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It has been estimated that 25% of monozygotic ("identical") twin pairs exhibit reverse asymmetry (RA) or "mirroring" of minor anatomical features as a result of delayed zygote division. Here, we examine whether identical twin mirroring accounts for patterns of dental asymmetry in a sample of monozygotic and dizygotic ("fraternal") twins. We focus on crown morphology to approach the following question: is there an association between dental RA frequency and twin type suggestive of the presence of mirror image twins in our sample? Data were collected from 208 deciduous and 196 permanent dentitions of participants of the University of Adelaide Twin Study using Arizona State University Dental Anthropology System standards. RA frequencies were compared across morphological complexes (deciduous, permanent), twin types (monozygotic, dizygotic), and traits. Fisher's exact tests were performed to formally evaluate the association between twin type and dental RA. Across the entire dataset, RA rates failed to exceed 8% for any twin type. In monozygotic twins, deciduous mirroring totaled 5.3% of observed cases, while permanent mirroring totaled 7.8% of observed cases. We found no statistically significant association between RA and twin type for any morphological character (p-value range: 0.07-1.00). Our results suggest the timing of monozygotic twin division does not explain the structure of asymmetry for our morphology dataset and that published estimates of identical twin mirroring rates may be inflated or contingent upon phenotype. Instead, rates reported for this sample more closely align with the proposed etiology of this condition., (© 2024 American Association for Anatomy.)

With diagnostic and therapeutic advances, over 80% of children diagnosed with cancer become long-term survivors. As the number of childhood cancer survivors (CCS) continues to increase, dental practitioners become more likely to have CCS among their patients. CCS may develop late complications from damage caused by their cancer treatment to endocrine, cardiovascular, musculoskeletal, and other organ systems. These complications may surface decades after the completion of treatment. Adverse outcomes of childhood cancer treatment frequently involve oral and craniofacial structures including the dentition. Tooth development, salivary gland function, craniofacial growth, and temporomandibular joint function may be disturbed, increasing oral health risks in these individuals. Moreover, CCS are at risk of developing subsequent malignancies, which may manifest in or near the oral cavity. It is important that dental practitioners are aware of the childhood cancer history of their patients and have knowledge of potential late complications. Therefore, this narrative review aims to inform dental practitioners of late oral complications of cancer treatment modalities commonly used in pediatric oncology. Furthermore, selected common non-oral late sequelae of cancer therapy that could have an impact on oral health and on delivering dental care will be discussed.

Background and Objective: The genetic basis of dentoalveolar characteristics has been investigated by several studies, however, the findings are equivocal. The objective of this systematic review and meta-analysis was to evaluate the heritability of dental arches and occlusal parameters in different stages of human dentition., Search Methods: Electronic databases PubMed, Embase, Scopus, Web of Science, and Dentistry and Oral Science Source were searched up to August 2023 without the restriction of language or publication date., Selection Criteria: Empirical studies investigating the heritability of dentoalveolar parameters among twins and siblings were included in the review., Data Collection and Analysis: Study selection, data extraction, and risk of bias assessment were performed independently and in duplicate by two authors and a third author resolved conflicts if needed. Joanna Briggs Institute's critical appraisal tool was used to evaluate the risk of bias among studies and the certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria., Results: Twenty-eight studies were included in the systematic review, of which 15 studies reporting heritability coefficients in the permanent dentition stages were deemed suitable for the meta-analysis. Random-effects meta-analyses showed high heritability estimates for maxillary intermolar width (0.52), maxillary intercanine width (0.54), mandibular intermolar width (0.55), mandibular intercanine width (0.55), maxillary arch length (0.76), mandibular arch length (0.57), and palatal depth (0.56). The heritability estimates for the occlusal parameters varied considerably, with relatively moderate values for crossbite (0.46) and overbite (0.44) and low values for buccal segment relationship (0.32), overjet (0.22), and rotation and displacement of teeth (0.16). However, the certainty of evidence for most of the outcomes was low according to the GRADE criteria., Conclusions: Based on the available evidence, it can be concluded that the dental arch dimensions have a high heritability while the occlusal parameters demonstrate a moderate to low heritability., Registration: PROSPERO (CRD42022358442)., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society.)

The aims of this study are to determine the oral health status of a rare sample of 19th-century migrant settlers to South Australia, how oral conditions may have influenced their general health, and how the oral health of this group compares with contemporaneous samples in Australia, New Zealand, and Britain. Dentitions of 18 adults and 22 subadults were investigated using non-destructive methods (micro-CT, macroscopic, radiographic). Extensive carious lesions were identified in seventeen adults and four subadults, and from this group one subadult and sixteen adults had antemortem tooth loss. Sixteen adults showed evidence of periodontal disease. Enamel hypoplastic (EH) defects were identified in fourteen adults and nine subadults. Many individuals with dental defects also had skeletal signs of comorbidities. South Australian individuals had the same percentage of carious lesions as the British sample (53%), more than other historic Australian samples, but less than a contemporary New Zealand sample. Over 50% of individuals from all the historic cemeteries had EH defects, suggesting systemic health insults during dental development were common during the 19th century. The overall oral health of the South Australian settlers was poor but, in some categories, (tooth wear, periapical abscess, periodontal disease), better than the other historic samples.

Objective: Chronic periodontal disease (CP) is a multifactorial infectious and inflammatory disease that occurs due to the challenge between the immune response of the host and specific periodontal bacteria, and that can lead to tooth loss due to damage inflicted to the supporting tissue. The current study investigates the genotypes of the GSTM1 and GSTT1 genes, along with the allelic frequency of the single nucleotide polymorphism [SNP; rs1695] in the GSTP1 gene and correlates them individually or in various combinations with the incidence of CP., Methods: A total of 203 clinically confirmed CP patients and 201 control subjects were enrolled from Multan and Dera Ghazi Khan Districts in Pakistan from April to July 2022. Multiplex Polymerase Chain Reaction (PCR) and tetra-primer amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR) approaches were applied to determine the genotypes of the studied GSTs. The association of rs1695 in GSTP1 with CP was studied both individually and in various combinations with GSTM1 and T1 ., Results: The absence of GSTM1 , the presence of GSTT1 and the presence of the mutant allele (G) at rs1695 in GSTP1 were found to be significantly associated with CP. Patients aged between 10 and 30 years were more affected by CP., Conclusion: Our results indicate that the genotypes of the analyzed GSTs affect the levels of protection from oxidative stress and may therefore influence the disease progression in CP.

