The ontogeny of the chin: an analysis of allometric and biomechanical scaling.

The presence of a prominent chin in modern humans has been viewed by some researchers as an architectural adaptation to buttress the anterior corpus from bending stresses during mastication. In contrast, ontogenetic studies of mandibular symphyseal form suggest that a prominent chin results from the complex spatial interaction between the symphysis and surrounding soft tissue and skeletal anatomy during development. While variation in chin prominence is clearly influenced by differential growth and spatial constraints, it is unclear to what degree these developmental dynamics influence the mechanical properties of the symphysis. That is, do ontogenetic changes in symphyseal shape result in increased symphyseal bending resistance? We examined ontogenetic changes in the mechanical properties and shape of the symphysis using subjects from a longitudinal cephalometric growth study with ages ranging from 3 to 20+ years. We first examined whether ontogenetic changes in symphyseal shape were correlated with symphyseal vertical bending and wishboning resistance using multivariate regression. Secondly, we examined ontogenetic scaling of bending resistance relative to bending moment arm lengths. An ontogenetic increase in chin prominence was associated with decreased vertical bending resistance, while wishboning resistance was uncorrelated with ontogenetic development of the chin. Relative to bending moment arm lengths, vertical bending resistance scaled with significant negative allometry whereas wishboning resistance scaled isometrically. These results suggest a complex interaction between symphyseal ontogeny and bending resistance, and indicate that ontogenetic increases in chin projection do not provide greater bending resistance to the mandibular symphysis.

Phenotype-genotype correlations of facial width and height proportions in patients with Class II malocclusion.

OBJECTIVES: To characterize soft-tissue facial height and width variation in Class II malocclusion and test for correlations with genes HMGA2, AJUBA, and ADK. SETTING AND SAMPLE POPULATION: Nine facial proportions were estimated from 2D frontal repose photographs of 330 Caucasian adults with Class II malocclusion. MATERIAL AND METHODS: After adjustments for age and gender, the facial proportions were submitted to a principal component analyses (PCA). The most meaningful phenotypic variations were correlated with SNPs rs7924176 (ADK), rs17101923 (HMGA2), and rs997154 (AJUBA) genotyped in 106 individuals. RESULTS: Principal component analyses resulted in four principal components (PCs), which explained 75% of total variation. PC1 captured variation in the intercanthus distance and explained 28% of total variation. PC2 explained 21% of the variations in facial taper and facial index. PC3 explained 14% and reflected variations in the vertical dimension of the lower face. PC4 explained 12% and captured variations in distance between the eyes, width of the commissures, and the length of the superior aspect of the lower face height corresponding to the vertical dimension of the philtrum of the upper lip. A suggestive association (p<0.05) was observed between PC4 and rs997154 corroborating the role of AJUBA in variation of facial dimensions. CONCLUSION: 2D frontal photographs can be used to derive quantitative measures of soft-tissue phenotypes that are of clinical relevance. The methods described are suitable for discovery and replication of associations between genotypes and malocclusion phenotypes.

Candidate Gene Analyses of Skeletal Variation in Malocclusion.

This study evaluated associations between craniofacial candidate genes and skeletal variation in patients with malocclusion. Lateral cephalometric radiographs of 269 untreated adults with skeletal classes I, II, and III malocclusion were digitized with 14 landmarks. Two-dimensional coordinates were analyzed using Procrustes fit and principal component (PC) analysis to generate continuous malocclusion phenotypes. Skeletal class classifications (I, II, or III) were used as a categorical phenotype. Individuals were genotyped for 198 single-nucleotide polymorphisms (SNPs) in 71 craniofacial genes and loci. Phenotype-genotype associations were tested via multivariate linear regression for continuous phenotypes and multinomial logistic regression for skeletal malocclusion class. PC analysis resulted in 4 principal components (PCs) explaining 69% of the total skeletal facial variation. PC1 explained 32.7% of the variation and depicted vertical discrepancies ranging from skeletal deep to open bites. PC1 was associated with a SNP near PAX5 (P = 0.01). PC2 explained 21.7% and captured horizontal maxillomandibular discrepancies. PC2 was associated with SNPs upstream of SNAI3 (P = 0.0002) and MYO1H (P = 0.006). PC3 explained 8.2% and captured variation in ramus height, body length, and anterior cranial base orientation. PC3 was associated with TWIST1 (P = 0.000076). Finally, PC4 explained 6.6% and detected variation in condylar inclination as well as symphysis projection. PC4 was associated with PAX7 (P = 0.007). Furthermore, skeletal class II risk increased relative to class I with the minor alleles of SNPs in FGFR2 (odds ratio [OR] = 2.1, P = 0.004) and declined with SNPs in EDN1 (OR = 0.5, P = 0.007). Conversely, skeletal class III risk increased versus class I with SNPs in FGFR2 (OR 2.2, P = 0.005) and COL1A1 (OR = 2.1, P = 0.008) and declined with SNPs in TBX5 (OR = 0.5, P = 0.014). PAX5, SNAI3, MYO1H, TWIST1, and PAX7 are associated with craniofacial skeletal variation among patients with malocclusion, while FGFR2, EDN1, TBX5, and COL1A1 are associated with type of skeletal malocclusion.

