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VARIJACIJE U bROJU KVRŽICA DONJIH pRVIH I DRUGIH MOLARA M1 I M2

VARIATION IN THE NUMBER OF CUSPS OF LOWER FIRST AND SECOND MOLARS M1 AND M2

Mirjana Burić1, Ljiljana Tijanić2, Vesna Rusić-Tasić1

1klinika za stOMatOlOGiju- Odelenje za OrtOdOnCiju , 2 uniVerzitet u niŠu- MediCinski Fakultet, niŠ, srbija

1CliniC OF dentistrY-dePartMent OF OrthOdOntiCs, 2 uniVersitY OF nis-FaCultY OF MediCine, nis, serbia

ActaStomatologicaNaissi Jun/June2011,vol.27,br./num.63str./p1059-1066

Apstrakt

Cilj Ispitati postojanje varijabilnosti u broju osnovnih kvržica donjih prvih i drugih molara M1 i M2. Materijal i metode Ispitivanje je obavljeno na studijskim modelima 400 ortodontskih pacijenata ( 164 osoba muškog pola i 236 osoba ženskog pola ).Rezultati Utvrđeno je da donji M1 u grupi molara najmanje podleže redukciji, tako da najveći broj pacijenata u okviru polnih grupa ( 75,61% dečaka i 66,95% devojčica ) ima prisustvo svih pet osnovnih kvržica tip M1-5. Tip M1-4, gde postoji potpuno odsustvo Hld- hipoko-nulida ima 21,35% dečaka i 32,63% devojčica. Prisustvo šeste kvržice je nadjeno kod 3,05% dečaka i 0,42% devojčica. Tip M2-4 dominira kod oba pola ( 86,59% dečaka i 91,1% devojčica), dok je tip M2-5 nadjen u mnogo manjem procentu (13,41% dečaka i 8,9% devojčica ). Zaključak Ispitanici našeg uzorka odlikuju se visokim procentom prisustva M1 sa pet kvržica (70,5%) i M2 sa 4 kvržice (89,25%). Ut-vrdjeno je i potpuno odsustvo samo distovestibularne kvržice –hipo-konulida.

Ključne reči: broj kvržica, varijacije, prvi molar, drugi molar

UvodZubi su po svom sastavu najotporniji el-

ementiljudskogorganizma,izbogtogaveomavažniu razumevanju tokaevolucije1.Njihovamorfološkastrukturaprilagodjenajevrstikon-zumiranehranepasamimtimpodložnaprome-namaieventualnojredukciji.Redukcijakvržicaodvijasesa5kvržicana3kvržiceitonadonjimmolarimaovimredom: hipokonulid,entoko-nidihipokonidtj.,nadistalnomdeluzuba2.Tajdeo,jemladjideozubaodmezijalnog.Donji

Abstract

Aim: To find the existence of variability in the number of primary cusps of the lower first and second molars M1 and M2.Materials and methods The study was conducted on the models of 400 orthodontic patients (164 males and 236 females),.Results It was found that the lower molars M1 in the group is least sub-ject to reduction so that the majority of patients within gender groups (75.61% boys and 66.95% girls), have the presence of all five basic cusps type M1-5. Type M1-4, where there is complete absence of hypo-conulid has 21.35% 32.63% boys and girls. The presence of the sixth cusp is found at 3.05% and 0.42% of boys of girls. Type M2-4 domi-nated in both sexes (86.59% boys and 91.1% girls), while type M2-5 found in much smaller percentage (13.41% boys and 8.9% girls).Conclusion The subjects of our sample are characterized by a high percentage of the presence of M1 with five cusps (70.5%) and M2 with 4 cusps (89.25%). It has been established the total absence of only dis-tovestibular cusp-hypoconulid.

Key words: cusps number, variation, fists molar, second molar

IntroductionTeetharethemostresistantelementsofthe

human body, and therefore very important inunderstandingofthehumanevolution1.Theirmorphologyisadaptedtothetypeoffoodcon-sumedandthereforesubjecttochangeandthepossible reduction. Reduction of cusp occursoutfrom5cuspsto3cuspsandonthelowermolars in this order: hypoconulid, eutoconidandhypoconidthereforethedistalpartofteeth2.It is a younger part of themedial tooth. The

KLINIČKI RADCLINICAL ARTICLE

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molarirazlikujusepooblikukruneodgornjihmolara iuglavnomsučetvorougaonogoblika.Postoji4tipabrojakvržica:6,5,4,3.Medjunji-manajvećapažnjaseposvećuje6.i4.kvržičnojformi(M1-6iM1-4)naprvommolaru(M1)i4.kvržičnojnadrugommolaru(M2),štosevidinareprezentativnimmodelimapacijentata(slika.1)

Cilj ovog rada je bio istražiti postojanjevarijabilnosti ubrojuosnovnihkvržicadonjihprvihidrugihmolaraM1iM2.

