Surface-Sensitive Microwear Texture Analysis of Attrition and Erosion.

Scale-sensitive fractal analysis of high-resolution 3-dimensional surface reconstructions of wear patterns has advanced our knowledge in evolutionary biology, and has opened up opportunities for translatory applications in clinical practice. To elucidate the microwear characteristics of attrition and erosion in worn natural teeth, we scanned 50 extracted human teeth using a confocal profiler at a high optical resolution (X-Y, 0.17 µm; Z < 3 nm). Our hypothesis was that microwear complexity would be greater in erosion and that anisotropy would be greater in attrition. The teeth were divided into 4 groups, including 2 wear types (attrition and erosion) and 2 locations (anterior and posterior teeth; n = 12 for each anterior group, n = 13 for each posterior group) for 2 tissue types (enamel and dentine). The raw 3-dimensional data cloud was subjected to a newly developed rigorous standardization technique to reduce interscanner variability as well as to filter anomalous scanning data. Linear mixed effects (regression) analyses conducted separately for the dependent variables, complexity and anisotropy, showed the following effects of the independent variables: significant interactions between wear type and tissue type ( P = 0.0157 and P = 0.0003, respectively) and significant effects of location ( P < 0.0001 and P = 0.0035, respectively). There were significant associations between complexity and anisotropy when the dependent variable was either complexity ( P = 0.0003) or anisotropy ( P = 0.0014). Our findings of greater complexity in erosion and greater anisotropy in attrition confirm our hypothesis. The greatest geometric means were noted in dentine erosion for complexity and dentine attrition for anisotropy. Dentine also exhibited microwear characteristics that were more consistent with wear types than enamel. Overall, our findings could complement macrowear assessment in dental clinical practice and research and could assist in the early detection and management of pathologic tooth wear.

Under your nose: a rare finding during dissection provides insights into maxillary supernumerary teeth.

BACKGROUND: A supernumerary tooth was found during anatomical dissection. The position of this tooth, still impacted in the maxilla, and the associated pathology make this a rare case. METHODS: During dissection by dental students of the sagittally-sectioned head of a cadaver, a supernumerary tooth was identified in the mid-palatal area. Further dissection revealed a swelling with a thin bony covering related to the crown of the tooth. The maxilla was removed en bloc and radiographic examination, CT scanning, electron microscopy and histology were undertaken. RESULTS: The tooth had a crenulated occlusal surface and a single root. It was 25 mm posterior to the root apex of the permanent upper central incisor. The swelling, confirmed by radiographs and CT imaging to be associated with the crown, occupied approximately one-third of the maxillary sinus. The 3D shape of the cystic lesion was visualized by a composite digital movie. CONCLUSIONS: The crown form, position of the tooth and the associated dentigerous cyst suggested it was a palatally developing supernumerary premolar which had been displaced to the palatal midline by the expanding cyst. This rare case highlights the learning and teaching opportunities available during dissection, showing important variations in both development and clinical anatomy.

The face, the future, and dental practice: how research in craniofacial biology will influence patient care.

It has been a privilege to assemble a group of Australian and international researchers to produce a special issue of the Australian Dental Journal that reflects the cutting edge of research in different aspects of craniofacial biology, and also considers how these advances will influence future education and practice within dentistry. The aim of this special issue is to provide a collection of concept papers and critical reviews on key topics that cover both fundamental and applied research in craniofacial biology and to consider the clinical implications. To do this, four questions have been addressed that lead to the four sections of this issue. These are: How have we come to the present exciting position in craniofacial biology with breakthroughs over the past 50 years? What are current fundamental research topics that are helping us to understand more about craniofacial and general development, possibly leading to future clinical developments? What are the current applied research topics that will influence future clinical practice? Looking forward, what new developments in craniofacial biology may come about that will change the face of dental education and practice? The refereed papers in this special issue are grouped into the four sections that seek to respond to these demanding questions.

The dentition: the outcomes of morphogenesis leading to variations of tooth number, size and shape.

