Cone-beam computed tomography-based investigation of pre-eruptive intracoronal resorption prevalence.

This retrospective study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PEIR) using cone-beam computed tomography (CBCT) and to explore the mechanism and characteristics of PEIR development. CBCT images of patients aged ≤ 20 years with unerupted teeth at Hiroshima University Hospital were collected. We examined 1530 patients with 10,576 unerupted teeth. Teeth with PEIR were identified for the detailed location and size of the PEIR in the crown using multiplanar reconstruction. The subject and tooth prevalence rates of PEIR were 1.96% and 0.31%, respectively. The teeth that were the most commonly affected by PEIR were mandibular third molars (3.09%). The prevalence of PEIR was significantly higher in females than in males, and higher in the mandible than in the maxilla. No significant difference between in the position of PEIR within the crown was observed. Moreover, CBCT imaging revealed the onset of PEIR in one case. This study demonstrated the prevalence of PEIR and identified statistically significant sex- and location-based differences. Furthermore, one case of CBCT imaging supports the hypothesis that the onset of PEIR was due to resorption after completion of the crown.

Pre-eruptive intracoronal radiolucencies in permanent dentition of children in Tamil Nadu-A cross-sectional study.

BACKGROUND: Pre-eruptive intracoronal radiolucency (PEIR) poses a challenge to paediatric dentists as it cannot be clinically detected. AIM: To estimate the prevalence and coexisting factors of PEIR in permanent teeth of children and adolescents in western Tamil Nadu, India. DESIGN: This cross-sectional study assessed 5012 digital panoramic radiographs of children and adolescents below 14 years of age obtained from private digital imaging centers, dental clinics, and dental colleges located in five districts of western Tamil Nadu. The prevalence and PEIR and its coexisting factors were assessed by two independent calibrated investigators. Data were analyzed using the chi-square test. RESULTS: The subject prevalence and tooth prevalence of PEIR were estimated to be 3.2% and 0.4%, respectively. Maxillary canines and mandibular premolars were commonly involved. Majority of the lesions were limited to less than one-third of dentin thickness (74%) and distal aspect of the crown (45.1%). Ectopic positioning (9.3%) and dental caries in the preceding primary tooth (9.9%) were the most common coexisting factors. CONCLUSION: Pre-Eruptive Intracoronal Radiolucency defects were commonly seen in maxillary canines, mandibular premolars, and distal aspect of the crown involving less than one-third dentin thickness. Ectopic positioning and caries in primary teeth were commonly seen along with the PEIR defects.

Age Related Prevalence of Pre-Eruptive Intracoronal Radiolucent Defects in the Permanent Dentition.

OBJECTIVE: The present study aimed to determine if the prevalence of pre-eruptive intracoronal radiolucent defects is higher for young age groups, in which there are more unerupted teeth. STUDY DESIGN: A retrospective study of panoramic and bitewing radiographs was conducted. An inclusion criterion was the presence of un-erupted permanent teeth with a formed and clearly visible crown. Age groups were: young (6-8 years), intermediate (9-12 years) and adults (13-53 years). Significance level was set at p≤0.05. RESULTS: Thirteen (3.9%) pre-eruptive lesions were detected in 335 records. No lesions were found in the young group (7.4%), in the intermediate and adult age groups six and seven lesions were found, respectively. In most cases the pre-eruptive lesion was found in a third molar. CONCLUSION: The prevalence of pre-eruptive intracoronal lesions was not higher for young age groups. The prevalence of pre-eruptive intra coronal radiolucent lesions is 3.9%, irrespective of age.

A retrospective analysis of prevalence and characteristics of pre-eruptive intracoronal resorption in unerupted teeth of the permanent dentition: a multicentre study.

AIM: This multicentred study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PIR) in unerupted teeth of the permanent dentition using a large sample of panoramic radiographs of a Turkish population. METHODOLOGY: Records of 28 612 patients from three cities in the different regions of Turkey were screened retrospectively in this multicentred study. Patient records and panoramic radiographs were evaluated by three oral and maxillofacial radiologists in the sites. The following data were recorded: age, gender, number of unerupted teeth, number of teeth showing intracoronal resorption, affected tooth type and number of intracoronal resorptions in each case. RESULTS: Overall, 5554 patients had at least one unerupted tooth in 28 612 patients, with a prevalence of 19.4%. Of the 5554 patients screened, 2267 were female and 3287 were male. Intracoronal resorption was observed in 40 of 5554 subjects, with a frequency of 0.7%. The mean age of the patients was 35.9 years. CONCLUSION: Pre-eruptive intracoronal resorption defects occurred in 40 subjects. Increased awareness and careful radiographic examination of unerupted teeth may improve early detection and treatment of PIR defects.

