Edward F. Harris

The A.B.F.O. Study of Third Molar Development and Its Use as an Estimator of Chronological Age

Radiographs depicting third molars (M3s) have been used to estimate chronological age in juvenile and adult suspects, but accuracy of the method has been in question. This study provides age benchmarks for American whites (age range: 14 to 24 years) based on cases (n = 823) drawn from diplomates of the American Board of Forensic Odontologists in the United States and Canada. Maxillary M3 formation was slightly advanced over mandibular M3s, and root formation occurred earlier in males than females. Mean and median ages for M3 formation are tabled using Demirjians eight-grade classification. Regression formulas and empirical probabilities are provided relative to the medicolegal question of whether an individual is at least 18 years of age. The M3 is the most variable tooth in the dentition, but situations arise where M3 formation is the only usable datum for age estimation.

A heritable component for external apical root resorption in patients treated orthodontically

External apical root resorption (EARR) is a common and occasionally critical problem in orthodontic patients. Mechanical forces compress the periodontium, leading to localized resorption of cementum that exposes dentin to destruction by clastic activity. Factors controlling occurrence and extent of EARR are poorly understood, but there may be a familial (genetic) factor in susceptibility. A sample of full siblings (103 pairs) was studied, all of whom were treated with the same technique by one orthodontist. Crown and root lengths were measured on cephalograms and panoral films before and after treatment. Six roots were scored on each patient, and decrease in root length was the dependent variable. Generalized linear models were used to quantify within and among sibship variances while controlling for sex, age, and severity of malocclusion (FMA, ANB, AOBO, overjet, NAP) as covariates. Results showed significantly greater among-than within-sibship variances, meaning there is a substantive genetic factor in susceptibility to EARR. Heritability estimates were fairly high, averaging 70% for three roots, although low for the mandibular incisor, probably because of little variation. No evidence was found for a sex or age difference in susceptibility. Quantification of a transmissible component suggests it would be useful to search for the biochemical factors controlling the familial differences in susceptibility.

Directions of orthodontic tooth movements associated with external apical root resorption of the maxillary central incisor

External apical root resorption is a multifactorial problem encountered in all disciplines of dentistry, but it is most commonly seen in cases treated orthodontically. Specific tooth movements that are most likely to exacerbate external apical root resorption are poorly understood. Purpose of the present investigation was twofold: (1) to quantify apical and incisal movements of the maxillary central incisor in the sagittal and vertical planes from cephalograms and (2) to use stepwise multivariate linear regression analyses to see which tooth movements and skeletodental relationships are most predictive of external apical root resorption. The sample consisted of 110 adolescents with similar pretreatment malocclusions (Class I crowded or bimaxillary protrusive) and treatment planned similarly (extraction of four first premolars) by experienced private practitioners. Each of three practitioners used a different orthodontic appliance; the sample was divided proportionately into cases treated with Tweed standard edgewise technique, Begg lightwire technique, and Roth-prescription straightwire technique. Lateral cephalograms were analyzed at the start, middle, and end of treatment. There was no statistical difference in average external apical root resorption between sexes or among techniques. Measures of tooth movement were highly predictive, explaining up to 90% of the variation in root resorption. Apical and incisal vertical movements and increase in incisor proclination were the strong predictors of external apical root resorption for each regression model. Incisor intrusion with increase in lingual root torque together were the strongest predictors of external apical root resorption. In contrast, distal bodily retraction, extrusion, or lingual crown tipping had no discernible effect.

Tooth Mineralization Standards for Blacks and Whites from the Middle Southern United States

Normative standards are provided for permanent tooth mineralization stages for blacks and whites of the middle southern United States. The data cover tooth development from 3.5 to 13 years of age. Females develop more rapidly than males, and blacks are nearly twice as sexually dimorphic (7.2%) as whites (3.7%). Within each sex, blacks achieve mineralization stages significantly earlier, by about 5%, than whites. This complements earlier findings that teeth erupt at appreciably earlier mean ages in blacks.

Heritability of craniometric and occlusal variables: A longitudinal sib analysis

There has long been interest in the inheritance of malocclusion, but few studies have distinguished between skeletal (craniometric) variables and occlusal, tooth-based variables (e.g., anterior irregularity, rotations, displacements). This study was based on serial assessments of untreated persons in 30 sibships from 4 years (full deciduous dentition) to 20 years of age (full permanent dentition) in the Bolton-Brush Growth Studies of Ohio. Results define a clear dichotomy: craniometric variables (k = 29) typically show significant additive components of variance; correlations increase from age 4 to age 20; and correlations average 0.43 at adulthood. Tooth-based variables of position and relationship (k = 21) reach significance only occasionally; correlations decrease with age to the extent that few variables for subjects at age 20 have a correlation significantly different from zero. In contrast to craniometric variables, which have high heritabilities, almost all of the occlusal variability is acquired rather than inherited.

