Odontology

https://doi.org/10.1007/s10266-020-00508-w

ORIGINAL ARTICLE

Size and bridging of the sella turcica in Japanese orthodontic patients

with tooth agenesis
Daisuke Sato1 · Toshiya Endo1

Received: 26 December 2019 / Accepted: 13 March 2020

© The Society of The Nippon Dental University 2020

Abstract
The purpose of this study was to investigate the association between the size and bridging of the sella turcica and tooth
agenesis, and whether the likelihood of second premolar agenesis can be predicted from the sella turcica size and bridging in
Japanese orthodontic patients. Patients were divided into four groups of 32: groups 1 and 2 consisted of patients with agenesis
of the maxillary and mandibular second premolars, respectively; group 3, patients with severe tooth agenesis; and group 4,
patients without tooth agenesis. Each group was divided into two subgroups of 16 each based on the patient’s age: patients
under 14 years of age (groups 1A through 4A, group A) and patients 14 years of age or older (groups 1B through 4B, group
B). Lateral cephalograms were used to evaluate the size and bridging of the sella turcica. The interclinoidal distance (ID)
was significantly shorter in groups 1 and 3 than in group 4, and in group 3 than in group 2. Group B exhibited significantly
greater depth, diameter, area, and perimeter of the sella turcica than group A. Groups 3 and 1B had a significantly higher
prevalence of sella turcica bridging than groups 4 and 4B, respectively. Maxillary second premolar agenesis and severe tooth
agenesis were associated with a reduced ID irrespective of age and increased occurrence of sella turcica bridging. The early
emergence in life of a short ID might be a predictor of possible second premolar agenesis in later life.

Keywords Sella turcica bridge · Interclinoidal distance · Severe tooth agenesis · Second premolar agenesis · Japanese
orthodontic patients

Introduction Williams syndrome [7] and Axenfeld-Rieger syndrome [8].

Others have shown that sella turcica morphology deviates
In orthodontics, the sella turcica is a significant anatomi- from normal in patients with lumbosacral myelomenin-
cal structure because the sella point, which is located at the gocele [9] and cleft lip and palate [10]. Still others have
midpoint of the sella turcica, is the most important land- demonstrated increased occurrence of sella turcica bridging
mark for cephalometric analysis [1, 2]. Sella turcica bridging in patients with dental anomalies, such as agenesis of the
is a morphological aberration of the sella turcica [3]. The mandibular second premolars [11, 12] and maxillary lateral
reported prevalence of sella turcica bridging varies widely incisors [12], dental transposition [13], and maxillary canine
from the lowest incidence of 3.9% in the Japanese population impaction [14]. Only one study has investigated not only the
to 39.74% in the Anatolian population [4]. occurrence of sella turcica bridging but also the association
Several studies have reported that altered sella turcica of sella turcica size with tooth agenesis [12]. Scribante et al.
morphology and sella turcica bridging appear in patients [12] reported no significant effect of mandibular second pre-
with some syndromes, such as Down syndrome [5, 6], molar and maxillary lateral incisor agenesis on the intercli-
noidal distance (ID) and sella turcica diameter and depth.
Becktor et al. [15] and Jones et al. [16] have suggested that
* Daisuke Sato more severe craniofacial deviations exhibit a higher occur-
d‑sato@ngt.ndu.ac.jp rence of sella turcica bridging, thus suggesting that the sever-
1
Department of Oral and Maxillofacial Growth ity of tooth agenesis may influence sella turcica morphology
and Development, Orthodontics and Dentofacial and bridging. For many clinicians, the timing for the accu-
Orthopedics, The Nippon Dental University Graduate School rate diagnosis of second premolar agenesis is a dilemma
of Life Dentistry At Niigata, 1‑8 Hamaura‑cho, Chuo‑ku, because the second premolars show the greatest variations in
Niigata 951‑8580, Japan

