Laganà et al.

BMC Oral Health (2017) 17:62

DOI 10.1186/s12903-017-0352-y

RESEARCH ARTICLE Open Access

Dental anomalies: prevalence and

associations between them in a large
sample of non-orthodontic subjects, a
cross-sectional study
G Laganà1*, N Venza1, A Borzabadi-Farahani2,3, F Fabi4, C Danesi1 and P Cozza1

Abstract
Background: To analyze the prevalence and associations between dental anomalies detectable on panoramic
radiographs in a sample of non-orthodontic growing subjects.
Methods: For this cross-sectional study, digital panoramic radiographs of 5005 subjects were initially screened from
a single radiographic center in Rome. Inclusion criteria were: subjects who were aged 8–12 years, Caucasian, and
had good diagnostic quality radiographs. Syndromic subjects, those with craniofacial malformation, or orthodontic
patients were excluded and this led to a sample of 4706 subjects [mean (SD) age = 9.6 (1.2) years, 2366 males and
2340 females]. Sample was subsequently divided into four subgroups (8, 9, 10, and 11–12 year-old groups). Two
operators examined panoramic radiographs to observe the presence of common dental anomalies. The prevalence
and associations between dental anomalies were also investigated.
Results: The overall prevalence of dental anomalies was 20.9%. Approximately, 17.9% showed only one anomaly, 2.
7% two anomalies, while only 0.3% had more than two anomalies. The most frequent anomalies were the displacement
of maxillary canine (7.5%), hypodontia (7.1%), impacted teeth (3.9%), tooth ankylosis (2.8%), and tooth transposition (1.4%).
The lower right second premolar was the most frequent missing teeth; 3.7% had only one tooth agenesis, and 0.08% had
six or more missing tooth (Oligodontia). Mesiodens was the most common type of supernumerary tooth (0.66%). Two
subjects had taurodontic tooth (0.04%). Tooth transpositions and displacement of maxillary canine were seen in 1.4 and 7.
5%, retrospectively (approximately 69 and 58% were in the 8 and 9 year-old groups, retrospectively). Significant
associations were detected between the different dental anomalies (P < .05).
Conclusions: The results of our study revealed significant associations among different dental anomalies and
provide further evidences to support common etiological factors.
Keywords: Tooth anomalies, Non-orthodontic subjects, Panoramic radiograph

Background morpho-differentiation or histo-differentiation stages of

Dental anomalies caused by complex interactions tooth development [2].
between genetic, epigenetic and environmental factors The associations between dental anomalies have been
during the process of dental development. This process a focus of a number of biologically enlightened clinical
is multifactorial, multilevel, and multidimensional [1]. orthodontists. Many authors have contributed recently
Developmental dental anomalies may be caused by gen- to our increased awareness of fundamental significant
etic and environmental factors in particular during the relationships among dental abnormalities [3].
Dental anomalies’ incidence and degree of expression
* Correspondence: giuseppinalagana@libero.it
in different population groups can provide important in-
1
Department of Orthodontics, Department of Clinical Sciences and Translational formation for phylogenic and genetic studies, allowing
Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
Full list of author information is available at the end of the article

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Laganà et al. BMC Oral Health (2017) 17:62 Page 2 of 7

