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Study on Teeth Morphology Variations Among Greek Romanian Journal of Oral Rehabilitation Vol. 9, No. 1, January - March 2017 STUDY ON TEETH MORPHOLOGY VARIATIONS AMONG GREEK PATIENTS Anca MihaelaVitalariu1, Chrysi-Christina Markomanolaki2, Irina Chonta3, Odette Luca4, Monica Silvia Tatarciuc1, Cristina Gena Dascalu5 1Grigore T. Popa" University of Medicine and Pharmacy Iași, Romania, Faculty of Dentistry, Department of Implantology, Removable Restaurations, Technology 2Dentist, Private practice, Greece 3Dentist, Private practice, Romania 4Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania, Faculty of Dental Medicine, Department of Prosthodontics 5Grigore T. Popa" University of Medicine and Pharmacy Iași, Romania, Faculty of Dentistry, Department of Medical Informatics and Biostatistics, *Corresponding author: Monica Silvia Tatarciuc e-mail: [email protected] ABSTRACT Purpose The aim of our study was to verify the variety of some permanent teeth, known as having multiple morphological variations: maxillary incisors, maxillary molars, mandibular premolars and molars. Material and Method. For this study we used intraoral images taken in a dental private practice, in Athens (Greece), between July 2014-July 2016. The study group was composed by 239 patients (105 males and 134 females) aged 17 to 52 years. The results were statistically analyzed with SPSS 16.0. Results. We found some expected morphological aspects, as are described in the literature, but there are some findings quite surprising, especially the number of cusps in mandibular premolars and molars. Conclusions The dentist should be aware that the diversity in human body it is found also in the diversity of teeth morphology. Although in dental school he is receiving a large amount of knowledge, he must continue to learn from his own clinical experience, because in real life, the real morphology is more diverse than in textbooks. Key words Teeth morphology variations, number of cusps, Cusp of Carabelli INTRODUCTION well known that no two individuals have an Dental anatomy is defined as the study identical dentition. Most of the present data of the development, morphology, function, on tooth morphology are derived from and identity of each of the teeth in the studies of samples of population of human dentitions. Thus, the study of dental European-American ancestry (EAa). anatomy, physiology, and occlusion Because of the immigration process, it is provides one of the basic components of the most likely that future tooth morphology skills needed to practice dentistry. The standards will reflect the significant change practitioner has to have knowledge of the in the ethnic makeup of the population. For morphology, occlusion, esthetics, and example, a shovel-shaped incisor trait is functions of these teeth to undertake an found in a Caucasoid population only rarely appropriate restorative dental treatment [1]. (less than 5%); however, it is one of the Dental varieties and anomalies have characteristics found in patients with Down important significance for clinical syndrome (trisomy 21) and normally in management, their incidence and degree of Chinese and Japanese individuals, expression providing important data for Mongolians, and Eskimos. Statistically then, phylogenic and/or genetic studies. It is not the shovel-shaped trait might be considered enough to know only the ―normal‖ to be abnormal in the Caucasoid population morphology, it is also necessary to accept but not so in the Mongoloid populations. the concept of morphological variability in a The practitioner must be prepared to adjust functional, esthetic, and statistical sense. It is to such morphological variations [2]. 68 Romanian Journal of Oral Rehabilitation Vol. 9, No. 1, January - March 2017 The aim of our study was to verify the or orthodontic treatment. The including variety of some permanent teeth, known as criteria for the group were: patient with having multiple morphological variations: sound teeth, unaltered crown morphology, maxillary lateral incisors, maxillary molars, no prosthodontic treatment, and no absent mandibular premolars and molars, among teeth. Informed consent was taken from all some Greek patients. the patients. The results were statistically MATERIAL AND METHOD analyzed with SPSS 16.0. The final number For this study we used intraoral images of the patients in the group was 239, 105 made on a group of patients, aged 12 to 52 males (43.9%) and 134 females (56.1%). years. The study was conducted in a dentist The patient‘s age ranged between 12 and 52 private practice, in Athens (Greece), years. For the statistical analysis, they were between 07.2014-072016. grouped into four groups, the larger and the The study group was composed by most representative for our study being the patients who addressed to the dentist mainly group 2 (19-30 years), as it is shown in fig.1. 