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92 ว.ทันต.ขอนแกน, ปที่ 13 ฉบับที่ 2 ก.ค.-ธ.ค. 2553 Prevalence and distribution of dental anomalies in pretreatment orthodontic Thai patients Suwadee Kositbowornchai* Chutimaporn Keinprasit** Nusara Poomat*** Abstract The aim of this study was to evaluate the prevalence and distribution of dental anomalies, including other pathologic findings in the pre-treatment records of Thai orthodontic patients at the Faculty of Dentistry, Khon Kaen University. Two observers retrospectively examined 570 panoramic radiographs, study models and pre-orthodontic records. Dental anomalies were recorded using panoramic radiographs and study models. The prevalence and distribution of the anomalies were assessed and reported as descriptive statistics. Patients were between 12 and 40 years of age(mean 19.38+4.23). Persons between 16 and 20 years of age comprised the most common age group (51.1%) requiring for orthodontic treatment. The patient types included: class I (25.3%), II (27.4%), III (13.2%) and superclass I (34.0%). Crowding and spacing were found in 89.6% and 73.2% of patients, respectively. It was found that 38.6% of patients had at least one dental anomaly: hypodontia being the most common (26.1%), followed by microdontia (13.7%), root shape abnormality (3.4%), hyperdontia (2.7%), transposition (1.6%), macrodontia (1.4%) and fusion 0.7%. In conclusion, the developmental dental anomalies found in Thai orthodontic patients were comparable with other research. Keywords: dental anomaly, panoramic radiograph, tooth abnormality, orthodontics Correspondence author Associate Professor Suwadee Kositbowornchai Department of Oral Diagnosis, Faculty of Dentistry Khon Kaen University, Amphur Muang, KhonKaen, 40002 Tel: ++66-4320-405 ext. 11154 Fax: ++66-4320-862 E-mail: [email protected] * Associate Professor, Department of Oral Diagnosis, Faculty of Dentistry Khon Kaen University ** Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Khon Kaen University *** Assistant Professor, Department of Community Dentistry, Faculty of Dentistry, Khon Kaen University KDJ. Vol.13 No.2 July - Desember, 2010 93 INTRODUCTION MATERIALS AND METHODS Dental anomalies, and their influence on malocclusions,have long been a concern to the dental profession.Ben-Bassat and Brin1 found that multiple congenitally-missing teeth affected the skeletal pattern. Endo et al.2 reported the association of hypodontia and craniofacial morphology in Japanese orthodontic patients. Uslu et al.3 found no statistically significant correlations between having a dental anomaly and the type of malocclusion, except having an impacted tooth or a short blunt root. An increased prevalence of an occlusal deep bite was reported in palatally-displaced maxillary canine subjects.4 Whether the prevalence of dental anomaly causes any orthodontic problem has not, however, been fully understood. The difference in the prevalence of dental anomalies in orthodontic patients reported over the past 10 years of publications was very high. Altug-Atac and Erdem5 reported 5.46% of the orthodontic patients in a group of 3,043 had at least 1 developmental dental anomaly, while Thongudomporn and Freer6 investigated 111 orthodontic patients and found that 74.8% had at least 1 dental anomaly. The possible cause of the variance in these reports might be due to race, sample selection and size, type of dental anomalies and malocclusion. Indeed, most of the publications reported the prevalence of hypodontia in orthodontic patients more than any other type of dental anomaly and no type of malocclusion was reported.7-9 These informational gaps limit our understanding of dental anomalies in persons with orthodontic problems. Our purpose8, therefore, was to investigate the prevalence and distribution of dental anomalies in panoramic radiographs of Thai orthodontic patients and evaluate whether the result was comparable with other studies among orthodontic groups published over the last decade. Pre-orthodontic study models and panoramic radiographs of 570 orthodontic patients were retrospectively evaluated. All of the patients had been seen at the Orthodontic Clinic, Faculty of Dentistry, Khon Kaen University, between 1999 and 2006. Detailed medical, dental and family histories were obtained for all subjects. The selection criteria follow: 1. No significant medical history, such as significant trauma to the jaw bones. 