{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:06:14Z","timestamp":1762193174633,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: This study aimed to evaluate the impacts of various dental anomalies on the complexity of malocclusion. Methods: This retrospective cross-sectional study employed a case\u2013control design. The sample comprised 140 patients, 59 cases, and 81 controls. The Index of Complexity Outcome and Need (ICON) was used to calculate a score indicating the complexity of the malocclusion. According to the ICON score, the level of malocclusion complexity was classified into easy, mild, moderate, difficult, and very difficult. The cases were subdivided into three groups based on their dental anomaly type (number, shape, or eruption anomalies). A chi-square test was used to compare the distribution of cases and controls across the ICON levels (p &lt; 0.05). A t-test and an ANOVA with Tukey\u2019s post hoc test were used to evaluate the differences in the ICON scores among groups (p &lt; 0.05). Results: The mean values of the ICON score were 56.77 \u00b1 17.1 for the cases and 47.44 \u00b1 17.54 for the controls (p = 0.002). Most patients in the case group were within the highest three ICON levels, while most controls were in the lowest three (p = 0.022). Patients with eruption anomalies had a higher ICON score, compared to the controls and those in other dental anomaly groups (p = 0.001). Conclusions: The presence of dental anomalies increases the complexity of malocclusion. Eruption anomalies are more complex to resolve than number and shape anomalies, due to their impact on occlusion and aesthetics.<\/jats:p>","DOI":"10.3390\/dj13110506","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T17:32:01Z","timestamp":1762191121000},"page":"506","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Malocclusion Complexity in Patients with Dental Anomalies\u2014A Case\u2013Control Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Mar\u00eda Fernanda","family":"Romero-Noh","sequence":"first","affiliation":[{"name":"School of Dentistry, Autonomous University of Yucatan, M\u00e9rida 97000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3015-7928","authenticated-orcid":false,"given":"Jos\u00e9 Rub\u00e9n","family":"Herrera-Atoche","sequence":"additional","affiliation":[{"name":"School of Dentistry, Autonomous University of Yucatan, M\u00e9rida 97000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4221-9919","authenticated-orcid":false,"given":"Iv\u00e1n Daniel","family":"Z\u00fa\u00f1iga-Herrera","sequence":"additional","affiliation":[{"name":"School of Dentistry, Autonomous University of Yucatan, M\u00e9rida 97000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bertha Arelly","family":"Carrillo-\u00c1vila","sequence":"additional","affiliation":[{"name":"School of Dentistry, Autonomous University of Yucatan, M\u00e9rida 97000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V\u00edctor Manuel","family":"Mart\u00ednez-Aguilar","sequence":"additional","affiliation":[{"name":"School of Dentistry, Autonomous University of Yucatan, M\u00e9rida 97000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura Beatriz","family":"P\u00e9rez-Traconis","sequence":"additional","affiliation":[{"name":"School of Dentistry, Autonomous University of Yucatan, M\u00e9rida 97000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1002\/wdev.66","article-title":"Diseases of the tooth: The genetic and molecular basis of inherited anomalies affecting the dentition","volume":"2","author":"Cobourne","year":"2013","journal-title":"Wiley Interdiscip. Rev. Dev. Biol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.15644\/asc56\/1\/7","article-title":"Prevalence of Dental Anomalies in Orthodontic Patients","volume":"56","author":"Balija","year":"2022","journal-title":"Acta Stomatol. Croat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4103\/jos.jos_56_24","article-title":"The prevalence of dental anomalies among Saudi Population in Makkah, Saudi Arabia","volume":"13","author":"Mahjoub","year":"2024","journal-title":"J. Orthod. Sci."},{"key":"ref_4","first-page":"1","article-title":"Prevalence of dental anomalies in a Mexican population","volume":"3000","author":"Orellana","year":"2014","journal-title":"Dentistry"},{"key":"ref_5","first-page":"52","article-title":"Prevalence and distribution of dental anomalies in orthodontic patients","volume":"13","author":"Montasser","year":"2012","journal-title":"Orthodontics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"231","DOI":"10.2334\/josnusd.53.231","article-title":"Prevalence and distribution of selected developmental dental anomalies in an Indian population","volume":"53","author":"Gupta","year":"2011","journal-title":"J. Oral Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.ajodo.2007.03.030","article-title":"Prevalence of dental anomalies in various malocclusions","volume":"135","author":"Uslu","year":"2009","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.arcped.2018.07.002","article-title":"Prevalence of dental anomalies in French orthodontic patients: A retrospective study","volume":"25","author":"Baron","year":"2018","journal-title":"Arch. Pediatr."