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The LightSpeed system.

This article describes the use of an innovative, engine-driven, rotary, root canal preparation instrument. The geometric design of this nickel-titanium instrument is totally different from currently marketed manual or engine-driven stainless steel or nickel-titanium instruments. The thin, taperless, noncutting shafts of LightSpeed instruments maximize the flexibility of the nickel-titanium alloy, particularly in the larger sizes. The three different methods for using the LightSpeed cutting heads and three different methods for using the LightSpeed system are described. LightSpeed instruments enable larger apical preparations in curved canals with less coronal flaring than is possible with most other techniques.

Dental Alloys↗

Electronic apex locator.

Locating the appropriate apical position always has been a challenge in clinical endodontics. The electronic apex locator (EAL) is used for working length determination as an important adjunct to radiography. The EAL helps to reduce the treatment time and the radiation dose, which may be higher with conventional radiographic measurements. According to recent publications, the accuracy of frequency-dependent EALs appears to be much higher compared with traditional-type EALs (simple resistance type or impedance type). This article reviews the history and the working mechanism of the currently available EALs, and suggests the correct usage of the apex locator for a better canal length measurement.

Dental Pulp Cavity↗

Endodontic working width: current concepts and techniques.

Root canal morphology is a critically important part of conventional and surgical endodontics (root canal therapy). Many in vitro studies have recorded the scales and average sizes of root canals, but there have been few clinical attempts to determine the working width. In the absence of a study that defines what the original width and optimally prepared horizontal dimensions of canals are, clinicians are making treatment decision without any support of scientific evidence. This article provides definitions and perspectives on the current concepts and techniques to handle working width-the horizontal dimension of the root canal system-and its clinical implications.

Dental Pulp↗

Evidence for reproductive isolation between cave bear populations.

The European cave bear (Ursus spelaeus), which became extinct around 15,000 years ago, had several morphologically different forms. Most conspicuous of these were small Alpine cave bears found at elevations of 1,600 to 2,800 m. Whereas some paleontologists have considered these bears a distinct form, or even a distinct species, others have disputed this. By a combination of morphological and genetic methods, we have analyzed a population of small cave bears from Ramesch Cave (2,000 m altitude) and one of larger cave bears from Gamssulzen Cave (1,300 m), situated approximately 10 km apart in the Austrian Alps (Figure 1A). We find no evidence of mitochondrial gene flow between these caves during the 15,000 years when they were both occupied by cave bears, although mitochondrial DNA sequences identical to those from Gamssulzen Cave could be recovered from a site located about 200 km to the south in Croatia. We also find no evidence that the morphology of the bears in the two caves changed to become more similar over time. We suggest that the two cave bear forms may have represented two reproductively isolated subspecies or species.

Animals↗

Mathematical analysis of tooth and restoration contour using image analysis.

OBJECTIVES: The aim of this study was to develop a methodology for comparison of the contour of artificial crowns in the mid bucco-lingual plane with their equivalent natural teeth on the opposing side of the same arch (antimeres) using a novel application of image analysis software. The objective was to determine whether artificial crowns were overcontoured. METHODS: Specimens consisted of thin sections of silicone putty impressions of the buccal and lingual surfaces of 55 full crown restorations and their natural antimeric teeth. A thin slice of the putty was obtained in the mid-tooth bucco-lingual plane and a digital image was captured and this was analysed to produce a data set (x, y) representing the curvature of the tooth surface. Further analysis was performed in order to describe the profile in optimum mathematical terms. RESULTS: The curves were best represented by three equations: y = a + bx(0.5), ln(y) = a + bx2, and y2 = a + bx. In all equations parameter (b), which expresses the contour curvature, was used as a deciding factor in comparing the degree of contour of the crown restorations with their natural antimeres. Most artificial crowns were found to be either similarly or undercontoured when compared with their natural antimeres. When overcontouring was present in the artificial crowns this tended to occur on the lingual aspects of anterior and posterior crowns. SIGNIFICANCE: Simplifying tooth contour into a mathematical model can be useful in determining whether restorations are overcontoured. Clinically, particular attention should be directed towards the lingual aspects of restorations which were more likely to be overcontoured.

Crowns↗

Evaluation of post-mortem estimated dental age versus real age: a retrospective 21-year survey.