Materijal i metode Ispitivanjejeobavljenonastudijskimmode-

lima 400 ortodontskih pacijenata (164 osobamuškogpolai236osobaženskogpola)KlinikezastomatologijuuNišu,kojisuimaliprisutneM1iM2,koristećilatinskenazivekvržica..Naoralnojstraninalazesedvekvržice:mezijalna–metakonid i distalna– entokonid, a naves-

lowermolarsdifferintheformofthecrownoftheuppermolarsandgenerallyasquareshape.There are 4 types of cusps: 6,5,4,3. Amongthemthemostattentionisgiventothesixthandfourcuspsforms(M1andM1-6-4)onthefirstmolar(M1)andfourcuspsonthesecondmolar(M2),asshownonrepresentativepatient’splas-termodels(Fig.1).

TheaimofthisstudywastoinvestigatetheexistenceofvariabilityinthenumberofbasiccuspsoffirstandsecondlowermolarsM1andM2.

Materials and methodsTheresearchwasdoneontheplastermod-

elsof400orthodonticpatients(164malesand236females)oftheDentalClinicofNis,whohadpresentM1andM2,usingtheLatinnamesofcupsaccordingtoCopeandtheOsborn4.Ontheoralsidetherearetwocusps:mesial-meta-

a)

c)

b)

Slika 1. Donji prvi molar: a) sa 6 kvržica (tip M1-6); b) sa 4 kvržice (tip M1-4 i M2-4) i c) sa 4 kvržice (tip M1-5 i M2-4)Figure 1. Lower first molar: a) with 6 cusps (type M1-6); with 4 cusps (type M1-4 and M2-4) and c) with 4 cusps (type M1-5 and M2-4)

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tibularnojstrani:mezijalno-protokonid,za-timhipokonid,adistalnohipokonulid.Oralno,izmedju dve kvržice javlja se prakvržica kodnekih rasa (američkih Crnaca ) koju Selenkanaziva„tuberkulumaccesoriummediuminte-rior3„.KorišćenaješemakvržicapoCope-uiOsborn–u4.(slika.2).

Rezultati

Procentualna zastupljenost broja kvržicana donjem M1, prikazana je na grafikonu 1.Dobijeni rezultati pokazuju da kod oba poladominiraju prvi molari sa 5 kvržica 70,5% istatističkiihjevišenozubasa4(28%)ili6(1,5%)kvržica(p<0,001).Kodženskogpolaje statistički značajno veći broj prvih molarasa 4 kvržice (32,63%) nego kod muškaraca(21,35%) (p<0,05 ). Donji prvi molari sa 5kvržicaprisutnisukodženskogpolau66,95%slučajeva,dokkodmuškaracauvećemprocen-tu75,61%.

Utvrđenojeipostojanjedonjegprvogmo-larasa5kvržica(slika.3).

Utvrđeno je postojanje, kod ženskogpola,statistički (32,63%) ,značajnovećibrojprvihmolarasa4kvržice(sl.4).

TipM1-6jebioveomaredak(1,5%)kodnašihpacijenata,ičešćikoddečaka3,05%negokoddevojčica0,42%(slika5).

Procentualna zastupljenost broja kvržicana donjem drugom molaru (M2)-, prikaza-na je grafikonom2.Kod oba pola nadjeno jestatističkiznačajnovišedonjihdrugihmolarasa

conidanddistal-entoconid,andonthevestib-ularside:mesial-protoconid,thenhypoconidand distal hypoconulid. Orally, between twocuspsappeareprecuspsinsomeraces(AfricanAmericans),describedbySelenkaandnamed“tuberculumaccesoriuminteriormedium3”.WeusedaschemeofcupsaccordingtoCopeandOsborn-in4.(Fig.2).

ResultsPercentage of the number of nodules on

thelowerM1,isshownonchart1.Theresultsshowthatinbothsexesisdominatedbythefirstmolarswithfivecusps,and70.5%werestatisti-callynomore teethwith4(28%)or6(1.5%)nodules(p<0.001).Femaleshaveasignificant-lyhighernumberoffirstmolarswith4cusps(32.63%) than men (21.35%) (p <0.05). Thelower firstmolarswith five cusps are presentinfemalesat66.95%,while inmenthere isagreaterpercentageof75.61%.

