A robust alternative to assessing three-dimensional relative enamel thickness for the use in taxonomic assessment.

OBJECTIVE: Three-dimensional relative enamel thickness (3DRET) is important for assessing hypotheses about taxonomy, phylogeny, and dietary reconstruction for primates. However, its weaknesses have not been thoroughly investigated. Here, we analyze its weaknesses and propose an index aiming at better taxonomic discrimination. MATERIALS AND METHODS: The dimensionless 3D index, ratio of enamel-thickness to dentine-thickness (3DRED), which is defined as the cubic root of the ratio of 3D average enamel thickness (3DAET) to 3D average dentine thickness (3DADT), is proposed here. To compare 3DRET and 3DRED and their sensitivity to voxel size, a fossil orangutan molar was scanned 14 times with different resolutions ranging from 10 to 50 µm. Enamel thickness analysis was carried out for each resultant digital model. In addition, enamel thickness measurements of 179 mandibular permanent molars (eight genera) were analyzed, followed by investigating the relationship between 3DRET and 3DAET and between 3DRED and 3DAET. RESULTS: Regarding sensitivity, 3DRED is more robust than 3DRET. In addition, 3DRET is correlated with 3DAET by linear curve with regression coefficients approximating or larger than 0.8 in most cases, while 3DRED shows less correlation with 3DAET. Furthermore, there are clear separations between different taxa in the bivariate plot of 3DRED against 3DAET, indicative of the taxonomic value of 3DRED. CONCLUSION: Under certain conditions, 3DRED promises to be a robust and reliable alternative to 3DRET in taxonomic study.

First systematic assessment of dental growth and development in an archaic hominin (genus, Homo) from East Asia.

Several human dental traits typical of modern humans appear to be associated with the prolonged period of development that is a key human attribute. Understanding when, and in which early hominins, these dental traits first appeared is thus of strong interest. Using x-ray multiresolution synchrotron phase-contrast microtomography, we quantify dental growth and development in an archaic Homo juvenile from the Xujiayao site in northern China dating to 161,000-224,000 years or 104,000-125,000 years before present. Despite the archaic morphology of Xujiayao hominins, most aspects of dental development of this juvenile fall within modern human ranges (e.g., prolonged crown formation time and delayed first molar eruption). For its estimated age-at-death (6.5 years), its state of dental development is comparable to that of equivalently aged modern children. These findings suggest that several facets of modern human dental growth and development evolved in East Asia before the appearance of fully modern human morphology.

The Middle Pleistocene (MIS 12) human dental remains from Fontana Ranuccio (Latium) and Visogliano (Friuli-Venezia Giulia), Italy. A comparative high resolution endostructural assessment.

The penecontemporaneous Middle Pleistocene sites of Fontana Ranuccio (Latium) and Visogliano (Friuli-Venezia Giulia), set c. 450 km apart in central and northeastern Italy, respectively, have yielded some among the oldest human fossil remains testifying to a peopling phase of the Italian Peninsula broadly during the glacial MIS 12, a stage associated with one among the harshest climatic conditions in the Northern hemisphere during the entire Quaternary period. Together with the large samples from Atapuerca Sima de los Huesos, Spain, and Caune de l'Arago at Tautavel, France, the remains from Fontana Ranuccio and Visogliano are among the few mid-Middle Pleistocene dental assemblages from Western Europe available for investigating the presence of an early Neanderthal signature in their inner structure. We applied two- three-dimensional techniques of virtual imaging and geometric morphometrics to the high-resolution X-ray microtomography record of the dental remains from these two Italian sites and compared the results to the evidence from a selected number of Pleistocene and extant human specimens/samples from Europe and North Africa. Depending on their preservation quality and on the degree of occlusal wear, we comparatively assessed: (i) the crown enamel and radicular dentine thickness topographic variation of a uniquely represented lower incisor; (ii) the lateral crown tissue proportions of premolars and molars; (iii) the enamel-dentine junction, and (iv) the pulp cavity morphology of all available specimens. Our analyses reveal in both samples a Neanderthal-like inner structural signal, for some aspects also resembling the condition shown by the contemporary assemblage from Atapuerca SH, and clearly distinct from the recent human figures. This study provides additional evidence indicating that an overall Neanderthal morphological dental template was preconfigured in Western Europe at least 430 to 450 ka ago.

