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PubMed1990

Cementum thickness and mesial drift.

Cementum thickness increases uniformly with age, and questionably from functional stimulation due to tensional forces. Mesial drift of teeth results in tensional forces on distal root surfaces. This study evaluated whether there was any discernible effect on cementum thickness related to mesial drift in humans. The material consisted of maxillary and mandibular bicuspids and molars with their surrounding periodontia from 5 humans (mean age at death, 48.6 years). The teeth and tissues had been sectioned histologically in a mesio-distal plane, and the analysis for each tooth was done using 3 step-serial sections from the mid-buccolingual region. On the mesial and distal surface of each tooth, cementum thickness was measured in microns at 3 defined locations at a level representing the mid-point of root length for bicuspids and molars. Means from the measurements on mesial and distal surfaces were compared using descriptive and and inferential statistical methods. For each individual tooth analyzed, the cementum was thicker on the distal surface (range greater, 32-107%; mean, 69%). The statistical comparisons showed that cementum thickness on the distal surface was significantly greater for bicuspids (mesial, 135 microns: distal, 216 microns), molars (mesial, 154 microns: distal, 284 microns), and all teeth combined (mesial, 154 microns: distal, 284 microns). The magnitude of this difference became greater with increasing age. It was concluded that cementum thickness was markedly greater on the distal surfaces of teeth from adult humans, and that this may be due to functional stimulation from mesial drift over time.

Adult↗
PubMed1990

Root exposure in the primary dentition studied in human skulls.

The aims of the present study were to examine, on the primary dentition of 75 human dried skulls, the distance from the cemento-enamel junction (CEJ) to the alveolar bone crest, and to evaluate its relation to developmental age, bone morphology and attrition. The measurements from the CEJ to the alveolar crest were longer for the maxillary teeth, the second molars showed the shortest measurements, while the cuspids showed the longest. Significant positive partial correlations were found between age and the distance from the CEJ to the alveolar crest when controlling for attrition (r = 0.64), and between age and attrition when controlling for the distance from the CEJ to the alveolar bone crest (r = 0.54). The partial correlation between migration and attrition when controlling for age proved to be not significant (r = 0.13). Significant correlations were found between age and the distances from the mental foramen to: the alveolar crest (r = 0.90), and to the lower border of the mandible (r = 0.97). These findings suggest that root exposure takes place in the primary dentition, as the result of continuous eruption at a faster rate than formation of alveolar bone, presumably to compensate for facial growth.

Age Factors↗
PubMed1991

Marginal alveolar bone height in an adult Swedish population. A radiographic cross-sectional epidemiologic study.

The purpose of the present cross-sectional epidemiologic study was to assess the interproximal alveolar bone level within the dentition of 732 randomly selected adult individuals, stratified according to gender and age. Full mouth series of periapical radiographs were used for the assessments of the relation alveolar bone height/root length (B/R). A computer/digitizer recording method was utilized for the assessments. The results were presented as (i) mean values per age group and gender, (ii) mean frequency of subjects with sites exceeding certain thresholds of bone loss and (iii) cumulative frequencies of subjects with various number and percentual proportion of sites in relation to different B/R-ratio intervals. The results showed a reduction in mean alveolar bone/root ratio with age. The women had a significantly more favourable mean B/R-ratio than men in the ages above 40 years; the women had, however, more missing sites above age 60 years. By older age, there was observed an increased variation between individual mean B/R-ratios. Only a few subjects had a mean B/R-ratio less than or equal to 50%. A subfraction of the subjects in the different age groups had greater than 20% of their sites below a B/R-ratio of 60%. This fraction increased with age.

Adult↗
PubMed1991

Periodontal characteristics in individuals with varying form of the upper central incisors.