},{"key":"ref_9","first-page":"267","article-title":"A controlled study of associated dental anomalies","volume":"68","author":"Baccetti","year":"1998","journal-title":"Angle Orthod."},{"key":"ref_10","first-page":"e71547","article-title":"Comprehensive Management of an Impacted Maxillary Central Incisor: A Case Report","volume":"16","author":"Nangia","year":"2024","journal-title":"Cureus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/jerd.12302","article-title":"Prevalence of dental developmental anomalies of permanent teeth in children and their influence on esthetics","volume":"29","author":"Fekonja","year":"2017","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e8199","DOI":"10.1002\/ccr3.8199","article-title":"Surgical orthodontic intervention for impacted maxillary permanent central incisors: A case series","volume":"11","author":"Jha","year":"2023","journal-title":"Clin. Case Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100815","DOI":"10.1016\/j.identj.2025.03.024","article-title":"Unilateral Agenesis of the Upper Permanent Lateral Incisors in Growing Patients: Gap Closure or Gap Opening? A Systematic Review","volume":"75","author":"Dipalma","year":"2025","journal-title":"Int. Dent. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"324","DOI":"10.4041\/kjod21.280","article-title":"Common dental anomalies in Korean orthodontic patients: An update","volume":"52","author":"Ku","year":"2022","journal-title":"Korean J. Orthod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/ortho\/27.2.149","article-title":"The development of the Index of Complexity, Outcome and Need (ICON)","volume":"27","author":"Daniels","year":"2000","journal-title":"J. Orthod."},{"key":"ref_16","first-page":"266","article-title":"Genetic Variants of MSX1, PAX9, and AXIN2 in Mayan Probands with Dental Agenesis from Yucatan, Mexico","volume":"26","year":"2024","journal-title":"ODOVTOS Int. J. Dent. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kerekes-M\u00e1th\u00e9, B., M\u00e1rtha, K., B\u0103nescu, C., O\u2019Donnell, M.B., and Brook, A.H. (2023). Genetic and Morphological Variation in Hypodontia of Maxillary Lateral Incisors. Genes, 14.","DOI":"10.3390\/genes14010231"},{"key":"ref_18","first-page":"e327","article-title":"Incidence, severity and orthodontic treatment difficulty index of impacted canines in Saudi population","volume":"10","author":"Alhammadi","year":"2018","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S1301","DOI":"10.4103\/jpbs.jpbs_1921_24","article-title":"Prevalence and Etiological Distribution of Midline Diastema- An Institutional Study","volume":"17","author":"Modak","year":"2025","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_20","first-page":"4105713","article-title":"Orthodontic Intervention to Impacted and Transposed Lower Canines","volume":"2017","author":"Oktay","year":"2017","journal-title":"Case Rep. Dent."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"cjae046","DOI":"10.1093\/ejo\/cjae046","article-title":"Digital analyses of Bolton tooth size ratios and their association to gender, angle class, and other occlusal traits: A study using a partially automated digital 3D model analysis","volume":"46","author":"Vorloeper","year":"2024","journal-title":"Eur. J. Orthod."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Cai, J., Chen, S., Chen, L., Yang, X., Dai, X., Dai, Z., and Xu, L. (2024). Digital-assisted diagnosis and orthodontic management of an impacted mandibular lateral incisor: A case report. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04902-6"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1080\/00016357.2021.1918348","article-title":"Associations between Bolton ratio and overjet deviations in a Finnish adult population","volume":"79","author":"Turtinen","year":"2021","journal-title":"Acta Odontol. Scand."},{"key":"ref_24","first-page":"86","article-title":"Management of an adult patient with missing one mandibular incisor, severe overjet, and midline discrepancy with asymmetric extraction, lingual appliance, and skeletal anchorage: A case report","volume":"9","author":"Nguyen","year":"2020","journal-title":"J. World Fed. Orthod."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.3109\/00016357.2013.775336","article-title":"Overjet, overbite and dental midline shift as predictors of tooth size discrepancy in a Bangladeshi population and a graphical overview of global tooth size ratios","volume":"71","author":"Alam","year":"2013","journal-title":"Acta Odontol. Scand."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/jerd.12040","article-title":"Interdisciplinary treatment of a class III patient with congenitally absent maxillary lateral incisors","volume":"25","author":"Oliveira","year":"2013","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.ajodo.2006.09.052","article-title":"Treatment of a patient with Class II malocclusion, impacted maxillary canine with a dilacerated root, and peg-shaped lateral incisors","volume":"133","author":"Tausche","year":"2008","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Eid, F.Y., Elkalza, A.R., Madian, A.M., and Yacout, Y.M. (2025). Buccolingual and arch distribution patterns of permanent teeth impactions in an Egyptian population: A CBCT-based retrospective analysis. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-06955-7"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"cjaf058","DOI":"10.1093\/ejo\/cjaf058","article-title":"Bullying, cyberbullying, self-esteem, psychological distress and relationship with oral health related quality of life: A cross-sectional survey in adolescents","volume":"47","author":"Cinelli","year":"2025","journal-title":"Eur. J. Orthod."},{"key":"ref_30","first-page":"17","article-title":"Young adult patient with two palatally maxillary impacted canines and forced traction on rigid arches of stabilization","volume":"9","author":"Mucedero","year":"2016","journal-title":"Case Rep. Oral Implantol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Mallineni, S.K., Aldhuwayhi, S., Deeban, Y., Almutairi, K.S., Alhabrdi, S.N., Almidaj, M.A., Alrumi, B.A., Assalman, A.S., Joseph, A.M., and Thakare, A.A. (2024). Prevalence, Occurrence, and Characteristics of Supernumerary Teeth Among the Saudi Arabian Population Using Panoramic Radiographs. Diagnostics, 14.","DOI":"10.3390\/diagnostics14222542"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1093\/ejo\/19.1.71","article-title":"The effect of tooth agenesis on dentofacial structures","volume":"19","year":"1997","journal-title":"Eur. J. Orthod."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2319\/071917-482.1","article-title":"Dental anomalies in different growth and skeletal malocclusion patterns","volume":"88","author":"Luiz","year":"2018","journal-title":"Angle Orthod."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s40510-018-0220-6","article-title":"Early diagnosed impacted maxillary canines and the morphology of the maxilla: A three-dimensional study","volume":"19","author":"Cacciatore","year":"2018","journal-title":"Prog. Orthod."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Sokmen, T., Bagc\u0131, N., and Balos Tuncer, B. (2024). Buccolingual inclination of posterior dentition in maxillary impacted canine patients using quadrant analysis\u2014A cone-beam computed tomographic study. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04782-w"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.ajodo.2012.11.021","article-title":"Etiologic factors for buccal and palatal maxillary canine impaction: A perspective based on cone-beam computed tomography analyses","volume":"143","author":"Yan","year":"2013","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ceraulo, S., Barbarisi, A., Oliva, B., Moretti, S., Caccianiga, G., Lauritano, D., and Biagi, R. (2025). Treatment options in impacted maxillary canines: A literature review. Dent. J., 13.","DOI":"10.3390\/dj13090433"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1093\/ejo\/cjac073","article-title":"Maxillary dimensions and arch shape with palatally displaced canines","volume":"45","author":"Saade","year":"2023","journal-title":"Eur. J. Orthod."},{"key":"ref_39","first-page":"249","article-title":"The palatally displaced canine as a dental anomaly of genetic origin","volume":"64","author":"Peck","year":"1994","journal-title":"Angle Orthod."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"cjae051","DOI":"10.1093\/ejo\/cjae051","article-title":"Palatal canine impaction is associated with craniofacial shape in humans","volume":"46","author":"Athanasiou","year":"2024","journal-title":"Eur. J. Orthod."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.jds.2020.03.006","article-title":"Growth differences in patients with dental agenesis, how its location impacts facial morphology","volume":"15","year":"2020","journal-title":"J. Dent. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.ajodo.2019.10.015","article-title":"The congenitally missing second premolar: Space closure. A viable option","volume":"157","author":"Williams","year":"2020","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/j.1708-8240.2012.00520.x","article-title":"Clinical management of tooth size discrepancies","volume":"24","author":"Grauer","year":"2012","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Pinho, T., and Amaral, R. (2025). Transposed Maxillary Canines: Narrative Review with Clinical Case Report. Dent. J., 13.","DOI":"10.3390\/dj13060251"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.ajodo.2005.06.027","article-title":"Prevalence and distribution of dental anomalies in orthodontic patients","volume":"131","author":"Erdem","year":"2007","journal-title":"Am. J. Orthod. Dentofac. Orthop."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/11\/506\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T17:54:10Z","timestamp":1762192450000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/11\/506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,3]]},"references-count":45,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["dj13110506"],"URL":"https:\/\/doi.org\/10.3390\/dj13110506","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,3]]}}}