Patterns of incisor root resorption before and after orthodontic correction in cases with anterior open bites

External root resorption is a frequent iatrogenic consequence of orthodontic treatment, particularly in the maxillary anterior teeth. Since resorption also occurs is a normal function of aging and since altered behaviors such as bruxism and chronic nailbiting accelerate resorption even in the absence of treatment, it was hypothesized that the long-term orthopedic forces of tongue thrusting leading to anterior open bites would also enhance the rates of clastic activity. In a series of 32 adolescents with open bites, the roots of permanent maxillary central incisors were significantly shorter and exhibited higher modal grades of periapical resorption than a matched series with deep bites before treatment. The open bite group also had less facial bony support for these teeth. Both series experienced discernible resorption during full-banded treatment but to comparable extents so that, after active treatment, the open bite series continued to possess significantly greater degrees of resorption. Consequently, the oral forces leading to apertognathia are themselves destructive of root integrity and merit early recognition and interception.

Loss of root length and creastal bone height before and during treatment in adolescent and adult orthodontic patients

It is broadly documented that orthodontic tooth movement enhances the risk of apical root resorption and loss of alveolar crestal bone height, but virtually all studies have focused on the conventional adolescent patient. In this study, samples from adolescent and adult patients were matched for sex, malocclusion, and treatment regimen. In-treatment changes in root length were the same for both groups, whereas loss of crestal bone height was somewhat greater in adults. Major differences, however, were found at the start of treatment: Adults (mean = 28 years) had significantly shorter roots and greater alveolar recession than the young teenagers (mean = 12 years). Consequently, treatment per se does not place adults at greater risk; it is the involvement extant at the start of mechanotherapy that merits careful evaluation.

An example of regional variation in the tempos of tooth mineralization and hand-wrist ossification.

Two groups of adolescent orthodontic patients, one from the Midwest and one from the Midsouth, were compared to test the clinical impression that the permanent teeth of southern children form and erupt at significantly later ages. Indeed, a marked difference is documented, with the Midsouth series achieving mineralization stages at least 1 1/2 years later on average. This suggests that regional differences are appreciably greater than previously suspected. Clinical consequences revolve on the use of conventional (generally Northeast-based) norms for tooth formation and eruption and predictive models of facial growth. In contrast, the analysis of rates of hand-wrist development (bone age) of these same subjects disclosed no difference; this further confirms the essential independence of development of the dental and osseous tissue systems.

Maxillary arch size and shape in American blacks and whites.

American blacks have larger teeth than whites, but they less frequently exhibit crowding--apparently because of larger arch dimensions. This study quantified differences in arch size and shape in these 2 constituents of the US population. Eighteen dental and bony landmarks were digitized from the maxilla of each of 332 subjects with permanent, intact dentitions, proportionately divided between blacks and whites, men and women. Linear, angular, and area measurements were computer-generated. Arch widths averaged 10% greater in blacks than whites, and mesiodistal arch depths had a greater difference, at 12%. Blacks, with a more square palate and significantly larger palatal index, were distinguished from whites primarily by greater intercanine and interpremolar widths. Arch perimeter was greater in blacks by 8%, and cross-sectional area of the arch was 19% greater in blacks than whites, so blacks and whites differ substantially for these parameters not only in size, but in shape as well. These differences are relevant in prosthodontics and orthodontics since individualization of treatment leads to more effective treatment by working within the patients natural arch form instead of making patients fit a single standard.

Genetic influence on dental arch form in orthodontic patients

Human arch form varies considerably. This study analyzed the size and shape of the maxillary and mandibular dental arches of 320 adolescents from 155 sibships. A broad battery of measurements (k = 48) was computer-generated from Cartesian coordinates of cusp tips and line angles of the permanent teeth, and heritability estimates were generated from intraclass correlations, controlling for sex and age where indicated. Arch size has a modest genetic component, on the order of 50%, although this estimate may contain shared environmental influences. Tooth rotations have low h2 estimates, most of them indistinguishable from zero. Arch shape, assessed as length-width ratios, also has a modest transmissible component, suggesting that arch length and width growth factors are largely independent. Highest heritability estimates, as a group, were for transverse arch widths, which averaged about 60%. Several measures of left-right asymmetry also were analyzed (k = 31), and, while the arches are systematically asymmetric (generally with left > right), there is only weak evidence of a transmissible component for directional asymmetry and essentially none for fluctuating asymmetry. In all, arch size and shape are seen to be more subject to environmental influences than to heredity. These findings direct attention toward the need to better understand what extrinsic factors modulate arch size and shape during development.