It has been suggested that the variation in the morphology of the human periodontium may be related to the shape and form of the teeth. Furthermore, the severity of symptoms of periodontal disease have been proposed to differ among these various morphologic entities or "biotypes". The aim of the present study was (i) to identify individuals with markedly different crown forms and (ii) to determine probing pocket depth, probing attachment level and amount of gingival recession that had occurred at different teeth and tooth surfaces in such individuals. Clinical photographs of the maxillary incisor tooth region of 113 subjects who had been recruited for a long-term study on periodontal disease were available. The length (CL) and width (CW) of the crowns were determined and the CW/CL ratio was calculated for each tooth. 10% in each tail, 11 subjects in each group, were arbitrarily chosen as having either a long-narrow (N) or a short-wide (W) form of the central incisors. The probing pocket depth, probing attachment level and gingival recession data available from all subjects and subjects in groups W and N were compared and analyzed using the Student t-test and multiple regression analysis. The result from the analyses demonstrated that: (1) subjects with a long-narrow form of the upper central incisors had experienced more recession of the gingival margin at buccal surfaces than subjects who had a short-wide tooth form; (2) there was a significant influence of the CW/CL-ratio on the probing attachment level (p less than 0.05) and the amount of gingival recession (p less than 0.01) on buccal tooth surfaces.(ABSTRACT TRUNCATED AT 250 WORDS)

Bicuspid↗
PubMed1993

Periodontal attachment loss assessed by linear and area measurements in vitro.

The aim of the present study was to investigate the relationship between linear and area measurements of periodontal attachment loss, and to determine the root surface area on different tooth-types. Extracted permanent teeth were collected in a national survey including a systematic random sample of 500 Norwegian dentists. The response rate was 70%. Altogether 329 teeth were received, 81 of them (excluding 3rd molars) were subjected to both linear and area measurements of attachment loss. Using a dissecting microscope (10 x), 4 to 8 duplicate linear measurements were recorded per tooth. The areas of both lost and remaining periodontal attachment were measured by a method based on controlled release of Cu and Co metal ions from coatings applied to the root surface. Linear loss of attachment for single-rooted teeth (n = 63) was mean = 44.0% and the area loss mean = 49.2%. The corresponding measurements for multi-rooted teeth (n = 18) were mean = 30.3% and mean = 35.1%, respectively. The correlation between linear and area loss was r = 0.78 for single-rooted and r = 0.75 for multi-rooted teeth (p < 0.01). The lower correlation in multi-rooted teeth is probably due to the more complex root anatomy. It is concluded that there is a strong correlation between linear loss of attachment and area of periodontal support lost for teeth with early to moderate loss of attachment, and that linear measurements tend to underestimate the remaining periodontal attachment.

Alveolar Bone Loss↗
PubMed1993

On the relationship between crown form and clinical features of the gingiva in adolescents.

The purpose of the present study was to examine the relationship between the form of the crowns in the maxillary front tooth segment and (1) a group of morphological characteristics and (2) the thickness of the gingiva. 108 subjects devoid of symptoms of destructive periodontal disease were examined regarding, e.g., probing depth, thickness of the free gingiva, width of the keratinized gingiva and the contour of the marginal gingiva. From clinical photographs of the maxillary front tooth region, the width (at the apical third--CW) and the length (CL) of the crowns of the 6 front teeth were determined. A CW/CL-ratio was calculated for each tooth and averaged for each tooth region. The individual mean CW/CL-ratio values for the central incisors were ranked. After correction for incisal attrition, the 10 subjects ranked highest and the 10 ranked lowest were selected as having either a long-narrow (group N) or a short-wide (group W) form of the crown of the tooth. The data for each of the examined parameters were averaged for each tooth region in each subject and mean values for subjects in groups W and N were compared using the Student t-test. Stepwise multiple regression analysis, including data from the whole sample, was performed for each tooth region with the thickness of the free gingiva as the dependent variable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

A meta-analysis of normal ranges for root surface areas of the permanent dentition.

The typical values and normal ranges of the permanent dentition root surface areas were estimated based on a meta-analysis of 4730 root surface area measurements collected from 22 published studies between 1950 and 1992. A typical dentition root surface area, excluding 3rd molars, was 75 cm2, and 95% of the dentitions had a total root surface area somewhere between 65 cm2 and 86 cm2. The prognostic significance of particular values of root surface areas for dental treatment outcomes requires further investigation.

