Microsoft Word - 96 2020_manuscript.docx Vol 8, No 1 (2020) ISSN 2167-8677 (online) DOI 10.5195/d3000.2020.96 http://dentistry3000.pitt.edu New articles in this journal are licensed under a Creative Commons Attribution 4.0 United States License. Dental anomalies in orthodontic patients with and without skeletal discrepancies Clarissa Christina Avelar Fernandez1, Mônica Gentil Mattos1, Christiane Vasconcellos Cruz Alves Pereira1, Marcelo de Castro Costa1 1 Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Abstract Objec&ve: To determine whether individuals with skeletal discrepancies of Class II or III display a higher frequency of dental anomalies in comparison with individuals with Class I malocclusion. Design: A systematic search of the main electronic medical scienti2ic literature databases was conducted. Observa- tional studies were selected if mentioning dental anomalies in the different skeletal malocclusion patterns. Results: A total of 4,768 studies were found and the duplicated studies (1,279) were removed, resulting in 3,489 papers to be analyzed. After screening by title, 138 were 2it for screening by abstract. After that, a total of 13 papers were carefully read in full. Five studies included dental anomaly frequencies in orthodontic patients and included 7,679 participants. The frequency of dental anomalies ranged from 11.2% to 40.3%. It was observed that individuals with skeletal discrepancies of Class II and III had more dental anomalies when compared to individuals with Class I. Conclusion: Individuals with skeletal malocclusion patterns have more dental anomalies and there is an association between dental anomalies and skeletal Class II or Class III malocclusion patterns. Cita%on: Fernandez CCA, et al. (2020) Dental anom- alies in orthodon&c pa&ents with and without skeletal discrepancies. Den5stry 3000. 1:a001 doi:10.5195/d3000.2020.96 Received: March 30, 2020 Accepted: April 5, 2020 Published: April 15, 2020 Copyright: ©2020 Fernandez CCA, et al. This is an open access ar5cle licensed under a Crea5ve Com- mons AJribu5on Work 4.0 United States License. Email: pJpo2009@yahoo.com.br Introduction Dental anomalies are clinical alter- ations resulting from disturbances during the tooth formation pro- cess.1 They represent disturbances of number, size, shape, position and structure of the teeth.1,2 The prevalence of dental anomalies can range from 5.46 to 74.7%,1,3 due to different ethnicities and di- agnostic criteria.1,4,5 The etiology of dental anomalies includes ge- netic and environmental fac- tors.2,5,6 Skeletal malocclusions are usually categorized and described by dis- turbances in the craniofacial and occlusal relationships7 and often appear together with the dental anomalies, asserting their relation and complicating therapy.8 It ap- pears that dental anomalies may be more likely to occur if individu- als have Class II or Class III rela- tionships in comparison to Class I.9 This sophisticated clinical defini- tion is a base for phenotype-geno- type correlation, that may contrib- ute to more accurate treatment predictions and to genetic stud- ies.9 This systematic review aimed to confirm that evidence exists that individuals with Class I skele- tal malocclusion are less likely to have dental anomalies. Material and Methods The present systematic review was registered at Prospective Register of Systematic Reviews (PROSPERO; Centre for Reviews and Dissemina- tion, University of York; and the National Institute for Health Re- search) under the registry number Dental anomalies in orthodon/c pa/ents with and without skeletal discrepancies Vol 8 No 1 (2020) DOI 10.5195/d3000.2020.96 http://dentistry3000.pitt.edu CRD42016038916 and followed the Preferred Reporting Items for Systematic Review and Meta Anal- yses (PRISMA) checklist.10 Search Strategy The following focused question was formulated: “Is there a difference in the frequency of dental anomalies in orthodontic patients with Class II or III versus Class I malocclusion?” To develop the focused question, a set of cri- teria for study eligibility was adopted, based on PECOS strategy (Population: orthodontic patients; Exposure: skeletal discrepancies; Comparator: standard of normality; and Outcome: dental anomalies), using MeSH, entry terms and key words (Table 1). The main search was conducted in November 2016 and was updated on January 2019. Publications of potential relevance to this study were identified after searching the main electronic medical scientific literature databases, including PubMed, Scopus, LILACS, Web of Science, the Cochrane Library, and Google Scholar. Additional articles of potential relevance were identi- fied by manual searches. Text- books, dissertations, case reports, case series, review articles, and abstracts were excluded. Studies in populations presenting specific systemic diseases, conditions (his- tory of trauma, cleft lip and/or pal- ate, syndromes), endocrine imbal- ances and/or metabolic disorders (being these sporadic or heredi- tary), and no descriptions of the three skeletal malocclusions were excluded. Two examiners (C.C.A.F. and M.G.M.) independently screened each paper by examining the title, abstract, and keywords. No re- striction was applied regarding language or date of publication. The selected studies were described in relation to the type of study, total sample, sex distribution, how the diagnosis of skeletal malocclusion and dental anomalies were performed, and the frequency of dental anomalies in each malocclusion. Dental anomalies were also grouped in anomalies of number, shape and position (Table 2). Results and Discussion