Evaluation of the frequency of dental anomalies in orthodontic patients with various malocclusions

Abstract

Background

The aim of this retrospective observational study was to evaluate the prevalence and distribution of dental anomalies in orthodontic patients with different malocclusions.

Methods

Pretreatment diagnostic records of 766 orthodontic patients were retrospectively evaluated in a single-center setting. Dental anomalies were classified according to sex, orthodontic malocclusion type (Class I, n = 122; Class II, n = 568; Class III, n = 76), and jaw localization. Statistical analyses were performed using Fisher’s exact test, Yates’ correction, and Pearson’s chi-square test.

Results

No statistically significant association was found between sex and the prevalence of dental anomalies (P = 0.739). At least one dental anomaly was detected in 71.8% of the patients. Root dilaceration was the most frequently observed anomaly (35%). The prevalence rates of numerical, dimensional, shape, eruption, and structural anomalies were 13.97%, 4.04%, 53.91%, 24.15%, and 30.67%, respectively. No significant difference in the prevalence of dental anomalies was observed among different malocclusion groups (P = 0.055).

Conclusions

Dental anomalies were frequently observed in this orthodontic population. The prevalence and distribution of anomalies varied according to anomaly type and jaw localization, highlighting the importance of radiographic evaluation in orthodontic patients. These findings may support earlier detection of diagnostic challenges and more individualized treatment planning in routine orthodontic practice. Early identification of dental anomalies may facilitate comprehensive orthodontic treatment planning and help prevent potential functional and structural complications.

Background

Dental anomalies may have genetic and environmental origins and can affect the number, size, shape, position, or structure of teeth. Although often asymptomatic, these anomalies may complicate dental procedures and influence occlusion, eruption patterns, and dental morphology [1, 2].

Dental anomalies can result in one, multiple, or all teeth and may also occur as part of systemic diseases or syndromes. Because such conditions can remain undetected during routine clinical examination, radiographic evaluation plays an important role in their identification and assessment [3, 4] .

The prevalence of dental anomalies has been widely investigated in different populations. Variations in reported prevalence rates have been attributed to geographic and genetic factors, as well as differences in study design and diagnostic criteria [4]. However, studies evaluating the association between orthodontic malocclusions and dental anomalies remain limited [5, 6] .

In addition to reporting prevalence rates, understanding how dental anomalies are distributed across different malocclusion types and jaw localizations may provide clinically relevant information for orthodontic diagnosis and treatment planning. Previous studies have often focused on limited anomaly groups, smaller sample sizes, or specific malocclusion categories. The present study differs by evaluating a wide spectrum of developmental dental anomalies simultaneously in a large orthodontic population and analyzing their distribution according to malocclusion type and jaw localization. This comprehensive approach allows a more integrated assessment of dental anomalies in orthodontic patients and may support clinicians in anticipating diagnostic and biomechanical challenges during treatment planning. Therefore, the present study aimed to provide a detailed assessment of the prevalence and distribution of dental anomalies according to malocclusion type and jaw localization in a large orthodontic sample.

Methods

This retrospective study was conducted to identify dental anomalies in patients with different orthodontic malocclusions and to evaluate their distribution according to dental malocclusion type. Ethical approval was obtained from the Hatay Mustafa Kemal University Non-Interventional Research Ethics Committee (protocol no. 07/06/2023-05). All procedures were conducted in accordance with the principles of the Declaration of Helsinki. Because this study was retrospective and based on archived diagnostic records with no direct patient contact, the requirement for informed consent was waived by the Hatay Mustafa Kemal University Non-Interventional Research Ethics Committee.