Analysis of Variance↗
PubMed1994

The topography of the furcation entrance in Chinese molars. Furcation entrance dimensions.

The purpose of the present study was to document the furcation entrance dimensions (FEDs) of the maxillary and mandibular 1st and 2nd molars and relate them to the choice of periodontal therapy. Study samples consisted of 89 maxillary molars (49 1st and 40 2nd molars) and 93 mandibular molars (50 1st and 43 2nd molars). All the FEDs of the molars were examined and measured under a stereomicroscope at 2.5 x equipped with a Bioscan OPTIMAS Image Analyzer (BOIA). The results may be summarized as follows. (1) The mean FEDs in the buccal, distal and mesial furcations of maxillary 1st and 2nd molars were 0.74 mm, 0.99 mm and 1.04 mm in the 1st molars, and 0.63 mm, 0.67 mm, 0.90 mm in the 2nd molars, respectively. In the buccal and lingual furcations of mandibular 1st and 2nd molars, they measured 0.88 mm and 0.81 mm, and 0.73 mm and 0.71 mm, respectively. (2) The %s of FEDs of 0.56 mm or less (the tip width of a Cavitron tip being 0.56 mm) in the buccal, distal and mesial furcations of maxillary 1st and 2nd molars, accounted for 32%, 8% and 6% of 1st molars, and 40%, 40% and 18% of 2nd molars. In the buccal and lingual areas of mandibular 1st and 2nd molars, they accounted for 16% and 26%, and 35% and 33% of the furcations, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The relationship between alveolar bone height and age in the primary dentition. A retrospective longitudinal radiographic study.

The natural history of changes in attachment level in the primary dentition should be determined before considering diagnostic criteria for periodontal diseases in children. The present study was designed to describe longitudinal changes in the distance between the alveolar bone crest and the cementoenamel junction (ABC-CEJ) determined radiographically. Bite-wing radiographs were obtained from 33 children as part of a routine annual dental examination in a rural community. The ABC-CEJ distance of 1500 sites located at the mesial and distal aspects of primary molars and distal aspect of primary cuspids were measured. An analysis of variance model was used to assess the effect of age, sex, tooth, side of the mouth, jaw, site and patient on the ABC-CEJ measurements. The side of the mouth (left, right) and the site (mesial, distal) had no significant effect on the ABC-CEJ distance. ABC-CEJ distances in the upper jaw were greater than in the lower jaw, and different teeth exhibited different ABC-CEJ distances. Canines had the greatest distance and second molars the smallest. The most interesting relationship was between alveolar bone height and age. The overall ABC-CEJ distance seemed to increase with age; however, this was not a linear relationship but followed the pattern of facial growth, with two spurts separated by a period of minimal increase. The results indicate that different levels of ABC-CEJ distance might be considered as a cut-off value for radiographic diagnosis of alveolar bone loss at different ages, for different primary teeth and for different jaws.

Age Factors↗
PubMed1995

Periodontal bone loss of teeth with metal posts. A radiographic study.

Periodontal bone loss was compared in teeth with metal posts and contralateral teeth without metal posts by means of intraoral radiographs. 250 subjects with a high standard of dental awareness and a great number of teeth retained were included in the study. The periodontal bone loss was calculated from the ratio of the distance from bone margin to apex (bone height) and the distance from crown tip to apex (tooth length). Intra-individual differences between experimental and control teeth were statistically analyzed with the Student paired t-test. 96 subjects (38%) had > or = 1 teeth with root posts. In all, 172 teeth with posts were found, i.e., on average 1.8 teeth per subject. The means +/- SEM of the ratio bone height to tooth length in experimental and control teeth were 0.52 +/- 0.007 and 0.56 +/- 0.006, respectively. The difference was statistically highly significant (P < 0.001). Statistically significant differences were found for incisors, premolars and molars. Regression analysis indicated more severe bone loss for teeth with longer posts. The results suggest that the periodontal bone support of teeth with metal posts is inferior to that of teeth without metal posts.