The aim of the study was to evaluate the reliability of methods used for forensic dental age estimation. We analysed all cases over the last 21 years (1984-2004) of unidentified bodies that were examined for identification purposes (including age assessment), and of which secure identification was subsequently achieved. In total, the study included 51 cases and 7 different methods had been used for dental age estimation, with the Bang/Ramm and the Gustafson/Johanson methods being the most frequently applied. The age estimates had usually been recorded as 10-year intervals. Factual ages at death were in the range of 6-76 years, with the largest concentration of cases being in the age interval of 25-55 years (34 cases). There was good agreement between estimated age interval and factual age at death in 37/51 (72%) of the cases. In eight cases the factual age at death deviated up to +/-5 years from the estimated age, and in six cases by more than 6 years. The average difference between factual age at death and estimated age was 4.5 years. The four subadults in the material were all correctly estimated within an age range of +/-3 years. Our study showed that forensic odontological age estimates are reliable. However, the implementation of the specific methods may need to be adjusted concerning age ranges. In the future we recommend to register anamnestic information and the different steps in the methods used. Clinical evaluation should contain more details about attrition, colour, number and presumed age of the restorations and periodontal status.

Adolescent↗

The chronology of third molar mineralization in the Austrian population--a contribution to forensic age estimation.

The aim of the present study was to determine the chronology of third molar mineralization and to establish Austrian reference data. Therefore, a cross-sectional study was undertaken by evaluating 610 panoramic radiographs in order to assess the mineralization status of the mandibular third molars of Austrian male and female individuals (275 males and 335 females) between the ages of 12 and 24. The evaluation was carried out using the eight grade scheme of Demirjian et al. (1973). Mean ages, standard deviations, standard errors and percentile distributions are presented for each stage of development. Significant differences between the left and right mandibular third molars were not found. Males reach the developmental stages earlier than females, statistically significant differences were noted in stages E and F. Both mandibular third molars were observed in the majority of the individuals of the Austrian sample (477 individuals, 78.2%). For medicolegal purposes the likelihood of whether an Austrian individual is older than 18 years or not was determined.

Adolescent↗

Topographic anatomy of the inferior wall of the maxillary sinus in Koreans.

Knowledge of the relationship between the root apex and the inferior wall of the maxillary sinus are crucial for diagnosing and treating a sinus pathosis as well as in assisting in dental implantation. Therefore, identifying the proximity between the root apex and the inferior wall of the sinus and clarifying the cortical thickness of the inferior wall of the sinus is essential for determining the topography of a spreading dental infection into the maxillary sinus. Accordingly, knowledge of the topography between the root apex and the inferior wall of maxillary sinus is important for diagnosing and planning dental implantation, endodontic procedures, and orthodontic treatment. This study was undertaken to clarify the morphological and clinical characteristics of the maxillary sinus, particularly the inferior wall of the sinus in Koreans, and to identify the relationship between the inferior wall of the maxillary sinus and the roots of the maxillary teeth. Twenty-four sides of the maxillae of hemi-sectioned Korean heads were used in this study. All specimens were decalcificated and sectioned coronally. On the sectioned specimens, 21 items were measured using an image analyzing system. The distances between the each root apex and the inferior wall of the maxillary sinus were measured. The distance from the root apex to the inferior wall of the sinus was the shortest in the second molar area and the longest in the first premolar area. The thickness of the cortical plate of the inferior wall of the maxillary sinus was thinnest in the first premolar area but it was thickest in the second premolar area. The vertical relationship between the inferior wall and the roots of the maxillary molars was classified into five types. Type I (the inferior wall of the sinus located above the level connecting the buccal and lingual root apices) dominated (54.5% in the first molar area, 52.4% in the second molar area). The horizontal relationship between the inferior wall of the sinus and the root apex was classified into three types. Type 2 (the alveolar recess of the inferior wall of the sinus was located between the buccal and lingual roots) was most common (80% in the first and second molar area). Overall, this study demonstrated the many anatomical characteristics and determined the relationships between the maxillary sinus and their surrounding structures. These findings may have an impact on the clinical management of patients.

Anatomy, Cross-Sectional↗

A morphometric analysis of the Late Pleistocene Human Skeleton from the Moh Khiew Cave in Thailand.