The diagnostic records of 1237 patients aged ≥ 14 years who applied for orthodontic treatment at the Department of Orthodontics, Faculty of Dentistry, between 2013 and 2023 were screened. The inclusion criteria for the study were as follows: patients with no history of systemic disease, dental trauma, surgical intervention in the maxillofacial region, and patients with digital panoramic radiographs of sufficient image quality to allow detailed evaluation were included in the study. A total of 766 patients who met the inclusion criteria were included in the analysis. All eligible patients within the study period who met the inclusion criteria were consecutively included to minimize selection bias. This approach was adopted to better represent the target orthodontic population. Patient data consisted of anamnesis records, pretreatment panoramic radiographs, intraoral photographs, and dental cast models. Malocclusions of patients were classified according to the Angle classification system. Sex, age, malocclusion type according to Angle’s classification, and the presence of developmental dental anomalies were recorded. Statistical evaluations were performed according to age, sex, malocclusion type, and jaw quadrant. Third molars were excluded from the analysis.

Patients younger than 14 years and those with systemic diseases, cleft lip and palate, ectodermal dysplasia, or syndromes associated with congenital dental anomalies were excluded. Records with incomplete data, low-quality radiographs, or tooth loss due to trauma or caries were also excluded. In this study, patients with a history of tooth extraction or previous dental treatment were completely excluded. Regarding tooth agenesis, whether a tooth had been previously extracted was confirmed by checking the anamnesis information obtained from the patients.

Panoramic radiographs were obtained from archived records under standardized conditions using a Vatech PCH-2500 unit (Vatech Co.). Panoramic radiographs and intraoral photographs were evaluated using a standard digital workstation. To minimize fatigue-related errors, no more than 30 patients were evaluated consecutively. Malocclusion status was determined based on intraoral dental cast models. All evaluations were conducted in standardized lighting environments with consistent screen brightness and resolution. An experienced orthodontist later reviewed cases involving disagreement.

Evaluation of developmental dental anomalies

Developmental dental anomalies were classified according to the following subcategories:

Numerical anomalies

Hypodontia : Agenesis of one to six teeth (excluding the third molars) [7].

Oligodontia: Absence of more than six teeth (excluding the third molars) [7] .

Anodontia : Complete absence of teeth [7] .

Supernumerary tooth: The presence of excess teeth either erupted or unerupted outside of the normal 32 permanent teeth or 20 primary teeth [8].

Dimensional anomalies

In accordance with previous studies, macrodontia and microdontia were classified as dimensional dental anomalies. Şen Yavuz et al. [9], Wagner et al. [10], and Budak et al. [6] evaluated macrodontia and microdontia within the category of dimensional anomalies.

Macrodontia: A tooth that is far larger than its contralateral homolog,“overfills” its space in the dental arch, or seems bigger because of exaggerated dimensions(conical, shaped, ortapered) [11].

Microdontia: A tooth with a narrower mesiodistal width of the crown than usual relative to its contralateral homolog [12]

Shape anomalies

Fusion: Union of two dental germs that would normally be separated resulting in a double tooth [13].

Gemination: Duplication of a single dental germ, resulting in the partial or total formation of two teeth that, however, do not separate completely [13].

Concresence: Union of two adjacent teeth just by the cement without dentin confluence [13].

Root Dilaceration: Root dilaceration is defined as an abnormal angular deviation or curvature of the tooth root, typically measuring 90 degrees or greater [14].

Taurodontism: Cases in which the tooth crown and/or pulp chamber grew vertically and the pulp chamber was observed in a rectangular configuration [15].

Dens invaginatus: It occurs as a result of the invagination of enamel into the dental papilla before the completion of calcification. Radiographic examination reveals a radiopaque invagination with a density similar to that of enamel, extending from the cingulum into the root canal [16].

Dens evaginatus: It is characterized by a supernumerary tubercle projecting from the occlusal surface [17].

Hypercementosis: Excessive non-neoplastic cement deposition along the root, leading to root thickening [13].

Talon Cusp: It refers to an accessory cusp projecting from the cingulum region or the cementoenamel junction of the tooth [18].

Peg Shaped: It is a maxillary lateral incisor whose mesiodistal width at the incisal region is narrower than that at the cervical region [19].