Ultrasound assessment of soft tissue augmentation around implants in the aesthetic zone using a connective tissue graft and xenogeneic collagen matrix - 1-year randomised follow-up.

PURPOSE: A comparative, ultrasound evaluation of the thickness of keratinized mucosa (TKT) around implants one year after gingival augmentation (GA) by means of a connective tissue graft (CTG) and the xenogeneic collagen matrix (CMX). MATERIALS AND METHODS: A total of 75 bone level tapered implants (Conelog® Camlog) were inserted in 57 patients in the aesthetic area of both jaws. The patients were divided into 3 groups: control group I- without GA; group II- GA 3 months before implantation, and group III- GA 3 months after implantation. Groups II and III were divided into two subgroups depends on type of material used for GA: (a) CMX (Mucograft®, Geistlich Pharma AG) and (b) CTG. The patients underwent a clinical and ultrasound examination before, then after 3 and 12 months following GA respectively to evaluate TKT at two points using ultrasound equipment (Pirop®, Echoson). Point 1 was considered to be in the middle of the line connecting the cemento-enamel junction (CEJ) to the adjacent teeth, and point 2 on the mucogingival junction (MGJ). RESULTS: Three months after GA, the highest increase in gingival thickness was noted in group IIIb (point 1 - 0.95mm, 2 - 1.01mm). However, 12 months after GA the highest gingival thickness was observed in group IIb (point 1 - 1.76mm, 2 - 1.36m) and next IIIb (point 1 - 1.52mm, 2 - 1.15mm). CONCLUSIONS: Both CTG and Geistlich Mucograft® increased TKT, but higher values were noted using CTG augmentation before implantation. An ultrasonic device can be used as a non-invasive, reliable, and reproducible method for evaluating TKT.

Factors Affecting the Quality of Tooth Enamel for In Vivo EPR-Based Retrospective Biodosimetry.

In vivo electron paramagnetic resonance biodosimetry on tooth enamel is likely to be an important technology for triage of overexposed individuals after a major radiological incident. The accuracy and robustness of the technique relies on various properties of the enamel such as the geometry of the tooth, the presence of restorations, whitening treatments or exposition to sunlight. Those factors are reviewed, and their influence on dosimetry specifically for triage purposes is discussed.

An in-vitro assessment of the shear bond strength of bulk-fill resin composites to permanent and deciduous teeth.

OBJECTIVES: This study aimed to evaluate the shear bond strength (SBS) of bulk-fill resin composites (RCs) to deciduous and permanent teeth. METHODS: The following parameters were investigated: (1) tooth type (deciduous and permanent), (2) tooth substrate (enamel and dentine), (3) restorative material (a high- and a low-viscosity bulk-fill RC and a regular nanohybrid RC as control), and (4) adhesive (two self-etching adhesives). The combination of those parameters resulted in a total of 24 different groups (n=20). Permanent caries-free human molars (240) and deciduous teeth (240) were selected. The bulk-fill RCs (Tetric Evo Ceram Bulk Fill and SureFil SDR) were applied in one 4-mm increment, whereas the regular RC (Tetric Evo Ceram) was layered in two consecutive 2-mm increments. The SBS was examined after storing the specimens for 24 h at 37 °C in distilled water, followed by thermal ageing (5000 cycles between 5 °C and 55 °C). RESULTS: Data were statistically analyzed using one- and multiway analyses of variance and an independent-samples t-test (α=0.05). The multivariate analysis (general linear model with partial eta-squared statistics) tested the influence of the parameters tooth type, tooth substrate, restorative material, and adhesive on the SBS. The parameter tooth type showed no significant impact on the SBS (p=0.576). The influence of the other parameters was significant (p<0.05) but low, and the highest influence was exerted by the parameter adhesive (η(P)(2)=0.120, p=0.0001) followed by tooth substrate (η(P)(2)=0.092, p=0.0001) and restorative material (η(P)(2)=0.028, p=0.0001). The fracture pattern was predominantly adhesive (61.9%) or mixed (38.1), and no cohesive or prefailure was registered. CONCLUSIONS: Bulk-fill materials performed comparable or better than the nanohybrid RC used as control, but the adhesive used was the most relevant factor of influence. This material type might be clinically an option for a faster restoration in both permanent and deciduous teeth. CLINICAL SIGNIFICANCE: Bulk-fill materials performed comparable or slightly better than the nanohybrid RC used as control. Clinically, flowable bulk-fill RCs might be an advantage in restoring deep, narrow cavities, with difficult access angles, whereas larger cavities might be restored easily and faster using high-viscosity compounds.