Study of the frequency, localisation and morphology of supernumerary teeth in 1960 Spanish non-syndromic paediatric patients.

AIM: The main objective was to study supernumerary teeth diagnosed during the routine checkups at the Paediatric Dentistry Service of Hospital de Nens, Barcelona (Spain), for four months. MATERIALS AND METHODS: A transversal, descriptive study, was performed in 1,960 patients, aged 1 to 17 years, visited during routine oral checkups. An intraoral exploration (with intraoral mirror and probe) was performed to all patients, and subjects older than 5 years also underwent panoramic x-ray examination. RESULTS: A total of 33 patients showed supernumerary teeth (1.68%), 22 boys and 11 girls. A total of 10 patients (8 boys/2 girls) had supernumerary teeth in the temporary dentition, 20 patients (12 boys/8 girls) in the permanent dentition and 3 patients (2 boys/1girls) in both temporary and permanent dentition. A total of 46 supernumerary teeth were diagnosed. CONCLUSION: Any alteration in the number of teeth in patients younger than 5 years are difficult to diagnose, as x-rays are usually not taken. We believe that starting at 5 years old, a radiological exploration (panoramic x-ray) has to be carried out as a complement to the clinical examination.

Caries experience in a child population in a deprived area of Brazil, using ICDAS II.

The aim of the present study was to assess the caries experience of children aged 6 to 7 years old in a socially deprived suburban area of Brazil's Federal District, using the ICDAS II system and to investigate determinants of dental caries. The survey was carried out in six public schools by three calibrated examiners, on a sample of 835 children. ICDAS II codes had to be converted into dmf/DMF components at surface and tooth levels, resulting in unfamiliar caries variables, to enable some meaningful reporting of the findings. The prevalence of dental caries, including enamel and dentinal carious lesions, in primary teeth was 95.6% and in permanent teeth it was 63.7%. Mean values of d(2)mf(2)-t (enamel and dentinal lesions), d(3)mf(3)-t (dentine lesions), D(2)MF(2)-T and D(3)MF(3)-T indices were 6.9 ± 3.8, 3.2 ± 3.4, 1.7 ± 1.6 and 0.2 ± 0.5, respectively. Enamel carious lesions predominated in the dmf-t/s and DMF-T/S indices. Seven-year-old children had statistically significantly more enamel and dentine carious lesions in permanent teeth than 6-year-old children had. Using ICDAS II, the prevalence of dental caries in both dentitions was very high. In both dentitions, the decay component predominated, with hardly any restorations or extractions observed. The new ICDAS II system leads to overvaluation of the seriousness of dental caries experience and made reporting of outcomes cumbersome. Guidelines on analysing data and reporting results should be agreed upon before this system can be used in epidemiological surveys globally.

Clinical epidemiological analysis of 173 supernumerary molars.

OBJECTIVES: To determine the prevalence of supernumerary molars in a sector of the population of Madrid, as well as the possible complications associated with the presence of hypergenetic molars. MATERIALS AND METHODS: A retrospective, descriptive study was carried out, which included a data assessment of all patients (13557) seeking dental care at a hospital's department of oral surgery across 4 years. The proposed methodology consisted of preparing a medical record in order to obtain data on the medical record number, age and sex of the patient, radiological findings such as location and type of supernumerary molar, retained/erupted molar, related accidents and tooth morphology. RESULTS: Supernumerary molars were found to be present in 130 patients, representing a prevalence of 0.96% of the total population studied. These patients had a total of 173 hypergenetic molars, consisting of 137 distomolars and 36 paramolars Mechanical-obstructive pathology was associated with 28.9%, whereas enlargement of the follicular sack bigger than 3 mm was present in 16.2% of the sample. CONCLUSION: Supernumerary molars are usually diagnosed as a coincidental radiological finding without any associated pathology. However a higher percentage of comorbidity was found than initially expected.