Eruption Anomalies

Impacted Tooth: A tooth which eruption, in normal functional occlusion, was obstructed by other teeth, bone or soft tissues [20].

Transposition: An unusual type of ectopic eruption or positional interchange of two teeth [21].

Ectopic Eruption: Eruption of a tooth in an abnormal position [11].

Persistant Primary Tooth: It is a primary tooth that remains in the dental arch despite the normal physiological exfoliation time having passed [22].

Structural Anomalies

Amelogenesis İmperfecta: It is a hereditary disorder that disrupts normal enamel formation in both primary and permanent teeth, affecting their clinical appearance and structure [23].

Dentinogenesis İmperfecta: Presence of bulbous crowns, short roots and obliteration of the pulp chambers and root canals [13].

Enamel Pearl: Well-defined nodules with enamel-like radiopacity along the root surfaces [13].

Pulp Stone: They are mineralized ectopic structures located within the dental pulp that differ in morphology, composition, and localization [24].

Statistical analysis

Diagnostic records of 1237 patients who presented to the Department of Orthodontics between 2013 and 2023 were reviewed. Of these, 766 patients meeting the inclusion criteria were included in the study. All 766 panoramic radiographs were re-evaluated after a one-month interval to reduce observational bias, and intra-observer agreement was assessed using the Kappa test. The Kappa statistic was interpreted according to standard reliability criteria.

Statistical analyses were performed using IBM SPSS software (version 23). Data distribution was assessed using the Kolmogorov–Smirnov test. As data from three or more groups did not show normal distribution, the Kruskal–Wallis test was used. Fisher’s exact test, Yates’ correction, and Pearson’s chi-square test were applied for categorical variables. Multiple comparisons were conducted using the Bonferroni-corrected Z test. Associations between anomaly types were examined using tetrachoric correlation analysis. Categorical variables are presented as frequency (percentage), and quantitative variables as mean ± standard deviation and median (minimum–maximum). A P value < 0.05 was considered statistically significant. Sample size was considered adequate to detect clinically meaningful differences among malocclusion groups.

Results

The Kappa coefficient was 1.00, indicating excellent intra-observer agreement between the initial and repeated evaluations.

The mean age of the patients was 16.05 ± 2.84 years (range: 14–45.42 years). Of the 766 patients included, 43.1% were male and 56.9% were female. Dental anomalies were not detected in 216 patients, whereas 550 patients presented with at least one anomaly, corresponding to an overall prevalence of 71.8%. The prevalence of dental anomalies was 71.3% in females and 72.4% in males. According to Angle’s classification, 15.9% of patients had Class I malocclusion, 74.2% Class II, and 9.9% Class III (Fig. 1).

Fig. 1.

Distribution of malocclusion types among the orthodontic patients

No statistically significant difference was observed in the distribution of dental anomalies among malocclusion types (P = 0.055). The prevalence rates were 63.9% in Class I, 72.5% in Class II, and 78.9% in Class III malocclusion groups.

Numerical anomalies were identified in 13.97% of patients. The prevalence of oligodontia was 0.3%, with the highest occurrence in Class II patients (0.4%) (Table 1). Hypodontia was detected in 11.5% of cases and was more frequent in males (11.8%). The highest prevalence of hypodontia was observed in Class II patients (11.8%), whereas the lowest prevalence was noted in Class III patients (10.5%) (Table 1). Supernumerary teeth were present in 2.2% of patients, occurring more frequently in males (3%), and were most commonly observed in Class II malocclusion (Table 1). No cases of anodontia were detected.

Table 1.