The clinical importance of variations of tooth number, size and shape is seen in many dental disciplines. Early diagnosis allows optimal patient management and treatment planning, with intervention at an appropriate time to prevent complications in development and so reduce later treatment need. Understanding the process of dental morphogenesis and the variations in outcomes is an important contribution to the multidisciplinary clinical team approach to treatment. Tooth number, size and shape are determined during the initiation and morphogenetic stages of odontogenesis. The molecular evidence of repetitive signalling throughout initiation and morphogenesis is reflected clinically in the association of anomalies of number, size and shape. This association has been statistically modelled from epidemiological evidence and confirmed by 2D and 3D measurement of human dental study casts. In individuals with hypodontia, the teeth that are formed are smaller than the population mean and often show reduced and simplified shape. In contrast, in individuals with supernumerary teeth, the other teeth are larger than average and may show an enhanced shape. Clinical observations in humans and studies of laboratory animals gave rise to the concept of morphogenetic fields within the dentition. The findings, which can also be considered as reflecting gene expression territories, have been developed to incorporate field, clone and homeobox theories. The clinical distribution of developmental anomalies tends to follow the pattern of these fields or territories. Improved care for patients with these anomalies will come not only from utilizing a multidisciplinary clinical team but also by expanding the approach to include other relevant scientific disciplines.

Epigenetics: a new frontier in dentistry.

In 2007, only four years after the completion of the Human Genome Project, the journal Science announced that epigenetics was the 'breakthrough of the year'. Time magazine placed it second in the top 10 discoveries of 2009. While our genetic code (i.e. our DNA) contains all of the information to produce the elements we require to function, our epigenetic code determines when and where genes in the genetic code are expressed. Without the epigenetic code, the genetic code is like an orchestra without a conductor. Although there is now a substantial amount of published research on epigenetics in medicine and biology, epigenetics in dental research is in its infancy. However, epigenetics promises to become increasingly relevant to dentistry because of the role it plays in gene expression during development and subsequently potentially influencing oral disease susceptibility. This paper provides a review of the field of epigenetics aimed specifically at oral health professionals. It defines epigenetics, addresses the underlying concepts and provides details about specific epigenetic molecular mechanisms. Further, we discuss some of the key areas where epigenetics is implicated, and review the literature on epigenetics research in dentistry, including its relevance to clinical disciplines. This review considers some implications of epigenetics for the future of dental practice, including a 'personalized medicine' approach to the management of common oral diseases.

Dental phenomics: advancing genotype to phenotype correlations in craniofacial research.

The field of dental phenomics provides many opportunities to elucidate the roles of genetic, epigenetic and environmental factors in craniofacial development. To date, research findings have helped to clarify the pathogenesis of many conditions, aiding diagnosis and clinical management. This paper provides an overview of dental phenomics research in some commonly encountered oral diseases in everyday clinical practice, as well as research relating to craniofacial growth and development. Clinically, advances in cariology and periodontology have led to better diagnostic capabilities and treatment provision. In the study of growth and development, important information regarding the varying clinical presentation and pathogenesis of many disorders is now apparent through the accurate quantification of phenotypes. Improvements in two-dimensional (2D) and three-dimensional (3D) imaging and analytical techniques have allowed for accurate dental phenotyping, and efforts are ongoing to apply these in vitro techniques to the in vivo setting. The field of dental phenomics represents an exciting avenue that links research findings to practical application, and collaboration between researcher and clinicians will help advance the field further.

General and craniofacial development are complex adaptive processes influenced by diversity.