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mineralization and differentiation among all teeth [17]. Several under 14 years of age were included in groups 1A through
researchers have reported very late development of second pre- 3A, and those 14 years of age or older were categorized
molars [18–20]. Some studies have adopted the age threshold as groups 1B through 3B. The distribution of the patients
of 14 years for the diagnosis of second premolars agenesis in each group is shown in Table 1. The minimum number
to avoid the registration of late development of this tooth as of patients among the groups was 16 in group 1A. There-
agenesis [21–23]. If an association between the size and bridg- fore, 16 patients were randomly selected from each of the
ing of the sella turcica and second premolar agenesis is found other groups. Another 2867 patients (1016 males and 1851
in patients under 14 years of age, this information about the females) without tooth agenesis were retrospectively selected
sella turcica may be used to predict the likelihood of second from the orthodontic files and they were divided into 1023
premolar agenesis. patients (401 males and 622 females) under 14 years of age
No literature was found on the effects of the number and and 1844 patients (732 males and 1112 females) 14 years
pattern of congenitally missing teeth on the size and bridg- of age or older. Group 4 was a control group comprising 16
ing of the sella turcica in Japanese orthodontic patients pre- Japanese patients (8 males and 8 females) under 14 years
sumably because of the fact that a Japanese population was a of age selected from 1023 patients without tooth agenesis
low incidence of sella turcica bridging [4]. The aims of this (group 4A) and 16 Japanese patients (9 males and 7 males)
study were to investigate the association between the size and 14 years of age or older selected from 1844 patients with-
bridging of the sella turcica and tooth agenesis in Japanese out tooth agenesis (group 4B). Probability sampling using
orthodontic patients, and whether the likelihood of second the random numbers table was adopted to avoid selection
premolar agenesis can be predicted from the sella turcica size bias. Group A was constituted of groups 1A through 4A
and bridging. The null hypothesis tested was that the chosen and group B was composed of groups 1B through 4B. The
pattern of congenitally missing teeth would have no effect on selection criteria were: available panoramic radiographs and
the size and bridging of the sella turcica. lateral cephalograms, no developmental anomalies such as
craniofacial anomalies, and no history of orthodontic treat-
Materials and methods ment or trauma before visiting our hospital. In this study, the
samples were selected from the archives of the orthodontic
Sample patients, although this cohort was considered to be biased
because it did not represent the healthy population.
A total of 156 Japanese patients (59 males and 97 females) A post hoc power analysis was conducted to calculate the
with agenesis of second premolars or five or more teeth power of two-way analysis of variance (ANOVA) at an effect
(the agenesis group) were retrospectively selected from the size of 0.4 (Cohen’s large effect size), number of groups
orthodontic files of the Nippon Dental University Niigata of 8, degree of freedom 3, alpha error probability of 0.05,
Hospital (Niigata, Japan). Third molars were excluded from and a sample size of 128 [24]. The power was 0.97, which
this study. The patients with agenesis were divided into three suggested that the sample size was adequate for statistical
groups according to their tooth agenesis pattern as follows. comparisons.
Group 1 consisted of 34 patients (13 males and 21 females)
with bilateral (9 males and 13 females) and unilateral (4
males and 8 females) agenesis of the maxillary second pre- Tooth agenesis
molars and without agenesis of other teeth. Group 2 com-
prised 57 patients (24 males and 33 females) with bilateral Panoramic radiographs were used for diagnosis of tooth
(15 males and 15 females) and unilateral (9 males and 18 agenesis. A tooth was regarded as congenitally missing when
females) agenesis of the mandibular second premolars and no mineralization of the tooth crown was observed on the
without agenesis of other teeth. Group 3 was composed of panoramic radiographs and when there was no history of
43 patients (18 males and 25 females) with five or more this tooth being extracted. The panoramic radiographs of the
congenitally missing teeth (severe tooth agenesis). To deter- patients receiving their first orthodontic examination at the
mine the effect of age on the sella turcica size and bridging, age of 14 years and over were available for the diagnosis of
groups 1 through 3 were divided into two subgroups accord- tooth agenesis. Panoramic radiographs taken at the age of
ing to the patient’s age. In each groups, 1 through 3, patients 14 years and over were also available for patients receiving