(1) Background: Hypodontia has a multifactorial aetiology, in which genetic factors are a major component. Associated with this congenital absence, the formed teeth may show differences in size and shape, which may vary with the specific genetic variants and with the location of the missing teeth. The aims of the present study were to investigate a specific variant of MSX1 , derive morphometric tooth measurements in a sample of patients with isolated maxillary lateral incisor agenesis and matched controls, and model the findings. (2) Methods: Genotyping of the MSX1 rs8670 genetic variant and morphometric measurements with a 2D image analysis method were performed for 26 hypodontia patients and 26 matched controls. (3) Results: The risk of upper lateral incisor agenesis was 6.9 times higher when the T allele was present. The morphometric parameters showed significant differences between hypodontia patients and controls and between the unilateral and bilateral agenesis cases. The most affected crown dimension in the hypodontia patients was the bucco-lingual dimension. In crown shape there was significant variation the Carabelli trait in upper first molars. (4) Conclusions: The MSX1 rs8670 variant was associated with variations in morphological outcomes. The new findings for compensatory interactions between the maxillary incisors indicate that epigenetic and environmental factors interact with this genetic variant. A single-level directional complex interactive network model incorporates the variations seen in this study.

The aim of this study is to investigate whether the genetic, epigenetic and environmental factors that give rise to supernumeraries in the maxillary incisor region and larger dimensions of the adjacent maxillary incisors are also associated with variations in the morphology of the mandibular incisors. If so, this would contribute to understanding the distribution and interactions of factors during dental development and how these can be modelled. The sample consisted of 34 patients with supernumerary teeth in the maxillary anterior region, matched for gender, age and White Caucasian ethnicity with 34 control subjects. The average ages of the supernumerary and control groups were 12.8 and 12.2 years, respectively. Study models of all subjects were constructed and imaged using a previously validated system. Using custom software, each of the mandibular incisor teeth were measured to obtain 17 parameters from the labial view and 17 from the occlusal view. Principal component analysis (PCA) was used to summarize the measurements into a smaller set representing distinct features of the clinical crowns, followed by a comparison between the supernumerary and control groups using 2-way ANOVA. Seven factors of tooth size of the mandibular central incisors and six factors of the mandibular lateral incisors were identified as major features of the clinical crowns. All parameters of both mandibular incisors were greater in the supernumerary group than in the control, with three of these, located in the incisal and cervical regions of the mandibular lateral incisors, being statistically significantly larger. The findings of this study indicate that the aetiological factors associated with supernumerary teeth in the maxillary anterior region also affect tooth crown dimensions of mandibular incisors. This new evidence enhances several models of the interactions of genetic, epigenetic and environmental components of dental development and supports a multi-model approach to increase understanding of this process and its variations., Competing Interests: The authors declare no conflict of interest.

Background: Chemotherapy treatment of cancer in children can influence formation of normal tissues, leading to irreversible changes in their structure and function. Tooth formation is susceptible to several types of chemotherapy that induce irreversible changes in the structure of enamel, dentin and dental root morphology. These changes can make the teeth more prone to fracture or to caries when they have erupted. Recent studies report successful treatment of brain tumors with the alkylating drug temozolomide (TMZ) in combination with veliparib (VLP) in a glioblastoma in vivo mouse model. Whether these drugs also affect tooth formation is unknown., Aim: In this study the effect of TMZ/VLP on incisor formation was investigated in tissue sections of jaws from mice and compared with mice not treated with these drugs., Materials and Method: The following aspects were studied using immunohistochemistry of specific protein markers including: (1) proliferation (by protein expression of proliferation marker Ki67) (2) a protein involved in paracellular ion transport (expression of tight junction (TJ) protein claudin-1) and (3) in transcellular passage of ions across the dental epithelium (expression of Na+, K+ 2Cl- cotransporter/NKCC1)., Results: Chemotherapy with TMZ/VLP strongly reduced immunostaining for claudin-1 in distal parts of maturation ameloblasts. No gross changes were found in the treated mice, either in cell proliferation in the dental epithelium at the cervical loop or in the immunostaining pattern for NKCC1 in (non-ameloblastic) dental epithelium. The salivary glands in the treated mice contained strongly reduced immunostaining for NKCC1 in the basolateral membranes of acinar cells., Discussion/conclusions: Based on the reduction of claudin-1 immunostaining in ameloblasts, TMZ/VLP may potentially influence forming enamel by changes in the structure of TJs structures in maturation ameloblasts, structures that are crucial for the selective passage of ions through the intercellular space between neighboring ameloblasts. The strongly reduced basolateral NKCC1 staining seen in fully-grown salivary glands of TMZ/VLP-treated mice suggests that TMZ/VLF could also influence ion transport in adult saliva by the salivary gland epithelium. This may cause treated children to be more susceptible to caries.

This study aims to expand our understanding of the genetic architecture of crown morphology in the human diphyodont dentition. Here, we present bivariate genetic correlation estimates for deciduous and permanent molar traits and evaluate the patterns of pleiotropy within (e.g., m1-m2) and between (e.g., m2-M1) dentitions. Morphology was observed and scored from dental models representing participants of an Australian twin and family study (deciduous n = 290, permanent n = 339). Data collection followed Arizona State University Dental Anthropology System standards. Genetic correlation estimates were generated using maximum likelihood variance components analysis in SOLAR v.8.1.1. Approximately 23% of deciduous variance components models and 30% of permanent variance components models yielded significant genetic correlation estimates. By comparison, over half (56%) of deciduous-permanent homologues (e.g., m 2 hypocone-M 1 hypocone) were significantly genetically correlated. It is generally assumed that the deciduous and permanent molars represent members of a meristic molar field emerging from the primary dental lamina. However, stronger genetic integration among m2-M1/M2 homologues than among paired deciduous traits suggests the m2 represents the anterior-most member of a "true" molar field. The results indicate genetic factors act at distinct points throughout development to generate homologous molar form, starting with the m2, which is later replaced by a permanent premolariform crown.

