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PubMed1985

Morphologic characteristics of the Alaskan Eskimo dentition: IV. Cusp number and groove patterns of mandibular molars.

Data on the permanent dentition of 63 coastal and 33 inland Alaskan Eskimos are presented. The number of cusps and groove pattern of the mandibular molars were recorded. Agenesis of the mandibular third molars was classified and the mesiodistal and buccolingual crown diameter was measured on the first and the second mandibular molars. The predominant pattern of the lower first molars was Y5, while for the second molar the dominating patterns were +5 and +4. In the lower third molar, +5 was found in the majority of cases. For M1 and M2, men showed a stronger tendency toward a conservative pattern than did women. In the case of M2, the inland population exhibited a more conservative trait than did the coastal population. No connection was seen between the groove pattern and agenesis of M3, however, a reduction in the mesiodistal crown diameter for the second molars was seen when the number of cusps is reduced from 5 to 4.

Alaska↗
PubMed2004

Growth and treatment changes distal to the mandibular first molar: a lateral cephalometric study.

This study examined space changes occurring distal to the mandibular first molar in growing patients treated using two different approaches. Two groups of 50 patients were selected for the study. The patients in group I were treated with the extraction of mandibular second premolars, whereas those in group II were treated without mandibular premolar extractions, by holding E-spaces with utility arches. Lateral cephalograms taken before and after treatment were used to measure space changes within the mandible. Follow-up written treatment records and radiographs were also examined to ascertain whether the mandibular third molars were ultimately extracted or retained. A greater mean space increase between Xi point and the mandibular first molar was found in boys and girls treated with second premolar extractions. The mean space increase between Xi point and the mandibular first molar, as well as the average increase in total mandibular length, was greater in boys than in girls for both treatment modalities. This reflects a greater amount of growth in boys during the treatment period. The greater mean space increase in the groups treated with second premolar extractions could be attributed to the fact that the first molar generally moved further mesially during treatment in the extraction subjects, whereas in the E-space subjects, the first molars were perhaps held back. It was noted that the mandibular third molars were ultimately more likely to have been extracted in the E-space groups than in the second premolar extraction groups within this sample.

Adolescent↗
PubMed2001

Periapical healing of mandibular molars after root-end sealing with dentine-bonded composite.

AIM: The purpose was to present the frequency of periapical healing in first and second/third mandibular molars, after root-end resections sealed with a dentine-bonded resin composite. METHODOLOGY: Root-end sealing of resected mandibular molar roots was made with dentine-bonded composite (Gluma-Retroplast) as a cover on the entire slightly hollowed root-end, in an attempt to prevent leakage. RESULTS: Out of the 834 roots recalled between 6 months and 12.5 years postoperatively, 92% showed complete apical healing, 1% uncertain healing and 7% exhibited failure. The healing result of 681 first molar roots was not significantly different (P = 0.21) from that of 153 second/third molar roots, and there was no significant difference in healing between mesial and distal roots (P = 0.32 for first molars, P = 0.86 for second/third molars) or amongst six age groups (P = 0.94). In the patient group: 71-89 years, 36 roots showed an average of 97% with complete healing. Out of 25 failures who were retreated surgically, 80% showed complete healing when examined subsequently. CONCLUSION: Root-end sealing of mandibular molars with dentine-bonded resin composite is a promising technique giving 92% complete healing in cases examined between 6 months and 12 years postoperatively.