Table 1  Number of patients in Group 1 Group 2 Group 3

each group
Group 1A Group 1B Group 2A Group 2B Group 3A Group 3B

Number of patients 16 18 34 23 17 26

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their first orthodontic examination under 14 years of age. cephalogram with tracing paper (Fig. 1). Six reference points
This critical age of 14 was adopted to avoid an inaccurate and measurements (five linear and one area) were used to
diagnosis of tooth agenesis due to late tooth mineralization evaluate the size of the sella turcica (Fig. 1). The STL (sella
in accordance with the precept that the upper age limit for turcica length), STDe (sella turcica depth), ID and STDi
agenesis of the third molars, which are the last permanent (sella turcica diameter) were measured with a digital caliper,
teeth to be mineralized, is 14 years of age [25]. and STA (sella turcica area) and STP (sella turcica perim-
eter) were measured with a computer system including an
Sella turcica size and bridging Image J analysis software program (version 1.51, National
Institutes of Health, Bethesda, Maryland, USA). The defini-
Lateral cephalograms for each patient were assessed by a tions of the measurements are in accordance with Jones et al.
single investigator (DS). All cephalograms were taken with [16] and Silverman [26].
the same cephalostat and with standardized settings. The The standard scoring scale was used to assess and quan-
contour of the pituitary fossa from the tip of the tubercu- tify the level of sella turcica bridging (calcification) [27].
lum sellae to the tip of the dorsum sellae and anterior and The degree of calcification ranged from class 1 to class 4:
posterior clinoid processes were manually drawn on each class 1, no calcification; class 2, less than half calcified; class
3, more than half calcified; and class 4, completely calcified.
Figure 2 shows typical X-ray images of classes 1 through 4.

Measurement error

To estimate measurement errors, a second measurement

was performed by the same investigator (DS) who randomly
selected 40 cephalograms 1 month after the first examina-
tion. Random errors, calculated in accordance with the Dahl-
berg formula [28], did not exceed ± 1.62 mm for the linear
measurements or ± 2.50 mm2 for the area measurement,
which were unlikely to invalidate the significant results in
this study. A paired t-test did not demonstrate any systematic
errors.
Fig. 1  Reference points and measurements used. TS indicates tuber-
culum sellae; DS dorsum sellae, STF sella turcica floor, PPF poste- Statistical analysis
rior inner wall of the pituitary fossa, ACP anterior clinoid process,
PCP posterior clinoid process; 1. STL (mm) sella turcica length, 2. Statistical analyses were performed using BellCurve for
STDe (mm) sella turcica depth, 3. ID (mm) interclinoidal distance, 4.
STDi (mm) sella turcica diameter, 5. STA ­(mm2) sella turcica area, 6. Excel software (version 2.12, SSRI Co, Ltd., Tokyo, Japan).
STP sella turcica perimeter (mm) The means and standard deviations were calculated for each

Fig. 2  Typical X-ray images of

sella turcica bridging in classes
1 through 4: 1 class 1 (no cal-
cification); 2 class 2 (less than
half calcified); 3 class 3 (more
than half calcified); 4 class 4
(completely calcified)

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measurement in each group. Two-way ANOVA and Tukey’s

test were used to test the main effects of the agenesis pat-

7 months ± 3 years
tern and the age on the sella turcica size and to identify
where differences occurred after confirming the normality

5 months
of the distribution and the homogeneity of the variance. The

Group 4B

18 years
Kruskal–Wallis, Steel–Dwass and Mann–Whitney U tests
were used to determine whether and where significant dif-
ferences in the distribution of sella turcica bridging occurred

9 months ± 2 years
between the groups. P values < 0.05 were regarded as statis-
tically significant.

10 months
Group 3B

17 years
Results

Table 2 shows the mean age of patients in each group. The

4 months ± 3 years
coefficients of variation of groups A and B were 17.1% and
17.0%, respectively. One-way ANOVA showed no signifi-

18 years 6 months ± 3 years 2 months

cant difference in the mean ages among groups 1A through

1 month
Group 2B

18 years
4A (p = 0.389, F = 1.021) or among groups 1B through 4B
(p = 0.545, F = 0.718).
Table 3 shows the means and standard deviations (SDs)

5 months ± 3 years
for all measurements in each group. Two-way ANOVA
showed no significant interaction between the two factors of
age and the agenesis pattern in each measurement (Table 4).

3 months
Group 1B
The ID was significantly shorter in groups 1 and 3 than in

Group B

19 years
group 4, and in group 3 than in group 2, and no significant
difference was observed between groups 2 and 4 (Table 4).
Group B exhibited significantly larger STDe, STDi, STA and

5 months ± 1 year
STP than group A (Table 4). No significant difference in the
STL was observed among groups 1 through 4 or between
groups A and B (Table 4).

9 months
Group 4A

As shown in Fig. 3, the Kruskal–Wallis and Steel–Dwass 10 years

tests showed significant differences in the distribution of the
degree of sella turcica bridging between groups 3A and 4A,
between groups 1B and 4B, and between groups 3B and 4B,
9 months ± 1 year

and no significant differences between groups 2A and 4A, or

Table 2  Mean age ± standard deviation of patients in each group

between groups 2B and 4B.