Objectives: To examine pathological evidence present in a sample of 19th -century settlers to South Australia in the context of an early industrial society., Materials: Skeletal remains of 20 adults and 45 nonadults from the government funded burial site (free ground) of St Mary's Anglican Church Cemetery, gravestones of privately funded burials and local parish records., Methods: Investigation of pathological manifestations of skeletal remains, church records and historic literature. Comparison with similar samples from Britain and from New South Wales., Results: Joint disease seen in 35% of adults. Porosity in bone cortices indicative of vitamin C deficiency seen in 32% of the total sample and porous lesions in the orbit (cribra orbitalia) in 7% of nonadults. Traumatic fractures identified in two adult males. Gastrointestinal conditions were the leading cause of death for nonadults, most adults died of pulmonary conditions. Life expectancy of people buried at the expense of the government was 23.8-42.6 years, those in private burials 57.1 years., Conclusion: Health of migrant settlers from the St Mary's free ground did not differ much from that of a similar population in Britain nor of settlers in New South Wales. Thus, it is characteristic for lower socioeconomic groups in early industrialised societies., Significance: St Mary's sample is a rarity due scarcity of similar Australian skeletal samples., Limitations: Small sample size and lack of similar samples for comparison., Suggestions for Further Research: Comprehensive investigation of dentitions in St Mary's sample and studies of more skeletal samples of early settlers in other Australian locations., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The British colony of South Australia, established in 1836, offered a fresh start to migrants hoping for a better life. A cohort of settlers buried in a section of St Mary's Anglican Church Cemetery (1847-1927) allocated for government funded burials was investigated to determine their health, with a focus on skeletal manifestations associated with metabolic deficiencies. Findings of St Mary's sample were compared with those published for contemporary skeletal samples from two British cemeteries, St Martin's, Birmingham, and St Peter's, Wolverhampton, to explore similarities and differences. To investigate the changing economic background of the St Mary's cohort, which may have influenced the location of their burial within the cemetery, the number and demographic profile of government funded burials and those in privately funded leased plots were compared. The study sample consisted of the skeletal remains of 65 individuals (20 adults, 45 subadults) from St Mary's Cemetery 'free ground' section. The bones and teeth of individuals in this cohort showed evidence of pathological manifestations, including areas of abnormal porosity in bone cortices in 9 adults and 12 subadults and flaring of metaphyses (one subadult) and costochondral junctions of the ribs (one subadult). Porous lesions of orbital roof bones (Types 3 to 4) were seen on three subadults. Macroscopic examination of teeth identified enamel hypoplastic defects and micro-CT scans showed areas of interglobular dentine. Comparison of St Mary's findings with the British samples revealed that prevalences of manifestations associated with vitamin C deficiency were higher at St Mary's and manifestations associated with vitamin D deficiency were lower respectively. The location of burial pattern at St Mary's Cemetery, from the mid-1840s to1860s, showed differences in the economic status of migrants. This pattern changed from the 1870s, which reflected improvements in the local economy and the economic recovery of the colony., Competing Interests: The authors have declared that no competing issues exist.

Context: With the rise of the Delta variant of SARS-CoV-2 and the low vaccination rates in the United States, mitigation strategies to reduce the spread of SARS-CoV-2 are essential for protecting the health of the general public and reducing strain on healthcare facilities. This study compares US counties with and without mask mandates and determines if the mandates are associated with reduced daily COVID-19 infection. US counties have debated whether masks effectively decrease COVID-19 cases, and political pressures have prevented some counties from passing mask mandates. This article investigates the utility of mask mandates in small US counties., Objectives: This study aims to analyze the effectiveness of mask mandates in small US counties and places where the population density may not be as high as in larger urban counties and to determine the efficacy of countywide mask mandates in reducing daily COVID-19 infection., Methods: The counties studied were those with populations between 40,000 and 105,000 in states that did not have statewide mask mandates. A total of 38 counties were utilized in the study, half with and half without mask mandates. Test counties were followed for 30 days after implementing their mask mandate, and daily new SARS-CoV-2 infection was recorded during this timeframe. The counties were in four randomly selected states that did not have statewide mask mandates. The controls utilized were from counties with similar populations to the test counties and were within the same state as the test county. Controls were followed for the same 30 days as their respective test county. Data were analyzed utilizing t-test and difference-in-difference analyses comparing counties with mask mandates and those without., Results: These data showed statistically significant lower averages of SARS-CoV-2 daily infection in counties that passed mask mandates when compared with counties that did not. The difference-in-difference analysis revealed a 16.9% reduction in predicted COVID-19 cases at the end of 30 days., Conclusions: These data support the effectiveness of mask mandates in reducing SARS-CoV-2 infection spread in small US counties where the population density may be less than in urban counties. Small US counties that are considering passing mask mandates for the population can utilize these data to justify their policy considerations., (© 2022 Hadie Islam et al., published by De Gruyter, Berlin/Boston.)

Objective: This study presents a quantitative genetic analysis of human anterior dental morphology in a longitudinal sample of known genealogy. The primary aim of this work is to generate a suite of genetic correlations within and between deciduous and permanent characters to access patterns of integration across the diphyodont dental complex., Design: Data were recorded from casted tooth crowns representing participants of a long-term Australian twin and family study (deciduous n = 290, permanent n = 339). Morphological trait expression was observed and scored following Arizona State University Dental Anthropology System standards. Bivariate genetic correlations were estimated using maximum likelihood variance decomposition models in SOLAR v.8.1.1., Results: Genetic correlation estimates indicate high levels of integration between antimeres but low to moderate levels among traits within a tooth row. Only 9% of deciduous model comparisons were significant, while pleiotropy was indicated for one third of permanent trait pairs. Canine characters stood out as strongly integrated, especially in the deciduous dentition. For homologous characters across dentitions (e.g., deciduous i 1 shoveling and permanent I 1 shoveling), ∼70% of model comparisons yielded significant genetic correlations., Conclusions: Patterns of genetic correlation suggest a morphological canine module that spans the primary and secondary dentition. Results also point to the existence of a genetic mechanism conserving morphology across the diphyodont dental complex, such that paired deciduous and permanent traits are more strongly integrated than characters within individual tooth rows/teeth., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: This study generates a series of narrow-sense heritability estimates for crown morphology of the deciduous and permanent dentition with two overarching aims. The first is to test the hypothesis that deciduous teeth provide a more faithful reflection of genetic information than their permanent successors. The second is to use quantitative genetic methods to evaluate assumptions underlying common data collection and analysis practices in biodistance research., Materials and Methods: Dental morphology data were collected from longitudinal dental casts representing Australian twins and families using Arizona State Dental Anthropology System standards. Polygenic models and estimates of narrow-sense heritability were generated using SOLAR v.8.1.1. Each model considered age, sex, and age/sex interaction as covariates., Results: Heritability estimates significantly differed from zero for the majority of morphological crown characters. Most estimates fell within the 0.4-0.8 range typically observed for crown morphology. Mean heritability was stable across the dental complex, but for paired homologues, permanent traits often yielded higher estimates than their deciduous counterparts. Results indicate directional asymmetry in environmental influence for crown morphology and inform biodistance "best practices" related to data collection and treatment., Conclusions: Overall, results for this sample support the use of crown morphology as a proxy for genetic variation in evolutionary research. This includes the deciduous dentition, which justifies the expansion of efforts to incorporate subadults into reconstructions of past microevolutionary processes. Results do not indicate that deciduous phenotypes more closely approximate underlying genotype, at least for deciduous/permanent homologues., (© 2020 Wiley Periodicals, Inc.)

