- Email: [email protected]
An Interesting Study of Two Thousand Seven Hundred and Eighty-Seven Radiographs Taken from One Thousand One Hundred and Forty Patients During the Year 1916, in the Dental Section of the Metropolitan Life Insurance Company
A N IN T E R E STIN G S T U D Y O F T W O T H O U S A N D S E V E N H U N D R E D A N D E IG H T Y -S E V E N R A D IO G R A P H S T A K E N F R O M ONE TH OUSAN D ONE HUNDRED AN D FORTY PA T IE N T S D U R IN G T H E Y E A R 1 9 1 6 , IN T H E D E N T A L S E C T IO N O F T H E M E T R O P O L IT A N LIFE IN S U R A N C E C O M P A N Y .
By T h a d d eu s P. H yatt, D . D . S., N ew Y o rk City, N . Y.
(Read before the Second District Dental Society o f New York March 12, 1917.)
T M UST be understood that this study is confined to those conditions w hich the radiographs show, and that it does not include any clinical findings, other than those w hich were necessary fo r the purpose o f selecting teeth w hich w ere uncrowned and known to have devital pulps. Some may question the advisa bility o f using the term “ infection,” as it is possible som e other cause might have brought about the decalcified area. W hile this is undoubtedly true, the radio graph does not show it. It also is true that the use of the term “ abscess” might be questioned. The condition shown in the radiograph which this term is used to describe, may not in the strict scien tific sense be an abscess, but it would need som e other methods than that of the X-ray to give this informatibn. The same criticism is true in those cases called “ no infection,” particularly, when applied to teeth with devital pulps having unfilled or im perfectly filled roots. It is my firm belief that a great mistake is being made when we assume that no harm is being done because the radio graph o f a tooth with a devital pulp does not show an area o f décalcification. The patient’s pow er o f resistance may be low . W ere the resistance high, there would be an effort on the part of nature to confine the influence to a circum
I
■
scribe and local area, and thus bring about sufficient disturbance w hich the radiograph would show. It must be understood that the term s used in this paper are not used in any arbitrary way, but only to explain conconditions seen in the radiographs. All crow ned teeth and those serving as abutments for bridges, as w ell as all teeth known to have devital pulps, were radiographed. As no clinical exam ina tion had been made to ascertain whether all crowned teeth contained vital pulps, only those show ing abscess, infection, perfectly filled roots, or im perfectly filled roots, are included under the heading of “ teeth with devital pulps.” That all may have a clear understand ing o f what condition is meant as named in the various classifications, a definition and illustration is given o f each.* Abscess — A w ell defined circum scribed decalcified area. (Figure 1.) Infection — A slightly decalcified area without any w ell defined line o f demarkation. (Figure 2.) Unfilled Roots.— Those w hich do not show any root filling. (Figure 3.) Some o f these roots may be filled with a preparation w hich does not show radiographically and they may be included in ♦These definitions are not offered to the profes sion fo r adoption.
594
H Y A T T .— AN INTERESTING STUDY OF RADIOGRAPHS. the class o f crow ned teeth w ith unfilled roots show ing “ no infection so they are not included in the study o f “ teeth with devital pulps.”
595
o f the others, it has heen thought be "it always to designate these conditions as
P e rfe c tly F ille d R oots.— Those which show radiographically they have heen filled to the apex. (Figure 4.)
“ infection.” W e shall, therefore, only record teeth as showing in fectio n , no in fe c tio n , or a b sce ss. As there seems to be so much that is uncertain, and so lit tle that is certain about the significance
Figure 1.
Figure 3.
Im p e rfe c tly F ille d R oots.— Those which show the roots only partially filled. (Figure 5.) It has been thought wise to discard the use of such terms as “ decalcified” and “ inflamed,” w hich are so often used with or in the place of in fe c tio n . W hile all
of “ thickened peridental membrane,” no record o f this condition has been made. Our study has been divided into four groups. The first is o f crowned teeth. The second of all teeth having devital pulps. The third is a percentage table of teeth with devital pulps, while the fourth
Figure 2.