Slika 2. Šema kvržica po Cope-u i Osborn-u3

Figure 2. Scheme of cusps according to Cope and Osborn

Grafikon 1. Procentualna zastupljenost broja kvržica na donjem M1

Chart 1. Schematic summary of results. A diagram shows percentage of number of cusps of the lower M1

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4-89,25%nosa5kvržica10,75%(p<0,001).Madajeneštovećiprocenatzubasa4kvržicekodženskogpola91,1%,nasprammuškogpola86,59%inisuutvrdjenestatističkiznačajneraz-likeizmedjupolovaubrojudonjegdrugogmo-larasa4,odnosno5kvržica.

Utvrđeno je da TipM2 -4- dominira kodobapola(sl.6).

M2-5tip-jeunašojstudijidijagnostikovanu10,75%ispitanika(sl.7).

Frekvencija redukcije hipokonulida kodM1iM2prikazanajenagrafikonu3.Statistčkije značajno veći broj donjih prvih molarasa redukcijom hipokonulida kod ženskog(32,63%) u odnosu na muški (21,35%) pol(p<0,05).Kodženskogpolajevećaredukcijahipokonulidaikoddonjihdrugihmolara,alineistatističkiveća.

Itwasdeterminedtheexistenceofthelowerfirstmolarwithfivecusps(Fig.3).

There existed, females, statistically(32.63%),with significantlymorefirstmolarswith4cusps(Fig.4).

TypeM1-6wasveryrare(1.5%)inourpa-tients,andmorecommoninboys3.05%thaninfemales0.42%(Fig.5).

Chart2showspercentageofthenumberofcuspsonthelowersecondmolar(M2)inbothsexes;it isfoundsignificantlymorelowersec-ondmolarwith4cusps-89.25%thanwith5cusps10.75%(p<0.001).Althoughasomewhathigherpercentageofteethwithfourcuspswasinfemales91.1%,versus86.59%ofmalesub-jects,andtherewerenostatisticallysignificantdifferencesbetweenthesexesinthenumberoflowersecondmolarwith4or5cusps.

ItwasfoundthatTypeM2-4-dominatedinbothsexes(Fig.6).

M2-5-type in our study was diagnosed in10.75%oftherespondents(Fig.7).

Frequency reduction of hypoconulida inM1andM2isshowninchart3.Statistically,therewassignificantlygreaternumberoflower

Slika 3. Donji prvi molar sa 5 kvržica (tip M1-5)Figure 3. Lower first molar with 5 cusps (M1-5)

Slika 4. Donji prvi molar sa 4 kvržice (tip M1-4)Picture 4. Lower first molar with 4 cusps (type M1-4)

Slika 5. Donji prvi molar sa 6 kvržica (tip M1-6)Picture 5. Lower first molar with 6 cusps (typ M1-6)

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Diskusija

NašinalazisunajbližinalazimaKallay-a3 od 72,6%iTijanić5 od72,52%zatipM1-5.Isma-guloviSihimbaeva6suutvrdilinastanovništvuKazahstana da imaju veći procenat (83,5%) ,sa slabo izraženim polnim razlikama.Kallay3 jenašaoizraženijepolnerazlikekoddevojčicaivećutendencijukanormalnomM1-5,doksudečaciimalitendencijukaM1-6.Naruskomstanovništvujezabeležennalazod66,4%,doknaukrainskomjevišiprocenatovihanomalijaanaMongolimaznatnomanji54,1%.

UtvrđenojeuovojstudijipostojanjeM1-5tipa, što jekarakteristično i zaameričke Indi-jance koji u u 100% imajuM1- 5 tip, zatimaustralijske urodjenike , kao i Kineze. Visok

firstmolars hypoconulida reduction in female(32.63%) than in malegender (21.35%) (p<0.05). Females have greater reduction hypo-conulida and the lower secondmolar, but notstatisticallysignificant.

DiscussionOurfindings are closest to the findings of

Kallay3 andTijanić5 ,who founds72.6%and72.52%respectivelyofthetypeM1-5.Isma-gulov and Sihimbaeva6 found in the popula-tionofKazakhstantohaveahigherpercentage(83.5%),butwithpoorlymarkedgenderdiffer-ences.Kallay3foundpronouncedgenderdiffer-encesingirlsandagreatertendencyfornormalM1-5, while boys tended toM1-6. The Rus-sianpopulationwasrecordedfindingof66.4%,whiletheUkrainianhigherpercentageoftheseanomaliesincomparisontoMongolswiththemuchlowerpercentagebeing54.1%.