Adult↗
PubMed1996

Tooth thickness at the furcation entrance of lower molars.

Better understanding of the furcation anatomy may serve to decrease the risk of pulpal injury during rotary odontoplasty, a procedure often used in conjunction with guided tissue regeneration. The purpose of this study was to determine (i) the tooth thickness about the furcation entrance of lower molars, and (ii) whether there is a relationship between tooth thickness and patient age. 40 mandibular 1st molars (M1) (mean age = 36.2; range 10-65 years) and 40 mandibular 2nd molars (M2) (mean age = 37.9; range 14-70 years) were collected. Age, gender and furcation involvement (if any) were noted for each tooth at the time of extraction. Teeth were sectioned in half, buccal-lingual, at the furcation entrance with a rotary diamond blade. A standardized linear reference scale was placed on each experimental section and an 8 x 10 in. photograph generated. The distance from the floor of the pulp chamber to 5 predetermined sites on the root surface was calculated. The data were expressed as (a) the mean of each site and (b) the mean of each tooth (the average of the 5 points of each tooth). Analysis of covariance failed to show a relationship between thickness measurements and gender or furcation involvement. Thus, the data was subjected to simple regression analysis to determine the relationship of age with tooth and cementum thickness. This study revealed that by site, the mean measurements ranged from 2.7-3.0 mm for both M1 and M2. The single least/greatest measurements of the 5 sites were for M1: 1.6/4.7 mm and for M2: 1.8/4.2 mm. By tooth, the average distance from the pulp to the root surface was 2.83 mm (+/- 0.49) for M1 and 2.88 mm (+/- 0.44) for M2. Regression analysis of tooth thickness with age was significant for M1 only. The maximum slope of the 5 sites was approximately 0.3 mm/10 years. No relationship was found between cementum thickness and age for either tooth group. The results of this study indicate that the majority of times the pulp is 1.6-4.2 mm from the root surface in the vicinity of the furcation entrance of lower 1st and 2nd molars. Although tooth thickness in this area may increase with age, the amount is not enough to forego judicious odontoplasty on older patients.

Adolescent↗
PubMed1996

Ultrasonic determination of gingival thickness. Subject variation and influence of tooth type and clinical features.

The objectives of the present study were (I) to determine the validity and reliability of measuring gingival thickness (GTH) with a recently developed, commercially available ultrasonic device; (II) to measure GTH in relation to tooth type and age of proband; (III) to correlate GTH with varying forms of premolars, canines and incisors. Ultrasonic measurements were performed in 200 periodontally healthy, male probands representing 3 different age groups (20-25, 40-45, 55-60 years). In the maxilla, mean GTH varied between 0.9 mm (canines, 1st molars) and 1.3 mm (2nd molars). In the mandible respective mean values ranged between 0.8 mm (canines) and 1.5 mm (2nd molars). No differences in means and standard deviations (0.36-0.39 mm) were observed in different age groups. In order to correlate GTH with other clinical parameters and form of tooth, in 42 probands of the youngest age group, presenting with no attrition or abrasion, no artificial crown restorations and (following prophylaxis) no overt gingivitis and no periodontal probing depth in excess of 3 mm, detailed clinical measurements and stone model cast analyses were performed. By stepwise multiple linear regression analysis, 24% (p < 0.0001) of the variation of GTH was explained by probing depth, recession, width of gingiva and tooth type. The ratio of the width of the crown to its length was not included into the model. When performing analysis of covariance with the subject as factor, the model was improved, now explaining 41% of the variation of GTH. In this model, the influence of periodontal probing depth was decreased, and recession was not included. It was concluded that there are individual differences in GTH (i.e., different biotypes). However, thickness mainly depends on tooth type and is correlated with width of gingiva. There appears to be no association with shape and form of the tooth. Validity and reliability of measuring GTH with the ultrasonic device was found to be excellent.

Adult↗
PubMed1997

Alveolar bone anatomic profiles as measured from dry skulls. Clinical ramifications.