Adolescent↗
PubMed2002

Grafting mandibular third molar extraction sites: a comparison of bioactive glass to a nongrafted site.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of bioactive glass used as a graft material for regeneration of bone after the removal of impacted third molars. The healing distal to the second molars was followed, with documentation of the level of radiographic osseous fill and measurement of the changes in clinical attachment levels. METHODS: Fourteen (5 male and 9 female) patients completed the study at 1 year. After surgical removal of bilateral impacted third molars, one site was grafted with bioactive glass particles (BioGran, Orthovita, Malvern, Penn). The patients were followed up at 1 and 2 weeks after surgery for signs or symptoms of infection or any other complications that may have been related to the surgical procedures. At 3, 6, and 12 months, the clinical attachment levels distal to the second molars were assessed. At 6 and 12 months, radiographs were obtained to assess the amount of osseous fill distal to the second molars. RESULTS: A split-mouth design was used to test the efficacy of the grafting materials. Clinical attachment levels in the grafted sites were significantly higher than in the nongrafted sites. There was not a significant increase in bone formation when comparing the 2 sides at 1 year. CONCLUSION: This study suggests that treatment of third molar extraction sites with bioactive glass does significantly alter the clinical attachment level but not the level of osseous fill distal to the second molars after 1 year.

Adult↗
PubMed1997

Effect of non-erupted third molars on roots of approximal teeth. A radiographic, clinical and histologic study.

This study was undertaken to evaluate clinically and histologically root resorption in extracted human second molars in close proximity to non-erupted third molars. The control group consisted of extracted second molars that were proximal to fully erupted third molars. Eight out of the 11 teeth in the study group presented different degrees of radiographic root resorption, nine presented clinical resorption, and all 11 had histologic evidence of root resorption. In the control group, no signs of root resorption were seen radiographically or clinically. Histologically, limited sites of resorption were identified in all teeth, which were partially repaired by cellular cementum. Histologic observation of study specimens revealed root surface resorption in 10 out of the 11 teeth, one showing replacement resorption as well. Inflammatory resorption was observed in the three most advanced cases in the study group. Reparative cementum partially lining resorbed areas was evident in all teeth with surface resorption. Within the limits of this study, radiographic identification of distal root resorption of second molars in close proximity to non-erupted third molars appears reliable. The findings may support the hypothesis that the presence of a non-erupted third molar in close proximity to the distal root of the second results in root resorption.

Adult↗
PubMedDate not supplied

Second molar replacement applied to dentofacial orthopedics and orthodontics much more than a technique.

There is seldom a consensus on any dental subject. The literature contains conflicting points of view and results of studies vary considerably. I have endeavored to present my paradigm of second molar replacement in dentofacial orthopedics and orthodontics. I have presented a summation of information known to date regarding this subject. I based this article on my extensive clinical experience and observations over many years. I participate in continuing education, and know many of the traditional and functional post-doctoral educators. I read the literature. For your benefit, I have presented this information and shared a paradigm that has positively changed my life, and perhaps will change the way you practice. Second molar replacement technique has revolutionized orthodontic treatment. The technique offers distinct benefits considering the patient's face, the jaw joints, and the teeth. The reader is strongly encouraged to read bibliography references for a mature understanding of second molar replacement in modern orthodontics and TMD therapy. When extraction of teeth is needed for orthodontic purposes Broadbent considers second molar replacement, second bicuspid removal, first bicuspid removal, lower incisor removal, and then other extraction possibilities to resolve the malocclusion. When extraction guidelines are followed and treatment mechanics are properly designed the extraction of second molars have predicable good results in a high percentage of cases. However, second molar removal may be contraindicated for numerous reasons. Diagnosis and case selection is paramount! The doctor must diagnosis and determine if and when second molar replacement would be in each patient's best interest. The bottom line for each individual patient is the best possible facial esthetics, functional occlusion, and health of jaw joints.

Adolescent↗
PubMed2001

Management of an impacted, dilacerated mandibular left permanent first molar: a case report.

A case of an unerupted mandibular left permanent first molar, a partially erupted permanent second molar, and a congenitally absent third molar in a 12-year-old girl is described. The permanent first molar, being dilacerated and impacted, required surgical exposure of the crowns of the first and second molars and distalization of the second molar, with the help of a space regainer, to bring the molars into occlusion.

Anodontia↗
PubMed1998

Biomechanical behaviour of modern human molars: implications for interpreting the fossil record.