Deciduous canine and permanent lateral incisor differential root resorption.

When a permanent maxillary canine erupts apical to the permanent lateral incisor and the deciduous canine, resorption typically takes place only on the deciduous canine root. An understanding of this differential resorption could provide insight into the reasons for excessive iatrogenic root resorption during orthodontic tooth movement. The purpose of the present study was to examine the response of roots of permanent lateral incisors and deciduous canines to simulated resorption, and to acid and enzyme attack, reflecting the physiologic environment of an erupting permanent canine. Groups of maxillary permanent lateral incisor and deciduous canine roots were exposed to 5 combinations of Ten Cate demineralizing solution, Ten Cate demineralizing solution with EDTA, and a Type I collagenase solution. Sections of the roots were examined under a polarized light microscope. Analysis of variation of the resulting root lesions demonstrated that the lesion depths for deciduous canines were greater than those for permanent lateral incisors when averaged across 4 of the conditions (F(1,24) = 7.49, P =.0115). On average, deciduous canine roots demonstrated lesions 10% deeper than did permanent lateral incisor roots. We concluded that when deciduous canine and permanent lateral incisor roots are subjected to acid and enzyme attack, reflecting the physiologic environment of an erupting permanent canine, significantly deeper demineralized lesions are seen in the deciduous roots compared with the permanent roots. This finding may partially explain the differential root resorption during permanent tooth eruption.

Alveolar process fractal dimension and postcranial bone density.

OBJECTIVES: Our goal was to determine whether the radiographic fractal dimension of the maxillary and mandibular alveolar processes is related to bone density of the alveolar processes, spine, hip, and radius in healthy women. STUDY DESIGN: Thirty-seven dentate healthy white women aged 20 to 78 years underwent assessment of systemic and alveolar process bone. After a periodontal examination, D-speed vertical bite-wing and periapical radiographs with aluminum step wedges and a density correction algorithm were used to make alveolar process fractal dimension and density calculations within regions of interest that avoided crestal bone and intrabony defects. Anteroposterior (L1-L4) and lateral (L2-L4) lumbar spine, total hip, and total wrist densities were determined by means of dual energy x-ray absorptiometry. RESULTS: Correlation analysis revealed significant relationships between maxillary alveolar process fractal dimension and maxillary alveolar process density (r = 0.47, P < or =.01), mandibular alveolar process density (r = 0.48, P < or =.01), and mandibular alveolar process fractal dimension (r = 0.44, P < or =.05); and between mandibular alveolar process fractal dimension and maxillary alveolar process density (r = 0.54, P < or =.01) and mandibular alveolar process density (r = 0.58, P < or =.001). No significant relationships were found between the maxillary alveolar process or the mandibular alveolar process fractal dimension and the density of any postcranial regions. CONCLUSIONS: In healthy women, the alveolar process radiographic fractal dimension is significantly related to the alveolar process density but is not related to the density of the spine, hip, or radius.

The relationship between the density of the alveolar processes and that of post-cranial bone.

