Summary JCM 18-1-2021

TOOTH AGENISIS PATTERNS IN JAPANESE
ORTHODONTIC PATIENTS WITH NON

SYNDROMIC OLIGODONTIA
Kazuhito Arai
Tokyo, Japan
INTRODUCTION: Permanent tooth agenesis is one of the most

common developmental anomalies in humans and is often found in
orthodontic patients. It has been clinically classified into 3 categories—
hypodontia, oligodontia, and anodontia—based on the number of
undeveloped teeth. Term oligodontia is defined as agenesis of 6 or
more permanent teeth excluding 3rd molars.
Prevalence of oligodontia ranges from 0.08 to 0.16 % in general
population and higher prevalence has been reported in orthodontic
patients. It is often associated with genetic syndromes like ectodermal
dysplasia, klienfelter syndrome, intercontinentia pigmenti and asperger
syndrome while the agenesis that occurs in non syndromic patients is
termed as “Non syndromic oligodontia”.
Location of the agenesis or the “pattern” is considerably
important in orthodontic patients as agenesis of anterior teeth will
have esthetic implications while agenesis in posterior region will
influence the skeletal growth, masticatory function and orthodontic
anchorage. Primary concern of patient presenting with oligodontia is
mostly esthetic but functional and psychological problems of such
patients are also serious. Management of such patients mostly requires
a multi-disciplinary approach with the orthodontist playing an
important role.
Ethnic backgrounds have shown to be linked with different
agenesis patterns and this study aims to expand the current knowledge
of hereditary factors on oligodontia. Patients with oligodontia have a
tendency for delayed tooth formation
The purposes of the present study were to investigate the
characteristics of permanent tooth agenesis patterns in orthodontic
patients with non syndromic oligodontia in Japan and confirm the
influence of evaluation cutoff age on analyses.
MATERIAL AND METHODS:

 Study protocol was reviewed and approved by the Research Ethics
Committee of Nippon Dental University, School of Life Dentistry at
Tokyo and the need for informed consent from individual patient
was waived.
 To estimate the number of hypodontia and oligodontia patients, a
preliminary questionnaire survey was conducted.
 According to the survey, 740 patients (508 female and 232 male)
with hypodontia (excluding oligodontia) and 58 patients (31
female and 27 male) with oligodontia were found among 11,195
new patients (7253 female and 3942 male) in 2012.
 All members were mailed to select and send panoramic
radiographs of orthodontic patients with oligodontia.
 Initial inclusion criteria were as follows: patients with agenesis of
6 or more permanent teeth, excluding third molars, diagnosed by
means of an orthodontic clinical examination, with diagnostic
records including panoramic radiographic examinations,
cephalometric evaluation, and dental cast analysis.
 Exclusion criteria were: cleft lip or palate, ectodermal dysplasia,
or other congenital anomalies.
 Records were sent to the author by mail on CD-ROMs. Before
mailing, patient’s personal information (name and address) was
removed.
 A total of 252 panoramic radiographs were collected during the
evaluation process, 1 image was excluded because of poor image
quality. Disagreement between the 2 evaluators occurred for 3
patients, whose images were excluded from the analyses
(agreement rate 248/251 patients, 98.8%) from 71 clinics.
 Twenty patients were also excluded based on age for the
following reasons: age unknown (n=2), age younger than 7 years
(n=17), and age older than 25 years (n=1). Finally, 228 patients
(141 female and 87 male) were selected.
 The number of missing teeth was counted for each patient, and
medians and interquartile ranges (IQRs) for female and male
patients were calculated and compared by means of the Mann-
Whitney U test. No significant difference was observed
 Tooth agenesis in other family members was reported for 48
patients (21.0%).
RESULTS:
 There was no significant difference in the median numbers of
missing teeth per patient between older and younger groups
according to cut off ages set from 8 to 14 years.
 Greatest number of missing teeth was observed for mandibular
second premolars, followed by the maxillary first premolar
 Tooth agenesis patterns in right and left quadrants for the
maxillary arch were pooled and 51 patterns were observed.
 Tooth agenesis patterns with higher prevalence included maxillary
first and second premolars (24.8%), followed by maxillary second
premolar only (10.3%).
 Forty-nine patterns were observed for the mandibular arch.
 Agenesis of second premolar only (25.0%) and first and second
premolars (20.2%) was prominently higher than other patterns.
 The 50% cumulative frequency was reached with only 3 patterns
 For occluding tooth agenesis pattern between maxilla and
mandible, 215 patterns were observed.
 The 50% cumulative frequency was reached with 27 patterns.
 For the full-mouth tooth agenesis pattern, 180 patterns were
observed for the 228 patients. Among them, 164 patients showed
a unique pattern. Sixty-six patterns were required to reach the
50% cumulative frequency
 Symmetric tooth agenesis patterns between right and left
quadrants were observed in 50% of patients for both maxillary
and mandibular arches, however, only 30% of patients showed a
symmetric pattern in both arches.
 Twelve patients had the same pattern for all 4 quadrants.
CONCLUSION:
Following conclusions were made in this study:
1. As compared to the European population, Japanese population
exhibits higher ranked tooth agenesis patterns including maxillary first
and second and mandibular second premolars
2. The prevalence of symmetric patterns between right and left
quadrants was significantly higher than observed between maxillary
and mandibular antagonistic quadrants.
3. 456 possible tooth agenesis patterns were identified, 51 and 49
patterns were observed for the maxillary and mandibular quadrants,
respectively. 215 patterns among 456 possible patterns
for occluding tooth agenesis pattern and 180 patterns for full-mouth
tooth agenesis patterns among 228 patients were observed, suggesting
large individual variations.

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TOOTH AGENISIS PATTERNS IN JAPANESE

ORTHODONTIC PATIENTS WITH NON

INTRODUCTION: Permanent tooth agenesis is one of the most

MATERIAL AND METHODS:

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