We read with great interest the article on dental age assessment in patients with maxillary canine displacement in the December 2011 issue. We congratulate the authors for their efforts in the preparation of this article.

The authors compared the dental development in patients with palatally and buccally displaced canines with that of a control group without canine displacement. In agreement with the authors, there have been few studies investigating the relationship between dental age and canine displacement. Thus, the study gives valuable information to readers, and it also seems to be the first, since it is comparing displaced and nondisplaced sides in patients with unilateral canine displacement. The authors of the article found that delayed dental development was associated with subjects who had a palatally displaced canine. However, the factors that might affect their dental development have not been completely discussed. In addition, I want to draw attention to some limitations.

The authors stated that patients with missing teeth were included in the study because of the high prevalence of hypodontia in patients with displaced canines. According to Kan et al and Tunc et al, dental development in children with mild-to-moderate hypodontia was significantly delayed, when compared with a control group. This finding shows that hypodontia of the other teeth might have affected their results.

Another important problem might be the possible malocclusions in their study sample, since there was no information in the inclusion criteria. In a recently published study, it was shown that dental development of orthodontic patients with sagittal skeletal malocclusions was approximately twice as advanced when compared with patients without sagittal skeletal anomaly patterns. In another study, 4 patients with crossbite showed a tendency for delayed dental development compared with a control group without crossbite. Those studies show that dental development is a multifactorial phenomenon, and thus readers might consider this situation while reading this well-written article about the dental development in patients with maxillary displaced canines.