Figure 4.
three terms are frequently used in arti cles and books upsn dental radiography, we have failed as yet to find a definition w hich will define the radiographic differ ences betw een these three conditions, nor have we seen any illustration of “ in flammation” w hich looked in any way different to those used to illustrate “ in fection” or “ decalcified.” As it is not only possible, but highly probable, that any one of these term s may include both
shows conditions found in the X-ray pic tures w hich w ere not found clinically. It was realized that crow ned teeth with un filled roots, Glass 1— contained an un known number o f teeth with devital pulps, therefore, it was decided to count as “ de vital” onfy those show ing “ infection” or “ abscess.” It is realized that in many of these teeth the pulp may n ot be com pletely devitalized, but even when only partly devital, they undoubtedly bring
596
TH E JOURNAL OF TH E NATIONAL DEN TAL ASSOCIATION.
about, or help cause to be brought about pathological conditions as are shown by the presence o f “ in fection ” or “ abscess.” It is also realized that am ong those classed as showing “ no infection,” Class 1-B may be many having devital pulps, this class has been discarded entirely in the consideration o f teeth with devital pulps. In the first and second groups, and in Part 1— Group 3, the classes have been arranged according to root fillings, viz., u n fille d , p e rfe c tly fille d , and im p e r fe c tly fille d . Each of these have been considered in relation to in fe ctio n , no in fe ctio n , and ab scess. The number of teeth found according to these conditions is shown in the first and second group, while in the third group, Part 1, the rela tion by percentage is given.
here presented are taken from a radiographic exam ination of 3,591 teeth which is, I believe, a safer basis to draw con clusion from than a consideration of only a few hundred. Also a considera tion by percentage is, I believe, safer than by numbers only. But even these figures I should not wish to be accepted as conclusive, as only a percentage se cured from several thousand in every sub-division of each class should be con sidered the basis for deductions. In Group 3, Part 2, which is a percent age study of 2,537 teeth with devital pulps, we w ill find a beautifully logical sequence of percentage that coincides with the hopes and expectations o f the
In Part 2, Group 3, w e have taken all the “ in fection s” and arranged them in order of their percentage, the highest com ing first, likew ise w ith those show ing “ no infection” and those showing “ abscess.” It is interesting to note in Group 1, Class 2, crowned teeth with perfectly filled roots, there is no abscess condition recorded. This might be unimportant because o f the smallness o f this class, but we notice the same is recorded in Group 2, Class 2, teeth with devital pulps having perfectly filled roots. Here also no abscess condition is recorded. W hile in Group 3, Part 1, Class 2, tw en ty-five per cent of pulpless teeth with perfectly filled roots show infection, it should be rem em bered that many of these teeth probably w ere filled after in fection was present, so we cannot, th ere fore, assume that infection came after root filling had been inserted. M ore sig nificant still is the fa ct that 75% of per fectly filled roots do not show infection, while none show abscess. This seems to disprove the contention of Dr. Carl J. Grove, based upon the examination of several hundred radiographs, that “ a greater percentage of rarefied areas ex ists at the apex of roots w hich are so termed “ perfectly filled.” The figures
Figure 5.
root canal w orkers o f up-to-date meth ods. Under A, show ing in fe ctio n , we find the sm allest per cent is shown by the p e rfe c tly fille d roots 25%, while the im p e rfe c tly fille d show 34% and the u n filled 61%. Under B, showing no in fe c tion, just as would be expected or rather hoped for, we find the p e rfe c tly fille d shows the largest per cent, heading the list with 75%, while im p e rfe c tly fille d is 58% and u n fille d 24%. But the greatest triumph of p e rfe c tly filled, roots is shown under C. H ere is considered the per centage of abscesses in relation to root fillings. P e rfe c tly fille d shows none, im p e rfe c tly filled shows 8% and u n filled 15%. Of the 2,537 teeth with devital pulps, we find 1,4C4 show ing pathological con ditions in - the tissue surrounding the roots. Of the 1,133 teeth w hich do not
H Y A T T .— AN INTERESTING STUDY OP RADIOGRAPHS. show pathological changes having taken place in the tissues im m ediately sur rounding the roots, w e are lead to fear that in many o f these cases harm is be ing done to the patients as explained in the beginning o f this paper. The pres ence or absence o f “ in fected” area sur rounding the roots may be not only a f fected by the resistance of the patient, but age probably is an im portant factor. Our next study o f these conditions w ill be in relation to the ages o f the pa tients, w hile our third study w ill be the physical conditions found in relation to dental infections. I w ish to express m y indebtedness to Dr. Dublin, Chief o f the Statistical Bu reau o f the M etropolitan L ife Insurance Company, for his aid and suggestion in the preparation o f these figures. NUMBER 1.
