Prevalence of Tooth Transpositions and Associated Dental Anomalies: a Cbct Study

doi:10.21203/rs.3.rs-4902536/v1

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Prevalence of Tooth Transpositions and Associated Dental Anomalies: a Cbct Study

https://doi.org/10.21203/rs.3.rs-4902536/v1

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Purpose: The aim of this study wasto evaluate the frequency and type of dental transposition and its relationship with other dental anomalies and pathologies using cone beam computed tomography (CBCT).

Materials Methods: Images of patients who had CBCT images taken for various reasons between 2012 and 2023 were evaluated for the occurrence of dental transposition. The demographic data of the patients, the presence of transposed teeth, their number, location, unilateral or bilateral nature, dental transposition classifications defined in the literature, other adjacent dental anomalies and pathologies were examined.

Results: CBCT images of 5000 patients were examined, and 42 transposed teeth were found in 39 of the patients (0.78%). It was observedunilaterally in 92.3% of the patientsand bilaterally in 7.7% of the patients. The most common method was maxillary canine-first premolar transposition (47.61%), and the least common was maxillary central-lateral transposition (2.38%). The presence of persistent primary teeth was the highest in the relevant region (61.53%). External root resorption of tooth roots adjacent to transposed teeth was diagnosed in 17.94% of the patients.

Conclusion: The prevalence of transposition in Turkish society was 0.78%. This study is the first to examine dental transpositions using CBCT in the Turkish population. External root resorption was observed in a number of the adjacent teeth showing transposition. A detailedCBCT examination is very important for diagnosing malocclusion and other problems that may occur due to transposed teeth.

Transposition

prevalence

CBCT

Transposition is a rare dental anomaly that typically involves positional changes in two adjacent teeth¹. Displacement of the crowns and roots of the related teeth in the dental arch was defined as complete transposition, and displacement of the crowns while the roots remained in their normal position was defined as partial transposition ². Although its prevalence is reportedly approximately 0.4% ³, it has not been reported in primary dentition ⁴.

Tooth transpositions are more common in the maxilla than in the mandible, and the most common transposed teeth are maxillary permanent canines ⁵. ALL is more common in women than in men, and it may be unilateral or bilateral ⁶. However, there are studies in the literature that report that these tumors are most commonly unilateral and on the left side. ⁷

The etiology of transposition has not yet been fully elucidated. Both genetic and environmental factors have a role ³. Various factors can be considered etiological factors, such as trauma, early loss of primary teeth, long-term retention, delayed root resorption and positional displacement of developing tooth buds; however, the main etiological factors are ^genetic4^{, 5, 6}.

Six types of dental transpositions have been defined in the literature ^{6, 8}:

A. Upper canine-first premolar transposition (Mx.C. P1) (Figure 1).

B. Upper canine–lateral incisor transposition (Mx.C.12)

C. Transposition of the upper canine to the first molar region (Mx. C to M1)

D. Upper lateral incisor-central incisor transposition (Mx.12.11)

E. Transposition of the upper canine to the central incisor region (Mx. C to 11) ⁶ (Figure 2)

F. Lower lateral incisor-canine transposition (Mn.12. C) ⁸

Dental transposition is usually associated with other dental anomalies, such as agenesis, primary canine retention and wedge-shaped lateral teeth ^2,9. They can also cause complications such as severe rotation of the teeth, malpositions, resorption or malformation of the adjacent tooth ¹. The aim of this study was to evaluate the frequency and type of dental transposition and its relationship with other dental anomalies/pathologies by using CBCT.

The protocol and method of the study were approved by the Clinical Research Ethics Committee of Ondokuz Mayıs University [OMU KAEK 2023 − 290].

Images of patients who underwent CBCT for various reasons between 2012 and 2023 were examined retrospectively for the occurrence of dental transposition. Patients who had pathological conditions such as cysts, tumors and fractures in the area to be examined and images that had inadequate diagnostic quality for various reasons were not included in the study. The demographic data of the patients, presence of transposed teeth, number and location of transposed teeth, presence of unilateral or bilateral teeth, presence of complete or partial teeth, presence of pathologies related to these teeth, presence of other dental anomalies and presence of dental transposition classifications, as described in the literature, were examined.

CBCT images of 5000 patients were examined retrospectively. A total of 42 dental transpositions were found in 39 of the patients (0.78%). A total of 53.8% (n = 21) of the patients were female, while 46.2% (n = 18) were male. The mean age of the female patients was 23.47 (14–70), while the mean age was 18.33 (14–25).