Frequency of unerupted mandibular third molar in mandibular angle fractures.

BACKGROUND: Fractures of the mandibular angle are common and comprise 31% of all mandibular fractures. Multiple recent studies report a 2-3 fold increased risk for mandibular angle fractures when un-erupted mandibular third molars are present. The objective of this study was to assess the frequency of un-erupted mandibular third molar in mandibular angle fractures. METHODS: This cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Ayub Medical College, Abbottabad from April to October 2009. One hundred and two patients were included both from the outdoor and ward on consecutive non-probability sampling base. Data were recorded on a structured Performa and analysed using SPSS-16. RESULTS: A hemi-mandible containing un-erupted mandibular third molar was seen to have a 1.41 times the risk of mandibular angle fracture then a hemi-mandible containing an erupted mandibular third molar. CONCLUSION: The presence of unerupted mandibular third molar is associated with an increased risk for mandibular angle fracture.

Mesiodens: a clinical and radiographic study in children.

BACKGROUND: A mesiodens is a supernumerary tooth located in the palatal midline between the two maxillary central incisors. The overall prevalence varies between 0.15 and 1.9%. The present study aimed to evaluate the epidemiological characteristics of mesiodens in the pediatric population. MATERIALS AND METHODS: A longitudinal prospective study was carried out in 7932 children to determine the prevalence of mesiodens. The following data were also recorded: age, sex, shape, sagittal position, orientation, eruption status, number and complications caused by mesiodens. RESULTS: The prevalence of mesiodens in the present study was 0.8%. The sex ratio was 1.78:1, favoring boys. The majority of mesiodens (67.9%) were conical in shape, followed by the supplemental (17.9) and tuberculate (14.1%) types. 71.8% of the mesiodens were palatally placed, 25.6% erupted on the arch and 2.6% were labially positioned. A majority of the mesiodens (62.8%) were vertically aligned. Inverted and horizontal positions were observed in 30.8% and 6.4% of the cases. Most of the mesiodens (53.8%) were impacted, and 14 children had two mesiodens. Most of the mesiodens were associated with complications, and only 26.9% were asymptomatic. CONCLUSIONS: The prevalence of mesiodens was 0.8% .Conical shape, palatal position and vertical orientation were common characteristic observations in the study.

Predictors of treatment decisions made by adult orthodontic patients presenting with unerupted permanent teeth.

OBJECTIVE: Unerupted permanent teeth are amongst the most commonly occurring dental anomalies in adults and present unique treatment challenges. The aim of this retrospective study was to (1) identify the prevalence of adult patients with unerupted teeth attending a multidisciplinary clinic and (2) to identify predictors (age, gender, incisor and skeletal classification) which influence the patients treatment decision. MATERIAL AND METHODS: Consecutive adult patients with unerupted permanent teeth attending the Joint Orthodontic-Restorative clinic were identified. Study variables were collected using a prespecified data collection form. Descriptive statistics were employed; Fisher's exact test was used to detect associations between variables and treatment decision outcome. Ordinal logistic regression derived multinomial regression relative risk ratios (RRR) and 95% confidence intervals (CI) were calculated for the effect of age, gender, incisor and skeletal classification on treatment decision/outcome. RESULTS: Sixty-six patients with impacted teeth were identified from a sample of 483. The prevalence of adults with unerupted teeth was 13.7%. The mean age was 30.7 years (SD 11.2). The majority of the sample had a Class I incisor relationship (54.6%) or Class I skeletal base relationship (54.6%), and the most common distribution of impacted teeth was a single unerupted upper right canine (34.9%). Orthodontic treatment (non-extraction or extraction basis incorporating the alignment or removal of impacted teeth) and restorative treatment only were equally favoured. Factors including age, gender, incisor and skeletal classification did not appear to influence or predict the final treatment decision. CONCLUSIONS: In this sample, adults presenting with impacted teeth favoured certain treatment modalities: orthodontic treatment only and restorative treatment only. Factors such as age, gender, incisor and skeletal classification did not influence the outcome.

Missing and unerupted teeth in osteogenesis imperfecta.