Few Late Pleistocene human remains have been found in Southeast Asia and the morphological features of the people of that age are still largely unknown due to the virtual lack of human remains in the area. Recent excavations at the Moh Khiew Cave in Thailand resulted in the discovery of a Late Pleistocene human skeleton in a relatively good state of preservation. An AMS radiocarbon date on the charcoal sample gathered from the burial gave a result of 25,800 +/- 600 BP, implying that the inhabitants of Moh Khiew Cave resided in a part of Sundaland during the last glacial age. In debates on the population history of Southeast Asia, it has been repeatedly advocated that Southeast Asia was occupied by indigenous people akin to present-day Australo-Melanesians prior to an expansion of migrants from Northeast Asia into this area. Morphometric analyses were undertaken to test the validity of this hypothesis. In the present study, cranial and dental measurements recorded from the Moh Khiew remains are compared with those of early and modern samples from Southeast Asia and Australia. These comparisons demonstrate that the Moh Khiew specimen resembles the Late Pleistocene series from Coobool Creek, Australia in both cranial and dental measurements. These results suggest that the Moh Khiew skeleton, as well as other fossil remains from the Tabon, Niah and Gua Gunung sites, represents a member of the Sundaland population during the Late Pleistocene, who may share common ancestry with the present-day Australian Aborigines and Melanesians.

Cephalometry↗

Odontometric systematic assessment of the Swartkrans SK 15 mandible.

This study reports a comparison of molar crown and cusp size and shape in the Swartkrans early Homo mandible SK 15 with relevant Plio-Pleistocene taxa. Univariate and multivariate methods are employed to consider the morphological affinities of this specimen and to assess its taxonomy. The case exists for classifying SK 15 in Homo habilis with 11 features aligning it with this species. The results of multivariate studies are consistent with this hypothesis. Moreover, SK 15 lacks a number of important features that characterise the mandibular molars of Homo sapiens erectus. Considerable evidence for parallelism in the dental morphology of SK 15 and H. habilis with A. robustus is discussed. Fossil evidence for the presence of H. sapiens erectus during the Plio-Pleistocene of South Africa presently seems to be lacking. Archaeological interpretations should take greater account of this gap in the fossil record.

Craniology↗

Risk analysis of failure of root canal treatment for teeth with inaccessible apical constriction.

OBJECTIVE: The risk of failure of root canal therapy was assessed in teeth with inaccessible apical constriction and factors influencing treatment outcome in these teeth were analyzed. METHODS: From the same 57 patients, one tooth with inaccessible apical constriction (n=57) and one tooth with adequate accessibility (n=57) were included in this retrospective investigation. Cox regression analysis was used to analyze factors that may have influenced the outcome one or more years after obturation. These factors included inaccessibility, systemic disease, canal curvature, preoperative periradicular lesion, widening of periodontal ligament space, patient gender and age, size of master apical file, preoperative pulp vitality, years of operator experience and obturation length. RESULTS: Inaccessible apical constriction was a significant factor related to outcome (odds ratio, 5.301). Preoperative presence of periradicular lesion significantly influenced the outcome in cases with inaccessibility (odds ratio, 4.448). CONCLUSION: Inaccessibility increases the risk of root canal therapy failure particularly in teeth with preoperative periradicular lesion.

Adult↗

Accuracy of electronic apex locators in comparison to actual length--an in vivo study.

OBJECTIVES: The measurement precision of four electronic apex locators (Root ZX, Morita, Tokyo, Japan; Endy, Loser, Leverkusen, Germany; Justy II, Hager-Werken, Duisburg, Germany; Endox Lysis, Milan, Italy) was examined in the present in vivo study. METHODS: The root canal length of 40 single-rooted and multi-rooted teeth was determined with the four devices prior to tooth extraction. To determine the actual root canal length, the apical third was longitudinally sectioned, the root canal instrument was positioned and the apex was examined using a microscope. RESULTS: The average measurement deviation (+/-SD) in relation to the apical constriction was 0.3 mm (+/-0.6) for the Root ZX, 0.7 mm (+/-1.0) for the Endy, 0.2 mm (+/-0.7) for the Justy II and 1.3 mm (+/-1.7) for the Endox. The limit of +/-0.5 mm from the apical constriction was attained by the Root ZX in 78%, by the Endy in 67%, by the Justy II in 80% and by Endox in 31% of all measurements. CONCLUSIONS: The latest generation of apex locaters provide the clinician with an accurate and useful adjunct for the determination of root canal length.

Dental Pulp Cavity↗

Assessment of convergence angles of tooth preparations for complete crowns among dental students.