Distribution of anomalies according to malocclusions

Anomaly	Class I	Class II	Class III
	n %	n %	n %	P*
Anodontia	0 0	0 0	0 0	---
Oligodontia	0 0	2 0,4	0 0	0,705
Hypodontia	13 10,7	67 11,8	8 10,5	0,903
Supernumerary Tooth	3 2,5	11 1,9	3 3,9	0,525
Macrodontia	1 0,8	8 1,4	0 0	0,521
Microdontia	2 1,6	16 2,8	4 5,3	0,328
Dens Invaginatus	0 0	2 0,4	0 0	0,705
Dens Evaginatus	0 0	5 0,9	2 2,6	0,165
Peg-Shaped Tooth	1 0,8	13 2,3	2 2,6	0,554
Fusion	0 0	0 0	0 0	---
Gemination	0 0	2 0,4	0 0	0,705
Concrescence	0 0	0 0	0 0	---
Talon Cusp	14 11,5	68 12	8 10,5	0,930
Root Dilaceration	42 34,4	193 34	33 43,4	0,266
Taurodontism	2 1,6a	19 3,3a	7 9,2b	0,016
Pulp Stone	3 2,5a	35 6,2ab	9 11,8b	0,080
Enamel Pearl	27 22,1	148 26,1	12 15,8	0,120
Ectopia	0 0	0 0	0 0	---
Transposition	0 0	4 0,7	2 2,6	0,114
Impacted Tooth	15 12,3	78 13,7	15 19,7	0,303
Amelogenesis Imperfecta	0 0	1 0,2	0 0	0,840
Dentinogenesis Imperfecta	0 0	0 0	0 0	---
Persistent Primary Tooth	9 7,4	53 9,3	9 11,8	0,571

^a-b: There is no difference between groups with the same letter

*Pearson Chi-Square Test

Dimensional anomalies were observed in 4.04% of patients. Macrodontia was present in 1.2% of cases and occurred significantly more frequently in males (P = 0.006), with the highest prevalence in Class II patients (1.4%) (Table 1). Microdontia was identified in 2.9% of patients and was more common in females (3.4%), with the highest prevalence in Class III patients (5.3%) (Table 1). Microdontia was significantly more frequent in the maxilla than in the mandible (P < 0.001).

Shape anomalies were detected in 53.91% of patients. The prevalence of dens invaginatus was 0.3%, with a higher occurrence in females (0.5%), and the highest rate was observed in Class II patients (0.4%) (Table 1). Dens evaginatus was detected in 0.9% of patients, occurring more frequently in males (1.2%) and most commonly in Class III malocclusion (2.6%) (Table 1). Dens evaginatus was significantly more frequent in the maxilla than in the mandible (P < 0.001). Peg-shaped teeth were observed in 2.1% of patients, with equal distribution between sexes, and were most prevalent in Class III patients (2.6%) (Table 1). Peg-shaped teeth were significantly more frequent in the maxilla (P < 0.001). Gemination was detected in 0.3% of patients and was observed only in males, with the highest prevalence in Class II malocclusion (0.4%) (Table 1). Talon cusp anomalies were identified in 11.7% of cases, with similar prevalence in males and females. The highest prevalence of talon cusp was observed in Class II patients (12%) (Table 1), and these anomalies were significantly more frequent in the maxilla (P = 0.001). Root dilaceration was detected in 35% of patients and occurred more frequently in males (35.8%). The highest prevalence of root dilaceration was observed in Class III patients (43.4%) (Table 1), with a significantly higher occurrence in the maxilla (P < 0.001). Taurodontism was identified in 3.7% of patients, with equal distribution between sexes. A statistically significant difference in taurodontism prevalence was found between Class III patients and other malocclusion groups (P = 0.016) (Table 1). No cases of fusion or concrescence were observed.

Eruption anomalies were detected in 24.15% of patients. Tooth transposition was observed in 0.8% of cases and occurred more frequently in females (0.9%), with the highest prevalence in Class III patients (2.6%) (Table 1). Impacted teeth were present in 14.1% of patients and were more frequent in males (16.1%), with the highest prevalence in Class III malocclusion (19.7%) (Table 1). Persistent primary teeth were detected in 9.3% of cases, occurring more frequently in females (9.4%), and were most commonly observed in Class III patients (11.8%) (Table 1). No cases of ectopia were identified.