Framework for e-learning assessment in dental education: a global model for the future.

The framework presented in this article demonstrates strategies for a global approach to e-curricula in dental education by considering a collection of outcome assessment tools. By combining the outcomes for overall assessment, a global model for a pilot project that applies e-assessment tools to virtual learning environments (VLE), including haptics, is presented. Assessment strategies from two projects, HapTEL (Haptics in Technology Enhanced Learning) and UDENTE (Universal Dental E-learning), act as case-user studies that have helped develop the proposed global framework. They incorporate additional assessment tools and include evaluations from questionnaires and stakeholders' focus groups. These measure each of the factors affecting the classical teaching/learning theory framework as defined by Entwistle in a standardized manner. A mathematical combinatorial approach is proposed to join these results together as a global assessment. With the use of haptic-based simulation learning, exercises for tooth preparation assessing enamel and dentine were compared to plastic teeth in manikins. Equivalence for student performance for haptic versus traditional preparation methods was established, thus establishing the validity of the haptic solution for performing these exercises. Further data collected from HapTEL are still being analyzed, and pilots are being conducted to validate the proposed test measures. Initial results have been encouraging, but clearly the need persists to develop additional e-assessment methods for new learning domains.

Visual and digital comparative tooth colour assessment methods and atomic force microscopy surface roughness.

This study compared digital and visual colour tooth colour assessment methods in a sample of 99 teeth consisting of incisors, canines and pre-molars. The teeth were equally divided between Control, Ozicure Oxygen Activator bleach and Opalescence Quick bleach and subjected to three treatments. Colour readings were recorded at nine intervals by two assessment methods, VITA Easyshade and VITAPAN 3D MASTER TOOTH GUIDE, giving a total of 1782 colour readings. Descriptive and statistical analysis was undertaken using a GLM test for Analysis of Variance for a Fractional Design set at a significance of P < 0.05. Atomic force micros copy was used to examine treated ename surfaces and establish surface roughness. Visual tooth colour assessment showed significance for the independent variables of treatment, number of treatments, tooth type and the combination tooth type and treatment. Digital colour assessment indicated treatment and tooth type to be of significance in tooth colour change. Poor agreement was found between visual and digital colour assessment methods for Control and Ozicure Oxygen Activator treatments. Surface roughness values increased two-fold for Opalescence Quick specimens over the two other treatments, implying that increased light scattering improved digital colour reading. Both digital and visual colour matching methods should be used in tooth bleaching studies to complement each other and to compensate for deficiencies.

Simulation of color perception of layered dental composites using optical properties to evaluate the benefit of esthetic layer preparation technique.

OBJECTIVES: Esthetic restorations require that dental restorative materials have similar optical properties to teeth. To improve the color perception, the inhomogeneous morphology of the native tooth can be imitated by layering two optically different restorative materials. However until now the benefit of this method has not been satisfactorily demonstrated. METHODS: The optical parameters, absorption coefficient µ(a), scattering coefficient µ(s), anisotropy factor g and effective scattering coefficient µ'(s), were determined for the enamel and dentin material of the restorative material systems Artemis(®) and Herculite XRV(®). This was carried out for each material system in the wavelength range between 400 and 700nm using integrating sphere measurements followed by inverse Monte Carlo simulations. RESULTS: Using the optical parameters and a forward Monte Carlo simulation, the color perception of layered samples could be predicted with a sufficient degree of accuracy. The total color impression was shown to be dependent on the sample thickness and the transparency/translucency of the single layers of enamel and dentin materials. CONCLUSION: The study demonstrated that the use of two materials is well-suited for the restoration of front teeth with their relatively high proportion of enamel. This study will continue further with the compilation of a data pool of optical parameters which will enable the application of calculation models to optimize the optical approximation of the natural tooth.

Non-destructive assessment of cavity wall adaptation of class V composite restoration using swept-source optical coherence tomography.

