Abstract
Objective:Neural tube defects may increase the risk of an abnormal development of skull, vertebral column and teeth formation, including dental agenesis in non syndromic patients. The association between the presence of a congenital Dental Agenesis (DA) and the Atlantooccipital Ligament (AOL) calcification, known as “Ponticulus Posticus” (PP), as possible links can be investigated.Design:After a systematic review of the scientific literature on this topic, two independent examiners assessed the AOL calcification in lateral cephalograms of 350 non syndromic patients(7-21 years old). The results were compared with a control group (non syndromic patients, without congenital missing teeth).Results:The 16.3% of the population studied by cephalometric analysis revealed a prevalence rate of PP (both complete and partial) with a slight male predominance is seen, not statistically significant (χ square test = 0.09; p= 0.76). In both sexes complete PP is more observed. In the patients affected by DA the frequency of PP is the 66.6% (both complete than partial). The χ square test with Yates correction showed a significative difference(χ= 66.20; p value= 0.00) between PP in patients with DA compared to not affected by DA.Conclusions:PP is not an uncommon anomaly. Since orofacial pain like migraine and other symptoms are often associated to PP, during routine radiographic examination, if detected, it should be documented in patients’ health record and with symptoms, further investigation should be sought for. These findings encourage to think there’s an association between DA in non syndromic patients and neuro-crestal cells defects.
Highlights
Many of the common dental anomalies affecting the human dentition during odontogenesis are interrelated to the embryologic processes involved in facial, jaws and vertebral column development
We considered the initial lateral cephalograms and orthopantomographs detecting the data at the early stage of clinical-radiographic observation. In those patients with dental agenesis but no ponticulus posticus, we considered cephalograms subsequent to the first, if requested for orthodontic reasons, to exclude or confirm the presence of ponticulus posticus
There’s a poor production of articles related this topic, and even if all the papers considered in the study used cephalograms like diagnostic tool to find ponticulus posticus in patients, only one study searches a positive association between the presence of ponticulus posticus and dental/orthodontic evaluations [30]
Summary
Many of the common dental anomalies affecting the human dentition during odontogenesis are interrelated to the embryologic processes involved in facial, jaws and vertebral column development. The most common congenital dental anomaly is the absence of teeth, it can affect permanent and deciduous dentition. Hypodontia is usually associated with other oral and dental and altered craniofacial growth [4]. Dental agenesis can occur in non-syndromic population [5, 6], like familiar form, or be part of a multi-symptomatic syndrome [7]. In the majority of cases dental agenesis has genetic origins and dental traumas, infections like rubella, chemo or radiotherapy, disturbances in local innervations, environmental situations, may influence and lead to the congenital absence of teeth [2, 7]
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