Partial transposition was achieved in 61.9% (n = 26) of the transposed teeth, while complete transposition was achieved in 38.1% (n = 16). Trade repositioning was unilateral in 92.3% of the patients (n = 36), while it was bilateral in 7.7% (n = 3) (Fig. 3).

A total of 92.3% (n = 36) of the teeth were in the maxilla, while 7.7% (n = 3) were in the mandible. While 58.9% (n = 23) of the transpositions in the maxilla were on the right, 41.1% (n = 16) were on the left. Transposition was present only on the right in the mandible.

The most common type of transposition (Type A, Mx.C. P1) was between canine and first premolar teeth (47.6%). The maxillary central-lateral region (Type D, Mx.12.11) was the least common type (2.4%). The type of transposition between the maxillary canine-first molar tooth (Type C, Mx. C to M1), which was included in the classification, was not found in this study (Table 1).

In 30 (76.92%) patients, different dental anomalies were observed on the affected side. Most commonly, 27 persistent primary teeth were found in 24 (61.53%) patients in the relevant area (Fig. 4). While 25 of the persistent primary teeth were primary canines, 1 was a primary lateral tooth, and 1 was a primary second molar tooth. In addition, microdontia was found in 2 lateral teeth of 2 patients (5.12%), 2 impacted teeth (1 central and 1 premolar tooth) were found in 2 patients (5.12%), one supernumerary tooth was found in one patient (2.56%), and one congenitally missing lateral tooth (maxillary lateral) was found in 4 patients (10.25%).

External root resorption (n = 7, 17.94%) was found in the adjacent tooth in 6 patients and in the transposed tooth in one patient (Fig. 5). Three resorptions were present in the lateral teeth, three were in the central teeth, and one resorption was in the first premolar tooth. Most of the teeth (71.42%) with resorption were included in lateral-canine transpositions (Type B, Mx.C.12).

The prevalence of transpositions is reported to be approximately 0.4% in the literature ^2,3. In our study, the frequency of transposition was 0.78%, which was greater than that in previous studies. This is the first study in which dental transpositions were examined in a Turkish population by using CBCT.

In their study, Cho et al. ⁹ reported that women were more frequently affected than men were. In a study by Yılmaz et al. ², both genders were found to be affected equally (11 males and 10 females). In our study, there were more women who underwent transposition than men. (21 were female and 18 were male)

In Yılmaz et al.’s ² studies, the age range was 9–45 years, the mean age was 17.7 years, the mean age of the women was 15.5 years, and the mean age of the men was 19.7 years. In our study, transposition was found between the ages of 14 and 70 years. In parallel with the previously conducted studies, the mean age of the patients was 21.10 years, the mean age of the women was 23.47 years, and the mean age of the men was 18.33 years.

In the study by Cho et al. ⁹, the number of unilateral patients was much greater than the number of bilateral patients (61 unilateral, 8 bilateral patients). According to these studies, most dental transpositions were unilateral (n = 36, 92.3%).

Dental transpositions are mostly observed in the maxilla ¹⁰. Shapira and Kuftinec ⁵ reported that 82% of transposed teeth were in the maxilla, while Peck et al. ¹⁰ reported that 83% of the cases were in the upper jaw. Our study was also in accordance with the literature, in which 39 of the 36 transposed teeth were in the maxilla (92.3%).

Cho et al. ⁹ did not find a significant difference in the right-left distribution in unilateral patients (29 right and 32 left). Yılmaz et al. ² reported that there were equal numbers of cases on the right and left sides; most of the maxillary transpositions were on the left side, and all of the mandibular transpositions were on the right side. In our study, of the unilateral patients in the maxilla, 20 had lesions on the right, 13 had lesions on the left, and all of the patients in the mandible had lesions on the right side; these findings are in parallel with those of Yılmaz et al.’s ² study.

There are two types of transposition: complete or partial ⁵. In Yılmaz et al.’s ² studies, 15 of 22 patients had complete transpositions, and 7 had partial transpositions. Çelikoğlu et al. ¹¹ reported that the numbers of complete and partial transposition cases were equal. There were 16 complete and 26 partial transpositions in our study. The difference in the number of complete and partial transpositions reported in the literature may be attributed to the use of panoramic radiography in the aforementioned studies, whereas CBCT was used for more detailed examinations in our study.