Structural anomalies were detected in 30.67% of patients. Amelogenesis imperfecta was observed in a single male patient with Class II malocclusion (0.1%) (Table 1). Pulp stones were present in 6.1% of patients and were more frequent in females (7.6%). A statistically significant difference in pulp stone prevalence was found between Class III and Class I patients (P = 0.028) (Table 1). Enamel pearls were detected in 24.4% of cases and were significantly more prevalent in females (28.4%) (P = 0.003), with the highest prevalence in Class II malocclusion (26.1%) (Table 1). Enamel pearls were significantly more frequent in the mandible than in the maxilla (P < 0.001). No cases of dentinogenesis imperfecta were observed.

Regarding tooth-specific distribution, hypodontia was most frequently observed in the upper right lateral incisors, and supernumerary teeth were most commonly mesiodens located between the maxillary central incisors. Macrodontia was most frequently detected in the upper left central incisors, whereas microdontia was predominantly observed in the upper left lateral incisors. Peg-shaped teeth and talon cusp anomalies were most commonly detected in the upper left lateral incisors. Root dilaceration was most frequently observed in the upper right first molars, and taurodontism was most common in the upper left second molars. Impacted teeth were most frequently maxillary left canines, persistent primary teeth were most commonly maxillary left deciduous canines, pulp stones were most frequently observed in maxillary left first molars, and enamel pearls were most frequently detected in mandibular right first molars (Fig. 2). These findings demonstrate the heterogeneous distribution of dental anomalies across different tooth groups and jaw regions. The prevalence of the dental anomalies for each teeth was presented in the Tables 2 and 3.

Fig. 2.

Teeth most commonly affected by dental anomalies

Table 2.

Distribution of common dental anomalies in the maxillary arch

Tooth number	17	16	15	14	13	12	11	21	22	23	24	25	26	27
Dental Anomaly
Oligodontia		16,7%		8,3%		16,7%			16,7%				16,7%
Hypodontia		2,9%	2,2%	2,2%	0,7%	23%	2,2%	1,4%	17,3%	1,4%	5%		2,9
Supernumerary Tooth			3,4%	3,4%		3,4%	20,7%	20,7%	3,4%		3,4%	3,4%
Macrodontia							40%	60%
Microdontia						25%	4,2%		66,7%
Dens Invaginatus						50%			50%
Dens Evaginatus	18,2%	9,1%	9,1%	9,1%							9,1%	9,1%	9,1%	18,2%
Peg Shaped Tooth						36,8%			63,2
Gemination						50%
Talon Cusp					6,3%	32,2%	8%	9,2%	36,2%	8%
Root Dilaceration	12,2%	13,4%	4,9%	3,4%	1,3%	4,4%	0,5%	1,5%	2,4%	1,3%	1,5%	3,8%	8,3%	10,7%
Taurodontism	14,4%	13,5%	1%									1%	12,2%	15,4
Pulp Stone	9,5%	24,6%						0,8%	0,8%				25,4%	8,7%
Enamel Pearl	1,4%	3,5%	0,4%	0,4%							0,7%		4,6%	2,1%
Transposition				6,3%	12,5%	6,3%			18,8%	18,8%
Impacted Tooth	5,1%		2,1%	1,3%	12,8%	1,7%	2,1%	1,7%	0,4%	15,4%	2,6%	6%		6%

Table 3.