2. No history of metabolic disorders or syndrome affecting bone metabolism and/or tooth formation. 3. No history of extraction or previous orthodontic treatment. 4. No cleft lip and/or palate, craniofacial anomalies and diagnosed syndromes. 5. Required good quality of study models with stable occlusion and good quality panoramic radiographs. Demographic data Age, sex and type of malocclusion were recorded for each patient. Panoramic radiographs and study models were examined for dental anomalies and pathologic findings, with agreement between an orthodontist and a radiologist. Descriptions of anomalies used the criteria presented by Langland et al.10. The following dental anomalies were assessed: 1. Number abnormalities (hypodontia and hyperdontia); 2. Size abnormalities (macrodontia and microdontia); 3. Shape abnormalities (fusion, gemination); 4. Location (transposition of tooth); 5. Other fidings. Statistical analysis Descriptive analyses—using the Statistical Package for Social Science (SPSS 9.0)—was used 94 ว.ทันต.ขอนแกน, ปที่ 13 ฉบับที่ 2 ก.ค.-ธ.ค. 2553 to calculate the prevalence and distribution within the dental anomaly data. Percentages and means were also calculated. RESULTS The sample group comprised 124 males (21.8%) and 446 females (78.2%). Age ranged between 12 and 40 years (mean, 19.38+ 4.23); the average for the male and female groups was 18.1 and 19.0, respectively. Most of those seeking orthodontic treatment were between 12 and 25 years of age (94.3%), with the largest group being between 16-20 years of age (51.1%). The patients were grouped into: class I (25.3%), II (27.4%), III (13.2%) and superclass I (34.0%). Crowding and spacing problems were found in 89.6% and 73.2% of patients, respectively. It was found that 38.6% of patients had at least one dental anomaly. The prevalence and distribution of dental anomalies follow: Hypodontia Of the 570 subjects, 149 (26.1%) had 350 missing teeth. The prevalence and distribution of hypodontia is presented in Table 1. The most common missing tooth was the third molar (68.9%), followed by the lateral incisor (15.1%) and the second premolar (8.6%). Except for the third molar, the other missing teeth occurred in mandible (17.4%) more often than in the maxilla (13.7%) and were distributed fairly evenly between the right and the left side. Among the hypodontia group, the percentage of patients with one, two, three, four or five congenitally missing teeth were 11.4, 6.5, 3.3, 3.0 and 0.7 respectively. The prevalence of six or more congenitally missing teeth was 1.4 % The highest number of congenitally missing teeth was 14 but in only one subject (0.2% of the total number of subjects) Table 1 Prevalence and distribution of hypodontia Number of tooth missing (% of missing tooth) 3 M 2ndM 2nd PM 1st PM C 2nd I 1stM Arch R L R L R L R L R L R L R L 80 60 0 1 0 1 7 3 4 4 1 1 11 13 Maxilla (40.0%) (0.3%) (0.3%) (2.9%) (2.3%) (0.6%) (6.9%) 52 49 1 2 0 2 10 10 0 2 0 1 16 13 Mandible (28.9%) (0.9%) (0.6%) (5.7%) (0.6%) (0.3%) (8.3%) 241 4 3 30 10 3 53 Total (68.9%) (1.1%) (0.9%) (8.6%) (2.9%) (0.9%) (15.1%) (M=molar, PM=premolar, C=canine, I= incisor, R=right, L=left) rd Hyperdontia refers to one or more extra teeth. Mesiodens is the extra tooth in the maxillary midline. Our study reports extra teeth, either supernumerary teeth or mesiodens, separately. A total of 15 subjects (2.6%) presented; 12 with supernumerary teeth and 9 with mesiodens (Table 2). Six subjects presented 1 supernumerary tooth and three with 2 extra teeth. Nine mesiodens were found in 6 subjects. Three 1st I Total R L 188 1 1 (0.6%) (53.7%) 2 2 162 (1.1%) (46.3%) 6 350 (1.7%) (100.0%) subjects had 2 cone-shaped mesiodens. The ratio of upper to lower and anterior to posterior supernumerary teeth was 2 to 1 and 