Finite-element models of 29 intact molars were created and subjected to cleavage-type loads in order to assess differences in the biomechanical behaviour of molars. A simulated food particle, which was one-third the size of the intercuspal distance and had the properties of a Mezzettia seed, was pushed onto the occlusal basin of these models at various angles, resulting in either both or one particular cusp being preferentially loaded. In all cases, the maximum tensile stresses occurred in enamel at the intercuspal fissure. With regard to first maxillary molars, supporting (functional) and guiding (nonfunctional) cusps apparently dissipate loads equally well, whereas, in second and third maxillary molars, the guiding cusps are better designed to resist loads. Overall, lingual cusps of maxillary posterior molars dissipate loads poorly. Conversely, loads exerted toward supporting cusps of mandibular molars are consistently well dissipated, regardless of position along the tooth row. Because the directions of loads to which these teeth are best adapted change along the tooth row, it seems reasonable to suggest that these may correlate with the well-documented structural and functional orofacial complex. This study indicates that the biomechanical behaviour of molars and the orofacial skeleton are likely to have undergone complementary directional changes during evolution. Consequently, caution must be exercised in making inferences about dietary adaptations of extinct species on the basis of isolated teeth or fragmentary gnathic remains without proper regard of the orofacial skeleton as a whole.

Anthropology, Physical↗
PubMed1999

Effects of loading on the biomechanical [correction of biochemical] behavior of molars of Homo, Pan, and Pongo.

In a previous study, we found systematic differences in the biomechanical behavior of modern human molars using finite element stress analyses (FESA), which led us to propose that molars are adapted to differently-directed loads depending on their position within the mouth (Spears and Macho [1998] Am. J. Phys. Anthropol. 106:467-482). While the FESA results thus derived have not been verified experimentally, such an interpretation seemed reasonable. To refine the model previously presented, this study assessed the effects of 1) food particle size on the biomechanical behavior of molars, and those of 2) differences in morphology, particularly enamel thickness, on stress distribution. In order to appraise the evolutionary significance of the findings, the FESA results for modern humans were subsequently compared with those obtained for molars of one individual of Pan and Pongo, respectively. Bearing in mind limitations imposed by the FESA models created and analyzed in this study, constant cleavage-type loads and cuspal tip loads at different directions were employed on all teeth: this facilitated comparisons of patterns of stress distribution across molars and species. In Pan and Homo, cleavage-type loads exerted by big food particles tended to be better dissipated anteriorly than posteriorly, although trends in Pongo were less clear-cut. Furthermore, similar to modern humans, the buccal cusps of mandibular molars appeared to be able to dissipate the loads associated with a pestle-type action, while maxillary molars were better designed to dissipate the loads which would result if they acted as mortars against which the food is crushed/ground. While increases in enamel thickness lowered the overall stress values in teeth only slightly, changes in outer morphology could have a more profound effect on these stress levels. Overall, Pan appeared to be most generalized, while Homo and Pongo showed a number of unique specializations, which are in accordance with what is currently understood about their respective masticatory apparatus and dietary niche.

Animals↗
PubMed2002

Statistical genetic comparison of two techniques for assessing molar crown size in pedigreed baboons.

Dental anthropologists and paleoanthropologists commonly use an estimated molar crown area (mesiodistal length multiplied by buccolingual width) to describe and compare individuals, populations, and species. Advances in digital imaging now allow researchers to measure the actual crown area of a molar in an occlusal two-dimensional plane. Because error is reduced by this more accurate measurement, actual crown area is thought to be a better representation of the mechanisms that determine tooth crown size, meriting the additional time required to collect it. We tested this assumption by estimating the heritability of both these measurements for the second left mandibular molar from a sample of individuals (n = 332) from a captive breeding colony of baboons. Heritability estimates of both the actual and estimated crown areas of molars are approximately 0.83. Therefore, both measurements are informative as population descriptors, with no significant difference between the accuracy of either to reflect additive genetic contributions to molar crown size. This is fortunate, because genetic studies and inference can be based on estimated areas rather than actual crown area. The heritability estimates for mesiodistal length and buccolingual width are both substantial but lower: approximately 0.67 and approximately 0.73, respectively. The best fitting models in these analyses show that sex, body size, and subspecific affinity differentially affect molar length and width. We interpret these results to suggest that potentially some of the genetics underlying these covariates also underlie tooth size. As such, measurements designed to describe molar crown size are useful for general descriptive purposes, but do not conform to the assumption of independence inherent in phylogenetic analyses, such as cladistics (Hennig [1966] Phylogenetic Systematics. Urbana: University of Illinois Press). Therefore, if variables like actual crown area and estimated crown area are to be used in phylogenetic parsimony analyses, we suggest that researchers account for the effects of covariates such as sex and body size in their analyses.