The purpose of this study was to evaluate gap formations under class V restoration using swept-source optical coherence tomography (SS-OCT). Wedge-shaped cavities were prepared on the buccal surface of 40 extracted premolar teeth at 2 locations; 1) cemento-enamel junction (CEJ) with enamel and cementum margin and 2) root surfaces with cementum margin. The cavity was treated with Clearfil S(3) Bond, restored with Clearfil Majesty and polished with abrasive disks. The specimens were kept in water at 37°C for 24 hours and subjected to a thermocycling procedure. Gap formations at the tooth-restoration interface were measured with SS-OCT image and conventional dye leakage under a microscope. There was no effect of the locations of the cavity and the margins of the cavity on the gap formation. Therefore, a significant effect of the observational methods was observed. The gap formation was 0.89±0.48 mm with the SS-OCT, and the gap formation was 0.34±0.41 mm with the dye leakage. The observation with SS-OCT demonstrated a greater degree of gap formation than the observation with dye leakage.

Assessment of the accuracy of dental enamel thickness measurements using microfocal X-ray computed tomography.

Tooth enamel thickness has long been an important character in studies of primate and especially hominin phylogeny, taxonomy, and adaptation. Current methods for accurately assessing enamel thickness involve the physical sectioning of teeth, because measurements of enamel thickness using some radiographic techniques are unreliable. However, because destructive methods limit sample sizes and access to important fossil specimens, it is desirable that they be replaced with nondestructive techniques. Although microfocal X-ray computed tomography (mCT) has been used recently in studies of enamel thickness, the accuracy of this technique has yet to be established. The present research compares physical sections to computer-generated mCT sections of teeth from a variety of primate and nonprimate, recent and fossil taxa to examine whether enamel thickness, tooth size, and diagenetic remineralization (fossilization) impact the ability of mCT to measure enamel thickness accurately. Results indicate that recent teeth of varying size and thickness are clearly and accurately depicted in mCT scans, with measurements from nearly identical planes in physical and mCT sections differing by 3-5%. A fossil papionin molar (ca. 2 Myr) was also accurately measured using mCT scans, although thinner enamel in much older therapsid (ca. 263-241 Myr) teeth could not be distinguished from dentine. mCT is thus an accurate technique for measuring enamel thickness in recent taxa, although heavily mineralized teeth pose an obstacle to the ability of mCT to distinguish dental tissues. Moreover, absolutely thin enamel (less than approximately 0.10 mm) is difficult to resolve adequately in raw mCT images based on pixel values alone. Therefore, caution must be exercised in the application of mCT to the study of fossilized teeth.

Dental radiography: tooth enamel EPR dose assessment from Rando phantom measurements.

Electron paramagnetic resonance dosimetry of tooth enamel is now established as a suitable method for individual dose reconstruction following radiation accidents. The accuracy of the method is limited by some confounding factors, among which is the dose received due to medical x-ray irradiation. In the present paper the EPR response of tooth enamel to endoral examination was experimentally evaluated using an anthropomorphic phantom. The dose to enamel for a single exposure of a typical dental examination performed with a new x-ray generation unit working at 65 kVp gave rise to a CO2- signal of intensity similar to that induced by a dose of about 2 mGy of 60Co. EPR measurements were performed on the entire tooth with no attempt to separate buccal and lingual components. Also the dose to enamel for an orthopantomography exam was estimated. It was derived from TLD measurements as equivalent to 0.2 mGy of 60Co. In view of application to risk assessment analysis, in the present work the value for the ratio of the reference dose at the phantom surface measured with TLD to the dose at the tooth measured with EPR was determined.

A radiographic assessment of enamel thickness in human maxillary incisors.

Crown sizes of human teeth are sexually dimorphic, with male larger than female. This holds for most human groups, though the extent of dimorphism varies among populations. It is not known whether size dimorphism is due to differences in enamel thickness, dentine differences, or some combination of the two. This study examined the pattern of variation in enamel thickness on the mesial and distal margins of the four maxillary permanent incisors. Standardized periapical radiographs of the incisors of 115 adolescent American whites were measured. Enamel was significantly thicker on the distal than the mesial margins of both the lateral and central incisors, with a mean difference of 0.1 mm. There was no sexual dimorphism in the maximum mesial or distal enamel thicknesses. In contrast, the widths of the dentine of the crowns were significantly greater in males, by an average of 6.5%. Sexual dimorphism in mesiodistal diameters of the incisors seems, then, to be due to the dentine component, which is the size attained at the end of the bell stage of tooth formation. Sex-specific correlations between enamel thickness and crown width of the dentine were low (and lower for males), indicating considerable independence between regulatory mechanisms of dentine and enamel development.