Skeletal mass declines in all populations with age, and the literature suggests that changes in oral bone may be linked to the status of the post-cranial (systemic) skeleton. However, there is a lack of information defining the relationship between alveolar process bone and the post-cranial skeleton in healthy individuals. The purpose of this study was to determine: (1) if the bone densities of the maxillary and mandibular alveolar processes are related to the bone density of the spine, hip, or radius in healthy women; and (2) if the alveolar process densities decline with age. Forty-one dentate Caucasian women aged 20 to 78 years underwent assessment of post-cranial (systemic) and alveolar process bone. D-speed vertical bitewing and periapical radiographs incorporating aluminum stepwedges, controlled exposure and processing conditions, and a density correction algorithm were used to make alveolar process density assessments with regions of interest (ROIs) apical to crestal bone and intrabony defects. Anteroposterior lumbar (L1 to L4) and lateral lumbar (L2 to L4) spine, total hip (and subregions), and radius bone densities were determined by dual-energy x-ray absorptiometry (DEXA). Correlation analysis revealed significant relationships between maxillary alveolar process bone density and the density of the mandibular alveolar process (r = 0.57, p < or = 0.001), anteroposterior lumbar spine (r = 0.53, p < or = 0.001), lateral lumbar spine (r = 0.52, p < or = 0.001), total hip (r = 0.39, p = 0.01), total radius (r = 0.39, p = 0.01), and age (r = -0.38, p = 0.01). A two-tailed t test comparison revealed significantly greater maxillary alveolar process bone density in women younger than 50 years of age than in those 50 and older (p < or = 0.01). We conclude that the density of maxillary alveolar process bone is significantly related to the density of the mandibular alveolar process, lumbar spine, hip, and radius in healthy women and that maxillary alveolar process bone density declines with age.

Evaluation of profile esthetic change with mandibular advancement surgery.

Our purpose was to investigate the impact of mandibular advancement surgery on profile esthetics and to attempt to define guidelines that could be of value to the clinician in predicting profile esthetic change. The sample consisted of 34 patients who had been treated with a combination of orthodontics and mandibular advancement surgery without genioplasty. Initial (pretreatment) and final (posttreatment) cephalometric radiographs of each patient were used to produce silhouette images and to quantify skeletal changes that occurred with surgery. The images were displayed randomly to lay persons and orthodontic residents who were asked to score the esthetics of each profile. On average, after mandibular advancement surgery, B point moved forward 5.0 mm (SD = 2.6 mm) and downward 4.7 mm (SD = 3.1 mm), and the ANB angle decreased 3.0 degrees (SD = 1.6 degrees ) Graphical analysis and results of paired t tests revealed that for patients with an initial ANB angle >/= 6 degrees, a consistent improvement in profile esthetics was seen following surgery (P

Mandibular bone density and fractal dimension in rabbits with induced osteoporosis.

OBJECTIVE: Our goal in this investigation was to examine the mandibular bone density and radiographic textural changes and the relationship between mandibular and spinal bone mineral density in an osteoporotic rabbit model. STUDY DESIGN: Three adult female New Zealand white rabbits in each of 4 groups received daily injections of cortisone acetate at a dosage of 0.0 (control), 3.0, 7.5, or 15.0 mg/kg for 4 weeks. The rabbits were then killed, and the mandible and spine of each animal were removed. Digital radiographs (70 kVp, 10 mA, 8 impulses) of the hemimandibles and spines were made. Lateral and anteroposterior bone densities of the lumbar spine (L2) were calculated, and average mandibular interdental bone density, fractal dimension, and gradient values were calculated. RESULTS: Correlation analysis revealed that cumulative steroid dose was strongly related to mandibular bone density (r = -0.80, P <.01), moderately related to mandibular fractal dimension (r = -0.61, P <. 05), and moderately related to anteroposterior lumbar spine density (r = -0.64, P <.05). Moderate correlations were found between mandibular interdental bone density and spinal density (r = 0.56, P <.05), but mandibular fractal dimension was not related to spinal density. CONCLUSIONS: In osteoporotic female rabbits, mandibular bone mineral density decreases in relation to spinal density and cumulative steroid dose. Mandibular fractal dimension decreases with cumulative steroid dose but is not significantly related to either mandibular density or spinal density.

Radiologic interpretation of bone striae: an experimental study in vitro.