9 months
Group 3A

The Mann–Whitney U test showed no significant differ-

10 years

ence in the distribution of the degree of sella turcica bridg-

ing between groups A and B in each of groups 1 through 4
(Fig. 3).
5 months ± 1 year

Discussion
10 years 4 months ± 1 year 9 months

9 months
Group 2A

10 years

The null hypothesis, that pattern of congenitally missing

teeth would have no effect on the size and bridging of the
sella turcica was rejected. Our results showed that irrespec-
8 months ± 1 year

tive of age, patients with maxillary second premolar agen-

esis (group 1) and severe tooth agenesis (group 3) exhibited
10 months

significantly shorter IDs than those without tooth agenesis

Group 1A
Group A

9 years

(group 4). Reduced IDs in groups 1 and 3 were considered

to be due to sella turcica bridging, as evidenced by the fact

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Table 3  Mean ± standard deviation of linear and area measurements

Group 1 Group 2 Group 3 Group 4
Measurement Group 1A Group 1B Group 2A Group 2B Group 3A Group 3B Group 4A Group 4B

STL (mm) 11.23 ± 1.35 12.45 ± 2.04 13.41 ± 2.66 13.23 ± 2.23 12.51 ± 1.63 13.05 ± 2.82 12.00 ± 1.89 13.31 ± 2.19
STDe (mm) 7.72 ± 1.09 8.75 ± 1.22 7.20 ± 1.66 8.56 ± 1.29 7.44 ± 1.20 7.52 ± 1.34 7.53 ± 1.31 8.24 ± 1.27
ID (mm) 3.72 ± 1.70 4.26 ± 1.93 5.35 ± 2.15 4.88 ± 2.29 3.72 ± 2.04 3.23 ± 1.86 6.37 ± 1.68 6.33 ± 1.79
STDi (mm) 12.22 ± 2.45 13.61 ± 1.87 13.47 ± 2.19 13.69 ± 2.08 13.05 ± 1.42 13.56 ± 2.09 12.81 ± 1.26 14.24 ± 2.12
STA ­(mm2) 68.54 ± 18.24 83.65 ± 17.53 66.93 ± 19.02 84.31 ± 18.08 68.41 ± 11.45 75.96 ± 16.74 67.64 ± 13.50 82.14 ± 17.54
STP (mm) 36.37 ± 4.76 39.10 ± 3.51 37.11 ± 4.39 39.37 ± 4.50 36.18 ± 2.76 37.83 ± 4.27 35.97 ± 3.35 39.27 ± 4.74

Table 4  Results of two-way ANOVA and Tukey’s test for linear and area measurements
Measurement Source Sum of squares Degree of Mean square F value ANOVA p value Comparison
freedom

STL (mm) Age 16.849 1 16.849 3.640 NS

Agenesis pattern 35.947 3 11.982 2.588 NS
Interaction 11.537 3 3.846 0.831 NS
Error 555.490 120 4.629
STDe (mm) Age 20.161 1 20.161 11.792 0.000*** A < B***
Agenesis pattern 9.116 3 3.039 1.777 NS
Interaction 7.076 3 2.359 1.380 NS
Error 205.176 120 1.710
ID (mm) Age 0.423 1 0.423 0.112 NS
Agenesis pattern 157.071 3 52.357 13.915 0.000*** 1 < 4***,
3 < 4***,
3 < 2**
Interaction 5.657 3 1.886 0.501 NS
Error 451.506 120 3.763
STDi (mm) Age 25.294 1 25.294 6.511 0.012* A < B*
Agenesis pattern 8.827 3 2.942 0.757 NS
Interaction 9.141 3 3.047 0.784 NS
Error 466.141 120 3.885
STA ­(mm2) Age 5949.905 1 5949.905 21.349 0.000*** A < B***
Agenesis pattern 292.999 3 97.666 0.350 NS
Interaction 432.017 3 144.006 0.517 NS
Error 33443.693 120 278.697
STP (mm) Age 197.433 1 197.433 11.778 0.000*** A < B***
Agenesis pattern 24.667 3 8.222 0.491 NS
Interaction 11.750 3 3.917 0.234 NS
Error 2011.549 120 16.763

