The frequency of ponticulus posticus in orthodontic patient and its relationship with skeletal malocclusion, dental anomalies and hyoid bone position.

BACKGROUND: This study aimed to investigate the prevalence of ponticulus posticus in relation to sex, skeletal malocclusion, dental agenesis, impacted teeth and hyoid bone position. METHODS: Lateral cephalometric and panoramic radiographs of 477 Turkish orthodontic patients (sample size = 477, 290 females, 187 males; mean age 17.3 ± 5.88 years) were analyzed. Participants were categorized into three groups based on the presence of ponticulus posticus: complete, incomplete and absence. Relationships between ponticulus posticus and sex, skeletal malocclusion, dental agenesis, impacted teeth and hyoid bone position were assessed. Skeletal malocclusion was determined using sagittal (ANB angle) and vertical (GoGn-SN angle) parameters. The position of the hyoid bone was quantified on lateral cephalometric radiographs using six linear (H-SN, H-FH, H-PP, MPH, H-C3, H-RGn) and four angular measurements (NSH, MPH, Lah-PP, SHGn). The study was conducted between November 2023 and September 2024. Statistical analyses were performed using IBM SPSS v23 (IBM Corp. Armonk, NY, USA). Ethical approval was obtained from the University Ethics Committee (Decision No: 2024-BİAEK/09–50). RESULTS: Ponticulus posticus was absent in 394 individuals (82.6%), complete in 51 individuals (10.7%), and incomplete in 32 individuals (6.7%). Significant differences were found in H-SN, H-FH, H-PP (p < 0.05) and MPH angular measurements (p < 0.05) between groups. No significant differences were observed in ANB, GoGn-SN, MPH linear, H-C3 linear, H-RGn linear, NSH angular, SHGn angular, Lah-PP angular values, dental agenesis, sex or impacted teeth (p > 0.05). Subgroup analysis by sagittal skeletal pattern showed differences in H-SN, H-FH, H-PP, and H-RGn (p < 0.05). Logistic regression revealed a significant association between GoGn-SN and ponticulus posticus presence (p = 0.045). CONCLUSIONS: Ponticulus posticus was observed in 17.4% of the individuals. A significant association was found between incomplete ponticulus posticus and a lower vertical position of the hyoid bone. No significant relationships were observed between ponticulus posticus and age, sagittal skeletal pattern or other craniofacial variables. However, the GoGn-SN angle showed a significant association with the presence of ponticulus posticus, suggesting that cranio-cervical posture may contribute to its development and clinical relevance.