I0003 3219 90 3 383
I0003 3219 90 3 383
I0003 3219 90 3 383
This study aimed to (1) identify the relationship BAMLIS and detailed clinical history for the study
between congenitally bilaterally absent maxillary lateral group, and patients with no absent teeth other than
incisors (BAMLIs) and skeletal anomalies and/or third molars for the control group. The exclusion criteria
normal variants in the cervicovertebral region, (2) were trauma, dental or craniofacial anomalies or
evaluate the presence and shape of STBs in patients syndromes, chemotherapy affecting the musculoskel-
with BAMLIs, and (3) compare the findings obtained etal system, and insufficient diagnostic records.
from the BAMLIs and control groups. The null To evaluate the differences in cervicovertebral
hypothesis was that the prevalence of skeletal anom- anomalies between individuals with BAMLIs and the
alies and/or normal variants seen in lateral cephalo- control group, 86 patients without any dental or skeletal
metric radiographs of patients with BAMLIs was similar anomalies were found to be sufficient for the control
to that of patients without dental or skeletal anomalies. group according to the power analysis. This group
consisted of randomly selected patients who presented
MATERIALS AND METHODS to the orthodontic clinic of the university between 2017
and 2019. Clinical and radiographic (with orthopanto-
This retrospective, case-control study was carried mographic and lateral cephalometric radiography)
out with data obtained from the pretreatment records of evaluation of the absence of maxillary lateral incisors
172 white patients who applied for treatment at Erciyes was performed visually by a single author (T.O.) during
University Faculty of Dentistry Department of Ortho- patient examination. Skeletal anomalies and normal
dontics. This study was approved by the Erciyes variants (PP, posterior arch deficiency of the atlas
University Local Ethics Committee (no: 2019/394). [PADA] or STB) on lateral cephalometric radiographs
The patients were divided into two groups; a study were detected visually by the same author. The
group and a control group. The study group included necessary measurements to determine the skeletal
86 orthodontic patients (62 girls, 24 boys; age 12–17 classes of the patients were performed using Dolphin
years; mean age ¼ 15.3 years) with BAMLIs,, and the Imaging Software (version 11.0; Dolphin Imaging and
control group included 86 orthodontic patients with no Management Solutions, Chatsworth, Calif). Radio-
congenitally absent teeth (55 girls ,34 boys; age 13–18 graphs taken with the patient in a standardized natural
years; mean age ¼ 15.8 years). A diagnosis was made head position were obtained by the same technician,
using the data obtained from clinical examination uploaded to the Dolphin Imaging Software, and
findings and standard radiographs (orthopantomo- analyzed digitally.
graphic and lateral cephalometric). PADA and PP were visualized on the first four
The inclusion criteria for case records were as cervical vertebrae on lateral profile radiographs. Data
follows: patients with dental orthopantomographic on PADA were evaluated as present or absent (Figure
(Planmeca Proline CC 2002, Planmeca, Helsinki, 1).1,5 Calcification of the atlanto-occipital ligament,
Finland) and lateral cephalometric (Orthoceph called ‘‘arcuate foramen’’ or ‘‘PP,’’ was evaluated
OP300, Instrumentarium, Tuusula, Finland) radio- visually and scored using a standardized method.3,10,19
graphs with clear visualization of the first four cervical It was scored according to the degree of atlanto-
vertebrae for both groups, patients with congenitally occipital ligament ossification as no calcification
(absent), partial calcification (incomplete), or complete to establish a statistically significant difference be-
calcification (complete) (Figure 2). The presence of tween cervicovertebral anomalies and dental anoma-
STB has been previously demonstrated on lateral lies. Statistical comparisons for the evaluation of
cephalometric radiographs.6,20,21 The presence of STB BAMLIs and skeletal anomalies and/or normal variants
was scored according to the degree of interclinoid and intragroup evaluation included Pearson v2 test,
ligament (ICL) calcification as no calcification of ICL Fisher exact test, and binary logistic regression
(initial form), little or half calcification of ICL (partial analysis. Statistical Package for the Social Sciences
form), or complete calcification of ICL (complete form) (SPSS version 24.0 Inc, Chicago, Ill) software was
(Figure 3). used for all statistical analyses. Statistical significance
was determined at P , .05.
