Evaluating craniofacial structures in patients with congenital missing teeth.

Background: This study aimed to evaluate the effects of congenital tooth agenesis (hypodontia) on craniofacial morphology and facial symmetry using cephalometric (CEPH) and posteroanterior (PA) canting analyses.

Materials and methods: This retrospective cross-sectional study included 141 individuals, comprising 101 patients with congenital tooth agenesis and 40 controls, all of whom had pre-treatment CEPH and PA radiographs. The data were obtained retrospectively from the digital archive of orthodontic patients between 2014 and 2024, enhancing the comprehensiveness of the findings. Subjects were classified based on the localization of missing teeth (maxilla, mandible, or both) and the affected facial side (right or left). Craniofacial morphology was assessed using cephalometric parameters via WebCeph software, while facial asymmetry in the transverse plane was evaluated using PA canting angles.

Results: SNA, SNB, and ANB angles, as well as anterior facial height, showed statistically significant differences according to the jaw in which the missing teeth were located (p < 0.05). Individuals with maxillary agenesis exhibited lower SNA values, while those with mandibular agenesis had higher ANB values. No statistically significant differences were observed among groups in terms of canting direction or degree (p > 0.05). Canting angles ranged from 0.56° to 1.84°, remaining below the threshold of esthetic detectability.

Conclusions: Congenital tooth agenesis can cause measurable changes in craniofacial morphology, particularly in the sagittal plane. However, the laterality of agenesis (right or left) did not significantly affect PA canting characteristics. These results suggest that the craniofacial impact of hypodontia varies according to the pattern of missing teeth and individual anatomical factors.