ANOVA analysis of variance, NS not significant

*p < 0.05; **p < 0.01; ***p < 0.001

that maxillary second premolar agenesis (group 1B) and with agenesis of specific teeth in some syndromes, such as
severe tooth agenesis (groups 3A and 3B) increased the Williams syndrome [7, 29], Axenfeld-Rieger syndrome [8]
prevalence of sella turcica bridging relative to the controls and Down syndrome [6, 30, 31]. In these syndromes, the
(groups 4A and 4B) in this study. Association of the tooth most frequently missing teeth were the maxillary and man-
agenesis patterns of groups 1 and 3 with the size and bridg- dibular second premolars, as investigated in this study, and
ing of the sella turcica has not been studied. These results lateral incisors [8, 29–31]. Moreover, patients with these
of ours might be supported by several researchers, who syndromes had five or more missing permanent teeth [8,
suggested that sella turcica bridging occurred concurrently 29–31], which was defined as severe tooth agenesis in this

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Fig. 3  Distribution of the

degree of sella turcica bridging
and statistical comparisons.
*p < 0.05; **p < 0.01

study. Therefore, agenesis of maxillary second premolars In this study, regardless of age, there was no significant
and severe tooth agenesis might be associated with sella tur- difference in the ID or the prevalence of sella turcica bridg-
cica bridging, as evidenced by this study. ing between patients with agenesis of mandibular second
Some studies have reported that tooth agenesis shares premolar (group 2) and those without tooth agenesis (group
a common genetic origin with maxillary canine impaction 4) in the Japanese population. Part of these results might be
[32] and dental transposition [33, 34], which are related to supported by Scribate et al. [12] who showed that patients
sella turcica bridging [13, 14]. Neural crest cells are involved with agenesis of maxillary lateral incisors or mandibular
in the development and formation both of the anterior and second premolars exhibited no significant differences in
intermediate lobes of the pituitary and the teeth [35–37]. the ID, compared with the controls. Contrary to our results,
From a genetic point of view, tooth agenesis may well be previous studies have indicated that agenesis of mandibular
related to sella turcica bridging. second premolars increases the occurrence of sella turcica
Several studies have performed the diagnosis of second bridging in the Italian populations [11, 12]. This discrepancy
premolar agenesis at the age of 14 and over because of pos- in the occurrence of sella turcica bridging between their
sible late development [21–23]. This study demonstrated results and ours was considered to be due to the difference in
that in patients with maxillary second premolar agenesis the populations examined. This consideration was based on
and severe tooth agenesis, reduced IDs could be observed the findings by Peker et al. [4], who reported that the preva-
in patients under 14 years of age. Hence, the ID might act as lence of sella turcica bridging varies greatly in the different
a useful diagnostic predictor of these tooth agenesis patterns, populations, and the Japanese population was found to be the
and could potentially improve early diagnosis of congeni- lowest prevalence with 3.9% in males and 6.0% in females.
tally missing teeth. Irrespective of the presence or absence of congenitally
In this study, regardless of age, patients with severe tooth missing teeth, patients 14 years of age or older (group B)
agenesis (group 3) exhibited a significantly shorter ID than exhibited significantly larger values for STDe, STDi, STA,
those with mandibular second premolar agenesis (group 2). and STP than those under 14 years of age (group A). These
Becktor et al. [15] reported that a clear tendency towards results are supported by previous studies that demonstrated
a greater occurrence of sella turcica bridging was noted in increases in STDe [3, 38–40], STDi [3, 38, 40, 41] and STA
patients with severe craniofacial deviations. Jones et al. [16] [39, 42] with aging. Apposition of bone at the turberculum
showed that the occurrence of sella turcica bridging was sig- sellae and resorption at the posterior boundary of the sella
nificantly higher in patients undergoing surgical orthodontic turcica were observed up to the age of 16–18 [43, 44]. It
treatment than in those undergoing orthodontic treatment. might be expected that STDe, STDi, STA and STP increased
These findings suggest that the ID was reduced with increas- due to normal development and growth of the sella turcica.
ing craniofacial deviation severity, which supports our find- In summary, subjects with maxillary second premolar
ing that the larger the number of missing teeth, the shorter agenesis and severe tooth agenesis exhibited reduced IDs
was the ID. Moreover, all 32 patients with severe tooth agen- irrespective of age, and an increased occurrence of sella tur-
esis (group 3) had one or two congenitally missing maxillary cica bridging. The early emergence in the life of a short ID
second premolars. It might be speculated that besides a large might be a predictor of possible second premolar agenesis
number of missing teeth, agenesis of the maxillary second in later life.
premolars caused the short ID in group 3.