INTRODUCTION: Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and craniofacial and dental abnormalities such as congenitally missing teeth and teeth that failed to erupt which are believed to be doubled in OI patients than normal populations and were associated with low oral health quality of life. However, the etiology of these abnormalities remains unclear. To understand the factors influencing missing and unerupted teeth, we investigated their prevalence in a cohort of OI patients as a function of the clinical phenotype (OI type), the genetic variant type, the tooth type and the onset of bisphosphonate treatment. METHOD: A total of 144 OI patients were recruited from The Shriners Hospital, Montreal, Canada, between 2016 and 2017. Patients were evaluated using intraoral photographs and panoramic radiographs. Missing teeth were evaluated in all patients, and unerupted teeth were assessed only in patients ≥15 years old (n = 82). RESULTS: On average, each OI patient had 2.4 missing teeth and 0.8 unerupted teeth, and the most common missing and unerupted teeth were the premolars and the upper second molars, respectively. These phenomena were more prominent in OI type III and IV than in OI type I, and were not sex or age-related. Missing teeth were significantly more common in patients with C-propeptide variants than all other variants (p-value <0.05). Unerupted teeth were significantly more common in patients with α1 and α2 glycine variants or substitutions than in those with haploinsufficiency variants. Early-onset of bisphosphonate treatment would significantly increase the risk of unerupted teeth in patients with OI types III and IV (OR = 1.68, 95% CI (1.15-1.53)). CONCLUSION: The prevalence of missing and unerupted teeth at the tooth type level in OI patients varies according to the nature of the collagen variants and the OI type. These findings highlight the role of collagen in tooth development and eruption.

The incidence of canine transmigration and tooth impaction in a Turkish subpopulation.

The purpose of this study was to determine the incidence of transmigrated maxillary and mandibular canine teeth and also of the other impacted teeth in a Turkish subpopulation. Five thousand consecutive panoramic radiographs taken of patients who attended the Department of Oral Diagnosis and Radiology, Selcuk University, for routine examination between 2005 and 2007 were examined to identify incidences of transmigrated and impacted teeth. Demographic information of all patients was also recorded. Transmigrations were categorized according to the classification of Mupparapu. The effect of age, gender, and sidedness (left or right side) on the recorded abnormality was evaluated using a t-test. The incidence of transmigrated upper and lower canine teeth was found to be 0.34 per cent [17 patients, 12 females/5 males, with a mean age of 34 years (range 16-76 years)] and 0.14 per cent [7 patients, 4 females/3 males, with a mean age of 37.1 years (range 17-62 years)]. The incidence of tooth impaction was 2.94 per cent [147 patients, 101 females/46 males, with a mean age of 29.7 years (range 15-80 years)]. The most frequently impacted tooth was the upper canine followed by the lower canine, lower second premolar, and upper second premolar. No incidence of maxillary first molar impaction was found. Gender and sidedness did not show a statistical significance on the recorded abnormality (P = 0.22 and P = 0.48, respectively). However, in the 15-29 year age group, this was statistically different (P < 0.05). The incidence of transmigration of impacted mandibular canine teeth was greater than other teeth. With the increased use of panoramic radiographs, it is inevitable that diagnosis of such anomalies will increase.

Unerupted incisors--characteristic features and associated anomalies.

The aims of this study were to investigate the association of unerupted incisors with other dental anomalies and to indicate the aetiological and clinical relevance of such associations. Forty-one patients with unerupted incisors were examined. The group comprised 30 males and 11 females, ranging in age from 7 to 39 years. The patients were assessed for nine dental anomalies: hyperdontia, hypodontia, microdontia, enamel hypoplasia, infraocclusion of the primary molars and ectopia of the canines, premolars, first permanent molars, and second permanent molars. The patients were matched with respect to age and gender to 41 consecutively selected control subjects with similar selection criteria but no history of problems with incisor eruption. The prevalence rates of the dental anomalies in association with failure of eruption of incisors were compared to the reference rates in the control group by means of Pearson chi-square tests. The results of this study revealed that unerupted incisors were more frequent in males than in females. A statistically significant association (P = 0.006) was found between unerupted incisors and other inherited dental anomalies, namely ectopic teeth, hyperdontia, and enamel hypoplasia. Unerupted incisors may be considered part of a spectrum of inheritable dental anomalies.

Increased occurrence of dental anomalies associated with second-premolar agenesis.