3 to 1 respectively. Regarding shape, the extra tooth shape resembled the adjacent permanent tooth, such as the incisor (2 cases), a cone shape (2 cases) or a canine (5 cases) at the anterior sextant and the premolar (1 case) or the molar shape (2 cases) at the posterior sextant. KDJ. Vol.13 No.2 July - Desember, 2010 95 Table 2 Prevalence and distribution of supernumerary tooth and mesiodens (% of the subjects) Supernumerary tooth - maxilla - mandible Patient's right sextant Anterior sextants Patient's left sextant Total 1 (0.2%) 1 (0.2%) 6 (1.1%) 3 (0.5%) 1 (0.2%) 0 (0.0%) 9subjects 12 teeth (1.6%) Mesiodens - maxilla Macrodontia and microdontia – The occurrence of macrodontia was less common than microdontia. Eight subjects had macrodontia (1.4% of the total 570 cases), including 5 cases of 1 macrodontia, 2 cases of 2 macrodontia [#28 (the maxillary left third molar) & #48(the mandibulary right third molar) and #25 (the maxillary left second premolar) & #34 (the mandibulary left first premolar)] and 1 case of 3 macrodontia [#15 (The maxillary right second premolar, #35 ( the mandibulary left second premolar & #45 the mandibulary right second premolar)]. Macrodontia did not appear in the anterior sextant. The most common type of macrodontia presented at the third 3(2cone shape) 3(1cone shape) 6subjects 9 teeth (1.1%) molar (7 teeth), followed by the second premolar (4 teeth) and the first premolar (1 tooth). There were 78 cases (13.7%, 120 teeth) of microdontia (Table 3). The most commonly affected teeth fairly equally represented the maxillary third molar (56 from the whole 120 teeth) and the maxillary lateral incisors (55). It is very common in the maxilla (96.7%) and very rare in the mandible (3.3%). The majority of patients presented one (40 cases) or two microdontias (35 cases). Two cases presented 3 microdontias and one case presented 4 microdontias. Table 3 Prevalence and distribution of hypodontia (% of microdontia) Fusion – There were four cases (0.7%) of 7 fused teeth, one case of single fusion, three cases of double fusion. Except for one tooth of the maxillary second premolar, the remaining six teeth had fusion at the mandible. Most fusion occurred among the lower canine and lower premolar teeth. There was only one case of fusion of a lower lateral incisor. Gemination was not found in this study. 96 ว.ทันต.ขอนแกน, ปที่ 13 ฉบับที่ 2 ก.ค.-ธ.ค. 2553 Transposition – Of the 9 transposition cases (1.6%), five were located between the lateral incisor and the adjacent canine, two between the canine and the first premolar and two between the first and second premolar. The abnormality occurred two times in the maxilla to the mandible (6/3). There was no transposition at all of the central incisor and molars. Other findings Among the 570 records, other radiographic findings were present (Table 4). Idiopathic osteosclerosis represented 10% of the findings followed by bifid root (1.8%), trifid root (0.2%), three root of the first mandibular molar (0.2%), and odontoma (0.7%). Idiopathic osteosclerosis occurred only in the mandible. Of the 14 bifid roots, 13 showed at the first mandibular premolars and one at the second mandibular premolar. Six cases presented single bifid root and four cases showed two bifid roots. One trifid of the first mandibular premolars was found. Of the 4 odontoma cases, three were in the maxilla and one in the mandible. Hypercementosis was found in 7 cases (1.2%, 9 teeth); one at the canine and the first molar and seven at the premolar teeth. No incisal tooth presented hypercementosis. Only one subject showed three hypercementosis (#15, #34, #35). Dental anomalies were ranked according to prevalence (Table 5). Missing teeth and microdontia occurred more often than extra teeth and macrodontia. Root abnormalities were more common than crown abnormalities. Table 4. The other findings by general anatomic location Findings Idiopathic osteosclerosis Bifid root Trifid root Three roots Compound odontoma Complex odontoma Hypercementosis Number (% of case) 54 (10%) 10 (1.8%) 1 (0.2%) 1 (0.2%) 2 (0.4%) 2 (0.4%) 7 (1.2%) Location (number of tooth) sextant 4,5,6 lower 1st, 2nd PM(13,1) lower 1st PM(1) lower 1st M(1) quadrant1(3) quadrant3(1) upper C,2nd PM(1,3) lower1st PM,2nd PM,1st M(3,1,1) (M=molar, PM=premolar, C=canine) Table 5. Dental anomaly problems according to prevalence order KDJ. Vol.13 No.2 July - Desember, 2010 DISCUSSION Although the prevalence and distribution of dental anomalies has been studied in various groups of orthodontic patients, the discrepancies in the various results have been attributed to racial differences, variable sampling techniques and different diagnostic criteria including the orthodontic problem selected. Hypodontia Hypodontia is a common dental anomaly found in orthodontic patients. Multiple missing teeth not only cause malocclusion but also make orthodontic treatment difficult due to poor occlusal support and stability. Some missing teeth have been reported in association with at least one other dental anomaly9,11,12 and may complicate orthodontic problems. The prevalence of hypodontia in orthodontic patients has been reported differently. Excluding the third molar, hypodontia ranges from 2.6% in Turkey5, to 5.5% in Mexico13, 6.3% in Brazil9, 8.5% in Japan7, 11.1% in Korea14, 14.7% in Hungary8, to 26.4% in Thais (this study). Altug-Atac and Erdem 5, Uslu et al.3 and our study found tooth agenesis was the most prevalent dental anomaly among orthodontic patients. The most common missing tooth in orthodontic patients varies among the studied groups. Endo et al. 7 reported the most commonly affected tooth was in the mandibular second premolar. The maxillary lateral incisor was the most frequent in many studies.3, 5, 9, 13 -15 In our study, the most commonly missing tooth, excluding the third molar, was the mandibular lateral incisor (8.3%), followed by the maxillary lateral incisor (6.9%) and the mandibular second premolar (5.7%). There are reported differences in symmetrical hypodontia: some have predominant symmetry7, 13 while in some unilateral dental agenesis is more common than bilateral agenesis.16 97 Hyperdontia Hyperdontia is detected by chance either during intraoral examination or on radiographs. In case of malocclusion, the orthodontist plays a key role in the diagnosis and therapy through a comprehensive examination. The treatment decision is based on the individual case and may require interdisciplinary cooperation. The prevalence of supernumerary teeth is usually lower than that of tooth agenesis.17 The prevalence of supernumerary teeth in orthodontic patients ranges between 0.3%-1.37% 3,17,18, while our study documented 1.6%. The difference in race significantly affects the frequency of hyperdontia.19 The most common site of supernumerary teeth is in the maxillary anterior region.3, 8 Mesiodens may cause delay or ectopic eruption of the permanent incisor or further alter occlusion and appearance. Early diagnosis is therefore needed for appropriate treatment, thereby reducing the invasiveness of surgery, orthodontic treatment and possible complications.20 Most of the studies reported mesiodens in terms of supernumerary teeth. The prevalence of mesiodens in orthodontic patients ranged between 0.3-1.8 %5, 6, which is not significantly different from the general population (0.15-1.9%).20 Our study found mesiodens in 1.1% of orthodontic patients. Size abnormalities (macrodontia and microdontia) Dental morphology is only one of several factors that may be involved in the etiology of dental crowding or spacing. Macrodontia is very much less common than microdontia.5 Compared with other studies3, 5, 6, the percentage of macrodontia and microdontia in our study was the highest (1.4% and13.7%, respectively). The most common microdontia was of the maxillary lateral incisor.5, 6 Maxillary and mandibular 98 ว.ทันต.ขอนแกน, ปที่ 13 ฉบับที่ 2 ก.ค.-ธ.