Itwas found in thisstudy theexistenceofM1-5 type,which is typical forAmerican In-dianswhohaveuu100%M1-5type, thenthe

Grafikon 2. Procentualna zastupljenost broja kvržica na donjem M2

Chart 2. Schematic summary of results. A diagram shows per-centage percentage of number of cusps of the lower M2

Grafikon 3. Frekvencija redukcije hipokonulida kod M1 i M2 Chart 3. Schematic summary of results. A diagram shows

reduction frequency of hypoconulid at M1 and M2

Slika 6. Donji drugi molar sa 4 kvržice (tip M2-4)Picture 6. Lower second molar with 4 cusps (type M2-4)

Slika 7. Donji drugi molar sa 5 kvržica (tip M2-5)Picture 7. Lower second molar with 5 cusps (type M2-5)

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procenatM1- 5 tipa imaju i crnci izAfrike u99%,Eskimiu97%,američkebeleženeu87%idrevniEvropljaniu83%.

Uporedjujućinašnalazprvihdonjihmolarasa4kvržiceTipM1-4 (28%), zaključili smoda se dosta razlikuje od nalaza raznih autora,odpotpunogodsustvaovog tipa:kodMongo-la ikodKirgizasvega1,4%.Crnci(AfrikeiAmerike)1%.Ismagulov6(1989)nalazjeutvr-diotakodjenizak,svega2,3%,Kallay3(1974)16,45% , M. de Terra7 11,6 %, Jonge 18%,Minkov8 ( 2006) na bugarskom stanovništvu7% -23%,.Najbliže našimnalazima su rezul-tatiistraživanjaTijanić4(2008)26,69%,.KodRusaiUkrainacasvega10,8%i10,5%.

TipM1-6jebioveomaredak(1,5%)kodnašihpacijenata,ičešćikoddečaka3,05%negokoddevojčica0,42%.DrugiautorikaoštosuTijanić5 i Minkov8 su utvrdili procenat od d0,5-2%.Kallay3 jenašaoneštoviši procenat5,08%,Ismagulov613,8%kaoiZubov911,3%kodKirgiza,dokjekodMongoladostavisok45,9%.

Najbliži našem istraživanju su rezultatikodRusaiUkrainaca6.VišinalazimaTijanić5 95,96% ,dok Ismagulov7(1989)navodimanjiprocenat 65,8% kao i Zubov9 na Kirgizima61%ikodMongolasvega5,6%.PoMinkovu6 , 4kvržiceima79%do94%ispitanika.

M2-5tip-M.deTerra7sa9,35%imavrloblizaknalaznašem(10,75%)Vaščaeva(1977)iSegeda(1979)15,5%iLenhossek16,6%.Is-magulov6jenašaodostavišiprocenat(31,5%)kaoiZubov9kodKirgizajakovisok61%.

Redukcija kvržica odvija se na donjimmolarima ovim redom : hipokonulid, entoko-nid, hipokonid, svi na talonidu , odnosno nadistalnom delu zuba.U našem uzorku nadjenje samo nedostatak hipokonulida. Na donjemprvommolaru u 28% slučajeva, a na donjemdrugommolaruu89,25%.KodbelihmuškaracaAmerike nadjen je vrlo visok procenat 99% ,drevnih Evropljana 86%, azijskih Mongola iameričkih Indijanaca 69,0%, Eskima 57,0% iaustralijskihurodjenika52,0%.

Rezultatiuovojstudijisuomogućilidaseustanovi povećanje broja kvržica u zavisnostiodtipamolara.Pitanjekojesenamećejedalipostojiipovećanjedebljinegleđiuodnosunatipmolara10,štoćebititemadaljihistraživanja.

Australian natives, and Chinese. A high per-centageofM1-5 typesareblacks fromAfricaand 99%, 97% in Eskimos, American whitewomenand87%ofancientEuropeansin83%.