Animals↗
PubMed1975

The functional adaptations of primate molar teeth.

Measurements were taken on the upper and lower molars of 37 species of primates and one tupaiid to assess the relative importance of shearing, crushing and grinding features. Significant correlations were found between pairs of allometrically standardized dimensions which measure the same molar function (shearing, crushing, or grinding). Correlations between pairs of dimensions which do not measure the same function are not significant. Second molar adaptations for shearing, crushing, and grinding, as well as the length of the second lower molar, and the total surface of the post-canine dentition are negatively allometric with respect to metabolic rate. Species which take different proportions of fruit, leaves, and insects in their diets have different molar structure. Frugivores have small teeth for their adult body size with poorly developed shearing, crushing, and grinding features on their molars. By contrast, leaf-eating species tend to have large teeth for their adult body size with well developed shearing, crushing, and grinding. The second molars of insectivorous species were found to parallel closely those of leaf-eating species. The two groups are clearly distinguishable from the former on the basis of body size alone: the smallest living primate leaf-eater is on order of magnitude larger than the largest living primate insectivore.

Adaptation, Physiological↗
PubMed2006

Associations between Carabelli trait and cusp areas in human permanent maxillary first molars.

Few dental anthropological studies have investigated the associations between tooth crown size and crown traits in humans using quantitative methods. We tested several hypotheses about overall crown size, individual cusp areas, and expression of Carabelli cusps in human permanent first molars by obtaining data from standardized occlusal photographs of 308 Australians of European descent (171 males and 137 females). Specifically, we aimed to calculate the areas of the four main molar cusps, and also Carabelli cusp, and to compare the relative variability of cusp areas in relation to timing of development. We also aimed to compare cusp areas between males and females and to describe how Carabelli cusp interacted with other molar cusps. Measurements included maximum crown diameters (mesiodistal and buccolingual crown diameters), the areas of the four main cusps, and the area of Carabelli cusp. The pattern of relative variability in absolute areas of molar cusps corresponded with their order of formation, the first-forming paracone displaying the least variation, and the last-forming Carabelli cusp showing the greatest. Overall crown size and areas of individual cusps all showed sexual dimorphism, with values in males exceeding those in females. Sexual dimorphism was smallest for paracone area and greatest for Carabelli cusp area. Overall crown size and cusp areas were larger in individuals displaying a Carabelli cusp, especially the hypocone area. Although the combined area of the protocone and a Carabelli cusp was greater in cuspal forms than noncuspal forms, protocone area alone was significantly smaller in the former. Our findings lead us to propose that, in individuals with the genotype for Carabelli trait expression, larger molar crowns are more likely to display Carabelli cusps, whereas molars with smaller crowns are more likely to display reduced forms of expression of the trait. We suggest that the pattern of folding of the internal enamel epithelium in developing molar crowns, particularly in the protocone region, can be modified by a developing Carabelli cusp.

Analysis of Variance↗
PubMed2001

Effects of dexamethasone on tooth eruption in rats: differences in incisor and molar eruption.