Observational studies were in- cluded because they mentioned dental anomalies in the different skeletal malocclusion patterns, enabling comparison between groups (Classe I, II and III) and different populations. Figure 1 shows the flow diagram of the search results from the databases. After search, a total of 4,768 rec- ords were found: 750 from Cochrane Library, 1,616 from Pub- Med, 911 from Scopus, 323 from Scopus-Med, 1,158 from Web of Science, four from LILACS and BBO, and six from Google Scholar. Table 1. PECOS strategy (Popula7on; Exposure; Comparator; and Outcome), using MeSH, entry terms and key words Dental anomalies in orthodon/c pa/ents with and without skeletal discrepancies Vol 8 No 1 (2020) DOI 10.5195/d3000.2020.96 http://dentistry3000.pitt.edu Table 2. Data extracted from the five selected studies. Dental anomalies in orthodon/c pa/ents with and without skeletal discrepancies Vol 8 No 1 (2020) DOI 10.5195/d3000.2020.96 http://dentistry3000.pitt.edu The duplicated studies (1,279) were removed, resulting in 3,489 records to be analyzed. After screening by title, 138 were fit for screening by abstract. After that, a total of 13 records were carefully read in full and five studies con- taining 7,679 participants were se- lected. The eight studies were excluded because they did not have the classification of skeletal malocclusions patterns. Table 2 shows the extraction of the data from the selected studies. The frequency of dental anomalies ranged from 11.2% to 40.3%.1,9,11,12,13 It was observed that individuals with skeletal discrepancies (Class II and III) had more dental anomalies when compared to individuals with no skeletal discrepancies (Class I).1,9,12,13 The same was observed for dental anomalies of num- ber,1,12,13 shape, and position.10 Three studies only made the diagnosis of tooth agenesis11,13 and/or third molar agenesis.11,12 The studies included in this systematic review had a frequency of dental anomalies raging from 11.2% to 40.3%. Celicoglu and Kamak (2012)12 reported a fre- quency of 22.7% of dental anoma- lies whereas Fernandez et al. (2018)9 reported a frequency of 15.7% of dental anomalies of num- ber, shape and position. Uslu et al. (2009)1 had the highest frequency of dental anomalies among ortho- dontic patients of the five studies selected (40.3%), having tooth agenesis, evagination, and invagi- nation as the most common den- tal anomalies. The studies that found the lowest frequency of dental anomalies in orthodontic patients were of Young (2010)5 and Chung et al. (2008),11 with a frequency of 11.3% and 11.2%, re- spectively. It is likely that these differences are due to the differ- ent populations studied (Turkish, Brazilian, and Korean) and differ- ent dental anomaly definitions. Conclusion In summary, individuals with skel- etal Class II or Class III malocclu- sion patterns have more dental anomalies than individuals who are Class I. In addition, there is an association between dental anomalies and skeletal Class II or Class III malocclusion patterns. Acknowledgments This work was developed as part of a course on systematic reviews and meta-analysis taken by C.C.A.F. and M.G.M. We thank Lucianne Cople Maia, Marcela Baraúna Magno, and Danielle Masterson for this learning experience. References 1. Prevalence of dental anomalies in various malocclusions. Uslu O, Akcam MO, Evirgen S, Cebeci I. Am J Orthod Dentofacial Orthop. 2009 Mar;135(3):328-35. doi: 10.1016/j.ajodo.2007.03.030. 2. The Class II Division 2 craniofa- cial type is associated with numer- ous congenital tooth anomalies. Basdra EK, Kiokpasoglou M, Stel- lzig A. Eur J Orthod. 2000 Oct;22(5):529-35. 3. [Agenesis in permanent denti- tion]. Diaz-Perez R, Echaverry-Na- varrete RA. Figure 1. Flow diagram of the literature search and selec7on process implemented. Dental anomalies in orthodon/c pa/ents with and without skeletal discrepancies Vol 8 No 1 (2020) DOI 10.5195/d3000.2020.96 http://dentistry3000.pitt.edu Rev Salud Publica (Bogota). 2009 Dec;11(6):961-9. 4. Prevalence and distribution of dental anomalies in orthodontic patients. Altug-Atac AT, Erdem D. Am J Orthod Dentofacial Orthop. 2007 Apr;131(4):510-4. 5. Investigation of hypodontia as clinically relates dental anomaly: Prevalence and characteristics. Kim YH. ISRN Dentistry 2011;Arti- cle ID 246135, 6 pages. 6. Studies of dental anomalies in a large group of school children. Küchler EC, Risso PA, Costa Mde C, Modesto A, Vieira AR. Arch Oral Biol. 2008 Oct;53(10):941-6. doi: 10.1016/j.archoralbio.2008.04.00. 7. Congenital tooth anomalies and malocclusions: a genetic link? Bas- dra EK, Kiokpasoglou MN, Kom- posch G. Eur J Orthod. 2001 Apr;23(2):145-51. 8. Prevalence of Dental Anomalies among School Going Children in India. Kathariya MD, Nikam AP, Chopra K, Patil NN, Raheja H, Kathariya R. J Int Oral Health. 2013 Oct;5(5):10-4. 9. Dental anomalies in different growth and skeletal malocclusion patterns. Fernandez CCA, Pereira CVCA, Luiz RR, Vieira AR, De Castro Costa M. Angle Orthod. 2018 Mar;88(2):195-201. doi: 10.2319/071917-482.1. 10. Preferred reporting items for systematic reviews and meta- analyses: the PRISMA statement. Moher D, Liberati A, Tetzlaff J, Alt- man DG; PRISMA Group. Int J Surg. 2010;8(5):336-41. doi: 10.1016/j.ijsu.2010.02.007. 11. The pattern and prevalence of hypodontia in Koreans. Chung CJ, Han JH, Kim KH. Oral Dis. 2008 Oct;14(7):620-5. doi: 10.1111/j.1601- 0825.2007.01434.x. 12. Patterns of third-molar agene- sis in an orthodontic patient popu- lation with different skeletal mal- occlusions. Celikoglu M, Kamak H. Angle Orthod. 2012 Jan;82(1):165- 9. doi: 10.2319/041911-274.1.