Statistical Analyses
To determine intraobserver error, cephalometric
Power analysis was used to determine that 172 analysis of 43 randomly selected radiographs was
patients were sufficient for the study and control groups repeated by the same author at a 2-week interval. The
Figure 3. The sella turcica area was evaluated. (A) The interclinoid ligament is not calcified (no presence of sella turcica bridging). (B) The
interclinoid ligament is partially calcified (sella turcica bridging is partially present). (C) The interclinoid ligament is fully calcified (sella turcica
bridging completely present).
degree of random error was evaluated as recommend- different when analyzed using Pearson v2 test (P ¼
ed by Dahlberg22 and Houston.23 .009) and Fisher exact test (P ¼ .008) (Table 3).
Table 3. Ponticulus Posticus Among Patients (Bilateral Absent Maxillary Lateral Incisor) and Control Patients
Maxillary Lateral Incisor
Present (Control) Absent (Study) Pearson’s v2 Fisher Exact Test
Ponticulus Posticus n % n % Value P* Value P*
No calcification (absent) 43 50.0 46 53.5 9.347 .009 8.987 .008
Incomplete calcification 28 32.6 37 43.0
Completely calcified 15 17.4 3 3.5
Total 86 100.0 86 100.0
* Statistical significance P , .05.
Table 4. Posterior Arch Deficiency of Atlas (PADA) Among Patients (Bilateral Absent Maxillary Lateral Incisor [BAMLI]) and Control Patients
Present (Control) BAMLI (Study) Pearson v2 Fisher Exact Test
n % n % Value P* Value P*
Present 15 17.6 25 29.1 13.341 ,.001 13.134 ,.001
Absent 71 82.4 61 70.9
Total 86 100.0 86 100.0
* Statistical significance P , .05.
Table 5. Sella Turcica Bridging (STB) Among Patients (Bilateral Absent Maxillary Lateral Incisor) and Control Patients
Present (Control) Absent (Study) Pearson’s v2 Fisher Exact Test
Interclinoid Ligament Calcification n % n % Value P* Value P*
Initial form 27 31.4 32 37.6 2.274 0.321 2.346 .328
Partial form 45 52.3 37 42.4
Complete form 14 16.3 17 20.0
Total 86 100.0 86 100.0
* Statistical significance P , .05.
can be considered as a part of an observable canine impaction. Am J Orthod Dentofacial Orthop. 2017;
21. Leonardi R, Farella M, Cobourne MT. An association other radiographs of orthodontic patients. Am J Orthod
between sella turcica bridging and dental transposition. Dentofacial Orthop. 1999;116:572–577.
Eur J Orthod. 2011;33:461–465. 31. Miletich I, Sharpe PT. Neural crest contribution to mamma-
22. Dahlberg G. Statistical Methods for Medical and Biological lian tooth formation. Birth Defects Res C Embryo Today.
Students. London: George Allen and Unwin; 1940:98. 2004;72:200–212.
23. Houston W. The analysis of errors in orthodontic measure-
32. Morotomi T, Kawano S, Toyono T, et al. In vitro differenti-
ments. Am J Orthod. 1983;83:382–390.
ation of dental epithelial progenitor cells through epithelial-
24. Sonnesen L, Pedersen CE, Kjaer I. Cervical column
mesenchymal interactions. Arch Oral Biol. 2005;50:695–
morphology related to head posture, cranial base angle,
and condylar malformation. Eur J Orthod. 2007;29:398–403. 705.
25. Sonnesen L, Kjaer I. Cervical vertebral body fusions in 33. Abou Neel EA, Aljabo A, Strange A, et al. Demineralization-
patients with skeletal deep bite. Eur J Orthod. 2007;29:464– remineralization dynamics in teeth and bone. Int J Nano-