Comparing our findings of the first low-ermolarswith 4 cusps typeM1-4 (28%),wefoundtobequitedifferentfromthefindingsofvarious authors, the complete absence of thistype:theMongolianandKirgizofonly1.4%.Blacks (African andAmerican) 1% . Ismagu-lov6alsofoundlow,only2.3%,Kallay3found16.45%,deTerra811,6%Minkov8intheBul-garianpopulation found 7%-23%, .Closestto our findings is the results of Tijanić4 whofound 26.69%. In the population of RussianandUkrainanitwasonly10.8%and10.5%.

TypeM1-6wasveryrare(1.5%)inourpa-tients,andmorecommon inboys than3.05%0.42%ingirls.OtherauthorssuchasTijanić5 , andMinkov8andfoundthepercentageofd0.5-2%.Kallay3 found a slightly higher percent-age of 5.08%, Ismagulov6 13.8% and 11.3%inKirgiz,whiletheMongolshaveratherhighpercentage45.9%.

Other results6which are closest toour re-searchresultswith85.6%and85.51%withinthe Russians and Ukrainaca. Higher findingshadTijanić595.96%,whileIsmagulov6givealowerpercentageof65.8%andZubov2 foundto Kyrgyzstan 61% and the Mongols only5.6%.ByMinkovu7,4cuspsarepresentat79%to94%.

M2-5-typeisfoundbyM.deTerra7inper-centof9.35%whichisveryclosetoourfind-ings(10.75%).Ismagulov6foundamuchhigh-erpercentage(31.5%) in theKirgizveryhigh61%. Reduction of cusp occurs on the lowermolars in this order: hypoconulid, entoconid,hipoconid, all on the talonidu i.e., the distalpartofthetooth.Inoursamplewefindonlyalackofhypoconulidonthelowerfirstmolarin28%ofcases,andthesecondmolarto89.25%.WhiteAmerican,wefoundaveryhighpercent-ageof99%,86%ofancientEuropeans,AsianMongols andNativeAmerican 69.0%, 57.0%ofEskimosandAustraliannatives52.0%.

The results in this study allowed to deter-minethe increase in thenumberofcusps,de-pendingonthetypeofmolar.Thequestionthatarises is whether there is increased thicknessof enamel in relation to the type ofmolars10, whichwillbe thesubjectoffurther investiga-tions.

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ZaključakU ovoj studiji dobijeni su podaci koji

nameću sledeći zaključak:1. Ispitanici našeg uzorka odlikuju se vi-

sokimprocentomprisustvaM1sapetkvržica(70,5%)iM2sa4kvržice(89,25%).

2. Prvi molar kod 28% ispitanika ima 4kvržiceisvegakod1,5%njih6kvržica.

3. Drugimolar samokod10,75% ima5kvržica.

4. Postoji prednostdevojčicakodM1-4 iM24tipadabizatimkodM1-5,M1-6iM2-5prešlanastranudečaka.

5. Utvrdjeno je potpuno odsustvo samodistobukalnekvržice-hipokonulida.

6. RedukcioniprocesnadonjimmolarimapokazujeznatnovišistepenizraženostinaM2(89,25%)uodnosunaM1(28,0%).

7. Prisustvo tipa M2 -4 je u granicamavrednosti koje vrede za zapadnu odontološkugrupu.

ConclusionIn this study, data were obtained by im-

posing the following conclusion:1.Thesubjectsofoursamplearecharacter-

izedbyahighpercentageofthepresenceofM1withfivecusps (70.5%)andM2with4cusps(89.25%).

2. The first molar in 28% of respondentshave four cusps andonly in1.5%of subjectsarewith6cusps.

3.Thesecondmolarwith5cucpsarefoundinonly10.75%ofsubjects.

4.ThereisanadvantageofgirlsinM1andM2-44 types thatwouldalso,atM1-5,M1-6andM2-5turnovertotheboysgroup.

5. It was found the complete absence ofonlydistobuccalcusp-hypoconulid.

6. Reduction process on the lowermolarsshowing a much higher level of expressionontheM2(89.25%)comparedtoM1(28.0%).

7.ThepresenceoftypeM2-4isintherangeofvalues thatarevalidforthewesterngroupofOdontology.

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Address of correspondence:MirjanaBuric,D.D.S.

SpecialistinOrthodonticsClinicofDentistry-DepartmentofOrthodontics

DrZoranDjindjic52BLVD18000Nis

E-mail:mirjana_buric@yahoo.com

Adresa za korespondenciju:Dr.Stom.MirjanaBurićSpecijalistaOrtodoncijeKlinikazaStomatologiju-OdelenjeortodoncijeBulevarDrZoranaĐinđića5218000NišE-mail:mirjana_buric@yahoo.com

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