OBJECTIVE: The purpose of this study was to determine whether the mandibular alveolar striae patterns seen in radiographs represent trabecular bone. STUDY DESIGN: Segments of human cadaver mandible were obtained. Two identical radiographs were made of each segment initially, after removal of trabecular bone, after slight smoothing of the endosteal surface, and after aggressive smoothing of the endosteal surface. The radiographs were projected in random pairs for each sample. Six dentists judged whether a difference in the amount of trabecular bone could be detected. RESULTS: Chi-square test analysis revealed no significant difference in the amount of trabecular bone judged initially and after removal of trabecular bone. A significant difference appeared to exist on radiographs made initially and after slight smoothing. A significant difference was judged to exist on radiographs made after slight removal of the endosteal surface and after aggressive removal of the endosteal surface. CONCLUSIONS: Mandibular radiographic striae patterns, interpreted as arising from trabecular bone, actually result from bone patterns on the endosteal surface.

Geometric and densitometric standardization of intraoral radiography through use of a modified XCP system.

OBJECTIVE: The purposes of this study were to examine the density correction afforded by curve-fitting algorithms and to investigate whether the device we developed significantly improves the reliability of longitudinal alveolar process bone radiographic density measurements. STUDY DESIGN: Stepwedges were radiographed over a range of impulse settings, and curve-fitting algorithms were fitted to sets of step images on each digitized film. Differences between the actual thicknesses of an alternate set of steps and their corresponding thickness estimates were calculated. Next, clinicians made periapical radiographs from interproximal bony sites on a dry skull using our imaging device. Differences in bone densities between corresponding regions of interest taken 1 week apart were calculated. RESULTS: Analysis of variance and Duncan's Multiple Range test demonstrated that piecewise linear, third-degree polynomial, and fourth-degree polynomial curves provided significantly better estimates of stepwedge thickness than did sigmoid or first degree polynomial-curves (P < .05) and that the differences between repeat bone density measurements made with density correction were significantly less than those made without density correction (P < .05). CONCLUSIONS: Piecewise linear, third-degree polynomial, and fourth-degree polynomial curve-fitting algorithms provided the best densitometric correction. The use of our imaging device increased the reliability of longitudinal bone density measurements.

Prediction of mandibular growth rotation: assessment of the Skieller, Björk, and Linde-Hansen method.

The purpose of this investigation was to assess the method proposed by Skieller, Björk, and Linde-Hansen in 1984 to predict mandibular growth rotation. Our sample consisted of 40 randomly selected, untreated, adolescent subjects representative of the patient population generally encountered in orthodontic practice. The four independent variables identified in the Skieller study as having the highest predictive value (mandibular inclination, intermolar angle, shape of the lower border of the mandible, and inclination of the symphysis) were identified on initial lateral cephalograms. The proposed regression equations were applied and predicted mandibular rotations obtained. Final lateral cephalograms made 6 years after the initial profile radiographs were superimposed and actual mandibular rotation recorded. The observed and predicted rotations were compared and regression analyses performed to determine the amount of variability in observed values accounted for by the four variables individually and in combination. Only 5.6% of the variability in mandibular growth rotation could be accounted for using the four variables individually. Only 9% of the variability could be accounted for with a combination of the variables. In addition, we performed a Monte Carlo analysis, which mirrored the Skieller analysis but used random numbers instead of actual cephalometric data, to determine if the Skieller results may simply have capitalized on chance. Using the same forward stepwise selection procedure with a rejection level of P >.1, we found after 5000 simulations that a mean of 84% and a median of 94% of mandibular growth rotation variability could be accounted for using meaningless data in the Skieller analysis. This result was comparable to the Skieller value of 86%. In conclusion, information derived from pretreatment lateral cephalograms using the Skieller, Björk, and Linde-Hansen method does not permit clinically useful predictions to be made in a general population relative to the direction of future mandibular growth rotation.

Storage-phosphor computed radiography versus film radiography in the detection of pathologic periradicular bone loss in cadavers.