Complex systems are present in such diverse areas as social systems, economies, ecosystems and biology and, therefore, are highly relevant to dental research, education and practice. A Complex Adaptive System in biological development is a dynamic process in which, from interacting components at a lower level, higher level phenomena and structures emerge. Diversity makes substantial contributions to the performance of complex adaptive systems. It enhances the robustness of the process, allowing multiple responses to external stimuli as well as internal changes. From diversity comes variation in outcome and the possibility of major change; outliers in the distribution enhance the tipping points. The development of the dentition is a valuable, accessible model with extensive and reliable databases for investigating the role of complex adaptive systems in craniofacial and general development. The general characteristics of such systems are seen during tooth development: self-organization; bottom-up emergence; multitasking; self-adaptation; variation; tipping points; critical phases; and robustness. Dental findings are compatible with the Random Network Model, the Threshold Model and also with the Scale Free Network Model which has a Power Law distribution. In addition, dental development shows the characteristics of Modularity and Clustering to form Hierarchical Networks. The interactions between the genes (nodes) demonstrate Small World phenomena, Subgraph Motifs and Gene Regulatory Networks. Genetic mechanisms are involved in the creation and evolution of variation during development. The genetic factors interact with epigenetic and environmental factors at the molecular level and form complex networks within the cells. From these interactions emerge the higher level tissues, tooth germs and mineralized teeth. Approaching development in this way allows investigation of why there can be variations in phenotypes from identical genotypes; the phenotype is the outcome of perturbations in the cellular systems and networks, as well as of the genotype. Understanding and applying complexity theory will bring about substantial advances not only in dental research and education but also in the organization and delivery of oral health care.

Functional dental occlusion: an anthropological perspective and implications for practice.

Physiologic changes occur in dental occlusion throughout life, resulting from the interplay between functional demands and reciprocating adaptive responses. These changes have been reported in the anthropological literature and they reflect evolutionary changes in the human stomatognathic system during the Paleolithic, hunter-gatherer period. Specific occlusal changes occur in response to different environments, leading to extensive variation within and between extinct and extant human populations. For example, functional demands can cause occlusal and interproximal tooth wear, resulting in shortening of the dental arch, continual tooth eruption and changes in masticatory patterns. Since the advent of farming through to our current industrialized culture, functional demands on the human masticatory system, and its adaptive responses to these demands, have been reduced considerably. Indeed, it is only occasionally that functional demands are severe enough to lead to obvious pathology in the modern human dentition. In contrast to normal masticatory activity, 'modern-day conditions' such as dental caries, periodontal disease and erosion, can lead to significant changes in dental occlusion that are pathological and need to be treated. The masticatory system is a dynamic, functional unit that displays considerable change over a lifetime. In this concept paper, it is proposed that modern human populations living in industrialized environments display dental occlusions that can be considered to be 'neotenous'; that is, our dentitions tend to reflect an unworn stage of our ancestors that was only seen in infants, juveniles and young adults. Clinicians can draw on both phylogenetic and ontogenetic perspectives of 'functional dental occlusion' to differentiate continual physiological changes occurring over time that require ongoing review, from pathological responses that require intervention.

The teeth and faces of twins: providing insights into dentofacial development and oral health for practising oral health professionals.

The continuing studies of the teeth and faces of Australian twins and their families in the Craniofacial Biology Research Group in the School of Dentistry at the University of Adelaide began 30 years ago. Three main cohorts of twins have been recruited, enabling various objectives and specific hypotheses to be addressed about the roles of genetic, epigenetic and environmental influences on human dentofacial growth and development, as well as oral health. This paper highlights some key findings arising from these studies, emphasizing those of direct relevance to practising oral health professionals. We also draw on published literature to review the significant developments in relation to the use of precision 2D and 3D imaging equipment, the application of modern molecular techniques, and the development of sophisticated computer software for analysing genetic relationships and comparing complex shapes. Such developments are valuable for current and future work. Apart from the classical or traditional twin model, there are several other twin models that can be used in research to clarify the relative contributions of genetic, epigenetic and environmental contributions to phenotypic variation. The monozygotic (MZ) co-twin model is one particularly valuable method, given that examination of only one pair of MZ twins can provide considerable insights into underlying causes of observed variation. This model can be used in a dental practice environment, with oral health professionals having the opportunity to explore differences in orofacial structures between MZ co-twins who are attending as patients. As researchers have become more aware of the complexities of the interactions between the genome, the epigenome and the environment during development, there is the need to collect more phenotypic data and define new phenotypes that will better characterize variations in growth processes and health status. When coupled with powerful new genetic approaches, including genome-wide association studies and linkage analyses, exciting opportunities are opening up to unravel the causes of problems in craniofacial growth and common oral diseases in human populations.

Intrauterine hormone effects on tooth dimensions.

