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Table of Contents
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 95-97

Coexisting Peg-Shaped Lateral Incisor and Hypodontia in a 9-Year-Old Child

Department of Pedodontics and Preventive Dentistry, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India

Date of Submission31-Jan-2020
Date of Decision08-Jun-2020
Date of Acceptance11-Jun-2020
Date of Web Publication12-Jan-2021

Correspondence Address:
Dr. Pratik B Kariya
Department of Pedodontics and Preventive Dentistry, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JIHS.JIHS_2_20

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Anomaly (Greek, anomalos; irregular) is a deviation from what is regarded as normal, standard, or expected. Disturbance of the epithelium along with mesenchymal interactions markedly alters the normal sequence of odontogenesis, which represents as developmental anomaly of teeth. This is dependent on the developmental stage during which the alteration takes place. Various anomalies could take place, e.g., alteration of number, structure, size, and/or shape. More than 300 genes have been identified in literature that are expressed in teeth responsible for odontogenesis. Defects in any of these genes result in the alteration of the development of tooth. Understanding the etiology of each dental anomaly helps not only in identification but also assists in determining the course of the treatment.

Keywords: Dental anomaly, hypodontia, peg lateral incisor, tooth agenesis

How to cite this article:
Shah PS, Kariya PB, Dave BH. Coexisting Peg-Shaped Lateral Incisor and Hypodontia in a 9-Year-Old Child. J Integr Health Sci 2020;8:95-7

How to cite this URL:
Shah PS, Kariya PB, Dave BH. Coexisting Peg-Shaped Lateral Incisor and Hypodontia in a 9-Year-Old Child. J Integr Health Sci [serial online] 2020 [cited 2023 Jun 4];8:95-7. Available from: https://www.jihs.in/text.asp?2020/8/2/95/306715

  Introduction Top

Esthetic concerns are increasing these days among the parents as well as children and adolescents. Alterations in shape, size, position, color, or texture of teeth have a negative impact on the esthetic harmony of smile.[1] Dental anomalies occur as a result of interplay of numerous genetic and environmental factors. Prenatal and postnatal periods are equally responsible for developmental anomalies in tooth.[2]

Around 300 genes have been found to be expressed in dental hard tissue, which are responsible for odontogenesis, to name a few, muscle segment homeobox 1 (MSX1), paired box gene 9 (PAX9), axis inhibition protein 2 (AXIN2), ectodysplasin A (EDA), SPRY2, TGFA, SPRY4, WNT10A, FGF3, FGF10, FGFR2, and BMP4.[2] Among these genes, PAX9, MSX1, AXIN2, and EDA are the most frequently reported genes which are associated with nonsyndromic hypodontia.[3] Gene mutation can be one of the reasons for defects in development of teeth.

Peg-shaped incisors are referred to as teeth that show a crown diameter that decrease from cervical margin to incisal edge than a normal tooth. Peg-shaped incisors affect the maxillary lateral incisors either bilaterally or unilaterally. The prevalence of peg-lateral incisor varies from 0.8% to 8.4% of the population.[2],[4] Indian population shows the prevalence of congenitally missing teeth of approximately 16.3%, whereas the prevalence of macrodontia, microdontia, odontoma, and transposition is 0.2%, 1.0%, 0.2%, and 0.1%, respectively.[5] There is equal prevalence found in unilateral and bilateral lateral incisors, whereas the left side is twice as common as the right side.[6]

Developmental defects in the count of teeth are seen commonly. Hypodontia is lack of development of one or more teeth. According to Gerber, excluding third molars frequency that a tooth can be congenitally missing is found to be 1.6%–9.6% in permanent dentition.[7] After the third molars, the second premolars are commonly affected, whereas lateral incisors are less commonly affected.

Autosomal dominant pattern in genetic inheritance is suggested to be vital etiological factor.[7] It may also be associated with some environmental insult during development.

This report presents a case with nonsyndromic maxillary peg-shaped lateral incisor and congenitally missing contralateral maxillary incisor.

