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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2021  |  Volume : 39  |  Issue : 3  |  Page : 321-324

A novel report of dental development pattern in a 3-year-old girl with three congenitally missing primary canines: A review of the literature and a case study

1 Department of Preventive Dental Science, College of Dentistry, Majmaah University, Al-Majmaah, KSA
2 Department of Pediatric Dentistry, Virginia Commonwealth University School of Dentistry, Richmond, Virginia, USA

Date of Submission13-Feb-2021
Date of Decision07-Jun-2021
Date of Acceptance12-Jul-2021
Date of Web Publication22-Nov-2021

Correspondence Address:
Dr. Jayakumar Jayaraman
Department of Pediatric Dentistry, Virginia Commonwealth University School of Dentistry, 520 N 12th Street, Richmond 23298, Virginia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jisppd.jisppd_56_21

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Dentists may encounter patients with numerical dental anomalies in clinical practice and understanding of these conditions would allow early detection as well as intervention. The absence of one or more teeth congenitally is referred as hypodontia. This dental anomaly is rarely reported in primary dentition and the most commonly affected teeth in the primary dentition are mandibular lateral incisors and primary canines are remarkably very rare and this entity has not been often reported. This case study was aimed to report a 3-year-old Indian girl with the absence of three canines primary dentition and also evaluate the overall dental development pattern of developing permanent teeth. Furthermore, a new finding for pediatric dentists that the development of permanent canines in case of missing primary canines.

Keywords: Canine, dental age estimation, dental anomaly, hypodontia, primary teeth

How to cite this article:
Mallineni SK, Jayaraman J. A novel report of dental development pattern in a 3-year-old girl with three congenitally missing primary canines: A review of the literature and a case study. J Indian Soc Pedod Prev Dent 2021;39:321-4

How to cite this URL:
Mallineni SK, Jayaraman J. A novel report of dental development pattern in a 3-year-old girl with three congenitally missing primary canines: A review of the literature and a case study. J Indian Soc Pedod Prev Dent [serial online] 2021 [cited 2022 Jan 24];39:321-4. Available from: https://www.jisppd.com/text.asp?2021/39/3/321/330719

   Introduction Top

Hypodontia is considered as congenitally missing teeth to the normal complement. It is very rarely reported in the primary dentition than the permanent dentition.[1] This numerical anomaly would most likely occur in connotation with syndromes and medical conditions, and less possibly in isolated situations.[2] The lateral incisor in the maxillary arch is the most commonly missing tooth type, and unilateral occurrence is more common than bilateral.[3] Nonsyndromic congenital absence of maxillary central incisors, primary molars, and canines is exceptionally very rare in occurrence. The published literature appears to comprise only three reports of five cases[2],[4],[5] reported on the occurrence of hypodontia of primary canines ranging from a single to all missing primary canines [Table 1]. Different opinions were recently reported on the development of permanent canines in case congenitally missing its predecessors. Kjaer[7] stated that a possible relationship might exist between delayed development of primary canines besides congenitally missing permanent canines. Consequently, Jayaraman and Mallineni[8] believed some basis of understanding developmental patterns of primary and permanent canines and the ethical dilemma in treatment planning for such conditions. However, the development of the permanent canines with agenesis of primary canines has not been discussed in the literature. Hence, the purpose of the present case report was to describe a 3-year-old Southern Indian girl with congenital absence of primary canines and evaluate the overall dental development pattern of developing permanent teeth.
Table 1: Published reports on congenitally missing primary canines along with the present case

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   Case Report Top

A 3-year-old girl belonging to Indian ethnicity consulted our specialty practice with a chief complaint of missing upper and lower front teeth. This was her first visit to a dentist, and her medical history was unremarkable. There was no history of missing teeth in her family. On intraoral examination, she was in primary dentition and presented with adequate oral hygiene. The right and left primary canines were clinically missing in the maxillary arch, while the right side primary canine was missing in the mandibular arch [Figure 1]. In consultation with the patient's father, it was confirmed that the primary maxillary canines were not extracted and were congenitally missing. In addition to this, a deep carious lesion was observed in tooth 75, and a deep fissure was noted on teeth 55, 65, and 85. A panoramic radiograph [Figure 2] of the patient confirmed clinical findings on the missing primary canines, and in addition, taurodontism was observed in all primary molars. Informed consent was obtained from the father before the evaluation and treatment. The carious lesions were subsequently restored, and the girl was reviewed regularly to monitor her dental development. Furthermore, all the permanent tooth germs were seen developing.
Figure 1: Intraoral views of 5.year.old child showing missing canines 53, 63, and 83