The human dentition is a complex adaptive system that is influenced by genetic, epigenetic, and environmental factors. Within this system, is sexual dimorphism related to the growth promotion of the Y chromosome, or to hormonal influences, or both? This study is the first to investigate both primary and permanent tooth sizes in females from opposite-sex dizygotic (DZOS) twin pairs compared with females from dizygotic same-sex (DZSS) and monozygotic (MZ) twin pairs to indicate the influence of intrauterine male hormone, including the initial testosterone surge, on dental development. Serial dental models of the primary, mixed, and permanent dentitions of 134 females from DZOS, DZSS, and MZ twins were examined. Mesiodistal, buccolingual, crown height, and intercuspal dimensions of all primary teeth and selected permanent teeth were determined by image analysis. Univariate and multivariate analyses showed statistically significantly larger crown size in DZOS females in both dentitions, with the crown height dimensions displaying the greatest increase in size. These findings strongly support the Twin Testosterone Transfer (TTT) hypothesis. We propose that the growth-promoting effects of the Y chromosome and intrauterine male hormone levels influence different tooth dimensions and contribute differentially to the sexual dimorphism of human teeth.

The structure and composition of deciduous enamel affected by local hypoplastic autosomal dominant amelogenesis imperfecta resulting from an ENAM mutation.

In a group of families in northern Sweden, a mutation in the ENAM gene (predicted to produce a highly truncated protein) results in the local hypoplastic form of autosomal dominant amelogenesis imperfecta. In this study, sections of deciduous teeth from members of 3 of these families were examined by scanning electron microscopy (SEM) and the enamel mineral was analysed by energy dispersive X-ray spectroscopy (EDX). The sections were also probed with antibodies raised to a conserved sequence of the enamelin protein. Selected intact teeth were first analysed by digital imaging and ascribed with an 'Enamel Defects Index' (EDI) score. SEM of tooth sections revealed disrupted prism morphology and the prisms had a glass-like appearance in some areas. These areas of dysplasia were sometimes irregular but formed regular arrays in others. Comparison of EDI scores with SEM indicated that in one tooth the surface had no measurable defects but significant defects were present in the underlying enamel microstructure. SEM immunohistochemistry with the antibody raised to a fragment of the enamelin protein produced positive, but light, labelling throughout normal enamel. In dysplastic areas, however, the labelling intensity appeared to be reduced. The results indicate that the presence of functional enamelin in the correct amounts is necessary for correct prism morphogenesis. In addition, a combination of EDI and structural analysis indicate that defects in enamel microstructure are not necessarily visible as defects on the surface of the tooth, suggesting the possibility, at least, that some instances of under-diagnosis may occur.

Multilevel complex interactions between genetic, epigenetic and environmental factors in the aetiology of anomalies of dental development.

Dental anomalies are caused by complex interactions between genetic, epigenetic and environmental factors during the long process of dental development. This process is multifactorial, multilevel, multidimensional and progressive over time. In this paper the evidence from animal models and from human studies is integrated to outline the current position and to construct and evaluate models, as a basis for future work. Dental development is multilevel entailing molecular and cellular interactions which have macroscopic outcomes. It is multidimensional, requiring developments in the three spatial dimensions and the fourth dimension of time. It is progressive, occurring over a long period, yet with critical stages. The series of interactions involving multiple genetic signalling pathways are also influenced by extracellular factors. Interactions, gradients and spatial field effects of multiple genes, epigenetic and environmental factors all influence the development of individual teeth, groups of teeth and the dentition as a whole. The macroscopic, clinically visible result in humans is a complex unit of four different tooth types formed in morphogenetic fields, in which teeth within each field form directionally and erupt at different times, reflecting the spatio-temporal control of development. Even when a specific mutation of a single gene or one major environmental insult has been identified in a patient with a dental anomaly, detailed investigation of the phenotype often reveals variation between affected individuals in the same family, between dentitions in the same individual and even between different teeth in the same dentition. The same, or closely similar phenotypes, whether anomalies of tooth number or structure, may arise from different aetiologies: not only mutations in different genes but also environmental factors may result in similar phenotypes. Related to the action of a number of the developmental regulatory genes active in odontogenesis, in different tissues, mutations can result in syndromes of which dental anomalies are part. Disruption of the antagonistic balance between developmental regulatory genes, acting as activators or inhibitors can result in dental anomalies. There are critical stages in the development of the individual tooth germs and, if progression fails, the germ will not develop further or undergoes apoptosis. The reiterative signalling patterns over time during the sequential process of initiation and morphogenesis are reflected in the clinical association of anomalies of number, size and form and the proposed models. An initial step in future studies is to combine the genetic investigations with accurate recording and measurement of the phenotype. They also need to collate findings at each level and exploit the accurate definition of both human and murine phenotypes now possible.