The purpose of this study was to evaluate the relationship of alveolar bone morphology to tooth shape and form. 111 dry skulls were evaluated at Baylor College of Dentistry (Dallas, Texas). The skulls were arbitrarily divided into flat, scalloped and pronounced scalloped anatomic profiles according to alveolar bone anatomy. The number of buccal dehiscences and fenestrations was determined for each skull according to their anatomic morphotype. 10 skulls from each group were selected for bone height measurements. The measurements were made with a periodontal probe and ruler from the height of the interproximal bone to the buccal alveolar crest. Kodachrome slides were used to measure mesial-distal tooth width and length from ten skulls from each anatomic category. The average number of fenestrations for each group was 3.5. The mean number of dehiscences for flat and scalloped skulls was 0.5. The average number of dehiscences for pronounced scalloped was 1.2. There were no significant differences when the groups were compared. The mean distance from the height of the interdental bone to the alveolar crest was statistically significant when the groups were compared (flat 2.1 mm, scalloped 2.8 mm, pronounced 4.1 mm) (Tukey, p = 0.05). There were no significant differences when tooth shapes were compared with bone anatomy. Pronounced scalloped anatomic profiles were slightly narrower when compared with the other groups. The observations reported have treatment ramifications when patients with scalloped or pronounced scalloped morphotypes are being considered for dental implant placement.

Adult↗
PubMed1997

Types and dimensions of root trunk correlating with diagnosis of molar furcation involvements.

The objective of the present study was to investigate the possible correlation of dimension, location, prevalence, and types of root trunk with molar furcation involvement (FI). The samples used in the study include 166 maxillary molars (70 1st and 96 2nd molars) and 200 mandibular molars (103 1st and 97 2nd molars). The dimensions of the root trunks and root lengths were measured with an electric caliper and their means and standard deviations calculated. The types of root trunks were identified by the ratio of root trunk dimension to root length and classified as types A, B, and C. The results may be summarized as follows. (1) Short-root trunks were more commonly found buccally, whereas long-root trunks were more commonly found mesially, in both maxillary molars. (2) Short-root trunks were most commonly found buccally, whereas long-root trunks were more commonly found lingually in both mandibular molars. (3) Long-root trunks were more commonly found on the 2nd molars than on the 1st molars. (4) Long-root trunks were associated with short root length. (5) There is a strong correlation between vertical length and type of root trunk and FI. The findings of the study indicated that an awareness of root trunk type together with horizontal and vertical attachment levels in molar FI may be helpful in the prognosis, diagnosis, and treatment of molar FI.

Adult↗
PubMed1997

Gingival phenotypes in young male adults.

In a previous study on 42 young adult, periodontally healthy subjects without any attrition, abrasion or crown restoration, gingival thickness (GTH) was determined at facial aspects of premolars, canines and incisors by a novel ultrasonic device. GTH strongly depended on periodontal probing depth, width of gingiva (WG), and tooth type. Whereas the ratio of crown width to its length (CW/CL) was not identified as an explanatory variable, a significant influence of the subject was ascertained. The aim of the present study was to extend these analyses in order to identify subjects with different morphological characteristics of gingiva, i.e., gingival phenotypes. When employing cluster analysis on standardized parameters mean GTH, WG and CW/CL of upper canines, lateral and central incisors, 3 clusters were identified. Cluster A comprised 2/3 of subjects, displaying "normal" GTH, WG and CW/CL. Cluster B (n = 9, 21%) had a significantly thicker and wider gingiva, and a more quadratic form of upper front teeth. A 3rd cluster (cluster C, n = 5, 12%) was identified showing "normal" GTH, high CW/CL, but a narrow zone of keratinized tissue. Some characteristics of gingival phenotype of the upper front tooth region were also found at upper premolars (WG, CW/CL) but in general not at mandibular teeth. Present results clearly indicate evidence for the existence of different gingival phenotypes. Clinical relevance of these observations has to be tested in longitudinal studies.