  Case Report Top

A 9-year-old male patient reported to the department of pediatric and preventive dentistry with his parents for routine dental checkup. No relevant medical history was found. Family medical history was also not significant. It was his first dental visit. On recording personal oral hygiene history, the patient brushed once in a day with an adult size tooth brush in horizontal brushing motion. The patient was of well built. His height was 4 feet 3 inch and weighed 25 kg. His gait was normal with straight posture. His body type was mesomorphic. His facial profile was convex and the lips were competent. On functional examination, the patient was a nasal breather along with adult type of swallow pattern.

On intraoral examination, no soft tissue abnormality was recorded [Figure 1] and [Figure 2]. The number of teeth present was 22. Permanent maxillary left lateral incisor was peg shaped [Figure 3], whereas permanent maxillary right lateral incisor was missing. His parents did not give a history of either extraction or trauma in relation to the maxillary right lateral incisor. Orthopantomographic examination confirmed our findings. The maxillary right lateral incisor was congenitally missing with peg-shaped maxillary left lateral incisor [Figure 4].
Figure 1: Maxillary arch

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Figure 2: Peg-shaped maxillary lateral incisor

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Figure 3: Missing maxillary right lateral incisor and peg-shaped left lateral incisor

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Figure 4: Orthopantamogram showing congenitally missing maxillary right lateral incisor and peg-shaped left lateral incisor

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Based on all the above investigations, the diagnosis of congenitally missing tooth was made. As the patient's parent was not willing for the treatment, no treatment was conducted for this case.

  Discussion Top

Single tooth microdontia is an uncommon dental anomaly. Of which, the most common forms of localized microdontia affect the third molars and less frequently lateral incisors, termed as “peg lateral.” Anterior teeth in the primary or permanent dentition which show a crown diameter that decrease from cervical margin to incisal edge than a normal tooth are termed as peg-shaped teeth. Evidence suggests that disturbances during morphodifferentiation stage might lead to abnormality in the form and size of the tooth. The function of the tooth and ameloblasts may or may not be affected in such cases.[2]

Although the exact cause is unknown, peg laterals are reported to occur about 2 times more frequently on the left side than on the right.[8] Al-Emran et al.[9] and Peck and Peck et al.[10] reported that patients with dental anomalies such as palatally displaced canines or contralateral peg laterals with congenitally missing maxillary lateral incisor have an increased incidence of skeletal Cass III malocclusion.

In addition, while an association between congenitally missing teeth and tooth size reduction has been suggested, it has been reported that developmental absence of teeth can be related genetically to overall tooth size.[10]

Kim et al.[8] reported associated dental anomalies with peg laterals, which include congenitally missing teeth (31.8%), dens invaginatus (19.7%), palatally placed canines (12.1%), supernumerary teeth (7.6%), and tooth transposition (7.6%).

The treatment aspect of peg-shaped tooth is focused on esthetic grounds through orthodontic correction. Dental esthetics is known to affect the overall quality of social and psychological life of an individual.

The proposed treatment options for such case are as follows: orthodontic treatment first to align the teeth in the arch, direct composite bonding onto peg laterals, indirect composite placement, bonded crowns, porcelain bonded to metal crowns (Bello 1997), crown lengthening surgery to get better gingival heights then direct bonding, extractions and implant placement, combinations of treatment in different sequences, or no treatment if patient is not concerned.[2]

At present, MSX1 and PAX9 are the two mutant genes known to cause agenesis of teeth.[7],[9] Early detection of a tooth agenesis is helpful in treatment planning and will help to prevent developing malocclusion.[11]

More than 300 genes have been known to be expressed in teeth that are responsible for odontogenesis.[12] Gene mutation is one of the etiological factors in the morphological defects of tooth. The peg-shaped laterals are usually genetically determined and can also be caused due to endocrinal disturbances.[13],[14] Online Mendelian Inheritance in Man lists over 60 different syndromic conditions that include hypodontia as part of their phenotypic spectrum of anomalies.[15],[16] Ectodermal dysplasia, oral–facial–digital syndromes, and oral–facial clefting syndromes such as Pierre–Robin sequence and Van Der Woude syndrome are commonly associated with syndromic hypodontia.[16]

In treating such cases of hypodontia, a multidisciplinary proper diagnosis and treatment planning is necessary to establish esthetics and function.