OF
X -R A Y
PICTURES
TA K E N ,
2.
Study o f teeth with devital pulps.
3.
Percentage
study
of
teeth
4. Conditions shown in were not found clinically.
X -r a y
with
devital
pulps.
CROWNED
CLASS 3. A .— Number with showing infection
pictures
which
TEETH.
imperfectly filled roots .............................. '.....................358
B.— Number with imperfectly filled roots showing no infection ................................................. 594 C.— Number with imperfectly filled roots showing abscess .................................................................... 73 Total
............................................................................. 1025
TEETH
WITH
DEVITAL
PULPS.
Class 1.— W ith unfilled roots..................................... 1033 Class 2.— W ith perfectly filled roots............................... 75 Class 3.— W ith imperfectly filled roots..................1429 Total
............................................................................. 2537 CLASS I.
A .— Number with unfilled roots showing in fection .............................................................................. 630 B .— Number with unfilled roots showing no infection ......................................................................... 249 C.— Number with unfilled roots, showing ab scess 154 Total
2787.
Study of teeth with crowns.
597
.............................................................................1033 CLASS 2.
A .— Number with perfectly filled roots show ing infection ...........................................................................19 B .— Number with perfectly filled roots show ing no infection .................................................................... 56 C.— Number with perfectly filled roots, show ing abscess ............................................................................. 0 Total
Class 1.— Crowned teeth with unfilled ro o ts .. 1434
.......................................................................................75 CLASS 3.
Class 2.— Crowned teeth with perfectly filled
A .— Number with imperfectly filled roots ............................................................................................ 39 roots showing infection ...................................................... 491 Class 3.— Crowned teeth with imperfectly B .— Number with imperfectly filled roots filled roots ......................................................................1025 showing no infection ............................................... 828
Total
.......................................................................2498 CLASS
I.
A .— Number with unfilled roots showing in fection
C.— Number with imperfectly filled roots showing abscess ........................................................ 110 Total
i-12
B.— Number- with unfilled roots showing no infection .............................................................................1054
.....................................................................
PERCENTAGE STUD Y OF TEETH WITH VITAL PULPS— PART I.
DE
Class 1— W ith unfilled roots .....................................4 1 % C lass 2— W ith perfectly filled roots......................... 2 % .............................................................................. 68 Class 3— W ith imperfectly filled roots............%.5 7 %
C.— Number with unfilled roots showing ab scess
CLASS I. Total
.............................................................................. 1434 CLASS 2.
A..— Number with perfectly filled roots showing infection
................................................................................ 7
B.— Number with perfectly ing
no
infection
filled roots show
............................................................. 32
C.— Number with perfectly filled roots showing abscess
................................................................................... 0
Total
................................................................................... 39
A .— W ith unfilled roots showing infection.. . .6 1 % B .— W ith unfilled roots showing no infection. 2 4 % C.— W ith unfilled roots showing abscess.............. 1 5 % C LASS 2. A .— W ith perfectly filled roots showing infec tion 25% B.— W ith perfectly filled roots showing no In fection 75% C.— W ith perfectly filled roots showing ab scess 0
59$
TH E JOURNAL OF TH E NATION AL D EN TA L ASSOCIATION. B.
CLASS 3. A .— W ith imperfectly filled roots, showing in fection ................................................................................3 4 % B .— W ith imperfectly filled roots showing no infection ............................................................................ 5 8 % C.— W ith imperfectly filled roots showing ab scess PERCENTAGE
ST U D Y OF
TEETH
WITH
Class 2.— B. Perfectly filled showing no in fection ............................................................................. 7 5 % Class 3.— B . Imperfectly filled showing no in fection ..............................................................................58 % Class 1.— B. Unfilled showing no infection. .2 4 % C.
8%
DE-
VITAL PULPS.— PART 2.
Class 1.— C. Class 3.— C.