The relationship between the mid-point and most-prominent point on the labial curve of upper anterior teeth.

OBJECTIVES: This study investigates coincidence of the most-prominent point and the mid-point on upper anterior teeth in relation to the use of straight-wire appliances. MATERIALS AND METHODS: Alginate impressions of the upper jaw were obtained from forty Caucasian patients. Impressions were cast using hard dental stone. The teeth on each upper study model (canine to canine) were marked along the facial axis of the clinical crown (FACC line) then separated using a very thin diamond disc. Each tooth was mounted on a glass slide using sticky wax and cut into two halves down this FACC line. Images were acquired of the sections and a straight line connecting the gingival margin and the incisal edge was drawn on the flat cut surfaces (now the proximal crosssectional view). From this line, perpendicular lines were drawn at the mid-point and most prominent point to the labial curve. Coincidence rate was calculated or whether the most prominent point was gingival or incisal to the mid-point. RESULTS: Approximately 80% of upper central incisors had coincident mid- and most-prominent points. Upper lateral incisors and canine teeth had approximately 50% coincidence. The vast majority of cases without coincidence showed the most-prominent point incisal to the mid-point for all tooth kinds with just 5% or less gingival. CONCLUSIONS: The high proportions of non-coincident examples found suggest that clinicians should be aware of individual variation and that this may possibly effect 3(rd) order alignment.

Variability and patterning in permanent tooth size of four human ethnic groups.

AIMS: Dental dimensions vary between different ethnic groups, providing insights into the factors controlling human dental development. This paper compares permanent mesiodistal crown diameters between four ethnic groups highlighting patterns of tooth size between these groups and considers the findings in relation to genetic and environmental influences. METHODS AND RESULTS: Mesiodistal crown dimensions were recorded using standardised manual measurements on dental casts derived from four different human populations: Southern Chinese, North Americans of European ancestry, Modern British of European ancestry and Romano-British. Analyses based on double determinations showed that measurements in all study samples were reliable to an accuracy of 0.1mm. The Southern Chinese sample was found to have the largest teeth overall, whereas the Romano-British sample generally displayed the smallest mesiodistal crown dimensions (p<0.001). However, the Modern British sample had the largest maxillary central incisors, mandibular central and lateral incisors, and mandibular canines, while the North American sample had the largest maxillary first and second molars. Comparisons of coefficients of variation for teeth within each class showed that the later-forming teeth displayed greater variation in mesiodistal size than the earlier-forming teeth. CONCLUSION: The different patterns of tooth size observed between the study samples are thought to reflect differences in the relative contributions of genetic, and environmental influences to dental development between the four populations. For example, it is proposed that major environmental insults during the early life of Romano-Britons, including recurrent illnesses, poor nutrition and excessive lead ingestion, contributed to the reduction in size and greater variability of their later-forming teeth. Using a standardised methodology, significant differences in mesiodistal crown diameters have been demonstrated between four human ethnic groups. There were also distinct differences in the patterns of crown size between the groups, with the later-forming teeth in each type generally showing greater size variation.

Epithelial histogenesis during tooth development.