Objectives: The objective of this study was to revisit the topic of compensatory interactions between maxillary anterior teeth during development advanced by Sofaer et al. (1971). We addressed the hypotheses listed by Sofaer and colleagues using data derived from our Australian twin sample to investigate whether final tooth size in permanent maxillary central incisors and canines showed evidence of developmental compensation for adjacent missing or microdont lateral incisors. Such compensation is one factor interacting in the complex system of dental development., Materials and Methods: A 2D image analysis system was used to measure crown height from the labial view, labiopalatal crown width from the incisal view, and mesiodistal crown width from both the labial (MDl) and incisal (MDi) views of the permanent maxillary central incisors and canines on the dental study model of twins enrolled in a longitudinal study of dental development., Results: Developmental variations of maxillary lateral incisors influence the morphogenesis of the adjacent teeth. For example, individuals with one missing lateral incisor and one lateral incisor of average dimensions, had significantly larger central incisors than the control group for the MDl and MDi dimensions (p < 0.05). Of the 7 monozygotic twin pairs, 6 were discordant in maxillary anterior hypodontia and microdontia, and 13 out of 14 dizygotic twin pairs were discordant., Conclusions: This study provides further evidence of developmental interactions in the maxillary anterior region, partially supporting Sofaer and colleagues' hypotheses. These interactions are part of a complex adaptive system involving genetic, epigenetic and environmental factors., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to investigate size and shape variation of human premolars between Indigenous Australians and Australians of European ancestry, and to assess whether sex and ancestry could be differentiated between these groups using 3D geometric morphometrics., Materials and Methods: Seventy dental casts from each group, equally subdivided by sex, were scanned using a structured-light scanner. The 3D meshes of upper and lower premolars were processed using geometric morphometric methods. Seventy-two landmarks were recorded for upper premolars and 50 landmarks for lower premolars. For each tooth type, two-way ANOVA was used to assess group differences in centroid size. Shape variations were explored using principal component analysis and visualized using 3D morphing. Two-way Procrustes ANOVA was applied to test group differences for ancestry and sex, and a "leave-one-out" discriminant function was applied to assess group assignment., Results: Centroid size and shape did not display significant difference between the sexes. Centroid size was larger in Indigenous Australians for upper premolars and lower second premolars compared to the Australians of European ancestry. Significant shape variation was noted between the two ancestral groups for upper premolars and the lower first premolar. Correct group assignment of individual teeth to their ancestral groups ranged between 80.0 and 92.8% for upper premolars and 60.0 and 75.7% for lower premolars., Discussion: Our findings provide evidence of significant size and shape variation in human premolars between the two ancestral groups. High classification rates based on shape analysis of upper premolars highlight potential application of geometric morphometrics in anthropological, bioarcheological and forensic contexts., (© 2018 Wiley Periodicals, Inc.)

Many representations of the movement of healthcare knowledge through society exist, and multiple models for the translation of evidence into policy and practice have been articulated. Most are linear or cyclical and very few come close to reflecting the dense and intricate relationships, systems and politics of organizations and the processes required to enact sustainable improvements. We illustrate how using complexity and network concepts can better inform knowledge translation (KT) and argue that changing the way we think and talk about KT could enhance the creation and movement of knowledge throughout those systems needing to develop and utilise it. From our theoretical refinement, we propose that KT is a complex network composed of five interdependent sub-networks, or clusters, of key processes (problem identification [PI], knowledge creation [KC], knowledge synthesis [KS], implementation [I], and evaluation [E]) that interact dynamically in different ways at different times across one or more sectors (community; health; government; education; research for example). We call this the KT Complexity Network, defined as a network that optimises the effective, appropriate and timely creation and movement of knowledge to those who need it in order to improve what they do. Activation within and throughout any one of these processes and systems depends upon the agents promoting the change, successfully working across and between multiple systems and clusters. The case is presented for moving to a way of thinking about KT using complexity and network concepts. This extends the thinking that is developing around integrated KT approaches. There are a number of policy and practice implications that need to be considered in light of this shift in thinking., (© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Image guidance for spine pain control procedures, including epidural steroid injection, nerve root block, and facet block, can be performed with either computed tomography (CT) or conventional fluoroscopy. CT has the advantage of improved anatomic localization and use of air for contrast; however, there are concerns that CT leads to higher radiation dose and longer procedure time., Objective: To evaluate procedure time and radiation dose for multiple types of spine pain control procedures performed under CT guidance., Study Design: Retrospective evaluation., Setting: Department of radiology in single academic medical center., Methods: Institutional review board approval was obtained. We reviewed CT-guided spine procedures performed over a 12-month period from January 2012 to December 2012. Procedure type, procedure time, and dose-length product were recorded. Patient age and gender were recorded for each case; additionally, demographic and medical history data were obtained for a sub-group of patients., Results: Nine hundred ninety-four studies (performed in 699 patients) were reviewed, including 585 epidural steroid injections, 228 nerve root blocks, and 90 facet blocks. For all studies, procedure time averaged 7:34 ± 5:05, and dose-length product averaged 75 mGy·cm ± 61. Additional medical history (available for 483 patients) revealed high rate of obesity (body mass index [BMI] = 30 ± 6.8, with 76% of patients overweight [BMI > 25] and 42% obese [BMI > 30]), and frequent medical comorbidities (including hypertension [n = 179], diabetes [n = 101], renal failure [n = 30], and heart failure [n = 17])., Limitations: This study was performed retrospectively, and limited to a single institution., Conclusion: These findings add to the growing evidence that CT guidance is a safe and effective technique for epidural steroid injection. These results further demonstrate that other spine intervention procedures, including nerve root block and facet block, can also be performed under CT guidance with short procedure time and reasonable levels of radiation exposure. This approach can be effectively used in a patient population with a high rate of obesity and medical comorbidities.

Background: Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult US population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure's safety profile in an older patient population., Objective: This retrospective study analyzed safety data among a single-center cohort of patients > 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015., Study Design: An Institutional Review Board (IRB)-approved retrospective chart review., Setting: University hospital center., Methods: A total of 688 CT-guided ESI procedures were evaluated and a linear regression analysis was conducted to examine the relationship between dose length product (DLP), body mass index (BMI), procedure duration, and kVp/mA settings. Further analysis was performed on a sample of long procedure time, average-DLP and high-DLP procedures., Results: Average age was 75.77 years, with 44% having a BMI > 30. The mean DLP was 55.58 mGy x cm and the mean procedure duration was 5.94 minutes. All procedures were technically successful and no complications were observed during or after any of the procedures, including at one-month follow-up office visits. The kVp and mA settings were the strongest predictors of DLP, followed by procedure time. The high-DLP cases had a greater number of needle placement series, more intervertebral disc spaces included in each planning series and higher machine settings (kVp 120; mA 87.5) than the average-DLP cases (kVp 100; mA 49.9)., Limitations: This study is limited by its retrospective design., Conclusion: CT-guided interlaminar ESIs can be performed safely, with low procedure times, relatively low DLP's and without complications in an older patient population. Key words: Epidural steroid injection, interlaminar approach, CT-guidance, older adults, back pain, lumbar spine, thoracic spine, cervical spine, dose length product, radiation exposure.