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Acknowledgement This study was approved by the Research Ethics 19. Sabri R. Management of over-retained mandibular deciduous second
Committee of the Nippon Dental University School of Life Dentistry molars with and without permanent successors. World J Orthod.
at Niigata (Approval No. ECNG-R-329). 2008;9:209–20.
20. Bicakci AA, Doruk C, Babacan H. Late development of a mandibu-
lar second premolar. Korean J Orthod. 2012;42:94–8.
Compliance with ethical standards 21. Garib DG, Peck S, Gomes SC. Increased occurrence of dental
anomalies associated with second-premolar agenesis. Angle Orthod.
Conflict of interest The authors declare that they have no conflict of 2009;79:436–41.
interest. 22. Ota S, Hirakata C, Endo T. Prevalence and patterns of tooth agenesis
among malocclusion classes in a Japanese orthodontic population. J
References Oral Sci. 2019;61:504–7.
23. Kabasawa Y, Seto-Sugiki Y, Endo T. Maxillary sinus size and pos-
terior tooth inclination in Japanese orthodontic patients with agen-
1. Meyer-Marcotty P, Reuther T, Stellzig-Eisenhauer A. Bridging
esis of maxillary second premolars. Odontology. 2019. https​://doi.
of the sella turcica in skeletal Class III subjects. Eur J Orthod.
org/10.1007/s1026​6-019-00462​-2.
2010;32:148–53.
24. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible
2. Kjaer I. Sella turcica morphology and the pituitary gland-a new
statistical power analysis program for the social, behavioral, and
contribution to craniofacial diagnostics based on histology and neu-
biomedical sciences. Behav Res Methods. 2007;39:175–91.
roradiology. Eur J Orthod. 2015;37:28–36.
25. Gaun SM, Lewis AB. The relationship between third molar agenesis
3. Axelsson S, Storhaug K, Kjaer I. Post-natal size and morphol-
and reduction in tooth number. Angle Orthod. 1962;32:14–8.
ogy of the sella turcica. Longitudinal cephalometric standards
26. Silverman FN. Roentgen standards for size of the pituitary fossa
for Norwegians between 6 and 21 years of age. Eur J Orthod.
from infancy through adolescence. Am J Roentgenol Radium Ther
2004;26:597–604.
Nucl Med. 1957;78:451–60.
4. Peker T, Anil A, Gülekon N, Turgut HB, Pelin C, Karaköse M. The
27. Cederberg RA, Benson BW, Nunn M, English JD. Calcification
incidence and types of sella and sphenopetrous bridges. Neurosurg
of the interclinoid and petroclinoid ligaments of sella turcica:
Rev. 2006;29:219–23.
a radiographic study of the prevalence. Orthod Craniofac Res.
5. Russell BG, Kjaer I. Postnatal structure of the sella turcica in Down
2003;6:227–32.
syndrome. Am J Med Genet. 1999;87:183–8.
28. Dahlberg G. Statistical methods for medical and biological students.
6. Korayem M, AlKofide E. Size and shape of the sella turcica in sub-
New York: Interscience Publications; 1940.
jects with Down syndrome. Orthod Craniofac Res. 2015;18:43–50.
29. Ferreira SB, Viana MM, Maia NG, Leão LL, Machado RA, Coletta
7. Axelsson S, Storhaug K, Kjaer I. Post-natal size and morphol-
RD, de Aguiar MJ, Martelli-Júnior H. Oral findings in Williams-
ogy of the sella turcica in Williams syndrome. Eur J Orthod.
Beuren syndrome. Med Oral Patol Oral Cir Bucal. 2018;23:e1–e6.
2004;26:613–21.
30. Kumasaka S, Miyagi A, Sakai N, Shindo J, Kashima I. Oligodontia:
8. Meyer-Marcotty P, Weisschuh N, Dressler P, Hartmann J, Stell-
a radiographic comparison of subjects with Down syndrome and
zig-Eisenhauer A. Morphology of the sella turcica in Axenfeld-
normal subjects. Spec Care Dentist. 1997;17:137–41.
Rieger syndrome with PITX2 mutation. J Oral Pathol Med.
31. Palaska PK, Antonarakis GS. Prevalence and patterns of permanent
2008;37:504–10.