A requirement for tooth eruption is the resorption of alveolar bone. Because bone resorption is stimulated by dexamethasone both in vivo and in vitro, dexamethasone 21-phosphate, a soluble form of dexamethasone, was injected into rats to determine its effect on tooth eruption. Such dexamethasone injections accelerate the time of intra-osseous eruption in rat incisors but do not accelerate the eruption time of rat molars when injected into rats. The injections of dexamethasone 21-phosphate also accelerate the time of eyelid opening in the postnatal rats, as well as retarding growth, as measured by body weight. These effects of dexamethasone 21-phosphate parallel the effects of epidermal growth factor injections, including the absence of an effect on molar eruption. This suggests that the molecular signals for the initiation of tooth eruption (i.e., onset of bone resorption) differ between rat incisors and molars. Given that rat incisors are teeth of continuous eruption whereas rat molars are teeth of limited eruption, as are human teeth, care must be taken in extrapolating results derived from rat incisors to human dentition. In vitro, dexamethasone has no effect on the gene expression of either osteoprotegerin or epidermal growth factor in dental follicle cells derived from molars. Because osteoprotegerin expression during normal tooth eruption is transitorily inhibited early postnatally in the molar dental follicle to allow osteoclast formation, the absence of inhibition of its expression by dexamethasone could explain why dexamethasone does not accelerate eruption in molars.

Animals↗
PubMed2004

Prevention of third molar tooth development in neonate rat with a long pulse diode laser.

BACKGROUND AND OBJECTIVES: Third molars (wisdom teeth) in humans have limited functional value and cause a high frequency of morbidity. A window of opportunity exists to stop their development. The purpose of this study is to evaluate whether a long pulse diode laser can selectively prevent third molar development in a rat animal model. STUDY DESIGN/MATERIALS AND METHODS: The study calculated theoretical diode laser parameters and irradiated 2- to 4-day-old rat pups in the posterior aspects of the oral cavity near the time of tooth bud initiation. Rats were sacrificed at 35-50 days and examined intraorally and radiographically for third molar development. Control and treated sides were compared histologically. RESULTS: Nearly half of the maxillary third molars and 80% of the mandibular third molars were selectively prevented from developing using a 20 W diode laser with infrequent, minor adverse effects on maxillary jaw growth. CONCLUSIONS: This study confirms the hypothesis that controlled, non-invasive laser treatment delivered on the surface of the oral mucosa near the site of tooth bud formation can selectively achieve third molar agenesis. It also offers hope that further innovative studies may bring about a safe, non-invasive laser treatment to selectively prevent third molar development in humans.

Animals↗
PubMed1999

Biomechanical analysis of arch-guided molar distalization when employing superelastic NiTi coil springs.

Two typical treatment situations (distalization of a last molar, distalization of a molar with the guiding arch fixed on the most distal abutment tooth) were simulated experimentally using the Orthodontic Measurement and Simulation System (OMSS). For this purpose an upper first molar was guided along steel arches with differing cross sections (0.016" x 0.022"/0.41 mm x 0.56 mm; 0.017" x 0.025"/0.43 mm x 0.64 mm) using a nickel-titanium (NiTi) compression spring. The 6 NiTi springs investigated differed in their design and in the type of force delivery. The force application that was eccentric with respect to the center of resistance caused a conflict situation between the tube and the guiding arch through rotations of the molar. Although the force level of the springs was almost constant, the orthodontically effective forces measured fluctuated due to frictional losses. With progressing distalization the mean frictional forces increased, reaching values between 50 and 80% of the applied force of the compression springs. Simultaneously fluctuations in the frictional losses increased. Lower frictional losses were determined with a 0.016" x 0.022", than with a 0.017" x 0.025" guiding arch. Fixing the arch on the 3rd molar resulted in higher frictional losses compared to the distalization of a last molar. There were intensive interactions of the compression springs with the guiding arch and the tube. This resulted in extreme frictional losses even in the initial phase of the movement and in a complete stop to the distalizing movement in extreme cases. After removal of the convertible, the freedom of the molar movement could be regulated by the tension of the ligature wire. The friction varied accordingly. The distalization rate was not influenced by the force delivered by the compression spring. Small forces are biologically more favorable and thus should be preferred.