In the transposition classification they conducted, Peck et al. ¹⁰ reported that the most common type of transposition was between maxillary canine and premolar teeth (types A-Mx.C. P1) (71%) ^{10, 12}, while Çelikoğlu et al. ¹¹ reported the most common type of transposition as maxillary canine-lateral dental transposition (Type B-Mx.C.12) (57.89%). In our study, similar to that of Peck et al. ¹⁰, the most common type of transposition was maxillary canine-premolar transposition (type A-Mx.C.). P1) with 47.6%. Peck et al. ¹⁰ reported the frequency of other transpositions as Type B (Mx.C.12) 20%, Type C (Mx. C to M1), 4%; Type D, 12.11×3%; Type E, Mx. C to 11) 2%. In our study, the order of frequency was Type B (Mx.C.12) (38.1%), Type D (Mx.12.11) (2.4%), Type E (Mx. C to 11) 4.7%; Type F (Mn.12. C) 7.2%.

Transpositions not including canine teeth, such as central-lateral incisory transpositions Type D (Mx.12.11) ⁶ and transpositions of maxillary canine and first molar (Type C-Mx. C to M1) are quite rare ¹³. The least common transposition in this study was Type D, which was found in only one patient. However, transposition between the maxillary canine and first molar was not found in our study.

It has been reported that transpositions can be observed with dental anomalies such as wedge-shaped lateral teeth (microdontia), congenital missing teeth, impacted teeth, persistent primary teeth, and supernumerary teeth ^2,9. While Papadopoulos et al. ¹⁴ did not find a relationship between dental transposition and other anomalies, Shapira and Kuftinec ⁵ reported that in 55.5% of the patients, dental transposition was observed together with one or more dental anomalies. In our study, similar to the findings of this study, dental anomalies other than transposition were found on the relevant side in 30 patients (76.92%). The relationship between dental transposition and persistent primary teeth has been described in the literature, and primary teeth are more frequently found to be persistent in transpositions related to permanent canines ¹⁵. In our study, 27 persistent primary teeth were found in the relevant area in 24 patients (61.53%). Of the persistent primary teeth, 25 were primary canines, 1 was a primary lateral tooth and 1 was a primary second molar tooth.

In the study of Çelikoğlu et al. ¹¹, the most frequently observed dental anomaly in all tooth transpositions was persistent primary teeth, and 57.9% of 19 patients had persistent primary teeth. In our study, microdontia was found in 5.12%, impacted teeth were found in 5.12%, supernumerary teeth were found in 2.56%, and 4 congenital missing teeth were found in 2 patients (two maxillary lateral and two maxillary second premolar teeth).

No data were found in the literature on external root resorption in dental transposition patients. External root resorption was found in 7 (17.94%) patients in our study. Pathologies such as external root resorption that can occur due to transposed teeth can be examined only with detailed tomographic images.

The prevalence of transposition was 0.78% in the Turkish population. The present study is the first to examine dental transpositions via CBCT in Turkish society. External root resorption was found in some of the transposition patients. Routinely used two-dimensional imaging methods are not sufficient for diagnosing problems such as external root resorption that may be due to transposed teeth. For this reason, CBCT is essential in planning the treatment of transposition cases.

Conflict of interest: The authors declare that there are no conflicts of interest.

'All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients included in the study.'

Ethics Committee Approval: Ethics committee approval was not received since sources obtained from humans or animals were not used in this study.

Financial Support: No financial support was received from any institution or organization for this study.

Conflict of interest: There are no conflicts of interest associated with this study.

Consent to participate: Not Applicable

Consent for publication: Not Applicable

Availability of data and material: Data and materials are available

Authors' contributions: Kubra Cam wrote the main manuscript text; Ayse Zeynep Zengin performed the data collection and text editing. All the authors reviewed the manuscript.

The datasets generated and/or analyzed during the current study are available in the Ondokuz Mayıs University repository. The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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TABLE 1- Distribution and rates of cases with transposition in terms of jaw, classification in literature:

	n	%
Jaw
Maxilla	36	92.3
Mandible	3	7.7
Type
A- Mx.C.P1	17	47.6
B- Mx.C.12	12	38.1
C- Mx.C to M1	0	0
D- Mx.12.11	1	2.4
E- Mx.C to 11	2	4.7
F- Mn.12.C	3	7.2

Type A (Mx.C. P1)- Upper canine-first premolar transposition. Type B (Mx.C.12)- Upper canine -lateral incisor transposition. Type C (Mx.C to M1)- Transposition of the upper canine to the first molar region. Type D (Mx.12.11)- Upper lateral incisor-central incisor transposition. Type E (Mx.C to 11)- Transposition of the upper canine to the central incisor region. Type F (Mn.12.C)- Lower lateral incisor-canine transposition.

The authors declare no competing interests.

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Prevalence of Tooth Transpositions and Associated Dental Anomalies: a Cbct Study

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INTRODUCTION

MATERIALS AND METHODS

RESULTS

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