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Figure 2: Panoramic radiograph showing congenitally missing teeth 53, 63, and 83 and taurodontism in all primary molars, and the presence of teeth 13, 23, 33 and 43

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Dental age (DA) estimation was conducted from the developing permanent teeth. The Anglo-Canadian classification system used for scoring classifies tooth development into eight stages (alphabets A through H).[9] All the teeth on the left side were involved in the scoring. The only exception to this was the right mandibular second molar chosen due to distortion of the left side's image. The United Kingdom Caucasian reference dataset was used to obtain the development stage and number (n-tooth development stage [TDS]), mean age (x-TDS), and standard deviation (SD-TDS) used for each tooth.[10] The girl's DA was calculated as 5.14 years, with a SD of 1.01 years. Chronological age (CA) was calculated from the date of birth (January 06, 2013) and the date of radiographic exposure (November 20, 2016). The CA was calculated as 3.87 years. The difference between the CA and DA (CA-DA) was −1.27 years, indicating advancement in dental development.

   Discussion Top

Among the reported cases, four were reported in males,[5],[6] whereas one was in female.[4] However, the present case was reported in a female patient. The cases were reported in the maxillary arch,[6] and another case was reported in only the mandibular arch.[5] A recent report observed congenital missing of all primary canines involving both the arches in a Chinese girl. A report[5] from Isreal described a boy with missing mandibular primary canines and no other dental abnormalities. Accordingly, the occurrence of missing primary canines may be a coincidental finding rather, and this abnormality is not specific to a particular gender. The case described in this clinical report illustrates an unusual presentation and unique occurrence. It is the only second case of missing canines involving both the arches to the best of our knowledge. In our study, all primary molars exhibited taurodontism. It has been frequently reported with the incidence rate of 0.25% and 18%.[11] Several authors have studied the association between taurodontism and hypodontia.[11],[12] Interestingly, this is the youngest case ever presented in the literature with missing primary canines (3.78 years). The first case with hypodontia of primary canines with bilateral occurrence in the maxillary jaw and unilateral occurrence in the mandibular jaw.

The Anglo-Canadian method of DA estimation comprises two components; primarily, dental development staging and second, estimating DA using the maturity scores.[13] Since the Anglo-Canadian method has shown consistent overestimation of CA, in the current case study, a new system of age estimation using the average age of attainment was employed[10] due to the unavailability of the Southern Indian specific dataset, the closest match corresponding to the United Kingdom Caucasian was utilized. All the permanent teeth, including the central incisor, lateral incisor, premolars, and first molars, showed advanced dental development. Compared to the other permanent teeth, teeth 13, 23, and 43 demonstrated accelerated development due to the absence of primary canines. The right mandibular permanent canine and both permanent maxillary canines were at Stage E of dental development. The mean age of completion of permanent maxillary canine at Stage E was 7.65 years (SD 1.46 years), which was 3.78 years ahead of the patient's CA. When the permanent maxillary canine was excluded from the analysis, the mean age of the patient reduced to 4.88 years [Table 2]. Despite the exclusion of permanent maxillary canine from the analysis, the DA of the patient was 1 year ahead of the CA. The findings of the present case were similar to an earlier DA report on a 4-year-old Southern Chinese girl with missing all primary canines. There was an accelerated development of permanent canines at Stage F[9] in Chinese girl, the in the present case (Stage E). There is a need for further studies required to explain these developmental changes.
Table 2: Dental age estimation for 5-year-old Southern Indian girl with three missing primary canines

