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Concept: Canine tooth


The aim of the study was to test the hypothesis that the gene defect causing congenital absence of maxillary lateral incisors also causes narrowing of the dentition. A total of 81 patients with one or two congenitally missing lateral incisors were retrieved; 52 (64.2 per cent) patients presented bilateral agenesis, whereas 29 (35.8 per cent) had unilateral agenesis. The control group consisted of 90 consecutively treated patients. The largest mesiodistal crown dimension for all teeth, except for the maxillary second and third molars, was measured on plaster casts using a digital caliper to the nearest 10th of a millimetre. Statistical testing was performed using the analysis of variance model (P < 0.05) to test for differences in the mesiodistal dimension between the sample and the control group. Significance has been assessed using a P-value threshold level of 5 per cent. Agenesis of maxillary lateral incisors was found to be a significant predictor of tooth size. Patients who were missing maxillary lateral incisors had smaller teeth compared to control subjects, except for the maxillary right and left first molars. This finding was true for both unilateral and bilateral lateral incisor agenesis. Interaction between maxillary lateral incisor agenesis and gender was not significant. Patients with congenitally missing lateral incisors have narrower teeth than patients without any dental anomalies, except for maxillary first molars. A higher prevalence of microdontic contralateral incisors was found in patients with unilateral agenesis with respect to the control group.

Concepts: Teeth, Analysis of variance, Molar, Incisor, Maxillary central incisor, Canine tooth, Maxillary lateral incisor, Mandibular lateral incisor


Background: Topography and fascicular arrangement of the inferior alveolar nerve (IAN) can provide critical information for the estimation of damage to IAN based on patient symptoms, or conversely to evaluate the symptoms resulting from injury to the IAN. Purpose: The fascicular composition and organization of the IAN were determined to confirm the microarchitecture of the IAN bundles into each of the mandibular teeth, including the composition of the mental nerve. Materials and Methods: The IAN within the mandibular canal (MC) was examined in 30 hemifaces of embalmed Korean cadavers. Results: The most common patterns of nerve fascicle innervation to the mandibular teeth could be grossly classified into three: (1) the superior buccal portion of the IAN innervating the molars, (2) the superior portion innervating the premolars, and (3) the superior lingual or the superior lingual and inferior lingual portions in the posterior MC and the lingual portions in the anterior MC, innervating the incisors and canine. The buccal two-thirds portion of the IAN was composed of the mental nerve. Conclusion: The IAN had distinctive fascicular organizations, which make it possible to forecast the degree, location, and extent of nerve damage according to presenting symptoms.

Concepts: Cranial nerves, Teeth, Mandibular nerve, Incisor, Canine tooth, Inferior alveolar nerve, Mandibular canal, Mental nerve


International Journal of Paediatric Dentistry 2013; 23: 145-152 Background.  Alternatives to vital pulpotomy treatment in primary teeth are being sought because of the high formaldehyde content of traditional formocresol (FC) pulpotomy medicaments. Aim.  The aim was to compare the clinical and radiographic success of vital pulpotomy treatment in primary molars using 3% sodium hypochlorite (NaOCl) versus a 1 : 5 dilution of Buckley’s FC. Design.  Pulpotomies were performed in primary molars of healthy children between 3 and 10 years old. Sixty-five primary teeth were randomized into two groups that were evaluated for treatment outcomes. Following treatment, the pulp chamber was filled with zinc oxide eugenol (ZnOE) and restored with a stainless steel crown cemented with glass ionomer cement. Clinical and radiographic outcomes were recorded at 6 and 12 months. Results.  The control (FC) and experimental (NaOCl) groups demonstrated 100% clinical success at 6 and 12 months. The NaOCl group had 86% (19/22) radiographic success at 6 months and 80% (12/15) at 12 months. The FC group had 84% (21/25) radiographic success at 6 months and 90% (9/10) at 12 months. No significant differences were found in the radiographic outcomes between the two groups at 6 and 12 months (Fisher’s exact test; P = 0.574 and P = 0.468, respectively). Conclusion.  NaOCl demonstrated clinical and radiographic success comparable to FC.