Distribution of common dental anomalies in the mandibular arch

Tooth number	47	46	45	44	43	42	41	31	32	33	34	35	36	37
Dental Anomaly
Oligodontia	8,3%		8,3%											8,3%
Hypodontia		0,7%	12,2%			1,4%	4,3%	5%	2,9%			11,5%	0,7%
Supernumerary Tooth			10,3	6,9%			3,4%	3,4%			6,9%	6,9%
Macrodontia
Microdontia			4,2%
Dens Invaginatus
Dens Evaginatus				9,1%
Peg Shaped Tooth
Gemination									50%
Talon Cusp
Root Dilaceration	7,6%	3,8%	1,6%	1,8%	0,5%	0,2%	0,4%	0,2%	0,2%	0,7%	1,5%	0,5%	4%	7,4%
Taurodontism	14,4%	4,8%	1,9%	1%							1%	1,9%	4,8%	12,5%
Pulp Stone	4,8%	7,9%	1,6%								0,8%	0,8%	10,3%	4%
Enamel Pearl	9,2%	45,8%									0,4%		25,7%	5,6%
Transposition					6,3%	6,3%			12,5%	12,5%
Impacted Tooth	3,8%		11,5%	2,6%	3%			0,4%		3%	1,7%	12%		4,7%

Discussion

The prevalence and distribution of dental anomalies have been reported to vary considerably within and between populations [4]. These variations have been attributed to differences in genetic background, ethnicity, geographic location, and diagnostic criteria. In the present study, dental anomalies were evaluated in orthodontic patients from a single region to provide population-specific data. Beyond reporting overall prevalence, the present findings highlight that certain developmental dental anomalies demonstrate distinct distribution patterns according to malocclusion type and jaw localization. This information may be clinically relevant, as the coexistence of specific anomalies with certain malocclusion patterns can influence orthodontic diagnosis, risk assessment, and treatment mechanics. Therefore, the results of this study extend existing prevalence data by providing a more detailed morphological and clinical perspective.

To ensure inclusion of individuals with complete permanent dentition and to allow reliable assessment of impacted teeth, patients aged 14 years and older were evaluated. A similar age range focusing on permanent dentition has been reported in previous studies investigating dental anomalies in orthodontic populations [5].

Dental anomalies are influenced by both genetic and environmental factors. Previous studies have suggested that genetic factors have a strong influence in the etiology of hypodontia, taurodontism, impacted teeth, Infraoccluded teeth and fusion [6, 25]. In the study conducted by Budak et al. [6] on twin pairs, it was stated that both genetic and environmental factors play a role in the etiology of microdontia, oligodontia, dilaceration, dens invaginatus, peg-shaped lateral incisors.

The prevalence of at least one dental anomaly was 71.8% in the present study. This finding is comparable to the prevalence reported by Uslu et al. [5], who observed dental anomalies in 40.3% of orthodontic patients. The relatively high prevalence observed in orthodontic populations may be related to the increased likelihood of anomalies among patients seeking orthodontic treatment.

Previous studies have reported inconsistent findings regarding the relationship between dental anomalies and malocclusion types. Uslu et al. [5] found dental anomalies to be most common in Class I malocclusion, whereas Basdra et al. [26] reported a significantly higher prevalence in Class III individuals. In the present study, no statistically significant difference was observed in the overall prevalence of dental anomalies among malocclusion groups (P = 0.055). However, taurodontism and pulp stones demonstrated significant variation, with higher prevalence in Class III malocclusion (P = 0.016 and P = 0.028, respectively).

Jamilian et al. [27] analyzed the prevalence of malocclusion among female students and evaluated orthodontic treatment needs using the Index of Orthodontic Treatment Need (IOTN). The researchers found that 83.7% of Tehranian schoolgirls exhibited malocclusion.

The prevalence of oligodontia in the present study (0.3%) was consistent with the findings of Eskibağlar et al. [4]. In the present study, different results were obtained regarding oligodontia findings compared with the study of Uslu et al. [5]. We believe that this discrepancy may be attributed to the fact that Uslu et al. [5] assessed oligodontia under the agenesis category.

Hypodontia was detected in 11.5% of patients, a prevalence slightly higher than that reported by Vinjolli et al. [28]. Similar to previous reports hypodontia was most frequently observed in Class II malocclusion [29], and the maxillary lateral incisors were the most commonly affected teeth [30]. Variations in prevalence among populations may be influenced by genetic and environmental factors.