OBJECTIVES: Convergence angles for complete crown preparations have been recommended at 4-12 degrees . However, practitioners have difficulty meeting these recommendations. This study measured and compared the convergence angles of tooth preparations for complete crowns prepared at three Colleges of Dentistry: the University of Tanta, Egypt, King Abdulaziz University, Saudi Arabia, and The Ohio State University, Columbus, Ohio. METHODS: The convergence angles of 499 tooth preparations for complete crowns were evaluated. These comprised of a random sample of 262 teeth prepared by third-year dental students at the University of Tanta on extracted molars under normal preclinical conditions, 37 preparations on molar teeth on typodonts done by first-year dental students. The Ohio State University and 200 molar typodont complete crown preparations done by fourth-year dental students at King Abdulaziz University, Saudi Arabia. The bucco-lingual and mesio-distal convergence angles of each preparation were measured with a goniometer microscope. Mean convergence angles were calculated, and differences between groups were tested for statistical significance with analysis of variance (ANOVA) at 5% level of confidence. RESULTS: Convergence angle measurements were significantly different between the groups and the dimensions (P<0.001). The greatest convergence value (19.8+/-10.0) was for bucco-lingual measurements prepared by Egyptian dental students. The smallest convergence value (14.1+/-3.8) was for mesio-distal measurements prepared by Saudi dental students. CONCLUSIONS: This study emphasized the difference between what is taught at dental schools (what is theoretically possible) and the school results of actual practice. There was a considerable disparity between the convergent angles recorded in this study and the ideal configurations recommended in fixed prosthodontic textbooks and the dental literature.

Crowns↗

Assessment of the amount of remaining coronal dentine in root-treated teeth.

OBJECTIVES: There is currently no standardised technique to measure the amount of coronal dentine remaining in a root-treated tooth after crown preparation. The aim of this study was to develop a method of measuring remaining coronal dentine in root-treated teeth and to propose an index for grading tooth restorability. METHODS: The study recruited 20 patients who had completed molar endodontic treatment at the Eastman Dental Hospital and had been prescribed an amalgam coronal-radicular core with a full coverage cast restoration. Using a series of interlocking special trays and impressions, a method was devised to produce a cast of the amount of remaining dentine coronal to the finish line after crown preparation. This cast was scanned using a laser profilometer and the volume of remaining dentine was calculated. A tooth restorability index (TRI) was developed to assess the strategic value of the remaining dentine. The TRI allowed scores of 0-3 in each sextant with a maximum score of 18 per tooth. RESULTS: Twenty teeth were scored by three examiners and the TRI scores varied from 2 to 13. The volume of coronal dentine varied from 61.73 to 232.22 mm(3). CONCLUSIONS: A tooth restorability index has been devised to assess the strategic value of remaining dentine. A Kappa statistic was calculated to produce values of 0.584, 0.688 and 0.720, giving moderate-good agreement between the examiners.

Crowns↗

Dental morphology of the Dawenkou Neolithic population in North China: implications for the origin and distribution of Sinodonty.

We compare the incidence of 25 nonmetric dental traits of the people of the Neolithic Dawenkou culture (6300-4500 BP) sites in Shandong Province, North China with those of other East Asian populations. The Dawenkou teeth had an overwhelmingly greater resemblance to the Sinodont pattern typical of Northeast Asia than to the Sundadont pattern typical of Southeast Asia. Multidimensional scaling using Smith's mean measure of divergence (MMD) statistic place the Dawenkou sample near the Amur and the North China-Mongolia populations in the area of the plot indicating typical Sinodonty. The existence of the Sinodont population in Neolithic North China suggests a possible continuity of Sinodonty from the Upper Cave population at Zhoukoudian (about 34000-10000 BP) to the modern North Chinese. The presence of Sinodonty in Shandong Province shows that the Japan Sea and East China Sea were strong barriers to gene flow for at least 3000 years, because at this time the Jomonese of Japan were fully Sundadont. In addition, we suggest that the descendants of the Dawenkou population cannot be excluded as one of the source populations that contributed to sinodontification in Japan.

Biological Evolution↗

Does space in the jaw influence the timing of molar crown initiation? A model using baboons (Papio anubis) and great apes (Pan troglodytes, Pan paniscus).