ค. 2553 first and second molars were the only teeth not affected by macrodontia or microdontia (Table 3). Shape abnormalities (fusion, gemination) Fusion requires management for esthetic reasons. Fusion and gemination in the general population are reportedly very low (0.19% and 0.22%, respectively) and extremely limited in orthodontic reports. Altug-Atac and Erdem5 reported the frequency of fusion and gemination was 0.23% and 0.07%, respectively. In our study, fusion occurred in only 0.7% and no gemination was found. In our study, fusion, macrodontia and gemination were not found in the maxillary first premolar, the maxillary and mandibular first and second molars, or the lower central incisor. Location abnormalities (transposition) Teeth transposition is a rare eruption anomaly that involves the permanent dentition (incidence 0.3-0.4%).21,22 Transposition are more frequently seen in the maxilla23, as in our study, and affecting (in descending order) the canines and first premolars, the canines and lateral incisors and the lateral and central incisors.23,24 Our study found the most frequently transposed teeth were the maxillary canine-lateral incisors. Transposition may occur with other anomalies, such as aplasia, peg-shaped lateral incisor and deciduous teeth retention.21 Diagnosis could be made at the radiological level: the earlier the diagnosis, the less risks related to orthodontic treatment. Other findings Except for idiopathic osteosclerosis, the number of root shape, odontoma and hypercementosis occurred at a very low rate in our study and was hardly seen in other reports. The correlation between dental anomalies and orthodontic problems has not been widely studied. Chung et al.14 reported the association of a congenitally missing third molar and skeletal class III malocclusion. Endo et al.2 evaluated the effect of hypodontia to craniofacial morphology. Whereas Bauer at al.25 found no statistically relevant correlation between the location of missing teeth and the craniofacial growth pattern. The difference in these results reflects the need for further study on both the prevalence, type of dental anomaly, location of abnormalities and type of orthodontic problems, in order to better understand whether there is a correlation between dental anomaly and orthodontic problems. CONCLUSION Prevalence and distribution of some dental anomalies in Thai orthodontic patients differed from other studies. Orthodontists should concern about the difference in dental anomalies in various group of patients. Careful diagnosis simplify treatment plan and reduce complications. ACKNOWLEDGEMENTS This study was supported by Faculty of Dentistry, Khon Kaen University, Thailand. Special thanks to Mr. Bryan Roderick Hamman for assistance with the English-language presentation of the manuscript. REFERENCES 1. 2. 3. Ben-Bassat Y, Brin I. Skeletodental patterns in patients with multiple congenitally missing teeth. Am J Orthod Dentofacial Orthop 2003;124:521-5. Endo T, Yoshino S, Ozoe R, Kojima K, Shimooka S. Association of advanced hypodontia and craniofacial morphology in Japanese orthodontic patients. Odontology 2004;92:48-53. Uslu O, Akcam O, Evirgen S, Cebeci L. Prevalence of dental anomalies in various malocclusions. Am J Orthod Dentofacial Orthop 2009;135:328-5. KDJ. Vol.13 No.2 July - Desember, 2010 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Leifert S, Jonas I. Dental anomalies as a microsymptom of palatal canine displacement. J Orofac Orthop 2003;64:108-20. Altug-Atac AT, Erdem D. Prevalence and distribution of dental anomalies in orthodontic patients. Am J Orthod Dentofacial Orthop 2007;131:510-4. Thongudomporn U, Freer TJ. Prevalence of dental anomalies in orthodontic patients. Aust Dent J 1998; 43:395-8. Endo T, Ozoe R, Kubota M, Akiyama M, Shimooka S. A survey of hypodontia in Japanese orthodontic patients. Am J Orthod Dentofacial Orthop 2006; 129: 29-35. Gabris K, Fabian G, Kaan M, Rozsa N, Tarjan I. Prevalence of hypodontia and hyperdontia in paedodontic and orthodontic patients in BUdapest. Community Dental Health 2006;23:80-2. Gomes R, da Fonseca J, Paula L, Faber J, Acevedo A. Prevalence of hypodontia in orthodontic patients in Brasilia, Brazil. The Eur J Orthod 2010;32(3):302-6. Langland O, Langlais R, CR M. Principles and practice of panoramic radiology including intraoral radiographic interpretation. WB Saunder Company, Philadelphia, 