This paper reviews the current understanding of the progressive changes mediating dental epithelial histogenesis as a basis for future collaborative studies. Tooth development involves morphogenesis, epithelial histogenesis and cell differentiation. The consecutive morphological stages of lamina, bud, cap and bell are also characterized by changes in epithelial histogenesis. Differential cell proliferation rates, apoptosis, and alterations in adhesion and shape lead to the positioning of groups of cells with different functions. During tooth histo-morphogenesis changes occur in basement membrane composition, expression of signalling molecules and the localization of cell surface components. Cell positional identity may be related to cell history. Another important parameter is cell plasticity. Independently of signalling molecules, which play a major role in inducing or modulating specific steps, cell-cell and cell-matrix interactions regulate the plasticity/rigidity of particular domains of the enamel organ. This involves specifying in space the differential growth and influences the progressive tooth morphogenesis by shaping the epithelial-mesenchymal junction. Deposition of a mineralized matrix determines the final shape of the crown. All data reviewed in this paper were investigated in the mouse.

Tooth size patterns in patients with hypodontia and supernumerary teeth.

AIMS: Anomalies of tooth number may not be isolated conditions but may have wider associations in the development of the dentition including tooth size. This study aimed to examine links between hypodontia, supernumerary teeth and crown size, considering the effect on the development of the whole dentition and so increase understanding of the aetiology of these conditions. METHODS AND RESULTS: The patients, who were all of European ancestry, were 60 young adults (30 males and 30 females) with hypodontia and 60 age and sex matched controls together with 60 young adults (39 males and 21 females) with supernumerary teeth and 60 age and sex matched controls. Hand measurements of mesiodistal and buccolingual dimensions were made of the teeth on dental study models using Mitutoyo electric callipers. The mean value of two measurements was used and intra-operator and inter-operator reliability determined. Patients with hypodontia had smaller teeth than the control group and this difference was statistically significant (p<0.05) for all teeth except the MD dimensions of 13, 23, 24 and 44. The difference in size was greatest for the BL dimensions in hypodontia patients. Further, the greater the number of missing teeth the smaller the tooth size. The hypodontia patients also showed higher variability in tooth dimensions than the control group. Patients with supernumerary teeth had larger teeth than the controls, with the greatest differences in the MD dimensions. In both hypodontia and supernumerary patients the differences in tooth size were generalised throughout the dentition. CONCLUSIONS: In anomalies of tooth number the size of teeth is also involved. In patients with hypodontia and supernumerary teeth the crown size of the whole dentition is affected. These findings are compatible with a multifactorial aetiology of these conditions.

Tooth dimensions in hypodontia with a known PAX9 mutation.

AIM: Congenital absence of teeth is a complex condition affecting several parameters of oral development. This is the first study to measure tooth crown dimensions using image analysis in a family with hypodontia in whom the mutation has been identified, and compare them with a control group. METHODS AND RESULTS: Study models were obtained from 10 family members from three generations affected by severe hypodontia with a missense mutation in PAX9 and 10 unaffected, unrelated controls. Using established image analysis techniques all teeth up to and including the first permanent molars were digitally imaged by two operators from the occlusal (O) and buccal (B) aspects three times and an average made for the mesio-distal (MDO and MDB) bucco-lingual (BL), area (A) and perimeter (P) measurements. Intra-class correlation coefficients (ICCC) were calculated to assess intra- and inter-operator reliability. Two-sample t-tests were then used to compare these dimensions with those of the controls. Reliability of the technique was high (mean r>0.95). The majority of tooth types throughout the dentition were significantly smaller in the family members with hypodontia than in the control group for all parameters measured. The levels of significance were very high for upper lateral incisors (p<0.0001) whilst the canines and first molars were less different. The greatest number of significant differences were found in BL and P, closely followed by MD and A measurements. CONCLUSIONS: The significantly smaller tooth crown dimensions recorded in the affected family members show that the effect of the PAX9 mutation is seen not only in the congenitally missing teeth but also in smaller crown size throughout the dentition.

Enamel defects in extracted and exfoliated teeth from patients with Amelogenesis Imperfecta, measured using the extended enamel defects index and image analysis.