Concepts: Horse, Chlorine, Teeth, Molar, Fisher's exact test, Exact test, Canine tooth, Zinc oxide eugenol


Skulls (n = 1,205) of southern sea otters were examined macroscopically according to defined criteria. The museum specimens, acquired from strandings, varied in age from juvenile to adult, with an equal sex distribution. The results from all young adult and adult specimens were pooled according to tooth type. Ninety-two percent of teeth were available for examination, with 6.5% artifactually absent, 0.6% deemed absent due to acquired tooth loss and 0.03% deemed congenitally absent. All teeth were normal in morphology, except for three pairs of fused teeth, including two instances of fused maxillary first incisor teeth. Supernumerary teeth were associated with 97 normal teeth (most commonly maxillary canine teeth) in 68 specimens. At least one persistent deciduous tooth was present in six skulls, two of which were from adults. The majority (94.6%) of alveoli, either with or without teeth, were not associated with bony changes consistent with periodontitis; however, the majority (74.4%) of specimens did have at least one tooth associated with mild periodontitis. The mesial root of the mandibular third premolar tooth was the most common location at which periodontal hard tissue lesions were observed (56.6%). Ten sea otters had lesions consistent with focal enamel hypoplasia. Approximately half of the teeth (52.0%) were abraded; almost all adult specimens (98.1%) contained at least one abraded tooth, while fewer young adults were affected (76.4%). Tooth fractures were uncommon, affecting 1,343 teeth (4.5%). Periapical lesions were associated with 409 teeth (1.3%) in a total of 176 specimens, and these would likely have caused considerable morbidity while the animals were alive.

Concepts: Teeth, Tooth development, Incisor, Canine tooth, Maxillary lateral incisor, Premolar, Sea otter, Deciduous teeth


Comparing modern humans and Neanderthals, we have previously shown that recent modern humans (RMH) and Neanderthals differ in anterior root lengths, and that this difference cannot be explained by group differences in overall mandibular size. Here, we first document the evolutionary changes of root size and shape of the anterior upper and lower dentition in a broad chronological and geographical framework. We then use the size and shape differences between RMH and Neanderthals to classify several isolated teeth from Kebara cave and Steinheim, and to interpret the anterior tooth roots of the Tabun C2 mandible. Our samples comprise permanent mandibular and maxillary incisors and canines from early Homo, Neanderthals, as well as extant and fossil modern humans (N = 359). In addition to root length, we measured cervical root diameter and area, total root volume, root pulp volume and root surface area from μCT scans. We quantified root shape variation using geometric morphometrics. Our results show that Neanderthals have not only significantly larger anterior roots than RMH overall, but also different root shapes for each tooth type. In the context of the ‘teeth-as-tools’ hypothesis, this could be an adaptation to better sustain high or frequent loads on the front teeth. We demonstrate that the two isolated incisors stored with the Steinheim skull are very likely recent. Tabun C2 shows an anterior dentition similar in size and shape to Neanderthals while its molar roots are non-Neanderthal. Two of the five isolated teeth from Kebara are classified as Neanderthals. Interestingly, early modern humans overlap with Neanderthals and RMH in root size and shape. Anterior roots of the Lower and Middle Pleistocene specimens are at least as large as Neanderthals, suggesting that Neanderthals retained a primitive pattern, which should prompt caution in the assessment of the earliest forms of modern humans.

Concepts: Human, Primate, Teeth, Neanderthal, Human evolution, Canine tooth, Pleistocene, Archaic Homo sapiens


BACKGROUND: Tooth autotransplantation has developed into a safe and predictable procedure, which preserves the continuity of the dental arch and the alveolar process and provides an acceptable aesthetic and physiological outcome. AIM: To describe our experience with autotransplantation of the developing mandibular premolar to the iliac crest grafted alveolar cleft as part of the cleft patient’s treatment protocol. MATERIAL AND METHODS: Four cleft affected patients were referred to the Orthodontic and Craniofacial Department, Rambam Health Care Campus, Haifa, Israel due to loss of teeth in the cleft area. In all cases, orthodontic closure of the missing teeth space in the maxillary dental arch was considered inappropriate and therefore autotransplantation of the extracted mandibular premolar to the bone-grafted alveolar cleft site was conducted. RESULTS: None of the transplanted teeth in the reported cleft affected patients had signs or symptoms of progressive root pathology, gingival disease or advanced tooth mobility. Long-term clinical follow-up examination revealed improved facial aesthetics and occlusal relationships along with increased self-esteem and welfare of the patients' with no need for future dental restorative treatment. CONCLUSION: Autotransplantation of mandibular premolars should be considered an alternative to prosthodontics in cleft affected patients as an integral part of the cleft patient’s treatment protocol.

Concepts: Health care provider, Pelvis, Teeth, Oral hygiene, Canine tooth, Premolar, Mandibular second premolar, Maxillary first premolar


The first-line treatment of non-restorable traumatically injured or carious deciduous teeth is extraction which may be a curse for the future dentition as well as social activity of a child. Various therapeutic modalities from removable partial dentures to fixed space maintainer can be used for replacement of such lost teeth. Two types of fixed aesthetic space maintainers for replacing premature loss of maxillary deciduous incisors in 4-year-old children are discussed.