us to understand variations within and between the dif- – The 9 year–old group: 1132 subjects (572 M and
ferent populations [4]. 560 F, mean age = 9.48 (0.28) years)
Understanding the process of morphogenesis and the – The 10 year–old group: 890 subjects (450 M and
variations in the outcomes is an important contribution 440 F, mean age = 10.48 (0.28) years)
to the multidisciplinary clinical team approach to treat- – The 11 and 12 year–old group: 814 subjects (413 M
ment [5]. and 401 F, mean age = 11.51 (0.28) years).
Early diagnosis allows optimal patient management
and treatment planning and can reduce complications Dental anomalies assessed and recorded
and the amount and complexity of the planned The presence of eight different anomalies was evaluated
treatment. following these criteria:
If such associations of hereditary origin occur, they
may be worth recognizing and studying, as early diagno-  Tooth agenesis or hypodontia (H): where no sign
sis of one tooth developmental disturbance may reveal a of crown calcification on the radiograph was evident
potential risk of future position or other teeth eruption and no evidence of loss attributable to caries,
disturbances. In fact, various dental anomalies of the periodontal disease, or trauma could be seen. If
dentition are frequently observed together in clinical missing teeth were suspected, we contacted the
practice [4]. referring dentist to ascertain that subjects did not
Changes in the pattern of tooth eruption can affect the have history of extractions, syndromes, or craniofacial
organization of the dental arches contributing to a mal- malformations. The lower limit of the age (8 years) in
occlusion [6]. the present sample was chosen to study hypodontia of
From a clinical point of view, the genetic compo- all permanent teeth, excluding third molars, with
nent of the causative observed tooth disturbance can minimal false-positive findings [7].
be investigated by evaluating the associated dental  Supernumerary tooth (ST): this was diagnosed
anomalies. when teeth were present in addition to the normal
The aim of this study was to analyze the prevalence dentition [8].
and the associations among dental anomalies detectable  Impacted tooth (IT): disturbance of eruption
by panoramic radiographs in a relatively large sample of determinate by some physical barrier in their path
non-orthodontic growing subjects. local factors (lack of space, cysts or benign tumors,
odontomas, persistent primary teeth) [9].
Methods  Tooth ankylosis (TA): a clinical condition whereby,
For this cross-sectional investigation, digital panoramic after eruption, a tooth loses its ability to maintain
radiographs of 5005 subjects were initially randomly se- the continuous eruptive potential as the jaws grow
lected from January 2006 to July 2015 from a single [10]. Radiographically and clinically evidenced by
radiographic center in Rome. The radiographs were eval- the presence of the infraocclusion.
uated in the Department of Orthodontics at “Tor  Odontomas (O): a radiopaque mass which is a
Vergata” University of Rome and after applying the ex- dental hamartoma composed of normal dental tissue
clusion criteria this led to a final sample of 4706 subjects that has grown in an irregular way. It presents in the
with mean age of 9.6 (SD = 1.2) years [2366 males (M) compound form, by many little tooth-like structures
and 2340 females (F)]. The study project was approved held together, or, in the complex form, by a single
by the Ethic Committee at the University of Rome Tor amorphous mass [11].
Vergata and written consent was obtained from all sub-  Taurodontism (T): where the tooth body and/or
jects’ parents. The inclusion criteria were: subjects of 8 pulp chamber enlarged vertically and pulp chamber
to 12 years of age, Caucasian, and subjects with good is in a rectangular configuration [12].
quality radiographs. In case of subjects with more than  Tooth transposition (TT): positional interchange
one panoramic radiographs, only the first one was evalu- of two adjacent teeth, or the development or eruption
ated. Exclusion criteria were: incomplete records (x-rays, of a tooth in a position normally occupied by a
clinical notes), syndromic and craniofacial subjects (e.g., non-adjacent tooth [13].
cleft lip/palate), or a history of previous orthodontic  Displacement of maxillary canine (DMC): a
treatment. condition wherein a maxillary canine does not
The final sample was divided into four subgroups as follow its normal eruption path with asymmetry
follows: between the right and left maxillary canines;
maxillary lateral incisor is late erupting, with
– The 8 year–old group: 1832 subjects (912 M and evidence of resorption or proclination. Radiographically
920 F, mean age = 8.38 (0.28) years) evaluated by the positional relationship between the
Laganà et al. BMC Oral Health (2017) 17:62 Page 3 of 7