OBJECTIVE: To evaluate the prevalence of dental anomalies in patients with agenesis of second premolars and compare the findings with the prevalence of these anomalies in the general population. MATERIALS AND METHODS: A Brazilian sample of 203 patients aged 8 to 22 years was selected. All patients presented agenesis of at least one second premolar. Panoramic and periapical radiographs and dental casts were used to analyze the presence of other associated dental anomalies, including agenesis of other permanent teeth, ectopia of unerupted permanent teeth, infraocclusion of deciduous molars, microdontia of maxillary lateral incisors, and supernumerary teeth. The occurrence of these anomalies was compared with occurrence data previously reported for the general population. Statistical testing was performed using the chi-square test (P < .05) and the odds ratio. RESULTS: The sample with agenesis of at least one second premolar presented a significantly increased prevalence rate of permanent tooth agenesis (21%), excluding third molars. Among the sample segment aged 14 years or greater (N = 77), occurrence of third-molar agenesis (48%) exceeded twice its normal frequency. Significant increases in occurrence of microdontia of maxillary lateral incisors (20.6%), infraocclusion of deciduous molars (24.6%), and distoangulation of mandibular second premolars (7.8%) were observed. Palatally displaced canine anomaly was also significantly elevated (8.1%). CONCLUSION: The results provide evidence that agenesis of other permanent teeth, microdontia, deciduous molar infraocclusion, and certain dental ectopias are the products of the same genetic mechanisms that cause second-premolar agenesis.

A descriptive study of 113 unerupted supernumerary teeth in 79 pediatric patients in Barcelona.

UNLABELLED: Unerupted supernumerary teeth, depending on the morphology, number and distribution can give rise to various alterations in the eruption and development of those permanent teeth to which they are related. OBJECTIVES: We aimed to make an epidemiological and descriptive study of the clinical characteristics of patients in Barcelona, their surgical treatment and how said treatment was hindered. MATERIALS AND METHODS: A descriptive study including 113 supernumerary teeth from 79 healthy pediatric patients between 5 and 19 years of age, which underwent surgery in our hospital during a 2 year period (May 2005 / May 2007), taking into account the variables of personal data, gender, age, location, number, morphology, position-axis, radiological study, surgical treatment, related pathologies, and surgical complications. RESULTS: Male patients (51) were more frequently affected than female (28) patients mainly within the central incisors-mesiodens (53.16%), in which the unique form (68.52%) predominates in conoid morphology (69.62%). Surgical treatment was done by palatal/lingual extraction (49.37%), with few surgical complications (only 1 case of post-surgical bleeding). CONCLUSION: Incidence in supernumerary teeth is higher among male patients (ratio M:F of 1.82:1). They are most frequently located in the maxilla (82%), specifically, in the premaxilla (77%). Most cases presented only one supernumerary tooth (68.5%) and, in multiple cases, the premolar region is predominant. The conoid shape is the commonest morphology (69.62%). Surgical extraction, was done by palatal/lingual in 49.37% of the cases, as opposed to the vestibular approach in 45.57%.

A survey on orthodontic-restorative dental services in a NHS hospital.

The provision of a joint orthodontic-restorative hospital service is important in providing a quality service for some dental malocclusions. A prospective survey was carried out of the joint orthodontic-restorative clinic at Mayday University Hospital, during the months of January to August 2005. Data was collected using a data collection form. In total 61 patient's attended 4 joint clinics. Fifty per cent of referrals were by general dental practitioners. The commonest referral reasons were spacing and dental trauma. Over one third of patients were seen within 12 weeks of their referral, whilst two thirds start their treatment within 12 weeks of consultation. The commonest restorative treatment was periodontal therapy, crown and bridgework. Over one third of patients required joint orthodontic and restorative treatment. More than 12% of patients require oral surgery in the form of removal of impacted teeth, exposure of unerupted teeth, placement of bone anchors or orthognathic surgery. Consultation and treatment waiting times could be reduced by the introduction of more clinics and employment of more staff A representative in oral surgery maybe useful with the increase use of bone anchors and mini implants to aid joint orthodontic-restorative treatment. Access to an orthodontic and restorative consultant clinic is useful in providing patients with a high quality of multidisciplinary treatment planning in an efficient manner.

Prevalence of pre-eruptive intracoronal radiolucencies in Thai children and adolescents: A retrospective study.

