingual tooth dimensions in patients with severe hypodontia than in those with mild hypodontia.23 10. the lateral incisor.44 6.79 0. for labiolingual dimension.04 7.61 5.07 11. mild hypodontia. these diastemata are caused not only by the absence of the teeth but also by the reduced size of the teeth that are present.15 8.000 .23 7.

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