maxillary canine cusp tip and adjacent lateral incisor one anomaly, 2.7% (n = 126) two anomalies, while only
and measurement of the angle formed by the long axis the 0.3% (n = 16) more than two anomalies.
of the maxillary canine and the midline or the distance The lower right second premolar was the most fre-
between the maxillary canine cusp tip and occlusal quent missing tooth. We detected 172 subjects (3.7%)
plane [14]. with only one agenesis, 120 (2.5%) with bilateral agene-
sis, 39 (0.9%) with 3–5 agenesis, and 4 (0.08%) subjects
Digital panoramic radiographs were acquired with the with more than six missing teeth (Oligodontia).
same radiographic equipment (Orthophos XG; Sirona A supernumerary tooth (ST) was found in 43 subjects
Dental Systems, Long Island City, NY using the follow- (25 M, 18 F) (0.9%). Only 3 subjects had two super-
ing parameters: 65–90 kV, 15 mA, 13 s, 110 mGy cm, numerary teeth (Table 2). Mesiodens was the most fre-
effective dose = 21.4 mSv). Images were stored in a quent type of supernumerary tooth (n = 31; 0.66%). The
digital database. Density and contrast enhancement tools groups showing the highest number of this anomaly
adjusted these digital radiographs. were the 9 and 11–12 year-old groups.
Images were evaluated independently by two different An impacted tooth (IT) was detected in 185 subjects
operators (N.V. and G.L.) on the computer monitor with (3.9%) and none of the impacted tooth caused by cyst or
subdued ambient lighting. To estimate the reproducibil- benign tumors. Maxillary impaction was found in 161
ity of diagnosis, 100 radiographs selected randomly were subjects, whereas only 24 subjects showed mandibular
examined once again separately by the two operators. impacted tooth. The most commonly impacted teeth
The agreement between the operators was substantial were: maxillary canines (n = 119; 2.5%), maxillary lateral
(Kappa > 90). incisors (n = 34; 0.7%), and maxillary central incisors
(n = 33; 0.7%). The most frequent ankylosed teeth
were the lower second deciduous molars (n = 109;
Statistical analysis
2.3%), lower first deciduous molars (n = 80; 1.7%) and
All descriptive and comparative statistical analyses were
the upper second deciduous molars (n = 27; 0.6%).
performed using the SPSS software package (Statistical
Odontomas (O) were found mainly in the maxillary
Package for Social Sciences, version 16.0, SPSS Inc.,
anterior region (27 of 32 cases in the central incisor
Chicago, USA). The Spearman rank correlation coeffi-
region). We detected two subjects with a taurodontic
cient was used to evaluate significant associations be-
tooth (0.04%) and no significant correlations with
tween the different dental anomalies. Any P value < .05
other anomalies were found.
was considered as significant. The prevalence and the
The unilateral displacement of maxillary canine
patterns of association were assessed among different
(DMC) was identified in 234 subjects (5.00%), while bi-
dental anomalies. The findings of the significant associa-
lateral DMC in 118 subjects (2.50%). DMC subjects were
tions between investigated dental anomalies and differ-
constantly found in all groups except for the 8-year–old
ent abnormal teeth were further analyzed by the
group, with the lower prevalence (6.23%).
chi-square test. The Cohen’s kappa statistic was used be-
Overall, we detected 67 (1.4%) cases with transposi-
tween the two assessors to test the reproducibility of
tions. The maxillary canine-first premolar transposition
diagnosis. Descriptive statistics and frequency tables
was the most frequent type (n = 44; 0.93%). We also de-
were then created for general descriptions of the results
tected 25 maxillary first premolar-second premolar
in the groups.
transpositions (0.53%) and four maxillary canine-lateral
incisor transpositions (0.08%). The M/F ratio in the sub-
Results jects with transposition was 39:28. Only ten cases with
The prevalence rate of the different anomalies in the bilateral transposition were observed. There were signifi-
final sample is shown in the Table 1. Figures 1 and 2 cant associations among different anomalies (P < .01,
show the distribution of different anomalies in the max- Table 3). Table 4 shows significant associations among
illary and mandibular arches. Cohen’s kappa statistic different abnormal teeth.
demonstrated substantial intra-examiner agreement be-
tween the two observers (Kappa > 0.90); no significant Discussion
errors were found between the two analyses. The most The present study analyzed the prevalence and the
frequent anomalies in the sample were the displacement pattern of associations of different dental anomalies
of maxillary canine (7.5%), hypodontia (7.1%), impacted in a large sample of non-orthodontic subjects.
tooth (3.9%) and tooth ankylosis (2.8%). The overall Numerous studies evaluated the prevalence of dental
prevalence of dental anomalies in the present sample anomalies in orthodontic or paediatric subjects. The
was 20.9% (n = 984), with a male/female ratio of 1:1. nature of the examined subjects influenced preva-
Approximately, 17.9% (n = 842) of subjects showed only lence rates of the examined anomalies, but it did not
Laganà et al. BMC Oral Health (2017) 17:62 Page 4 of 7

