Missing Before Eruption: A Case Report of Second Premolars Agenesis in A 12-Year-Old Girl
Abstract
The human dentition follows a remarkably precise developmental sequence; however, deviations from this pattern are not uncommon. Among these, tooth agenesis represents one of the most prevalent developmental anomalies and continues to challenge clinicians involved in pediatric oral healthcare. Defined as the congenital absence of one or more teeth, agenesis ranges from hypodontia to the complete absence of dentition, with hypodontia being the most frequently encountered form. Premolars, after third molars, are among the teeth most commonly affected, making premolar agenesis a clinically significant finding during the transitional years of dental development. [1–5]
Premolar agenesis often remains “silent,” escaping clinical detection until the mixed dentition stage, when delayed exfoliation of primary molars or routine radiographic evaluation reveals the absence of permanent successors. This quiet absence can have profound implications, influencing arch integrity, occlusal harmony, alveolar bone development, and future esthetic outcomes. The etiology is complex and multifactorial, with genetic determinants such as mutations in odontogenesis-related genes interacting with environmental influences. While premolar agenesis may be associated with syndromic conditions, the majority of cases present as non-syndromic, isolated findings in otherwise healthy children. [1,2,6,7]