The prevalence of supernumerary teeth (2.2%) was consistent with previous studies [31]. Mesiodens was the most commonly observed supernumerary tooth, in agreement with Eskibağlar et al. [4]. Differences in the distribution of supernumerary teeth among malocclusion types may be associated with variations in genetic background, ethnic characteristics, sample composition, and diagnostic criteria among the studied populations.

The prevalence of macrodontia (1.2%) was lower than that reported by Pedreira et al. [20], whereas the prevalence of microdontia (2.9%) was comparable to previous reports [20]. Consistent with earlier studies, macrodontia most frequently affected the maxillary central incisors [30], whereas microdontia was most commonly observed in maxillary lateral incisors [20].

The prevalence of dens invaginatus (0.3%) was similar to that reported by Baron et al. [32] and lower than that reported by Shayan et al. [33]. Consistent with previous studies [1, 34], maxillary lateral incisors were the teeth most frequently affected. The prevalence of dens evaginatus (0.9%) was lower than that reported in Turkish populations [5, 35], and variation in the affected tooth type was observed.

Peg-shaped teeth were detected in 2.1% of patients, a prevalence comparable to that reported by Balija et al. [34]. Similar to previous findings, peg-shaped teeth were most frequently observed in Class III malocclusion.

Altuğ-Ataç et al. [30] reported a gemination prevalence of 0.07% in a Turkish population, compared to 0.3% in our study. Due to its rarity, gemination is often overlooked.

Eskibağlar et al. [4] reported a prevalence of talon cusp of 3.8% in a Turkish population, whereas we found a prevalence of 11.7%. We attribute the higher prevalence of talon cusp in our study to the fact that our sample consisted of patients seeking orthodontic treatment.

Root dilaceration was the most frequently observed anomaly (35%). This prevalence was higher than that reported in some populations [33] but consistent with findings in orthodontic samples, where root dilaceration was most common in Class III malocclusion and was more frequently observed in the maxilla [5, 29].

Taurodontism was detected in 3.7% of patients, a prevalence higher than that reported by Balija et al. [34]. This discrepancy may be attributed to population-based variations, as Balija et al. [34] investigated a Croatian population, whereas the present study was conducted in a Turkish population.

Pulp stones were detected in 6.1% of patients, a prevalence lower than that reported by Çıtak et al. [35]. Similar to previous findings, pulp stones were most frequently observed in maxillary first molars [36].

Enamel pearls were detected in 24.4% of patients, a prevalence markedly higher than that reported by Chrcanovic et al. [37]. This discrepancy may be explained by methodological differences, as panoramic radiographs may allow detection of smaller enamel pearls that could be overlooked during visual inspection of extracted teeth [38]. Consistent with Özveren et al. [2], enamel pearls were more frequently observed in mandibular molars.

The prevalence of transposition (0.8%) was slightly higher than that reported in European populations [26, 32]. Similar to previous reports, transposition was most frequently observed in Class III malocclusion [26].

The prevalence of impacted teeth (14.1%) was comparable to that reported by Aydın et al. [29]. Differences in the most frequently impacted tooth among studies may reflect variations in sample characteristics. According to previous reports, impacted maxillary canines have been associated with small-sized maxillary lateral incisors, enamel hypoplasia, second premolar aplasia, and infraocclusion of primary molars [39].

Amelogenesis imperfecta was a rare finding (0.1%), consistent with previous population-based studies [20]. Retained primary teeth were most frequently observed in the maxillary left primary canine, in agreement with Işık AB et al. [40].

The retrospective design and reliance on panoramic radiographs, intraoral photographs, and dental cast models without clinical examination should be considered when interpreting these findings.