Table 1 Prevalence rate of different anomalies in the sample and in four sub-groups
Whole SAMPLE 8 year–old group 9 year–old group 10 year–old group 11–12 year–old group
Prevalence M Prevalence M Prevalence M Prevalence M Prevalence M
n. (%) n. (%) n. (%) n. (%) n. (%)
F F F F F
DMC 352 (7.5%) M = 173 116 (6.3%) M = 62 89 (7.8%) M = 46 79 (8.8%) M = 35 68 (8.3%) M = 30
F = 179 F = 54 F = 43 F = 44 F = 38
H 335 (7.1%) M = 168 118 (6.4%) M = 59 96 (8.4%) M = 51 54 (6,0%) M = 28 67 (8.2%) M = 30
F = 167 F = 59 F = 45 F = 26 F = 37
IT 185 (3.9%) M = 87 72 (3.9%) M = 35 40 (3.5%) M = 19 39 (4.4%) M = 17 34 (4.2%) M = 16
F = 98 F = 37 F = 21 F = 22 F = 18
TA 131 (2.8%) M = 79 49 (2.6%) M = 32 31 (2.7%) M = 19 24 (2.7%) M = 12 27 (3.3%) M = 16
F = 52 F = 17 F = 12 F = 12 F = 11
TT 67 (1.4%) M = 39 34 (1.8%) M = 19 12 (1.1%) M=7 8 (0.9%) M=4 13 (1.6%) M=9
F = 28 F = 15 F=5 F=4 F=4
ST 43 (0.9%) M = 25 13 (0.7%) M=6 13 (1.1%) M=8 8 (0.9%) M=4 9 (1.1%) M=7
F = 18 F=7 F=5 F=4 F=2
O 30 (0.6%) M = 13 13 (0.7%) M=7 7 (0.6%) M=2 5 (0.6%) M=2 5 (0.6%) M=2
F = 17 F=6 F=5 F=3 F=3
T 2 (0.04%) M=1 1 (0.1%) M=1 0 M=0 0 M=0 1 (0.1%) M=0
F=1 F=0 F=0 F=0 F=1
DMC Displacement of maxillary canines, H Hypodontia, IT Impacted Teeth, TA Tooth Ankylosis, TT Tooth Transposition, ST Supernumerary Teeth, O Odontomas,
T Taurodontism

necessarily reflect the prevalence in the general The findings of the present study revealed significant
population. The present study design was such that associations among different dental anomalies and this
overcame some methodological drawbacks of previ- may support a common etiological origin for these
ous investigations on associated dental anomalies. conditions.
Furthermore, no studies in Italy analyzed dental Esenlik et al. [15], in a study of a Turkish population,
anomalies on such a high number of non- analyzed 2599 radiographs of subjects with a similar age
orthodontic subjects. range. They found a prevalence rate of ST of 2.7%. The
The aim of the present investigation was to provide literature analysis suggests a prevalence rate of ST to be
further evidence on reciprocal associations and distribu- between 0.2 and 3% [16]. These findings are similar to
tion of different dental anomalies in a large population ours showing a prevalence rate of 0.9%. Furthermore, we
of growing subjects. found that the 8 year-old group had the lowest

Fig. 1 Number and prevalence of abnormal teeth found in maxillary arch. DMC: Displacement of maxillary canines; H: Hypodontia; IT: Impacted
Teeth; TA: Tooth Ankylosis; TT: Tooth Transposition; ST: Supernumerary Teeth; (m): Mesiodens; O: Odontomas; T: Taurodontism
Laganà et al. BMC Oral Health (2017) 17:62 Page 5 of 7