1982. Becker A, Smith P, Behar R. The incidence of anomalous maxillary lateral incisors in relation to palatally-displaced cuspids. The Angle Orthodontist 1981;51:24-9. Garib D, Peck S, Gomes S. Increased occurence of dental anomalies associated with second-premolar agenesis. Angle Orthodontist 2009;79:436-41. Silva Meza R. Radiographic assessment of congenitally missing teeth in orthodontic patients. Int J Paediatr Dent 2003;13:112-6. Chung C, Han J, Kim K. The pattern and prevalence of hypodontia in Koreans. Oral Diseases 2008; 14: 620-625. Fekonja A. Hypodontia in orthodontically treated children. European Journal of Orthodontics 2005; 27: 457- 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 99 Polder B, Van’t Hof M, Van der Linden F, Kuijpers-Jagtman A. A meta-analysis of the prevalence of dental agenesis of permanent teeth. Community Dent Oral Epidemiol 2004;32:217-26. Legovic M, Ceranic I, Cehich A. Anomalies in the number of permanent teeth in orthodontic patients in 2 localities in Croatia. Schweizer Monatsschrift fur Zahnmedizin 1990;100:286-90. Alberti G, Mondani P, Parodi V. Eruption of supernumerary permanent teeth in a sample of urban primary school population in Genoa, Italy. Eur J Paediatr Dent 2006;7:89-92. Harris E, Clark L. An epidemiological study of hyperdontia in American blacks and whites. Angle Orthodontist 2008;78:460-5. Russell K, Folwarczna M. Mesiodens-diagnosis and management. J Can Dent Assoc 2003;69:362-6. Budai M, Ficzere I, Gabris K, Tarjan I. Frequency of transposition and its treatment at the Department of Pedodontics and Orthodontics of Semmelweis University in the last five years. Fogorvosi szemle 2003;96:21-4. Yilmaz HH, Turkkahraman H, Sayin MO. Prevalence of tooth transpositions and associated dental anomalies in a Turkish population. Dentomaxillofac Radiol 2005;34:32-5. Ely N, Sherriff M, Cobourne M. Dental transposition as a disorder of genetic origin. Eur J Orthod 2006; 28:145-1. Shaipura y, Kuftinec M. Maxillary tooth transpositions:characteristic features and accompanying dental anomalies. Am J Orthod Dentofacial Orthop 2001;119:127-34. Bauer N, Heckmann K, Sand A, Lisson J. Craniofacial growth patterns in patients with congenitally missing permanent teeth. J Orofac Orthop 2009; 70:139-51. Baccetti T. A controlled study of associated dental anomalies. Angle Orthod 1998;68:267-74. 100 ว.ทันต.ขอนแกน, ปที่ 13 ฉบับที่ 2 ก.ค.-ธ.ค. 2553 ความชุกและการกระจายของวิกลภาพแหงฟนในผูปวย ชาวไทยกอนเขารับการรักษาทางทันตกรรมจัดฟน สุวดี โฆษิตบวรชัย* ชุติมาพร เขียนประสิทธิ์** นุสรา ภูมาศ*** บทคัดยอ บทความนี้มีวัตถุประสงคเพื่อประเมินความชุกและการกระจายของวิกลภาพแหงฟนรวมถึงพยาธิ สภาพอื่นๆในภาพรังสีพานอรามิกกอนการจัดฟนของผูปวยที่เขารับการจัดฟนที่คณะทันตแพทยศาสตร มหาวิทยาลัยขอนแกน โดยผูอานภาพรังสี 2 คน ศึกษาภาพรังสีพานอรามิกยอนหลัง จํานวน 570 ภาพ แบบจําลองศึกษาและบันทึกประวัติผูปวย รายงานความชุกและการกระจายของวิกลภาพแหงฟนดวยสถิติ เชิงพรรณนา ผลการศึกษาพบผูปวยอายุระหวาง 12 ถึง 40 ป (อายุเฉลี่ย 19.38+ 4.23 ป) โดยอายุที่เขารับ การจัดฟนมากที่สุดอยูระหวาง 16-20 ป (รอยละ 51.1) ผูปวยประกอบดวย การสบฟนชนิด คลาสวัน (รอยละ 25.3) คลาสทู (รอยละ 27.4) คลาสทรี (รอยละ 13.2) และ ซูเปอรคลาสวัน (รอยละ 34) พบฟนซอน และฟนหางรอยละ 89.61 และ 73.2 ตามลําดับ รอยละ38.6 ของผูป ว ยพบลักษณะวิกลภาพแหงฟนอยางนอย 1 อยาง โดยพบภาวะฟนนอยเกิน มากทีส่ ดุ คือ รอยละ 26.1 ตามดวย สภาพฟนเล็ก รอยละ 13.7 ความผิดปกติ ของรูปรางรากฟน (รอยละ 3.4) สภาพฟนมากเกิน (รอยละ 2.7) ฟนขึ้นผิดตําแหนง (รอยละ1.6) สภาพ ฟนใหญ(รอยละ 1.4) และการรวมตัวของฟน(รอยละ 0.7) กลาวโดยสรุป วิกลภาพแหงฟนในผูปวยคนไทย กอนเขารับการรักษาทางทันตกรรมจัดฟนมีปริมาณเทียบเคียงไดกับของผลงานวิจัยอื่นๆ คําไขรหัส : วิกลภาพแหงฟน, ภาพรังสีพานอรามิก, ความผิดปกติของฟน, ทันตกรรมจัดฟน ผูรับผิดชอบบทความ รองศาสตราจารย สุวดี โฆษิตบวรชัย ภาควิชาวินิจฉัยโรคชองปาก คณะทันตแพทยศาสตร มหาวิทยาลัยขอนแกน อ. เมือง จ. ขอนแกน 40002 โทรศัพท 0-4320-405 ตอ 11154 โทรสาร 0-4320-862 จดหมายอิเล็กทรอนิกส [email protected] *รองศาสตราจารย ภาควิชาวินิจฉัยโรคชองปาก คณะทันตแพทยศาสตร มหาวิทยาลัยขอนแกน **ผูชวยศาสตราจารย ภาควิชาทันตกรรมจัดฟน คณะทันตแพทยศาสตร มหาวิทยาลัยขอนแกน ***ผูชวยศาสตราจารย ภาควิชาทันตกรรมชุมชน คณะทันตแพทยศาสตร มหาวิทยาลัยขอนแกน