The radiographic assessment of pulp size: validity and clinical implications.

A study was performed to determine if the radiographic appearances of the coronal pulp spaces provide a reliable indication of pulp size in maxillary incisors. The use of student and staff assessor groups showed that length of clinical experience did not influence assessments of the size of the coronal pulp. A measuring grid, superimposed over a duplicate set of films, decreased the students' perception of the size of the coronal pulp. The presence of small carious lesions or restorations did not affect the assessments for either of the film types viewed. The data were pooled to give a mean radiographic size for each tooth, and the teeth were sectioned. Analysis of the results demonstrated the value of carefully viewing incisor crowns shown on pre-operative periapical radiographs. Sectioning of the teeth suggested that very little dentine may remain to protect the pulp after routine crown preparations. Even the very conservative preparations sometimes necessary when providing veneers might be considered a hazard to the pulp, as they may expose large areas of the dentine of an immature tooth.

Assessment of bone loss in periodontitis from panoramic radiographs.

Bone loss in chronic periodontitis was assessed from panoramic radiographs by direct measurement from the cemento-enamel junction (CEJ) and by measuring the proportion of the tooth length supported by bone. Mesial and distal bone levels of all available teeth were assessed for 50 patients aged 30-39 years referred for periodontal treatment. 85% and 74% of surfaces were measurable by the proportional and direct techniques, respectively. 27% of surfaces had no bone loss according to the proportional score, whereas 22% had a CEJ to alveolar bone distance of less than 2 mm. In addition, over half the surfaces with a proportional bone loss score of zero had a CEJ to alveolar bone distance of 2 mm or more, and for each proportional bone loss score, there was considerable overlap in the CEJ to alveolar bone distances recorded. The validity of the CEJ to alveolar bone measurements was established by comparison with direct measurements at periodontal surgery. The results support the use of direct measurement from the CEJ to alveolar bone rather than the assessment of the proportion of the tooth length within the bone when investigating bone loss from panoramic radiographs. This population of 30-40-year-old periodontal patients had a mean of 50% of sites with a CEJ to alveolar bone distance of 3 mm or more, and at such sites, there was a mean additional bone loss of 2.1 mm.

In vitro assessment of the effect of Scotchbond on the marginal leakage of class II composite restorations in primary molars.

By means of dye penetration, the authors determined the microleakage at the interface of class II composite restorations in thirty-eight extracted or naturally exfoliated primary molars. Scotchbond was used as the bonding agent in half of the prepared cavities' dentin and enamel; the control group (B) used Concise bonding agent in the enamel only. The use of Scotchbond in class II cavities did not prevent marginal leakage under the conditions of this study.

The cervical margin of amalgam restorations: a radiographic and clinical assessment.

In a study of the condition of the cervical margin of class II amalgam restorations, a radiographic method of assessment was compared with clinical assessment using mouth mirror and probe. The radiographic method assesses the type of defect of the cervical margin on the one hand, and the degree of defect on the other. In addition, an in-vitro study was performed of forty-six primary molars with multiple-surface amalgam restorations, in order to evaluate the results of the comparative study. Comparison of the results of clinical assessment with those of radiographic assessment revealed that: There is no correlation between the type of defect of the cervical margins of the amalgam restorations and their clinical assessment. There is a correlation between the degree of cervical margin defect and clinical assessment, as long as the defect does not exceed 1.5 mm. There is no significant difference between the clinical and the radiographic methods of assessment. Using both methods, only 20 percent of the cervical margins seemed to show "good" adaptation. The results of the in-vitro study warrant the conclusion that: In this study, too, only 20 percent of the cervical margins showed good adaptation. The restorations of the forty-six shed primary molars were of the same quality as those involved in the comparative study. These two conclusions warrant the postulate that, when only one of the two methods of assessment is used, the results must be divided by two in order to gain an accurate impression of the condition of the cervical margins.