Analysis of Variance↗
PubMed2006

Molar-incisor hypomineralization (MIH) in a group of school-aged children in Benghazi, Libya.

OBJECTIVE: Molar-incisor hypomineralization (MIH) is common in many countries and it has significant impact on treatment need. The aim of the present study was to assess developmental enamel defects with an emphasis to MIH in children from four primary schools in Benghazi, Libya. METHODS: Permanent first molars of a total of 378 (188 females) 7.0-8.9-year-old children were examined for demarcated opacities, diffuse opacities and hypoplasia in their schools using a portable light, a mirror, and a probe. A subgroup of children attending two of the four schools and having all incisors and first molars erupted (N = 154) was examined for enamel defects in these teeth. RESULTS: Eleven children (2.9%) had MIH. The mean value of demarcated opacities in their first molars was 1.5. MIH lesions were found only in 1.1% of the children's first molars (tooth prevalence) and all lesions were mild. Six children (1.6%) had diffuse opacities and 3 (0.8%) had hypoplastic defects in their first molars. Fourteen out of 154 children (9%) who had both incisors and molars examined had some kind of developmental enamel defect: 11 children (7.1%) had demarcated opacities, 3 (1.9%) had diffuse opacities, and none had hypoplasia. CONCLUSION: MIH was rare in Benghazi, Libya. The prevalence was clearly lower than in comparable studies performed in Italy or in Nordic countries, where, according to the earlier reports, MIH is seen in every fifth or sixth child. Our result may be valuable when so far mostly unknown etiology behind MIH is investigated.

Child↗
PubMed2006

Leveling of the second molar with a superelastic spring.

BACKGROUND: Second permanent molars often erupt during fixed appliance treatment. When they are to be incorporated into the fixed appliance, it is often not possible to bond the buccal tube in the correct position. MATERIAL AND METHODS: We describe herein a method for aligning second permanent molars by means of a superelastic segmental archwire. This involves the application of a rigid steel archwire extending from the right first molar to the left first molar for anchorage. This method was investigated in-vitro and in its clinical application. The in-vitro test was carried out with a hexapode simulating the vertical deviation of the second molar. RESULTS: A .016'' x .022'' stainless steel archwire achieved forces of 13 N; a TMA archwire attained 5 N (both with a deflection of 2 mm), and the superelastic late-leveler achieved a maximum force of 1.3 N with a 5 mm deflection. The maximum uprighting torquing moments were 55 Nmm with the stainless steel archwire, 25 Nmm with the TMA archwire and 2 mm deflection, and 4 Nmm with the late-leveler and 5 mm deflection. CONCLUSIONS: The forces and moments of stainless-steel and TMA archwires are too high for the alignment of second permanent molars. The moderate forces and moments occurring with the superelastic late-leveler are capable of intruding, derotating and uprighting the second molar. The vertical component prevents artificial opening of the bite.

Alloys↗
PubMed2005

Overeruption without root exposure of third molars and periodontal health in the mandible.

Bone formation is seen around the third molar even when the tooth is exposed to the oral environment due to overeruption. To determine if overeruption of the third molar with or without root exposure is related to the status of the exposure of other teeth in the mandible, using orthopantomographs, 424 third molars were studied in 371 patients who were over 41 years of age. The rate of overeruption and root exposure in third molars was measured, and its relationship to the number of teeth lost and the rate of root exposure in other teeth in the mandible was analyzed. Tooth loss in the group of third molars with overeruption without root exposure was greater than in that without overeruption or root exposure in men, whereas the relationship was not seen in women. We found that root exposures of other teeth in the group of third molars with overeruption without root exposure were significantly smaller than in those with root exposure in both genders. Third molars with overeruption without root exposure, in which bone formation was easy to observe for radiographic diagnosis, were correlated with periodontal health in the mandible, suggesting a component of precision determination for predicting resistance to periodontitis.

Adult↗