Radiographic and histological studies of baboon (Papio hamadryas, P. anubis) and chimpanzee (Pan troglodytes) permanent tooth development have found that periods of molar crown mineralization overlap markedly in chimpanzees but are staggered in baboons. Here we test the hypothesis that these intertaxon differences in molar initiation are primarily due to the space available in the mandibles of each species for these teeth. This study includes radiographic, linear measurement, and three-dimensional (3D) coordinate landmark data taken from baboon (Papio anubis n=51) and great ape (Pan paniscus n=43, P. troglodytes n=60) mandibles and permanent molars across a broad developmental range for each taxon. Unexpectedly, 3D multivariate statistical shape analysis of the molar crypt, crown, and root data shows that all three species trajectories of molar row shape change are indistinguishable from each other. Qualitative analysis of these 3D data reveals subtle and inconclusive intergeneric differences in the space maintained between adjacent molars during growth. The space distal to each newly initiated molar is slightly greater in the baboon. Bivariate analyses comparing molar row and mandibular corpus proportions in Papio and Pan fail to show clear or consistent taxonomic differences in the ratio of space afforded developing molars in the alveolar bone. Thus, there is a poor correlation between mandibular proportion and both intermolar spacing and 3D molar development pattern. Contrary to earlier studies, these results suggest that pattern of molar crown initiation and temporal overlap of adjacent mineralizing crowns is not significantly different between Papio and Pan. This may be due in part to the inclusion here of not only 3D molar crown data but also 3D molar crypt data. This study strongly refutes the hypothesis that space available in the mandible directly underlies different times of permanent molar crown initiation between Papio and Pan.

Animals↗

Variation in hominoid molar enamel thickness.

Enamel thickness has figured prominently in discussions of hominid origins for nearly a century, although little is known about its intra-taxon variation. It has been suggested that enamel thickness increases from first to third molars, perhaps due to varying functional demands or developmental constraints, but this has not been tested with appropriate statistical methods. We quantified enamel cap area (c), dentine area (b), and enamel-dentine junction length (e) in coronal planes of sections through the mesial and distal cusps in 57 permanent molars of Pan and 59 of Pongo, and calculated average (c/e) and relative enamel thickness (([c/e]/ radicalb) * 100). Posteriorly increasing or decreasing trends in each variable and average (AET) and relative enamel thickness (RET) were tested among molars in the same row. Differences between maxillary and mandibular analogues and between mesial and distal sections of the same tooth were also examined. In mesial sections of both genera, enamel cap area significantly increased posteriorly, except in Pan maxillary sections. In distal sections of maxillary teeth, trends of decreasing dentine area were significant in both taxa, possibly due to hypocone reduction. Significant increases in AET and RET posteriorly were found in all comparisons, except for AET in Pongo distal maxillary sections. Several significant differences were found between maxillary and mandibular analogues in both taxa. Relative to their mesial counterparts, distal sections showed increased enamel cap area and/or decreased dentine area, and thus increased AET and RET. This study indicates that when AET and RET are calculated from samples of mixed molars, variability is exaggerated due to the lumping of tooth types. To maximize taxonomic discrimination using enamel thickness, tooth type and section plane should be taken into account. Nonetheless, previous findings that African apes have relatively thinner enamel than Pongo is supported for certain molar positions.

Animals↗

Population systematics of chimpanzees using molar morphometrics.

When dental morphological variation within extant species is used as a guideline to partition variation within fossil samples into species, the underlying assumption is that fossil species are equivalent to extant species. This is the case despite the fact that dental morphology, which is commonly used to differentiate fossil species, is rarely used to differentiate extant species. Aspects of external morphology, ecology, behavior, breeding patterns, and molecular structure that are used to delineate living species are generally not available for fossils. In this paper, the utility of dental evidence for sorting fossil samples into species is evaluated by testing whether molar occlusal morphology is capable of sorting populations of Pan into the species and subspecies already well-established by nondental evidence. The dentitions of 341 chimpanzee individuals, sampled from regions throughout equatorial Africa, were sorted into 16 populations using rivers to demarcate the boundaries between populations. Digital-imaging software was used to measure 15 traits on the occlusal surface of each upper molar and 19 on each lower molar. After applying size adjustments, size-transformed and untransformed variables were subjected to discriminant analysis, with separate analyses carried out for each molar type. Results indicate that populations of Pan troglodytes and Pan paniscus are well differentiated at all molar positions. Populations of P. t. verus are distinct from other populations of P. troglodytes. Populations of P. t. troglodytes and P. t. schweinfurthii show close dental similarity. A distinct population is recognized at the Nigeria-Cameroon border, indicating the presence of P. t. vellerosus. The concordance between the patterns of diversity recognized by this study and other molecular and nonmolecular studies indicates that paleontological species that are similar to species of Pan in terms of size and patterns of diversification may be differentiated using molar morphology.

Africa↗