  Conclusion Top

The present case report states that alteration in shape and size of tooth in a child can affect the psychological well-being. In order to fulfill the demanding needs of esthetics, a multidisciplinary approach should be facilitated. This would accomplish functional as well as esthetic needs of the patient in total.

The incidence of skeletal Class III malocclusion is high when peg-shaped lateral incisor is associated with congenitally missing tooth.[8] Hence, it makes this case unique from the preventive aspect of orthodontic treatment needs.

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

Shrestha A, Marla V, Shrestha S, Maharjan IK. Developmental anomalies affecting the morphology of teeth – A review. RSBO 2015;12:68-78.  Back to cited text no. 1
Devasya A, Sarpangala M. Dracula tooth: A very rare case report of peg-shaped mandibular incisors. J Forensic Dent Sci 2016;8:164-6.  Back to cited text no. 2
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Alves-Ferreira M, Pinho T, Sousa A, Sequeiros J, Lemos C, Alonso I. Identification of genetic risk factors for maxillary lateral incisor agenesis. J Dent Res 2014;93:452-8.  Back to cited text no. 3
Ezoddini AF, Sheikhha MH, Ahmadi H. Prevalence of dental developmental anomalies: A radiographic study. Community Dent Health 2007;24:140-4.  Back to cited text no. 4
Patil S, Doni B, Kaswan S, Rahman F. Prevalence of dental anomalies in Indian population. J Clin Exp Dent 2013;5:e183-6.  Back to cited text no. 5
Hua F, He H, Ngan P, Bouzid W. Prevalence of peg-shaped maxillary permanent lateral incisors: A meta-analysis. Am J Orthod Dentofacial Orthop 2013;144:97-109.  Back to cited text no. 6
Rajendran R, Sivapathasundharam B, Levi SH. Developmental disturbances of oral and para oral structures. In: Rajendran R, Sivapathasundharam B, editors. Shafer's Textbook of Oral Pathology. 6th ed.. India: Elsevier; 2011. p. 45-6.  Back to cited text no. 7
Kim JH, Choi NK, Kim SM. A retrospective study of association between peg-shaped maxillary lateral incisors and dental anomalies. J Clin Pediatr Dent 2017;41:150-3.  Back to cited text no. 8
Al-Emran S. Prevalence of hypodontia and developmental malformation of permanent teeth in Saudi Arabian schoolchildren. Br J Orthod 1990;17:115-8.  Back to cited text no. 9
Peck S, Peck L, Kataja M. Prevalence of tooth agenesis and peg-shaped maxillary lateral incisor associated with palatally displaced canine (PDC) anomaly. Am J Orthod Dentofacial Orthop 1996;110:441-3.  Back to cited text no. 10
Stockton DW, Das P, Goldenberg M, D'Souza RN, Patel PI. Mutation of PAX9 is associated with oligodontia. Nat Genet 2000;24:18-9.  Back to cited text no. 11
Karatas M, Akdag MS, Celikoglu M. Investigation of the peg-shaped maxillary lateral incisors in a Turkish orthodontic subpopulation. J Orthod Res 2014;2:125-8.  Back to cited text no. 12
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Hunstadbraten K. Hypodontia in the permanent dentition. ASDC J Dent Child 1973;40:115-7.  Back to cited text no. 13
Pindborg JJ. Pathology of the Dental Hard Tissues. Philadelphia: W.B. Saunders; 1970.  Back to cited text no. 14
Witkop CJ. Clinical aspects of dental anomalies. Int Dent J 1976;26:378-90.  Back to cited text no. 15
Chhabra N, Goswami M, Chhabra A. Genetic basis of dental agenesis – Molecular genetics patterning clinical dentistry. Med Oral Patol Oral Cir Bucal 2014;19:e112-9.  Back to cited text no. 16


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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