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Some form of dental anomalies

Some form of dental anomalies, or at least dental irregularity is found in nearly every individual, including men, women and children. Some of these are relatively mild and simple, as in rotations of teeth, small interdental spacing and unusually shaped teeth. Others are more complex and cause more functional and esthetic concerns. Among the latter, one should include congenitally missing, impacted and severely crowded teeth and also craniofacial anomalies, such as various forms of clefts. An orthodontist, who is primarily concerned with the function and esthetic of the human dentition, sees these dental anomalies as a challenge in his efforts to change a malocclusion to a more normal and cosmetic occlusion.

Traits of Malocclusion

It is well accepted that among all the traits of malocclusions of the modern man, dental crowding is the most preva- lent, possibly second only to the rotation of an individual tooth. For that reason, it is not surprising that dental crowding occupies a central place in this specialty’s discussions about etiology and pathogenesis of malocclusions. It could be well speculated that if practitioners understood the mechanisms of crowding, they could be able, at some point, to intercept or even prevent it and thus substantially reduce the incidence of malocclusion in the modern population. However, the way things stand right now it is not very likely that this important public health issue will be affected any time soon.

Second to dental crowding, anomalies in the number of teeth represent a large group of primary factors causing malocclusions. This is closely followed by an anomalous position of teeth, chiefly represented by impactions and ectopic eruption, but also including transpositions and transmigrations. Therefore, these etiologic factors should also be looked at in an effort to understand and reduce or even eliminate them in the future. Consequently, it is necessary to revisit some of the salient features of these anomalies. Particularly challenging will be to summarize the recent investigative reports in this area, as well as to speculate where future research should be directed. Once we are able to substantially reduce these underlying dental anomalies, we will be well equipped and ready to tackle even more complex cranio-facial problems.

Etiology and pathogenesis of dental crowding

There are two basic mechanisms in creating the condition that we refer to as dental crowding. By definition, crowding is a discrepancy between the cumulative widths of the dental units or teeth, and the available space to accommodate these teeth within the alveolar bone. Thus, one can represent a ratio between the tooth size and the supporting bone size. When this ratio exceeds unity, we define such a condition as dental crowding. If the ratio is one or less than unity, we don’t speak about dental crowding, but may, in fact, identify the condition as dental spacing. Arguably, crowding exceeds spacing by a large margin, perhaps as large as 100 or more to one. The ratio of exact unity or one is so rare in real life that it can, for all practical purposes, be ignored.

It is generally recognized that the most common positional anomaly of a tooth is rotation. Rotations are so prevalent that it is difficult to find a modern man or woman with an occlusion that does not exhibit some degree of this common anomaly. Because this anomaly is so ubiquitous, many clinicians do not even list them as a trait of malocclusion, except when rotations are severe, e.g. a Orthodontics tooth rotated more than 45 degrees.

From the clinical aspect, rotations are not overly difficult to correct, particular- ly with the use of fixed orthodontic appliances. It is important to keep in mind, however, that corrected rotations also represent the condition most likely to relapse. Various strategies have been developed to guard against, or to minimize, rotational relapse. One of the most effective ones is the procedure known as supra-crestal fiberotomy [SCF], a minor surgical procedure in which the supra-crestal gingival fibers are sev- ered.4

Ectopic position constitutes the second most common positional anomaly of the dentition. Within this category, the one that concerns clinicians the most is impaction. Even though any one tooth from either dental arch can be impacted, impaction of the maxillary permanent canine receives most attention. This is the case for numerous reasons, including the central role that the canine plays in the function of articulation and occlusion. A second, nearly equally important reason, is its role in facial esthetics.

A brief mention will be made of yet another positional anomaly of the canines: transmigration. Transmigration is exclusive of the mandibular perma- nent canine. In this anomaly, the canine from one side of the arch migrates through the bone and erupts on the opposite side of the arch. For instance, the right mandibular canine migrates through the sympheseal area and erupts into the arch in the place where the left canine usually erupts. This anomaly could present a complex clinical problem, because the clinician will be facing a situation where the canine from one side appears to be missing, while the opposite side may appear to have a supernumerary canine.15 Like so many dental problems, this last anomaly is best detected by radiographic examination. If detected early enough, its treatment may not be too difficult. This will reinforce the urging of a mature teacher to obtain and examine our patients’ records with care and attention to detail.

A clinician faces a large variety of dental anomalies in his or her everyday work. This review dealt with only the most common ones that particularly affect an orthodontist. A better understanding of these will make the work of a clinician more efficient and perhaps a bit more enjoyable.

(08/22/2020)
by Dr. Mladen Kuftinec

More Information: http://www.dentalnews.com/2017/06/28/dental-anomalies/

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