Fig. 2 Number and prevalence of abnormal teeth found in mandibular arch. H: Hypodontia; IT: Impacted Teeth; ST: Supernumerary Teeth;
O: Odontomas; T: Taurodontism

prevalence of ST. This result could be considered as a associated dental anomalies [18]. The prevalence of H in
false positive data, related to a delayed ST development the present sample was 7.1%, which is well within the
[8]. Present study revealed significantly higher preva- same range [18] and showed significant associations with
lence of ST in the maxillary arch (0.89%), than in the the DMC and TT. As described in the previous article
mandibular arch (0.01%). The most common dental we demonstrated that the missing elements are often the
anomaly associated with ST was the IT and TT, similar distal teeth in each group of homogeneous teeth: upper
to authors who described associations with the dis- and lower third molars, lateral incisors and lower second
placement of a permanent tooth and failure of premolars [19]. In particular, agenesis of maxillary lat-
eruption [5, 17]. The higher prevalence of tooth im- eral incisors was significantly associated with DMC.
pactions in the present sample could be partially ex- The present findings contrast with Peck’s findings
plained by a higher proportion of these cases detected reporting that agenesis of the mandibular second pre-
in the 8 and 9 year-old groups (~60%) and it is pos- molars is more prevalent than agenesis of the maxil-
sible that some of these cases normalize later on and lary lateral incisors [20]. Moreover, contradictory to
do not present as the tooth impactions. Al-Abdallah’s conclusions, we demonstrated that man-
In a review of Rakhshan [18], he estimated the preva- dibular hypodontia was not significantly associated
lence of agenesis in permanent dentition, excluding third with IT and TA [7].
molars, to be in a range of 0.15 and 16.2%. Similarly, au- Very few studies described the prevalence of tauro-
thors revealed IT, DMC and T as the most frequent dontism: the most recent one was conducted in a
Trinidad and Tobago’s population and revealed an inci-
Table 2 Number of abnormal teeth in the same subject for dence of 4.79%. This is significantly higher than ours
each anomalies (0.04%) and it could be due to racial difference and
One abnormal Two abnormal Trhee or more differences in diagnostic methods [21].
tooth n. (%) teeth n. (%) abnormal teeth
n. (%) A considerably higher prevalence of tooth transposi-
DMC 234 (5,0%) 118 (2.5%) 0 tions in the present general population (1.4%) was found,
compared with Papadopulos’ meta-analysis (0.33%) [22].
H 172 (3.7%) 120 (2.5%) 43 (0.9%)
Moreover, present findings suggest a higher prevalence
IT 133 (2.8%) 45 (1,0%) 7 (0.1%)
in male subjects. Peck and Peck [23] suggest that trans-
TA 60 (1.3%) 50 (1.1%) 21 (0.4%) position equally affects both sexes, while others, similar
TT 57 (1.2%) 10 (0.2%) 0 to our findings, have found a higher prevalence in males
ST 40 (0.8%) 3 (0.1%) 0 [24]. The higher prevalence of tooth transpositions could
O 29 (0.6%) 0 1 (0.0%) be partially explained by a higher proportion of these
cases detected in the 8 and 9 year-old groups (~69%)
T 2 (0.0%) 0 0
and it was possible that some of these cases normalized
DMC Displacement of maxillary canines, H Hypodontia, IT Impacted Teeth, TA
Tooth Ankylosis, TT Tooth Transposition, ST Supernumerary Teeth, O Odontomas,
later on and did not present the tooth transpositions.
T Taurodontism Significant associations reported in the literature were
Laganà et al. BMC Oral Health (2017) 17:62 Page 6 of 7