Concepts: Teeth, Tooth development, Maxillary central incisor, Canine tooth, Removable partial denture


OBJECTIVE: Determine the differences in skeletal and dental maxillary expansion as evidenced by the degree of dental tipping and if this is symmetrical or not. METHODS: Sixty-two patients who were diagnosed as requiring maxillary expansion treatment were recruited over an 18-month period. Patients were randomly allocated into three groups where a total of three to four cone-beam computerized tomographies (CBCT) were obtained throughout a one-year period depending on the group allocated. Landmarks used were from the first and second molars and premolars of the maxilla. For each of the eight teeth, three landmarks were identified: the root apex, alveolar bone and pulp chamber. Statistical analysis consisted in the use of MANOVA and after significant overall effects were detected, the univariate repeated measures results were analyzed along with separate ANOVA for each variable at each of the four time points. RESULTS: There was strong overall significance for time, group, and time*group. The first and second molars saw both bone- and tooth-anchored treatment groups with significantly different dental inclination than the control group. For the second premolars, only the tooth-anchored group was significantly different from control. The tooth-anchored group was also significantly different than the control group in the first premolar measurements. For the analysis of asymmetry in dental inclination, no significant time, group, or time*group effects were seen overall. CONCLUSION: The analysis provided evidence that dental tipping does occur in the molars for both RME treatments, while the premolars showed increased tipping in the tooth-anchored, but not the bone-anchored group.

Concepts: Scientific method, Symmetry, Teeth, Analysis of variance, Incisor, Canine tooth, Premolar, Maxillary first premolar


Abstract Objective. This study evaluated the influence of framework material and vertical misfit on stress created in an implant-supported partial prosthesis under load application. Materials and methods. The posterior part of a severely reabsorbed jaw with a fixed partial prosthesis above two osseointegrated titanium implants at the place of the second premolar and second molar was modeled using SolidWorks 2010 software. Finite element models were obtained by importing the solid model into an ANSYS Workbench 11 simulation. The models were divided into 15 groups according to their prosthetic framework material (type IV gold alloy, silver-palladium alloy, commercially pure titanium, cobalt-chromium alloy or zirconia) and vertical misfit level (10 µm, 50 µm and 100 µm). After settlement of the prosthesis with the closure of the misfit, simultaneous loads of 110 N vertical and 15 N horizontal were applied on the occlusal and lingual faces of each tooth, respectively. The data was evaluated using Maximum Principal Stress (framework, porcelain veneer and bone tissue) and a von Mises Stress (retention screw) provided by the software. Results. As a result, stiffer frameworks presented higher stress concentrations; however, these frameworks led to lower stresses in the porcelain veneer, the retention screw (faced to 10 µm and 50 µm of the misfit) and the peri-implant bone tissues. Conclusion. The increase in the vertical misfit resulted in stress values increasing in all of the prosthetic structures and peri-implant bone tissues. The framework material and vertical misfit level presented a relevant influence on the stresses for all of the structures evaluated.

Concepts: Bone, Finite element method, Materials science, Osseous tissue, Partial differential equation, Finite element method in structural mechanics, Canine tooth, Yield surface


- Primary tooth impaction is a rare phenomenon when compared to permanent teeth impaction. The purpose of this report is to present a 5-year-old Chinese girl who exhibited impaction of tooth 51, its unusual consequence on the permanent successor tooth and its comprehensive management. Her parents revealed that at 6 months of age, the patient had fallen from her bed and struck her face on the floor; however, there were no teeth present in the oral cavity. The intraoral examinations identified a bony-like projection on the buccal aspect of the alveolus in the 51 region. Radiographic examination revealed that tooth 51 exhibited an unfavourable orientation, with the crown directed towards the palate. Therefore, the impacted tooth 51 was surgically removed, and two years later tooth 11 erupted into the oral cavity with an indentation on its incisal aspect, which resembled the crown of the primary teeth, thus giving the appearance of a tooth within a tooth or ‘dens in dente’. Subsequently, enameloplasty and composite resin build-up was performed on tooth 11 for aesthetic reasons. It is very unusual to have the clinical crowns of both primary and permanent teeth in such close proximity within the alveolar bone, and the present case is a good example to emphasize that trauma to the primary teeth is of considerable importance due to the close proximity of the primary teeth to permanent tooth germs.

Concepts: Teeth, Incisor, Maxillary central incisor, Canine tooth, Maxillary lateral incisor, Deciduous teeth, Permanent teeth