Objective: The aim of this study was to investigate the prevalence of selected dental variations in association with infraocclusion, as well as determining the effects of infraocclusion on dental development and tooth size, in singletons and twins., Design: Two samples were analysed. The first sample comprised 1454 panoramic radiographs of singleton boys and girls aged 8-11 years. The second sample comprised dental models of 202 pairs of monozygotic and dizygotic twins aged 8-11 years. Adobe Photoshop CS5 was used to construct reference lines and measure the extent of infraocclusion (in mm) of primary molars on the panoramic radiographs and on 2D images obtained from the dental models. The panoramic radiographs were examined for the presence of selected dental variations and to assess dental development following the Demirjian and Willems systems. The twins' dental models were measured to assess mesiodistal crown widths., Results: In the singleton sample there was a significant association of canines in an altered position during eruption and the lateral incisor complex (agenesis and/or small tooth size) with infraocclusion (P<0.001), but there was no significant association between infraocclusion and agenesis of premolars. Dental age assessment revealed that dental development was delayed in individuals with infraocclusion compared to controls. The primary mandibular canines were significantly smaller in size in the infraoccluded group (P<0.05)., Conclusion: The presence of other dental variations in association with infraocclusion, as well as delayed dental development and reduced tooth size, suggests the presence of a pleiotropic effect. The underlying aetiological factors may be genetic and/or epigenetic., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: The associations seen clinically between variations in tooth number, size and shape reflect the repetitive genetic interactions occurring between the epithelium and mesenchyme during the initiation and morphogenetic stages of the Complex Adaptive System that is dental development. The aim of this study was to investigate the clinical relationship further by comparing multiple crown parameters, including cusp numbers, between patients with mild hypodontia and controls in a Romanian sample., Design: Digital images of dental casts of the permanent dentition from 28 patients with mild hypodontia and 28 controls were used. Measurements from the vestibular and occlusal surfaces were performed using a 2D image analysis method and cusps, including the Carabelli trait, were counted. Two-way analysis of variance was performed., Results: The dimensions of the mild hypodontia group had smaller values than the controls, with many measurements being significantly different (significance values varied from p=0.049 to p=0.001). The most affected regions were the upper and lower anterior region in both sexes. Mesio-distal, bucco-lingual and occlusal area and perimeter dimensions were affected. Females from the hypodontia group had significantly less tricuspidated lower premolars when compared with the control group. Carabelli cusps were present in the hypodontia group less frequently, the difference being highly significant (p=0.0002) in women., Conclusions: The hypodontia patients presented with reduced crown dimensions and shape compared with controls. This is the first published study to demonstrate smaller cusp numbers in patients with hypodontia than in controls. The findings are compatible with a model of dental development as a Complex Adaptive System incorporating associations between tooth number, size and shape., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Context: In the non-invasive detection of markers of disease, mass spectrometry is able to detect small quantities of volatile markers in exhaled air. However, the problem of size, expense and immobility of conventional mass spectrometry equipment has restricted its use. Now, a smaller, less expensive, portable quadrupole mass spectrometer system has been developed. Helicobacter pylori has been implicated in the development of chronic gastritis, gastric and duodenal ulcers and gastric cancer., Objectives: To compare the results obtained from the presence of H. pylori by a carbon-13 urea test using a portable quadrupole mass spectrometer system with those from a fixed mass spectrometer in a hospital-based clinical trial., Methods: Following ethical approval, 45 patients attending a gastroenterology clinic at the Royal Liverpool University Hospital exhaled a breath sample into a Tedlar gas sampling bag. They then drank an orange juice containing urea radiolabelled with carbon and 30 min later gave a second breath sample. The carbon-13 content of both samples was measured using both quadrupole mass spectrometer systems. If the post-drink level exceeded the pre-drink level by 3% or more, a positive diagnosis for the presence of H. pylori was made., Results: The findings were compared to the results using conventional isotope ratio mass spectrometry using a laboratory-based magnetic sector instrument off-site. The results showed agreement in 39 of the 45 patients., Conclusions: This study suggests that a portable quadrupole mass spectrometer is a potential alternative to the conventional centralised testing equipment. Future development of the portable quadrupole mass spectrometer to reduce further its size and cost is indicated, together with further work to validate this new equipment and to enhance its use in mass spectrometry diagnosis of other medical conditions.

Objectives: A priority research area in minimal intervention dentistry is the characterization of the early stages of dental erosion. The aim of this in vitro study was to assess the effect of short, repetitive erosive challenges to human enamel over 2 min at pH 1.5 and 3.0 under conditions simulating gastric regurgitation., Methods: Enamel surfaces were subjected to erosive challenges at pH 1.5 (Group 1, n=10) and pH 3.0 (Group 2, n=9) for periods of 30s (stage 1), 60s (stage 2) and 120 s (stage 3). Quantitative changes were assessed longitudinally by measuring the 3D average surface roughness (Sa) values using 3D confocal microscopy. Qualitative micrographic assessment of surface changes was also conducted by using environmental scanning electron microscopy., Results: Linear mixed model analysis showed significant effects of the pH values (p<0.001) and the stages (p<0.001) on the observed Sa values. Post hoc tests showed significant increases in the Sa values between baseline and other stages in both groups (p<0.01). The mean Sa values also increased significantly from stage 1 to stage 2 in Group 1 (p<0.05). Micrographic analysis displayed severely etched enamel rods in Group 1, but only subtle changes in Group 2., Conclusions: The complexity of the enamel surface is influenced by both acid concentration (pH value) and duration of acid exposure during early stages of erosion. Erosion occurring under conditions simulating GORD can be detected in its initial stages, opening up the possibilities of early diagnosis and management of this condition., Clinical Significance: Erosive tooth wear occurs progressively and insidiously, often creating complex treatment challenges. This emphasizes the need for early diagnosis and management in accordance with minimal intervention philosophy. Our findings provide a foundation for further research that could lead to the development of highly-sensitive clinical diagnostic tools and preventive strategies., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The Craniofacial Biology Research Group in the School of Dentistry at The University of Adelaide is entering an exciting new phase of its studies of dental development and oral health in twins and their families. Studies of the teeth and faces of Australian twins have been continuing for nearly 30 years, with three major cohorts of twins recruited over that time, and currently we are working with twins aged 2 years old to adults. Cross-sectional data and records relating to teeth and faces of twins are available for around 300 pairs of teenage twins, as well as longitudinal data for 300 pairs of twins examined at three different stages of development, once with primary teeth, once at the mixed dentition stage, and then again when the permanent teeth had emerged. The third cohort of twins comprises over 600 pairs of twins recruited at around birth, together with other family members. The emphasis in this third group of twins has been to record the timing of emergence of the primary teeth and also to sample saliva and dental plaque to establish the timing of colonization of decay-forming bacteria in the mouth. Analyses have confirmed that genetic factors strongly influence variation in timing of primary tooth emergence. The research team is now beginning to carry out clinical examinations of the twins to see whether those who become colonized earlier with decay-forming bacteria develop dental decay at an earlier age. By making comparisons within and between monozygotic (MZ) and dizygotic (DZ) twin pairs and applying modern molecular approaches, we are now teasing out how genetic, epigenetic, and environmental factors interact to influence dental development and also oral health.