Table 3 Associations among different anomalies and the corresponding p values, correlation coefficients and 95% confidence interval
ST O H IT DMC TA TT
ST – .162 .080 P < 0.01 .479 .854 P < 0.001
.020 .026 .038 -.010 -.003 .083
-.045–.086 -.040–.091 -.028–.103 -.076–.055 -.068–.063 .017–.148
O – .923 P < 0.001 .387 .353 .376
-.001 .162 -.013 -.014 0.13
-.067–.064 .097–.228 -.078–.053 -.079–.052 -.053–.078
H – .409 P < 0.01 .051 P < 0.001
.012 .044 .029 .057
-.053–.077 -.022–.109 -.037–.094 .009–.122
IT – .740 P < 0.05 P < 0.001
.005 .132 .068
-.061–.070 -.034–.097 .002–.133
DMC – P < 0.01 .996
.040 .000
-.026–.105 -.066–.065
TA – .110
.023
-.042–.089
TT –
Spearman rank correlation coefficient. P value < .05 was considered as significant
DMC Displacement of maxillary canines, H Hypodontia, IT Impacted Teeth, TA Tooth Ankylosis, TT Tooth Transposition, ST Supernumerary Teeth, O Odontomas,
T Taurodontism

among agenesis, microdontic teeth and tooth ankylosis. The prevalence of displaced maxillary canines in the
The correlation test showed a significantly higher per- Caucasian population is reported to be about 2–3% [26].
centage of ST (P < .001), H (P < .001) and IT (P < .001). In this non-orthodontic sample, the prevalence was
Prevalence of deciduous molar ankylosis has been re- 7.5%. Male-to-female ratio of DMC in the present study
ported in previous studies with some variability; to be was 1:1 and bilateral-to-unilateral ratio was 1:2, with a
between 1.3 and 38.5% [25]. This variability is probably bilateral occurrence of 2.50%. By contrast, Peck et al.
due to different inclusion criteria, age of the sample, and [27] reported that DMC occurred twice in females than
racial differences between studied sample populations. in males and the bilateral occurrence was reported to be
Our study identified significant associations between an- in the range of 19–45%. Similar to tooth transposition,
kylosis of mandibular deciduous molars and displace- the higher prevalence of displaced maxillary canines
ment of maxillary canines (P < .01). could be due to a higher proportion of these cases being
detected in the 8 and 9 year-old group (~58%) and it is
Table 4 Significant associations among different abnormal teeth
possible that some of these cases normalized later on
Abnormal tooth Significant associations (P < .01)
and did not present as displaced maxillary canines.
Hypodontia 12 Hypodontia 15, 22, 25, 35, 45; DMC 13, 23
Hypodontia 15 Hypodontia 12, 22, 25, 35, 45; Ankylosis 85 Conclusions
Hypodontia 22 Hypodontia 12, 15, 25, 35, 45; DMC 13, 23
Hypodontia 25 Hypodontia 12, 15, 22, 35, 45  Numerous and significant associations between
Hypodontia 35 Hypodontia 12, 15, 25, 22, 45
different dental anomalies were found. In particular,
significant associations were detected between
Hypodontia 45 Hypodontia 12, 15, 22, 25, 35
Supernumerary teeth and Impacted teeth, Tooth
Impacted 13 Impacted 23 transposition; Odontomas and Impacted teeth;
Impacted 23 Impacted 13 Hypodontia and Displacement of maxillary canines,
DMC 13 Hypodontia 12, 22; DMC 23; Ankylosis 75 Tooth Transposition; Impacted Teeth and Tooth
DMC 23 Hypodontia 12, 22; DMC 13 Ankylosis, Tooth Transposition; Displacement of
Ankylosis 74 Ankylosis 75, 84, 85
maxillary canines and Tooth Ankylosis. These
results may suggest common etiological factors for
Ankylosis 75 DMC 13; Ankylosis 74, 84, 85
these conditions.
Ankylosis 84 Ankylosis 74, 75, 85  The present findings can be used in estimation of
Ankylosis 85 Hypodontia 15; Ankylosis 74, 75, 84 prevalence of common dental anomalies in the Italian
Spearman rank correlation coefficient population.
Laganà et al. BMC Oral Health (2017) 17:62 Page 7 of 7

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