Unfilled showing abscess............... 1 5% Imperfectly filled showing ab
scess ................................................................................... 8 % Class 2.— C. Perfectly filled showing abscess 0
A. Class 1.— A.
Unfilled showing
in fection .. . .6 1 %
Class 3.— A. Imperfectly filled*................... showing in fection •........................................................ 3 4 % Class 2.— A. Perfectly filled showing infec tion ..................................................................................... 2 5 %
CONDITIONS SHOWN IN X -R A Y PICTURES TH AT W ER E NOT FOUND CLINICALLY. Number o f roots...................................................................33 Number of unerupted teeth............................................ 4 Number of iqipacted teeth.............................................20 Number of temporary teeth............................................ 2
By T h a d d eu s P. H yatt, D . D . S., N ew Y o rk City, N . Y.
(Read before the Second District Dental Society o f New York March 12, 1917.)
T M UST be understood that this study is confined to those conditions w hich the radiographs show, and that it does not include any clinical findings, other than those w hich were necessary fo r the purpose o f selecting teeth w hich w ere uncrowned and known to have devital pulps. Some may question the advisa bility o f using the term “ infection,” as it is possible som e other cause might have brought about the decalcified area. W hile this is undoubtedly true, the radio graph does not show it. It also is true that the use of the term “ abscess” might be questioned. The condition shown in the radiograph which this term is used to describe, may not in the strict scien tific sense be an abscess, but it would need som e other methods than that of the X-ray to give this informatibn. The same criticism is true in those cases called “ no infection,” particularly, when applied to teeth with devital pulps having unfilled or im perfectly filled roots. It is my firm belief that a great mistake is being made when we assume that no harm is being done because the radio graph o f a tooth with a devital pulp does not show an area o f décalcification. The patient’s pow er o f resistance may be low . W ere the resistance high, there would be an effort on the part of nature to confine the influence to a circum
I
■
scribe and local area, and thus bring about sufficient disturbance w hich the radiograph would show. It must be understood that the term s used in this paper are not used in any arbitrary way, but only to explain conconditions seen in the radiographs. All crow ned teeth and those serving as abutments for bridges, as w ell as all teeth known to have devital pulps, were radiographed. As no clinical exam ina tion had been made to ascertain whether all crowned teeth contained vital pulps, only those show ing abscess, infection, perfectly filled roots, or im perfectly filled roots, are included under the heading of “ teeth with devital pulps.” That all may have a clear understand ing o f what condition is meant as named in the various classifications, a definition and illustration is given o f each.* Abscess — A w ell defined circum scribed decalcified area. (Figure 1.) Infection — A slightly decalcified area without any w ell defined line o f demarkation. (Figure 2.) Unfilled Roots.— Those w hich do not show any root filling. (Figure 3.) Some o f these roots may be filled with a preparation w hich does not show radiographically and they may be included in ♦These definitions are not offered to the profes sion fo r adoption.
594
H Y A T T .— AN INTERESTING STUDY OF RADIOGRAPHS. the class o f crow ned teeth w ith unfilled roots show ing “ no infection so they are not included in the study o f “ teeth with devital pulps.”
595
o f the others, it has heen thought be "it always to designate these conditions as
P e rfe c tly F ille d R oots.— Those which show radiographically they have heen filled to the apex. (Figure 4.)
“ infection.” W e shall, therefore, only record teeth as showing in fectio n , no in fe c tio n , or a b sce ss. As there seems to be so much that is uncertain, and so lit tle that is certain about the significance
Figure 1.
Figure 3.
Im p e rfe c tly F ille d R oots.— Those which show the roots only partially filled. (Figure 5.) It has been thought wise to discard the use of such terms as “ decalcified” and “ inflamed,” w hich are so often used with or in the place of in fe c tio n . W hile all
of “ thickened peridental membrane,” no record o f this condition has been made. Our study has been divided into four groups. The first is o f crowned teeth. The second of all teeth having devital pulps. The third is a percentage table of teeth with devital pulps, while the fourth
Figure 2.