The strengths of this study include the large sample size, comprehensive evaluation of multiple anomaly types, and the use of standardized diagnostic records. Despite these limitations, the present study provides a comprehensive overview of developmental dental anomalies in a large orthodontic population using standardized diagnostic records. But the sample consisted only of patients seeking orthodontic treatment may have resulted in a higher reported prevalence of dental anomalies than in the general population. This can be considered a limitation of our study.

Panoramic radiography is considered a useful and widely accepted imaging modality for epidemiological evaluation of dental anomalies because it allows simultaneous visualization of both jaws, developing dentition, tooth number anomalies, eruption disturbances, impactions, transpositions, taurodontism, and other major developmental alterations with relatively low radiation dose and cost-effectiveness. Several previous studies investigating dental anomalies have also primarily relied on panoramic radiographs for screening and diagnosis [1, 2, 4, 20, 27, 29, 31–35]. However, we acknowledge that panoramic radiographs have inherent limitations related to image magnification, distortion, superimposition, and lower spatial resolution compared with cone-beam computed tomography (CBCT) or intraoral radiographs. Therefore, certain anomalies—particularly those involving detailed root morphology or mild structural alterations—may not be assessed with the same accuracy as advanced three-dimensional imaging techniques. Considering the retrospective and epidemiological design of the present study, panoramic radiography was regarded as an appropriate and clinically acceptable method for evaluating the dental anomalies included in this investigation.

By simultaneously evaluating a wide range of anomaly types and their distribution according to malocclusion patterns and jaw localization, this study adds a clinically oriented perspective to existing prevalence data rather than limiting the analysis to descriptive reporting. These findings may assist clinicians in early identification of potential diagnostic challenges and in anticipating biomechanical considerations during orthodontic treatment planning. Future prospective studies incorporating three-dimensional imaging modalities may further clarify the clinical relevance of these associations. At the population level, these data may also support improved screening strategies and preventive orthodontic care. Awareness of these anomalies is essential for accurate diagnosis, risk assessment, and individualized orthodontic treatment planning. From a clinical perspective, the coexistence of dental anomalies with specific malocclusion patterns may increase treatment complexity and influence biomechanical strategies, highlighting the importance of comprehensive diagnostic evaluation before orthodontic intervention.

Conclusions

A high prevalence of dental anomalies (71.8%) was observed among orthodontic patients in the present study. Root dilaceration was the most frequently detected anomaly (35%). Microdontia, dens evaginatus, peg-shaped teeth, talon cusp, root dilaceration, and pulp stones were more commonly observed in the maxilla, whereas enamel pearls were significantly more prevalent in the mandible across all malocclusion types. No statistically significant association was found between orthodontic malocclusions and the overall prevalence of dental anomalies, thereby supporting the null hypothesis. These findings emphasize the importance of comprehensive radiographic assessment in orthodontic patients, as early identification of dental anomalies may help prevent treatment complications and improve long-term outcomes.

Clinical Significance

Dental anomalies are common in orthodontic populations and may influence diagnosis, treatment planning, biomechanics, and long-term stability. Early detection through careful clinical and radiographic evaluation allows clinicians to anticipate potential complications, select appropriate treatment strategies, and provide individualized care for affected patients.

Authors’ contributions

Conceptualization: FBZ; Data curation: YK; Formal analysis: YK; Investigation: YK; Methodology: FBZ; Project administration: FBZ; Resources: YK; Software: YK; Supervision: FBZ; Validation: YK; Visualization: FBZ; Writing – original draft: YK; Writing – review and editing: FBZ.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

Data are available from the corresponding author upon reasonable request (subject to institutional and ethical restrictions).

Declarations

Ethics approval and consent to participate

This retrospective study was approved by the Hatay Mustafa Kemal University Non-Interventional Research Ethics Committee (approval no. 07/06/2023-05). The requirement for informed consent was waived by the Hatay Mustafa Kemal University Non-Interventional Research Ethics Committee due to the retrospective design and use of archived records. All procedures were conducted in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.