Mutations in human and in mouse orthologous genes Amelx and Enam result in a diverse range of enamel defects. In this study we aimed to investigate the phenotype-genotype correlation between the mutants and the wild-type controls in mouse models of amelogenesis imperfecta using novel measurement approaches. Ten hemi-mandibles and incisors were dissected from each group of Amelx(WT), Amelx(X/Y64H), Amelx(Y/Y64H), Amelx(Y64H/Y64H), and Enam(WT), Enam(Rgsc395) heterozygous and Enam(Rgsc395) homozygous mice. Their macro-morphology, colour and micro-topography were assessed using bespoke 2D and 3D image analysis systems and customized colour and whiteness algorithms. The novel methods identified significant differences (p ≤ 0.05) between the Amelx groups for mandible and incisor size and enamel colour and between the Enam groups for incisor size and enamel colour. The Amelx(WT) mice had the largest mandibles and incisors, followed in descending order of size by the Amelx(X/Y64H), Amelx(Y/Y64H) and Amelx(Y64H/Y64H) mice. Within the Enam groups the Enam(WT) incisors were largest and the Enam(Rgsc395) heterozygous mice were smallest. The effect on tooth morphology was also reflected by the severity of the enamel defects in the colour and whiteness assessment. Amelogenin affected mandible morphology and incisor enamel formation, while enamelin only affected incisors, supporting the multifunctional role of amelogenin. The enamelin mutation was associated with earlier forming enamel defects. The study supported the critical involvement of amelogenin and enamelin in enamel mineralization., (Copyright © 2012 S. Karger AG, Basel.)

The aim of this review is to highlight some key recent developments in studies of tooth number, size and shape that are providing better insights into the roles of genetic, environmental and epigenetic factors in the process of dental development. Advances in molecular genetics are helping to clarify how epigenetic factors influence the spatial and temporal regulation of the complex processes involved in odontogenesis. At the phenotypic level, the development of sophisticated systems for image analysis is enabling new dental phenotypes to be defined. The 2D and 3D data that are generated by these imaging systems can then be analysed with mathematical approaches, such as geometric morphometric analysis. By gathering phenotypic data and DNA from twins, it is now possible to use 'genome-wide' association studies and the monozygotic co-twin design to identify important genes in odontogenesis and also to clarify how epigenetic and environmental factors can affect this process. Given that many of the common dental anomalies affecting the human dentition are interrelated, apparently reflecting pleiotropic genetic effects, the discoveries and new directions described in this paper should have important implications for clinical dental practice in the future.

Utilising data derived from twins and their families, different approaches can be applied to study genetic and environmental influences on human dental variation. The different methods have advantages and limitations and special features of the twinning process are important to consider. Model-fitting approaches have shown that different combinations of additive genetic variance (A), non-additive genetic variance (D), common environmental variance (C), and unique environmental variance (E) contribute to phenotypic variation within the dentition, reflecting different ontogenetic and phylogenetic influences. Epigenetic factors are also proposed as important in explaining differences in the dentitions of monozygotic co-twins. Heritability estimates are high for most tooth size variables, for Carabelli trait and for dental arch dimensions, moderate for intercuspal distances, and low for some occlusal traits. In addition to estimating the contributions of unmeasured genetic and environmental influences to phenotypic variation, structural equation models can also be used to test the effects of measured genetic and environmental factors. Whole-genome linkage analysis, association analysis of putative candidate genes, and whole genome association approaches, now offer exciting opportunities to locate key genes involved in human dental development.

This paper reviews the concept of morphogenetic fields within the dentition that was first proposed by Butler (Butler PM. Studies of the mammalian dentition. Differentiation of the post-canine dentition. Proc Zool Soc Lond B 1939;109:1-36), then adapted for the human dentition by Dahlberg (Dahlberg AA. The changing dentition of man. J Am Dent Assoc 1945;32:676-90; Dahlberg AA. The dentition of the American Indian. In: Laughlin WS, editor. The Physical Anthropology of the American Indian. New York: Viking Fund Inc.; 1951. p. 138-76). The clone theory of dental development, proposed by Osborn (Osborn JW. Morphogenetic gradients: fields versus clones. In: Butler PM, Joysey KA, editors Development, function and evolution of teeth. London: Academic Press, 1978. p. 171-201), is then considered before these two important concepts are interpreted in the light of recent findings from molecular, cellular, genetic and theoretical and anthropological investigation. Sharpe (Sharpe PT. Homeobox genes and orofacial development. Connect Tissue Res 1995;32:17-25) put forward the concept of an odontogenic homeobox code to explain how different tooth classes are initiated in different parts of the oral cavity in response to molecular cues and the expression of specific groups of homeobox genes. Recently, Mitsiadis and Smith (Mitsiadis TA, Smith MM. How do genes make teeth to order through development? J Exp Zool (Mol Dev Evol) 2006; 306B:177-82.) proposed that the field, clone and homeobox code models could all be incorporated into a single model to explain dental patterning. We agree that these three models should be viewed as complementary rather than contradictory and propose that this unifying view can be extended into the clinical setting using findings on dental patterning in individuals with missing and extra teeth. The proposals are compatible with the unifying aetiological model developed by Brook (Brook AH. A unifying aetiological explanation for anomalies of tooth number and size. Archs Oral Biol 1984;29:373-78) based on human epidemiological and clinical findings. Indeed, this new synthesis can provide a sound foundation for clinical diagnosis, counselling and management of patients with various anomalies of dental development as well as suggesting hypotheses for future studies.

Aims: In studying aetiological interactions of genetic, epigenetic and environmental factors in normal and abnormal developments of the dentition, methods of measurement have often been limited to maximum mesio-distal and bucco-lingual crown diameters, obtained with hand-held calipers. While this approach has led to many important findings, there are potentially many other informative measurements that can be made to describe dental crown morphology. Advances in digital imaging and computer technology now offer the opportunity to define and measure new dental phenotypes in 3-D that have the potential to provide better anatomical discrimination and clearer insights into the underlying biological processes in dental development. Over recent years, image analysis in 2-D has proved to be a valuable addition to hand-measurement methods but a reliable and rapid 3-D method would increase greatly the morphological information obtainable from natural teeth and dental models. Additional measurements such as crown heights, surface contours, actual surface perimeters and areas, and tooth volumes would maximise our ability to discriminate between samples and to explore more deeply genetic and environmental contributions to observed variation. The research objectives were to investigate the limitations of existing methodologies and to develop and validate new methods for obtaining true 3-D measurements, including curvatures and volumes, in order to enhance discrimination to allow increased differentiation in studies of dental morphology and development. The validity of a new methodology for the 3-D measurement of teeth is compared against an established 2-D system. The intra- and inter-observer reliability of some additional measurements, made possible with a 3-D approach, are also tested., Methods and Results: From each of 20 study models, the permanent upper right lateral and upper left central incisors were separated and imaged independently by two operators using 2-D image analysis and a 3-D image analysis system. The mesio-distal (MD), labio-lingual (LL) and inciso-gingival (IG) dimensions were recorded using our 2-D system and the same projected variables were also recorded using a newly developed 3-D system for comparison. Values of Pearson's correlation coefficient between measurements obtained using the two techniques were significant at the 0.01 probability level for variables mesio-distal and incisal-gingival with labio-lingual significant at the 0.05 level for the upper left side only, confirming their comparability. For both 2-D and 3-D systems the intra- and inter-operator reliability was substantial or excellent for variables mesio-distal, labio-lingual, incisal-gingival actual and projected and actual surface area. The reliability was good for inter-operator reliability measurement of the labio-lingual dimension using 3-D., Conclusions: We have developed a new 3-D laser scanning system that enables additional dental phenotypes to be defined. It has been validated against an established 2-D system and shown to provide measurements with excellent reliability, both within and between operators. This new approach provides exciting possibilities for exploring normal and abnormal variations in dental morphology and development applicable to research on genetic and environmental factors.