Figure 4.
three terms are frequently used in arti cles and books upsn dental radiography, we have failed as yet to find a definition w hich will define the radiographic differ ences betw een these three conditions, nor have we seen any illustration of “ in flammation” w hich looked in any way different to those used to illustrate “ in fection” or “ decalcified.” As it is not only possible, but highly probable, that any one of these term s may include both
shows conditions found in the X-ray pic tures w hich w ere not found clinically. It was realized that crow ned teeth with un filled roots, Glass 1— contained an un known number o f teeth with devital pulps, therefore, it was decided to count as “ de vital” onfy those show ing “ infection” or “ abscess.” It is realized that in many of these teeth the pulp may n ot be com pletely devitalized, but even when only partly devital, they undoubtedly bring
596
TH E JOURNAL OF TH E NATIONAL DEN TAL ASSOCIATION.
about, or help cause to be brought about pathological conditions as are shown by the presence o f “ in fection ” or “ abscess.” It is also realized that am ong those classed as showing “ no infection,” Class 1-B may be many having devital pulps, this class has been discarded entirely in the consideration o f teeth with devital pulps. In the first and second groups, and in Part 1— Group 3, the classes have been arranged according to root fillings, viz., u n fille d , p e rfe c tly fille d , and im p e r fe c tly fille d . Each of these have been considered in relation to in fe ctio n , no in fe ctio n , and ab scess. The number of teeth found according to these conditions is shown in the first and second group, while in the third group, Part 1, the rela tion by percentage is given.
here presented are taken from a radiographic exam ination of 3,591 teeth which is, I believe, a safer basis to draw con clusion from than a consideration of only a few hundred. Also a considera tion by percentage is, I believe, safer than by numbers only. But even these figures I should not wish to be accepted as conclusive, as only a percentage se cured from several thousand in every sub-division of each class should be con sidered the basis for deductions. In Group 3, Part 2, which is a percent age study of 2,537 teeth with devital pulps, we w ill find a beautifully logical sequence of percentage that coincides with the hopes and expectations o f the
In Part 2, Group 3, w e have taken all the “ in fection s” and arranged them in order of their percentage, the highest com ing first, likew ise w ith those show ing “ no infection” and those showing “ abscess.” It is interesting to note in Group 1, Class 2, crowned teeth with perfectly filled roots, there is no abscess condition recorded. This might be unimportant because o f the smallness o f this class, but we notice the same is recorded in Group 2, Class 2, teeth with devital pulps having perfectly filled roots. Here also no abscess condition is recorded. W hile in Group 3, Part 1, Class 2, tw en ty-five per cent of pulpless teeth with perfectly filled roots show infection, it should be rem em bered that many of these teeth probably w ere filled after in fection was present, so we cannot, th ere fore, assume that infection came after root filling had been inserted. M ore sig nificant still is the fa ct that 75% of per fectly filled roots do not show infection, while none show abscess. This seems to disprove the contention of Dr. Carl J. Grove, based upon the examination of several hundred radiographs, that “ a greater percentage of rarefied areas ex ists at the apex of roots w hich are so termed “ perfectly filled.” The figures
Figure 5.
root canal w orkers o f up-to-date meth ods. Under A, show ing in fe ctio n , we find the sm allest per cent is shown by the p e rfe c tly fille d roots 25%, while the im p e rfe c tly fille d show 34% and the u n filled 61%. Under B, showing no in fe c tion, just as would be expected or rather hoped for, we find the p e rfe c tly fille d shows the largest per cent, heading the list with 75%, while im p e rfe c tly fille d is 58% and u n fille d 24%. But the greatest triumph of p e rfe c tly filled, roots is shown under C. H ere is considered the per centage of abscesses in relation to root fillings. P e rfe c tly fille d shows none, im p e rfe c tly filled shows 8% and u n filled 15%. Of the 2,537 teeth with devital pulps, we find 1,4C4 show ing pathological con ditions in - the tissue surrounding the roots. Of the 1,133 teeth w hich do not
H Y A T T .— AN INTERESTING STUDY OP RADIOGRAPHS. show pathological changes having taken place in the tissues im m ediately sur rounding the roots, w e are lead to fear that in many o f these cases harm is be ing done to the patients as explained in the beginning o f this paper. The pres ence or absence o f “ in fected” area sur rounding the roots may be not only a f fected by the resistance of the patient, but age probably is an im portant factor. Our next study o f these conditions w ill be in relation to the ages o f the pa tients, w hile our third study w ill be the physical conditions found in relation to dental infections. I w ish to express m y indebtedness to Dr. Dublin, Chief o f the Statistical Bu reau o f the M etropolitan L ife Insurance Company, for his aid and suggestion in the preparation o f these figures. NUMBER 1.
OF
X -R A Y
PICTURES
TA K E N ,
2.
Study o f teeth with devital pulps.
3.
Percentage
study
of
teeth
4. Conditions shown in were not found clinically.
X -r a y
with
devital
pulps.