AIM: The aim of the present study was to determine the prevalence, location, size, and tooth type of pre-eruptive intracoronal radiolucencies (PEIR) from panoramic radiographs in Thai patients. METHODS: A retrospective study of PEIR was conducted on 1599 panoramic radiographs of 629 Thai males and 970 Thai females with an age range of 4-20 years (average age: 14.0 ± 4.0 years). Each radiograph was reviewed by two calibrated examiners. The age and sex of the patients, location, size, and tooth type of the lesions were recorded. The SPSS program was used for statistical analysis. RESULTS: The PEIR were found in 0.32% of tooth samples (29/9060) and 1.63% of patients (26/1599). There was no statistical difference in the presence of PEIR between both sexes. The mandibular second molars were the most affected teeth. The lesions were mostly located at the central part of the crown. The lesion sizes were mostly limited to less than one-third of dentinal thickness. CONCLUSIONS: The present study showed that the prevalence of PEIR in Thai samples is 1.63%. This could raise dentists' awareness in reviewing unerupted teeth in panoramic radiographs. Early detection of the lesions should aid in proper treatment planning of affected teeth to prevent complications from carious invasion after tooth eruption.

Prevalence, characteristic features, and complications associated with the occurrence of unerupted permanent incisors.

This study examined the prevalence, characteristic features, and complications associated with the occurrence of unerupted permanent incisors among children and adolescents attending a university dental teaching hospital. A retrospective review was performed of the clinical records of children and adolescents who attended the Prince Philip Dental Hospital, Hong Kong between 2005 and 2014. All patients who had at least one unerupted permanent incisor tooth were included. A total of 266 subjects with 320 unerupted permanent incisors were identified. The prevalence of unerupted permanent incisors among children and adolescents was 2.0%. Permanent maxillary central incisors (70.6%) were the most commonly affected teeth. The most common cause for unerupted incisors were dilacerations (n = 83, 36.7%) for maxillary central incisors; developmental dental anomalies (n = 22; 30.6%) together with unfavorable root development (n = 22; 30.6%) for maxillary laterals incisors; and abnormal tooth/tissue ratio (n = 11, 50.0%) for mandibular incisors. A majority of unerupted incisors presented with complications the most common being ectopic/displacement/rotation of the unerupted incisors (46.6%), loss of space (36.9%) and midline shift (27.5%). In conclusion, the causes were distinct for different manifestations of unerupted permanent incisors. As the majority of unerupted incisors presented with complications, a systematic and organized method of history taking as well as clinical and radiographic examinations is mandatory in the diagnosis of unerupted permanent incisors.

Primary failure of eruption (PFE): a systematic review.

BACKGROUND: Primary failure of eruption (PFE) is a rare disease defined as incomplete tooth eruption despite the presence of a clear eruption pathway. Orthodontic extrusion is not feasible in this case because it results in ankylosis of teeth. To the best of our knowledge, besides the study of Ahmad et al. (Eur J Orthod 28:535-540, 2006), no study has systematically analysed the clinical features of and factors associated with PFE. Therefore, the aim of this study was to systematically evaluate the current literature (from 2006 to 2017) for new insights and developments on the aetiology, diagnosis, genetics, and treatment options of PFE. METHODS: Following the PRISMA guidelines, a systematic search was performed using the PubMed/Medline database for studies reporting on PFE. The following terms were used: "primary failure of tooth eruption", "primary failure of eruption", "tooth eruption failure", and "PFE". RESULTS: Overall, 17 articles reporting clinical data of 314 patients were identified. In all patients, the molars were affected. In 81 reported cases, both the molars and the premolars were affected by PFE. Further, 38 patients' primary teeth were also affected. In 27 patients, no family members were affected. Additional dental anomalies were observed in 39 patients. A total of 51 different variants of the PTH1R gene associated with PFE were recorded. CONCLUSIONS: Infraocclusion of the posterior teeth, especially if both sides are affected, is the hallmark of PFE. If a patient is affected by PFE, all teeth distal to the most mesial tooth are also affected by PFE. Primary teeth can also be impacted; however, this may not necessarily occur. If a patient is suspected of having PFE, a genetic test for mutation in the PTH1R gene should be recommended prior to any orthodontic treatment to avoid ankylosis. Treatment options depend on the patient's age and the clinical situation, and they must be evaluated individually.