A female patient is described with clinical symptoms of both microphthalmia with linear skin defects (MLS or MIDAS) and dental enamel defects, having an appearance compatible with X-linked amelogenesis imperfecta (XAI). Genomic DNA was purified from the patient's blood and semiquantitative multiplex PCR revealed a deletion encompassing the amelogenin gene (AMELX). Because MLS is also localized to Xp22, genomic DNA was subjected to array comparative genomic hybridization, and a large heterozygous deletion was identified. Histopathology of one primary and one permanent molar tooth showed abnormalities in the dental enamel layer, and a third tooth had unusually high microhardness measurements, possibly due to its ultrastructural anomalies as seen by scanning electron microscopy. This is the first report of a patient with both of these rare conditions, and the first description of the phenotype resulting from a deletion encompassing the entire AMELX gene. More than 50 additional genes were monosomic in this patient., (2009 Wiley-Liss, Inc.)

Two metaphors are presented to highlight concepts that could lead to a paradigm shift in dental studies of twins. The first, derived from the Song of Solomon in the Bible, refers to teeth as being twins. This viewpoint emphasises that each tooth should be viewed as a paired structure, not only with its antimere (within the same arch) but also with its isomer (in the opposing arch). The other metaphor provided by Waddington in 1957 is visual and involves 'an epigenetic landscape' that represents the processes of decision-making by cells during development. It likens the different stages of cellular decision-making to a ball rolling down an undulating landscape of interconnecting hills and valleys. This viewpoint helps to explain how distinct differences in dental phenotypes may arise both within and between monozygotic (MZ) co-twins due to relatively minor temporospatial effects during development. Measurements of maximum mesiodistal diameters of teeth in a pair of MZ twins, using calipers and also 2D and 3D imaging systems, have demonstrated that differences in dental crown size occur between antimeric pairs and between corresponding teeth of MZ co-twins. By defining new dental phenotypes that provide more comprehensive descriptions of tooth size and shape, and by drawing on the metaphors described, we are confident of providing new insights into the reasons for observed similarities and differences within, and between, the dentitions of twins. Our approaches will focus on multivariate analyses that take into account the paired arrangement of teeth and also explore epigenetic, as well as genetic and environmental, sources of variation., (Copyright (c) 2009 S. Karger AG, Basel.)

Background: Three-dimensional measurement of dental morphology is providing new variables and shape information not available previously, and the reliability of these data has proved to be substantial. Accurate superimposition of 2D and 3D data-sets has several applications in dental research when making comparisons of similar structures. For example, two data-sets of the same object can be superimposed to highlight differences apparent in limited region(s) of the tooth crown. When significant regions represented by the two data-sets are identical, registration of the images can be achieved by standard superimposition methods. However, for comparisons of crown morphologies between monozygotic and dizygotic co-twins, the data sets are similar but not identical so a new approach to superimposition has been developed., Aim: To develop a non 'best fit' (Synetic) method for the 3D superimposition of non-similar objects that forms one comparable interface providing enhanced methodology for the analysis of differences within the dentition of twins., Method: A minimised least-squares registration approach is followed by diffusion based registration to provide global minimisation between points that is not based on a best fit algorithm. This process is linear and therefore the method ensures uniqueness of the superimposition., Results: Initial results indicate a reliable method producing only one output as opposed to best fit approaches that may generate a different output each time., Conclusion: Diffusion-based registration offers a more reliable approach to superimposing non-identical objects, such as the tooth crowns of monozygotic co-twins, than conventional best-fit methods., (Copyright (c) 2009 S. Karger AG, Basel.)

Objective: To assess the reproducibility of a mobile non-contact camera-based digital imaging system (DIS) for measuring tooth colour under in vitro and in vivo conditions., Methods: One in vitro and two in vivo studies were performed using a mobile non-contact camera-based digital imaging system. In vitro study: two operators used the DIS to image 10 dry tooth specimens in a randomised order on three occasions. In vivo study 1:25 subjects with two natural, normally aligned, upper central incisors had their teeth imaged using the DIS on four consecutive days by one operator to measure day-to-day variability. On one of the four test days, duplicate images were collected by three different operators to measure inter- and intra-operator variability. In vivo study 2:11 subjects with two natural, normally aligned, upper central incisors had their teeth imaged using the DIS twice daily over three days within the same week to assess day-to-day variability. Three operators collected images from subjects in a randomised order to measure inter- and intra-operator variability., Results: Subject-to-subject variability was the largest source of variation within the data. Pairwise correlations and concordance coefficients were > 0.7 for each operator, demonstrating good precision and excellent operator agreement in each of the studies. Intraclass correlation coefficients (ICCs) for each operator indicate that day-to-day reliability was good to excellent, where all ICC's where > 0.75 for each operator., Conclusion: The mobile non-contact camera-based digital imaging system was shown to be a reproducible means of measuring tooth colour in both in vitro and in vivo experiments.

The Enamel Defects Index (EDI) was created based on three innovative principles: (i) a basic level of the three major categories of defects; (ii) more detailed subcategories of each major category; and (iii) each category scored independently as present [1] or absent [0], simplifying decision making. The aim of this investigation was to further test the index in a number of applications and to expand it to record defect subtype and treatment need. Testing was undertaken by operators with different levels of clinical experience. A computer-assisted learning (CAL) package was developed for operator training and calibration. The index was also used on clinical photographs and high-resolution digital images of exfoliated and extracted teeth. Scoring of photographs revealed substantial intra-operator agreement. Training using the CAL package resulted in significant improvement in index use. Intra-operator reproducibility was good to excellent, and interoperator reproducibility was good for buccal surfaces on digital images. Index expansion allowed information on defect subtype, location, and treatment need to be gathered readily. The EDI has high reproducibility and allows more rapid and accurate data collection from clinical and in vitro studies than the Fédération Dentaire Internationale Developmental Defects of Enamel index.