Adult↗
PubMed2004

Prevalence of horizontal attachment loss in extracted teeth.

OBJECTIVE: Probing attachment level provides useful information on patterns of destruction of the periodontium. It is difficult to detect complex attachment loss in clinics. The purpose of this study was to estimate prevalence of vertical and horizontal attachment loss in extracted teeth. MATERIAL AND METHODS: We collected 10,212 extracted teeth from 130 dentists in Japan. After staining of periodontal membrane with erythrosine, linear loss of vertical and horizontal attachment was measured using a digital caliper. RESULTS: Mean vertical attachment loss varied from 5.3 to 8.6 mm. Incisors had severe attachment loss at mesial sites. Specific local attachment loss at palatal sites was observed in maxillary premolars and molars as well as in mandibular canines and premolars. Horizontal attachment loss was observed in 23% of the teeth. Frequency of horizontal attachment loss of > or = 2.1 mm was 6.4%. CONCLUSION: Severe attachment loss was observed on the palatal side of maxillary premolars. More than 1/3 of the maxillary first molars showed horizontal attachment loss. It may be impossible to debride 6.4% of teeth in cases of severe periodontitis because horizontal attachment loss may be deeper than the curette blade length.

Humans↗
PubMed2005

Classification, reproducibility and prevalence of root proximity in periodontal patients.

AIM: The primary aim of this study is to define and classify root proximity. The secondary aim is to examine the reproducibility of the measurement tools, to study the prevalence per inter-dental area and to examine whether the distance from the cemento-enamel junction (CEJ) to the bone crest (BC) differs between sites with root proximity and their contra-lateral sites without root proximity. MATERIAL AND METHODS: In order to indicate the location of root proximity, a modification of the Shei ruler was developed, dividing the roots into three equal parts. A radiographic template was used to measure the distance between the roots, in this way determining the severity of the root proximity. The reproducibility of the measurement tool was tested, the prevalence was calculated and the distances CEJ-BC for root proximity sites and contra-lateral sites were recorded. RESULTS: A two-digit classification was obtained dividing the root into three locations [apical (A), between (B) and coronal (C)], with each location having the possibility of three different severities of root proximity. The described modification of the Shei ruler and the measurement tool for the severities can be considered as reproducible measurement tools. Root proximity was most prevalent in maxillary molars and between central and lateral incisors in the maxilla and mandible. There was no difference in CEJ-BC distance between the root proximity sites and their contra-lateral sites. CONCLUSION: We can conclude that a two-digit classification for root proximity was established. Root proximity in untreated periodontal patients has no influence on the distance CEJ-BC. However, the location of root proximity becomes important from the moment that periodontal disease has been established at that site. The severity of root proximity is important for choosing treatment options. There is a striking similarity between bone loss patterns and tooth loss and the location of inter-dental spaces where root proximity is most prevalent.

Adolescent↗
PubMed2005

Root proximity as a risk marker for periodontal disease: a case-control study.

AIM: The aim of this study is first, to examine the prevalence, symmetry and spread of root proximity using the measurement tools and classification as described in part I of the study, and second to examine whether root proximity is a risk marker for periodontal disease. MATERIAL AND METHODS: The radiographs of 227 patients were examined. The study consisted of a study group of 197 patients with advanced periodontal disease with at least one site with bone loss more than one third of the root length and 30 controls without periodontal disease. Every inter-proximal space was assessed on the full-mouth radiographs and a score was assigned according to severity and location. Consequently prevalence of severity and location, symmetry, spread and an odds ratio and relative risk for periodontal disease was calculated. RESULTS: Root proximity is a symmetrical and localized but widespread phenomenon in periodontal patients and to lesser extend in the non-periodontal control group. In periodontal patients root proximity was most often encountered in the coronal and intervening part whereas subjects without periodontal disease had more root proximity in the apical and intervening part where it is less critical. Subjects with bilateral root proximity had a 3.6 times higher chance to have periodontitis. CONCLUSION: Root proximity must be taken into consideration as a risk marker for periodontal disease.

Adolescent↗