CROWNED
CLASS 3. A .— Number with showing infection
pictures
which
TEETH.
imperfectly filled roots .............................. '.....................358
B.— Number with imperfectly filled roots showing no infection ................................................. 594 C.— Number with imperfectly filled roots showing abscess .................................................................... 73 Total
............................................................................. 1025
TEETH
WITH
DEVITAL
PULPS.
Class 1.— W ith unfilled roots..................................... 1033 Class 2.— W ith perfectly filled roots............................... 75 Class 3.— W ith imperfectly filled roots..................1429 Total
............................................................................. 2537 CLASS I.
A .— Number with unfilled roots showing in fection .............................................................................. 630 B .— Number with unfilled roots showing no infection ......................................................................... 249 C.— Number with unfilled roots, showing ab scess 154 Total
2787.
Study of teeth with crowns.
597
.............................................................................1033 CLASS 2.
A .— Number with perfectly filled roots show ing infection ...........................................................................19 B .— Number with perfectly filled roots show ing no infection .................................................................... 56 C.— Number with perfectly filled roots, show ing abscess ............................................................................. 0 Total
Class 1.— Crowned teeth with unfilled ro o ts .. 1434
.......................................................................................75 CLASS 3.
Class 2.— Crowned teeth with perfectly filled
A .— Number with imperfectly filled roots ............................................................................................ 39 roots showing infection ...................................................... 491 Class 3.— Crowned teeth with imperfectly B .— Number with imperfectly filled roots filled roots ......................................................................1025 showing no infection ............................................... 828
Total
.......................................................................2498 CLASS
I.
A .— Number with unfilled roots showing in fection
C.— Number with imperfectly filled roots showing abscess ........................................................ 110 Total
i-12
B.— Number- with unfilled roots showing no infection .............................................................................1054
.....................................................................
PERCENTAGE STUD Y OF TEETH WITH VITAL PULPS— PART I.
DE
Class 1— W ith unfilled roots .....................................4 1 % C lass 2— W ith perfectly filled roots......................... 2 % .............................................................................. 68 Class 3— W ith imperfectly filled roots............%.5 7 %
C.— Number with unfilled roots showing ab scess
CLASS I. Total
.............................................................................. 1434 CLASS 2.
A..— Number with perfectly filled roots showing infection
................................................................................ 7
B.— Number with perfectly ing
no
infection
filled roots show
............................................................. 32
C.— Number with perfectly filled roots showing abscess
................................................................................... 0
Total
................................................................................... 39
A .— W ith unfilled roots showing infection.. . .6 1 % B .— W ith unfilled roots showing no infection. 2 4 % C.— W ith unfilled roots showing abscess.............. 1 5 % C LASS 2. A .— W ith perfectly filled roots showing infec tion 25% B.— W ith perfectly filled roots showing no In fection 75% C.— W ith perfectly filled roots showing ab scess 0
59$
TH E JOURNAL OF TH E NATION AL D EN TA L ASSOCIATION. B.
CLASS 3. A .— W ith imperfectly filled roots, showing in fection ................................................................................3 4 % B .— W ith imperfectly filled roots showing no infection ............................................................................ 5 8 % C.— W ith imperfectly filled roots showing ab scess PERCENTAGE
ST U D Y OF
TEETH
WITH
Class 2.— B. Perfectly filled showing no in fection ............................................................................. 7 5 % Class 3.— B . Imperfectly filled showing no in fection ..............................................................................58 % Class 1.— B. Unfilled showing no infection. .2 4 % C.
8%
DE-
VITAL PULPS.— PART 2.
Class 1.— C. Class 3.— C.
Unfilled showing abscess............... 1 5% Imperfectly filled showing ab
scess ................................................................................... 8 % Class 2.— C. Perfectly filled showing abscess 0
A. Class 1.— A.
Unfilled showing
in fection .. . .6 1 %
Class 3.— A. Imperfectly filled*................... showing in fection •........................................................ 3 4 % Class 2.— A. Perfectly filled showing infec tion ..................................................................................... 2 5 %
CONDITIONS SHOWN IN X -R A Y PICTURES TH AT W ER E NOT FOUND CLINICALLY. Number o f roots...................................................................33 Number of unerupted teeth............................................ 4 Number of iqipacted teeth.............................................20 Number of temporary teeth............................................ 2