OBJECTIVES: The purpose of this study was to compare D-speed film, E-speed film, and the Soredex Digora system with respect to the detection of periradicular pathosis. STUDY DESIGN: Radiographic images of 100 cadaver jaws were made with E-speed film, D-speed film, and the Soredex Digora. Each set of 100 images was interpreted by four observers, with 30 days separating each of three viewing sessions from the next. The presence or absence of pathologic (inflammatory) periradicular bone resorption was determined by histologic examination of the samples. The observer performance was compared with the true histologic findings and evaluated with receiver operating characteristic and corrected receiver operating characteristic analysis. RESULTS: No statistically significant differences were found in diagnostic performance among the three radiographic techniques. In addition, no imaging technique was a good indicator of pathosis as determined by histologic analysis. CONCLUSION: Under the conditions of this study, it was determined that D-speed film, E-speed film, and the Soredex Digora were equivalent diagnostic imaging modalities with regard to the detection of pathologic periradicular bone resorption. No technique predictably indicated inflammatory resorption.

Fractal dimension in radiographic analysis of alveolar process bone.

OBJECTIVES: This in vitro study examined radiographic fractal dimension changes in alveolar process bone during simulated osteoporosis. STUDY DESIGN: Ten specimens of human maxillary alveolar process bone were progressively decalcified, and the percentage of calcium lost at each decalcification stage was quantified. Four radiographs of each specimen, together with an aluminum step-wedge, were exposed at 70 kVp at each stage. The test set of 560 radiographs was digitized, identical bony regions of interest were selected from the density-corrected images of each specimen, the regions were digitally filtered to reduce film-grain noise, and fractal dimension was computed on a line-to-line basis. Correlation analysis quantified the relationship between calcium loss and fractal dimension change. Analysis of variance and Duncan's multiple range test determined whether a difference existed in fractal dimension computed from images at x-ray beam angulations of -5, 0, and +5 degrees. RESULTS: A strong correlation (average r = -0.94, p < or = 0.0037) was found between generalized demineralization and decreasing fractal dimension. In every bone sample fractal dimension changed significantly (p < or = 0.0189) with angular change. CONCLUSIONS: Radiographic fractal dimension holds promise for detecting simulated osteoporosis in the maxilla under ideal conditions, but the sensitivity of fractal dimension to small x-ray beam angular change renders its clinical application questionable.

Prevention of enamel demineralization during orthodontic treatment: an in vitro study using pit and fissure sealants.

Enamel demineralization during active orthodontic treatment remains a significant problem. The purpose of this in vitro study was to evaluate the efficacy of applying a light-cured unfilled resin, a conventional pit and fissure sealant, to the labial surface of teeth with previously placed orthodontic appliances to prevent demineralization. Orthodontic brackets were bonded to 40 extracted human teeth with a commercially available orthodontic adhesive. The exposed labial surfaces of 30 teeth (experimental group) were sealed with a clear, light-cured, unfilled resin. The remaining 10 teeth (control group) were left unsealed. Both groups were placed in a demineralization environment, and then all teeth were sectioned and examined under polarized light microscopy for the presence or absence of enamel demineralization. Every member of the control group exhibited demineralization of the entire exposed labial surface, whereas 80% of the sealed teeth exhibited no demineralization. Small, isolated areas of enamel loss were seen in six of the sealed teeth representing "breaks" in the sealant layer. The results of this study indicate that light-cured sealant treatment after orthodontic appliance placement significantly reduces enamel demineralization.

Detection of simulated osteoporosis in maxillae using radiographic texture analysis.

An effective mass screening tool for detecting osteoporosis is currently lacking. Alveolar bone, routinely examined during periodic dental examinations, may provide a window into the status of systemic bone density. The primary objective of this investigation was to compare the performance of various textural features, computed from dental radiographs, in detecting early simulated osteoporosis of alveolar bone. Five specimens of human maxillary alveolar bone were progressively decalcified and the percentage calcium lost at each decalcification stage quantified. Two radiographs of each specimen, together with an aluminum stepwedge, were exposed at 70 kVp at each stage. The test set of 140 radiographs was digitized, identical bony regions of interest selected from the density-corrected images of each specimen, the regions digitally filtered to reduce film-grain noise, and textural features computed on a line-to-line basis. Correlation analysis identified a set of features whose changes consistently exhibited a moderate-to-strong linear association with bone mineral loss over a wide range of decalcification. Repeated measures analysis of variance was subsequently applied to this set to measure the minimal decalcification that could be detected by each feature under optimal conditions of x-ray beam angulation (0 degrees) and suboptimal conditions (+/- 5 degrees). The best performing features were mean intensity, gradient, Laws' texture energy measures, and fractal dimension which detected 5.7% bone decalcification at optimal beam angulation and 9.4-12.6% at suboptimal angulation.