tooth agenesis in individuals with Down syndrome: a meta-analysis.
9. Kjaer I, Wagner A, Madsen P, Blichfeldt S, Rasmussen K, Russell
Eur J Oral Sci. 2016;124:317–28.
B. The sella turcica in children with lumbosacral myelomeningocele.
32. Baccetti T. A controlled study of associated dental anomalies. Angle
Eur J Orthod. 1998;20:443–8.
Orthod. 1998;68:267–74.
10. Nielsen BW, Mølsted K, Kjaer I. Maxillary and sella turcica mor-
33. Shapira Y, Kuftinec MM. Maxillary tooth transpositions: charac-
phology in newborns with cleft lip and palate. Cleft Palate Craniofac
teristic features and accompanying dental anomalies. Am J Orthod
J. 2005;42:610–7.
Dentofacial Orthop. 2001;119:127–34.
11. Leonardi R, Barbato E, Vichi M, Caltabiano M. A sella tur-
34. Ely NJ, Sherriff M, Cobourne MT. Dental transposition as a disorder
cica bridge in subjects with dental anomalies. Eur J Orthod.
of genetic origin. Eur J Orthod. 2006;28:145–51.
2006;28:580–5.
35. Sharpe PT. Neural crest and tooth morphogenesis. Adv Dent Res.
12. Scribante A, Sfondrini MF, Cassani M, Fraticelli D, Beccari S,
2001;15:4–7.
Gandini P. Sella turcica bridging and dental anomalies: is there an
36. Soukup V, Epperlein HH, Horácek I, Cerny R. Dual epithelial origin
association? Int J Paediatr Dent. 2017;27:568–73.
of vertebrate oral teeth. Nature. 2008;455:795–8.
13. Leonardi R, Farella M, Cobourne MT. An association between
37. Bancalari RE, Gregory LC, McCabe MJ, Dattani MT. Pituitary
sella turcica bridging and dental transposition. Eur J Orthod.
gland development: an update. Endocr Dev. 2012;23:1–15.
2011;33:461–5.
38. Alkofide EA. The shape and size of the sella turcica in skel-
14. Ali B, Shaikh A, Fida M. Association between sella turcica bridg-
etal Class I, Class II, and Class III Saudi subjects. Eur J Orthod.
ing and palatal canine impaction. Am J Orthod Dentofacial Orthop.
2007;29:457–63.
2014;146:437–41.
39. Andredaki M, Koumantanou A, Dorotheou D, Halazonetis DJ. A
15. Becktor JP, Einersen S, Kjaer I. A sella turcica bridge in subjects
cephalometric morphometric study of the sella turcica. Eur J Orthod.
with severe craniofacial deviations. Eur J Orthod. 2000;22:69–74.
2007;29:449–56.
16. Jones RM, Faqir A, Millett DT, Moos KF, McHugh S. Bridging and
40. Chaitanya B, Pai KM, Chhaparwal Y. Evaluation of the effect of age,
dimensions of sella turcica in subjects treated by surgical-orthodon-
gender, and skeletal class on the dimensions of sella turcica using
tic means or orthodontics only. Angle Orthod. 2005;75:714–8.
lateral cephalogram. Contemp Clin Dent. 2018;9:195–9.
17. Fass EN. Aberrant second premolars. ASDC J Dent Child.
41. Valizadeh S, Shahbeig S, Mohseni S, Azimi F, Bakhshandeh H.
1970;37:494–8.
Correlation of shape and size of sella turcica with the type of facial
18. Aasheim B, Ögaard B. Hypodontia in 9-year-old Norwegians
skeletal class in an Iranian group. Iran J Radiol. 2015;12:e16059.
related to need of orthodontic treatment. Scand J Dent Res.
42. Cesur E, Altug AT, Toygar-Memikoglu U, Gumru-Celikel D,
1993;101:256–60.
Tagrikulu B, Erbay E. Assessment of sella turcica area and skeletal

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 Odontology

maturation patterns of children with unilateral cleft lip and palate. Publisher’s Note Springer Nature remains neutral with regard to
Orthod Craniofac Res. 2018;21:78–83. jurisdictional claims in published maps and institutional affiliations.
43. Björk A. Cranial base development. Am J Orthod. 1955;41:198–225.
44. Melsen B. The cranial base. The postnatal development of the
cranial base studied historically on human autopsy material. Acta
Odontol Scand. 1974;32:57–71.

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