The Association between Ponticulus Posticus and Dental Agenesis: A Retrospective Study

Alessandra Putrino1, *, Rosa Maria Leonardi2, Ersilia Barbato1, Gabriella Galluccio1
1 Department of Oral and Maxillofacial Sciences, University “Sapienza” of Rome, Roma, Italy
2 Department of Medical and Surgical Sciences, II Dental Unity, University of Catania, Catania, Italy

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© 2018 Putrino et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to the author at the Department of Oral and Maxillofacial Sciences, University “Sapienza” of Rome, Roma, Italy; Tel: +390672016195; E-mail:



Neural tube defects may increase the risk of an abnormal development of skull, vertebral column and teeth formation, including dental agenesis in non syndromic patients. The association between the presence of a congenital Dental Agenesis (DA) and the Atlantooccipital Ligament (AOL) calcification, known as “Ponticulus Posticus” (PP), as possible links can be investigated.


After a systematic review of the scientific literature on this topic, two independent examiners assessed the AOL calcification in lateral cephalograms of 350 non syndromic patients(7-21 years old). The results were compared with a control group (non syndromic patients, without congenital missing teeth).


The 16.3% of the population studied by cephalometric analysis revealed a prevalence rate of PP (both complete and partial) with a slight male predominance is seen, not statistically significant (χ square test = 0.09; p= 0.76). In both sexes complete PP is more observed. In the patients affected by DA the frequency of PP is the 66.6% (both complete than partial). The χ square test with Yates correction showed a significative difference(χ= 66.20; p value= 0.00) between PP in patients with DA compared to not affected by DA.


PP is not an uncommon anomaly. Since orofacial pain like migraine and other symptoms are often associated to PP, during routine radiographic examination, if detected, it should be documented in patients’ health record and with symptoms, further investigation should be sought for. These findings encourage to think there’s an association between DA in non syndromic patients and neuro-crestal cells defects.

Keywords: Dental anomalies, Ponticulus Posticus (PP), Dental Agenesis (DA), Atlantooccipital Ligament (AOL), Oligodontia, Hypodontia, Anodontia.