41-52 12-18 31-40 years years years 7.9% 14.6% 24.7% 19-30 years 52.7% Fig.1.Patients distribution by age RESULTS can be straight (fig.2a), but very often is We found some expected morphological curved, because of its rounded incisal angles aspects, as are described in the literature, but (fig.2b). Actually, it is the most rounded there are some quite surprising findings, incisal margin of all incisors. In some especially the number of cusps in patients can be found a pointed form, named mandibular premolars and molars. peg-shaped lateral (fig.2c), due to Maxillary lateral incisors vary in form microdontia in individual teeth. During the more than any other tooth in the mouth odontogenesis period, injury to the except the third molar. The Incisal margin of developing tooth can lead to these lateral incisor resembles the central incisor, anomalous morphological features [3]. a b c Fig. 2. Incisal ridge of Maxillary Lateral Incisors; a. Straight, b. Rounded, c. Peg lateral In our study we found that the frequency smaller number of the patients in our group, of the straight incisal margin (52,3%) is comparing with larger researches. very close to that of the rounded incisal In Maxillary first molars a margin (47,3%) among the patients we supplemental cusp, called the cusp/tubercle examined. In addition, the frequency of the of Carabelli, found at the mesiolingual line peg lateral in our research was lower than in angle of maxillary first molars, is quite literature (0.4), probably because of the common in European dentitions. This 69 Romanian Journal of Oral Rehabilitation Vol. 9, No. 1, January - March 2017 morphological trait can be found as a well- This cusp (tubercle) usually serves to developed fifth cusp, or it can grade down to identify the maxillary first molar, and has a series of grooves, or depressions, on the been used to distinguish populations. mesial portion of the lingual surface (fig. 3). Fig. 3. Cusp of Carabelli In our group we found only 29 patients gender, performed with Pearson Chi-Square (12,1%) with no Carabelli cusp. The rest of test, showed very closed results and, for 210 patients showed various shapes and both, were not statistically significant sizes of Carabelli‘s cusp (fig. 4), but (Pearson Chi-Square = 7.472, p > 0.05)(fig. statistical analysis of the correlations 5). between these variations and the patient 21.9% v small 24.7% v small 26.9% 30.5% small 31.0% small 31.3% 13.3% no 12.1% no 11.2% medium 12.4% M 10.0% medium 8.2% F indistinct 10.9% 6.7% indistinct 14.2% big 11.3% 15.2% big 8.2% 0.0% 10.0% 20.0% 30.0% 40.0% 0.0% 10.0% 20.0% 30.0% 40.0% Fig. 4. Carabelli‘s cusp variations in size and Fig. 5. Correlations between Carabelli‘s Cusp shape and the patient gender Maxillary second molar can show two - Heart-shaped type is similar to a third types of occlusal surface: molar, with a very small distolingual cusp. - Rhomboidal - is the most common Sometimes the distolingual cusp is form, and it looks much like the first molar, completely absent, therefore the second except the rhomboid is more pronounced. In molar has only 3 cusps (fig.6b) this case there are always 4 cusps (fig.6a.) a b Fig.6.Shapes of Maxillary second molar: a. Rhomboidal (4 cusps). b. Heart (3 cusps) In our study we found the 4 cusps variant in 51 patients (21.3%). Regarding the variant in 188 patients (78.7%) and 3 cusps correlations between the number of cusps 70 Romanian Journal of Oral Rehabilitation Vol. 9, No. 1, January - March 2017 and the patient gender, the results were not significant lower number of patients with statistically significant (p > 0.05). The age over 40 years have 3 cusps (5.3%) situation was the opposite regarding the compared with the other age categories, and correlation with the patients age, in our a significant lower number of patients with group the results of statistical analysis age between 19-30 years have 4 cusps performed with Pearson Chi-Square test (69.0%) compared with the other age being statistically significant (Pearson Chi- categories Square = 15.285, p = 0.002) (fig.7). A . >40 y 31-40 y 19-30 y <18 y M F 94.7% 1.9% 89.8% 4 cusps 4 cusps 69.0% 85.7% 78.1% 3 cusps 5.3% 62.7% 10.2% 3 cusps 20.0% 31.0% 2 cusps 14.3% 37.3% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Fig. 7. Correlations between number of cusps Fig. 8. Correlations between number of cusps and the patient age - Maxillary 2nd molar and the gender - Mandibular 2nd premolar Mandibular second premolar can be (one Buccal and one Lingual cusp) (fig.9b). found in two forms: with 3 cusps (one The difference between these two types is Buccal and two Lingual cusps - the most primarily in the occlusal surface‘s shape common form) (fig.9a) and with 2 cusps .
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