This randomized controlled trial compared the effects of outreach placement with traditional, exclusively dental school-based clinical experience on students' confidence in providing treatment for patients presenting with common dental problems. Senior dental students (n=49) were allocated at random to existing dental school-based clinics or placement in primary care clinics to work supervised by local dentists. At baseline, students self-rated their global confidence on a five-point scale. These measures were repeated at follow-up, augmented by a transition judgment and a then-test of confidence (asking students to look back and re-rate their pre-placement confidence). Groups were comparable at baseline. Follow-up scores for global confidence were similar between groups. The outreach group scored higher in the transition judgment (mean 3.7, SD 0.9) than the control group (mean 3.1, SD 1.1, P=0.05). In the then-test, on reflection, the outreach group considered their baseline ratings of confidence were overoptimistic (mean then-test scores 3.2, SD 0.9 and baseline 3.7, SD 0.5) while the control group thought theirs were accurate (mean then-test scores 3.8, SD 0.7 and baseline 3.6, SD 0.8, P=0.01). The findings suggest dental outreach training in primary care settings is more effective than dental school training alone in improving students' confidence in tackling clinical situations. The measurement of change in confidence is complicated by shifts in students' internal scales arising from insights gained on outreach.

Enamel hypoplasia is a quantitative defect of enamel thickness. Methods previously used for its measurement have limitations in clinical studies. The aim of this study was to investigate new methods of measurement using image analysis. Lesions on 8 teeth affected by enamel hypoplasia were quantified from study models and impression surfaces using an image-analysis system. The measurements made included lesion area and tooth surface area; from these the proportion of tooth surface area affected was calculated. For comparison, manual measurement was performed on impression surfaces and study models, using digital callipers. Images were also acquired of lesions on 12 exfoliated teeth, and the lesion area and total tooth area were calculated. For assessment of intra-operator reliability, the +/-repeatability coefficient was calculated. Measurement of the surface of lesions direct from the exfoliated teeth gave the best results overall, followed by direct image analysis of the silicone impression.

This study investigated hypoplastic enamel defects in a well-defined sample of Romano-Britons from the 3rd to the 5th century AD and compared the findings with a modern British sample investigated by the same authors. All 178 excavated skulls with intact dentitions were examined for hypoplastic defects using the Federation Dentaire International (FDI) Developmental Defects of Enamel Index criteria. Histopathological and microradiographic sections were prepared of 5 teeth. Hypoplastic defects were found in the teeth of 37% of skulls, with 25% having 4 or more teeth affected. The teeth most frequently involved were canines. Of the defects, 75% were horizontal grooves, 12.7% were pitting, and 7.1% were areas of missing enamel. The location of defects was 82% buccal, 16.5% lingual, and 1.2% occlusal. The reproducibility of diagnosis was 84%. Microscopic and microradiographic investigations showed areas of hypomineralization of enamel and wide zones of interglobular dentine related to the hypoplastic grooves. There was higher frequency, different morphology, and greater severity of hypoplastic enamel defects compared with the modern British sample. The defects may be related to repeated environmental stresses between the ages of 2 and 6 yr. Identified environmental stresses in these Romano-Britons, including high lead ingestion, poor nutrition, and recurrent infections, may be important etiological factors for the enamel defects.

Objective: Fluctuating dental asymmetry as an indication of the effect of environmental insults during tooth development requires further investigation. The aim of this study was to assess asymmetry in tooth crown dimension for the increased range of parameters possible with image analysis compared to previous manual measurements., Methods: Study models of 25 male and 25 female white Caucasian subjects were measured from buccal and occlusal views to determine mesio-distal, bucco-lingual, occluso-gingival and tooth surface area dimensions using image analysis. Method errors were assessed by the repeatability coefficient RC and asymmetry assessed calculating intra-class correlation coefficients between pairs of antimere teeth., Results: The method errors calculated using RC were small. There was a high degree of symmetry with correlation coefficients with a range of 0.67-0.96 for linear measurements and 0.80-0.97 for tooth surface areas. No significant differences were found between the genders or between the upper and lower jaws. Asymmetry tended to follow a pattern in morphogenic tooth fields with the mesial tooth showing greater symmetry than the more distal. There were differences in the degree of symmetry among the variables measured with the mesio-distal dimension showing the greatest symmetry., Conclusions: This new technique was reliable and readily applicable, providing also a greater range of measurements. While the asymmetry generally followed a similar pattern to earlier manual studies, there were variations in the degree of symmetry between different parameters.

Objective: Identifying the patterning of congenitally absent teeth will contribute to understanding the aetiology of hypodontia. The aim of this study was to investigate patterns of hypodontia in a group of young adults in Sheffield, UK involving specific tooth types, gender differences and maxilla:mandible and left:right correlations., Methods: The patients were 198 unrelated Caucasian young adults (86 males and 112 females) with non-syndromic hypodontia. Statistical methods included the multivariate techniques of cluster analysis and principal components analysis and associated display devices of circular dotplots and biplots. Autologistic regression was used to model the relationship of the presence or absence of a particular tooth to the status of other teeth., Results: The results revealed distinct patterns of dependence. Common patterns included either third molars and second premolars missing in all quadrants and/or combinations of these two tooth types and the incisors. The gender of the patient and the severity of hypodontia did not have a significant effect on patterns of tooth type absence. If a tooth was missing, the odds ratios that the same tooth type in the horizontally or vertically opposite quadrant was also missing were some 20 times higher than if the tooth was present. For diagonally opposite quadrants the dependence was much weaker., Conclusions: These statistical techniques are valuable for increasing understanding of hypodontia and identifying groups of patients for genetic studies.

The aim of this study was to investigate correlations between the shape of mandibular incisor crowns and crowding. Study models of 50 untreated white subjects (25 men and 25 women) with varying degrees of crowding were studied. The lower incisors were sectioned and imaged at the contact point and midpoint levels, and the mesiodistal width was measured. Crowding was quantified by using both Little's irregularity index and anterior tooth size-arch length discrepancy. The ratio of the 2 mesiodistal widths was correlated with Little's irregularity index and anterior tooth size-arch length discrepancy. In the women, the ratio showed correlations of 0.52 (P =.008) and 0.55 (P =.005) for central and lateral incisors, respectively, with anterior tooth size-arch length discrepancy. No predictors of lower incisor crowding could be established from mandibular incisor crown shape in this study.

We describe the molecular analysis of three families with hypodontia involving primarily molar teeth and report two novel mutational mechanisms. Linkage analysis of two large families revealed that the hypodontia was linked to the PAX9 locus. These two families revealed missense mutations consisting of a glutamic acid substitution for lysine and a proline substitution for leucine within the paired domain of PAX9. A pair of identical twins affected with hypodontia in a third family demonstrated a 288-bp insertion within exon 2 that resulted in a putative frameshift mutation and a premature stop codon. The insertion was associated with the loss of 7-bp from exon 2. A block of 256-bp of sequence within the insertion was completely identical to downstream sequence from the second intron of the PAX9 gene. These studies extend the spectrum of mutations in PAX9 associated with hypodontia to include heretofore undescribed categories, including missense mutations., (Copyright 2003 Wiley-Liss, Inc.)