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Numerous hypotheses have been suggested to illuminate the hypodontia involving different tooth types with evolutionary (Butler's field theory,[14]) and anatomic models (Sofaer's model,[15] Svinhufvud's anatomic model,[16]) and neuro-osteological developmental fields in the jaws.[7] Most recently, Anthonappa and King[4] proposed that genetic and environmental factors are responsible for hypodontia. There is a strong association between missing primary teeth and permanent dentition.[17] It has been reported that hypodontia in primary teeth may show various anomalies in tooth numbers, ranging from hypodontia,[18] talon cusps,[19] and hyperdontia[3] in permanent dentition. However, in the present case, it is interesting that all tooth germs were presented appropriately for the patient's age, although a slight advancement/delay in dental development was observed. Dentists may encounter patients with numerical dental anomalies in clinical practice, and understanding these conditions would allow early detection and intervention. Isolated, missing primary canines are a rare phenomenon, excluding individuals with anodontia. Furthermore, a new finding for pediatric dentists that the development of permanent canines in case of missing primary canines. The only second case in the literature presented with missing primary canines involving both the arches. The advanced DA of the patient was observed due to the accelerated development of permanent canines corresponding to the missing primary canines.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Daugaard-Jensen J, Nodal M, Kjaer I. Pattern of agenesis in the primary dentition: A radiographic study of 193 cases. Int J Paediatr Dent 1997;7:3-7.  Back to cited text no. 1
Kjaer I, Daugaard-Jensen J. Agenesis or late maturity of primary canines? Eur Arch Paediatr Dent 2017;18:135.  Back to cited text no. 2
Mallineni SK, Nuvvula S, Cheung A, Kunduru R. A comprehensive review of the literature and data analysis on hypo-hyperdontia. J Oral Sci 2014;56:295-302.  Back to cited text no. 3
Anthonappa RP, King NM. Hypodontia of all primary canines. Eur Arch Paediatr Dent 2016;17:485-7.  Back to cited text no. 4
Cho SY, Lee CK. Congenitally missing maxillary primary canines: Report of three cases. Int J Paediatr Dent 2006;16:444-7.  Back to cited text no. 5
Birnboim-Blau G, Spierer S, Keinan D. Congenital bilateral missing primary mandibular canines while their successors exist: A case report. Dentistry 2014;4:224.  Back to cited text no. 6
Kjaer I. Can the location of tooth agenesis and the location of initial bone loss seen in juvenile peri-odontitis be explained by neural developmental fields in the jaws? Acta Odontol Scand 1997;55:70-2.  Back to cited text no. 7
Jayaraman J, Mallineni SK. Does hypodontia of primary canines result in delayed dental development? Eur Arch Paediatr Dent 2017;18:371-2.  Back to cited text no. 8
Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol 1973;45:211-27.  Back to cited text no. 9
Roberts GJ, Parekh S, Petrie A, Lucas VS. Dental age assessment (DAA): A simple method for children and emerging adults. Br Dent J 2008;204:E7.  Back to cited text no. 10
Ruprecht A, Batniji S, el-Neweihi E. The incidence of taurodontism in dental patients. Oral Surg Oral Med Oral Pathol 1987;63:743-7.  Back to cited text no. 11
Seow WK, Lai PY. Association of taurodontism with hypodontia: A controlled study. Pediatr Dent 1989;11:214-9.  Back to cited text no. 12
Jayaraman J, Wong HM, King NM, Roberts GJ. The French-Canadian data set of Demirjian for dental age estimation: A systematic review and meta-analysis. J Forensic Leg Med 2013;20:373-81.  Back to cited text no. 13
Sofaer JA, Chung CS, Niswander JD, Runck DW. Developmental interaction, size and agenesis among permanent maxillary incisors. Hum Biol 1971;43:36-45.  Back to cited text no. 14
Svinhufvud E, Myllärniemi S, Norio R. Dominant inheritance of tooth malpositions and their association to hypodontia. Clin Genet 1988;34:373-81.  Back to cited text no. 15
Butler PM. Studies of the mammalian dentition–differentiation of the postcanine dentition. Proc Zool Soc Lond B 1939;109:1-36.  Back to cited text no. 16
Davis PJ, Darvell BW. Congenitally missing permanent mandibular incisors and their association with missing primary teeth in the southern Chinese (Hong Kong). Community Dent Oral Epidemiol 1993;21:162-4.  Back to cited text no. 17
Mallineni SK, Panampally GK, Chen Y, Tian T. Mandibular talon cusps: A systematic review and data analysis. J Clin Exp Dent 2014;6:e408-13.  Back to cited text no. 18
Mallineni SK, Yiu CK, King NM. Schwartz-Jampel syndrome: A review of the literature and case report. Spec Care Dentist 2012;32:105-11.  Back to cited text no. 19


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]


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