AIMS: To enhance the phenotypic description and quantification of enamel defects from a North Sweden sample of extracted and exfoliated teeth originating from families with Amelogenesis Imperfecta by use of the extended enamel defects index (EDI) and image analysis to demonstrate the comparable reliability and value of the additional measurements. METHODS AND RESULTS: The sample comprised 109 deciduous and 7 permanent teeth from 32 individuals of 19 families with Amelogenesis Imperfecta in Northern Sweden. A special holder for individual teeth was designed and the whole sample was examined using the extended EDI and an image analysis system. In addition to the extended EDI definitions, the calibrated images were measured for tooth surface area, defect area and percentage of surface affected using image analysis techniques. The extended EDI was assessed using weighted and unweighted Kappa statistics. The reliability of imaging and measurement was determined using Fleiss' intra-class correlation coefficient (ICCC). Kappa values indicated good or excellent intra-operator repeatability and inter-operator reproducibility for the extended EDI. The Fleiss ICCC values indicated excellent repeatability for the image analysis measurements. Hypoplastic pits on the occlusal surfaces were the most frequent defect in this sample (82.6%). The occlusal surface displayed the most post-eruptive breakdown (39.13%) whilst the incisal portion of the buccal surfaces showed most diffuse opacities (53.4%). Image analysis methods demonstrated the largest mean hypoplastic pit areas were on the lingual surfaces. The largest mean post-eruptive breakdown areas were on the lingual surfaces of posterior teeth. The largest mean demarcated opacity areas were found on the labial surfaces. CONCLUSIONS: The extended EDI and the standardised image acquisition and analysis system provided additional information to conventional measurement techniques. Additional phenotypic variables were described.

The aetiology of hypodontia: the prevalence, severity and location of hypodontia within families.

AIMS: Previous studies have indicated that hypodontia has a significantly higher prevalence in the relatives of affected individuals than in the general population. This study aims to examine further the roles of genetic and environmental factors in the aetiology of hypodontia by investigating the relationship between the severity and distribution of hypodontia between family members, and any discernable effect of maternal health during pregnancy and birth weight. METHODS AND RESULTS: 117 first degree relatives of 41 index patients were examined clinically and radiographically to identify the presence, severity and location of hypodontia. Both siblings and parents of index patients had a higher prevalence of hypodontia than the general population. The number and location of missing teeth was not related to the number and location of missing teeth in parents or siblings. The expression of hypodontia within a family was not affected by maternal health during pregnancy. CONCLUSIONS: The variation found in the expression of hypodontia within families suggests that its occurrence is not solely determined by genetic factors, but epigenetic and environmental factors probably also are important. This finding is consistent with a multifactorial aetiology for this condition.

Multiple crown size variables of the upper incisors in patients with supernumerary teeth compared with controls.

AIMS: As part of ongoing studies of the aetiology of dental anomalies the aims of this study were to identify multiple components of tooth size of the upper permanent incisors in 34 patients with supernumerary teeth and to compare them with those in a control group to determine whether the presence of a supernumerary tooth has a local effect on the size of the surrounding dentition. METHODS AND RESULTS: The labial and occlusal aspects of the clinical crowns of the upper permanent central and lateral incisors on the study models of 74 subjects were digitally imaged and measured using an image analysis system and automated macro (34 patients with supernumerary in the upper incisor region: 17 males and 17 females and 40 controls: 20 males and 20 females). The macro-defined 17 variables from each view. From the labial view these were: the mesio-distal and occluso-gingival length and additional measurements along 25 and 75% of the mesio-distal line and at 25, 50 and 75% along the occluso-gingival line such that all these sub-divisions extended to the periphery of the tooth. From the occlusal view these were: the mesio-distal and labio-lingual lengths, and additional variables that sub-divided the mesio-distal again at 25 and 75% along the length and at 25, 50 and 75% along the labio-lingual dimension. Principal component analysis (PCA) was used to identify the key factors with the most random variability. Comparisons were then carried out between the supernumerary cases and control group using 2-way ANOVA. Seven factors of tooth size for the upper central incisors and eight factors for the upper lateral incisors were extracted. Most of these variables were found to be larger in the supernumerary group than in the control. Statistically significant differences were found for 5 out of 7 and 4 out of 8 for the upper central and lateral incisors respectively. CONCLUSIONS: A number of factors of tooth size were identified and found to be larger in the supernumerary group compared to the control (7 for upper central and 8 for upper lateral incisors); the majority reached the 0.05 significance level. Tooth crown size of the upper central incisor was affected more than that of the upper lateral incisor, supporting a local field effect.