Intrusion anchorage potential of teeth versus rigid endosseous implants: a clinical and radiographic evaluation.

The purpose of this study was to compare the intrusion anchorage potential of teeth to osseointegrated titanium implants. Titanium implants were surgically placed unilaterally in a healed mandibular fourth premolar extraction site in eight adult mongrel dogs. The implants were surgically uncovered 3 months later and second stage abutments with soldered edgewise brackets secured. Edgewise brackets were also placed on the ipsilateral third premolars and on the contralateral third and fourth premolars. Segmental edgewise arch wires were placed between the implant and the third premolar and between the contralateral third and fourth premolars. Intrusion arch wire bends (v-bends) just mesial to the implant and the fourth premolar brackets were adjusted to apply a 50 to 60 gm intrusive force to the third premolars, bilaterally. Seven weeks later this force was increased to approximately 100 gm. Force levels were monitored biweekly for a total period of 16 weeks. Superimposition of initial and final periapical radiographs with bone markers demonstrated that for each dog the implant remained immobile and the third premolar on the implant anchor side was intruded in a curved path. On the contralateral side of the arch the dental anchor (fourth premolar) underwent an adverse reactive tip-back movement, and the third premolar was not intruded. We conclude that rigid endosseous implants are superior to dental anchorage for orthodontic intrusion of teeth and offer a potential means to intrude anterior teeth in adult patients with missing posterior teeth.

Performance of filters for noise reduction in maxillary alveolar bone imaging.

Film-grain noise degrades image detail, hinders detection of subtle radiographic bone changes, and could thwart attempts to use dental radiographs of alveolar bone to detect osteoporosis. The purpose of this investigation was to quantify and compare the performance of various 1- and 2-D spatial and frequency domain filters in suppressing this noise. Estimates of noise-free bone profiles (scan lines) from each of five maxillary interdental areas were made by superimposing and averaging 16 identically exposed and digitized radiographs. The average mean absolute error and mean-squared error between the 80 initially noisy images and their respective noise-free profiles were calculated to provide an estimate of initial noise. Filter performance was measured as the change in these values after filtering the noisy images. Frequency domain analysis revealed that bone signal power spectra dominated at frequencies less than 2-3 cycles/mm and that some form of low-pass filtering would be applicable. The 2-D Butterworth low-pass filter provided the best performance, removing 57% of the film-grain noise when measured by mean absolute error, and over 80% when measured by mean-squared error. Surprisingly, the Lee, Lp mean, geometric mean, binomial, median, and simple neighborhood averaging filters offered comparable levels of performance.

Detection of simulated osteoporosis in human anterior maxillary alveolar bone with digital subtraction.

The purpose of this in vitro study was to examine radiographic changes in human anterior maxillary alveolar bone during simulated osteoporosis (decalcification) and to determine the minimal amount of generalized decalcifications that can be detected under optimal radiographic conditions with the use of digital subtraction. Five samples of human anterior maxillary alveolus were progressively decalcified at timed intervals with 0.1 N hydrochloric acid solutions, and the percentage of calcium lost during each interval was quantified with calcium assays. Sets of four radiographs were exposed at 70 kVp initially and after each decalcification interval. The radiographs were digitized and digitally filtered, and bone profiles (scan lines) were generated between selected points on lead markers. To further reduce corrupting film-grain noise each set of four profiles were superimposed and averaged on a pixel-by-pixel basis. The averaged profile from each stage of decalcification was subtracted from the averaged initial profile on a pixel-by-pixel basis, and the mean profile intensity change for each decalcification stage calculated. Statistical analysis was performed with repeated measures analysis of variance. Results indicate that generalized decalcification less than or equal to 5.3% was detected in all samples of human anterior maxillae with the use of digital subtraction.