Jae Joon Hwang

Paleopathological Study of Dwarfism-Related Skeletal Dysplasia in a Late Joseon Dynasty (South Korean) Population

Skeletal dysplasias related to genetic etiologies have rarely been reported for past populations. This report presents the skeletal characteristics of an individual with dwarfism-related skeletal dysplasia from South Korea. To assess abnormal deformities, morphological features, metric data, and computed tomography scans are analyzed. Differential diagnoses include achondroplasia or hypochondroplasia, chondrodysplasia, multiple epiphyseal dysplasia, thalassemia-related hemolytic anemia, and lysosomal storage disease. The diffused deformities in the upper-limb bones and several coarsened features of the craniofacial bones indicate the most likely diagnosis to have been a certain type of lysosomal storage disease. The skeletal remains of EP-III-4-No.107 from the Eunpyeong site, although incomplete and fragmented, provide important clues to the paleopathological diagnosis of skeletal dysplasias.

Regulation of root patterns in mammalian teeth

Mammalian teeth have diverse pattern of the crown and root. The patterning mechanism of the root position and number is relatively unknown compared to that of the crown. The root number does not always match to the cusp number, which has prevented the complete understanding of root patterning. In the present study, to elucidate the mechanism of root pattern formation, we examined (1) the pattern of cervical tongues, which are tongue-like epithelial processes extending from cervical loops, (2) factors influencing the cervical tongue pattern and (3) the relationship among patterns of cusp, cervical tongue and root in multi-rooted teeth. We found a simple mechanism of cervical tongue formation in which the lateral growth of dental mesenchyme in the cuspal region pushes the cervical loop outward, and the cervical tongue appears in the intercuspal region subsequently. In contrast, when lateral growth was physically inhibited, cervical tongue formation was suppressed. Furthermore, by building simple formulas to predict the maximum number of cervical tongues and roots based on the cusp pattern, we demonstrated a positive relationship among cusp, cervical tongue and root numbers. These results suggest that the cusp pattern and the lateral growth of cusps are important in the regulation of the root pattern.

Factors Influencing Superimposition Error of 3D Cephalometric Landmarks by Plane Orientation Method Using 4 Reference Points: 4 Point Superimposition Error Regression Model

Superimposition has been used as a method to evaluate the changes of orthodontic or orthopedic treatment in the dental field. With the introduction of cone beam CT (CBCT), evaluating 3 dimensional changes after treatment became possible by superimposition. 4 point plane orientation is one of the simplest ways to achieve superimposition of 3 dimensional images. To find factors influencing superimposition error of cephalometric landmarks by 4 point plane orientation method and to evaluate the reproducibility of cephalometric landmarks for analyzing superimposition error, 20 patients were analyzed who had normal skeletal and occlusal relationship and took CBCT for diagnosis of temporomandibular disorder. The nasion, sella turcica, basion and midpoint between the left and the right most posterior point of the lesser wing of sphenoidal bone were used to define a three-dimensional (3D) anatomical reference co-ordinate system. Another 15 reference cephalometric points were also determined three times in the same image. Reorientation error of each landmark could be explained substantially (23%) by linear regression model, which consists of 3 factors describing position of each landmark towards reference axes and locating error. 4 point plane orientation system may produce an amount of reorientation error that may vary according to the perpendicular distance between the landmark and the x-axis; the reorientation error also increases as the locating error and shift of reference axes viewed from each landmark increases. Therefore, in order to reduce the reorientation error, accuracy of all landmarks including the reference points is important. Construction of the regression model using reference points of greater precision is required for the clinical application of this model.

Eruption of posterior teeth in the maxilla and mandible for age determination of water deer.

OBJECTIVE Eruption of posterior teeth, including premolars and molars in the mandible rather than in the maxilla, is accepted as an accurate reference for age determination of deer. In water deer, Hydropotes inermis, the eruption age of mandibular molars has been described in two studies, but the ages were inconsistent with each other. In this study, we aimed to confirm the eruption age of mandibular posterior teeth for the accurate age determination of water deer and to evaluate the efficacy of maxillary posterior teeth for the age determination of deer. DESIGN The eruption of mandibular and maxillary posterior teeth was investigated in the dry skulls of individual wild water deer of both sexes, up to an age of about 15 months. RESULTS The eruption age of mandibular molars in water deer was consistent with that of a previous study. The eruption age of posterior teeth was almost the same in the maxilla and mandible of individual water deer. The deciduous mandibular fourth premolar and the permanent maxillary fourth premolar were two easiest teeth to be identified for the age determination. CONCLUSIONS The former controversial eruption age of mandibular posterior teeth in water deer was confirmed. Our study first presented the eruption age of maxillary posterior teeth in water deer. It is suggested that posterior teeth not only in the mandible but also in the maxilla are useful indicators for the age determination of water deer.

The anomalous canal between two accessory foramina on the mandibular ramus: the temporal crest canal

OBJECTIVES The temporal crest canal (TCC) is a variation of the bony canal with two accessory foramina that correspond to an entrance and an exit on the mandibular ramus. This study investigated the anatomical characteristics of the TCC using CBCT. METHODS The study population consisted 446 patients who had undergone CBCT. Sagittal, cross-sectional and three-dimensional images were evaluated for the presence of a TCC. The canals were classified into two types according to the configuration, and the location of the posterior accessory foramen of the TCC was also recorded. RESULTS 6 TCCs were present in 4 of 446 patients (0.90% of the total population). All of the TCCs were observed in males, and all of the posterior foramina were located superior to the mandibular foramina on the medial aspect of the mandibular ramus. There were five noticeably curved and increasingly narrow canals (Type 1) and one slightly curved and uniformly wide canal (Type 2). CONCLUSIONS Precise knowledge of the TCC is clinically important for suitable local anaesthetic nerve block and the planning of surgical procedures that involve the mandibular ramus. Three-dimensional images of CBCT data are particularly effective for confirming the presence of this variation.

Analysis of the root position of the maxillary incisors in the alveolar bone using cone-beam computed tomography

Purpose The purpose of this study was to measure the buccal bone thickness and angulation of the maxillary incisors and to analyze the correlation between these parameters and the root position in the alveolar bone using cone-beam computed tomography (CBCT). Materials and Methods CBCT images of 398 maxillary central and lateral incisors from 199 patients were retrospectively reviewed. The root position in the alveolar bone was classified as buccal, middle, or palatal, and the buccal type was further classified into subtypes I, II, and III. In addition, the buccolingual inclination of the tooth and buccal bone thickness were evaluated. Results A majority of the maxillary incisors were positioned more buccally within the alveolar bone, and only 2 lateral incisors (0.5%) were positioned more palatally. The angulation of buccal subtype III was the greatest and that of the middle type was the lowest. Most of the maxillary incisors exhibited a thin facial bone wall, and the lateral incisors had a significantly thinner buccal bone than the central incisors. The buccal bone of buccal subtypes II and III was significantly thinner than that of buccal subtype I. Conclusion A majority of the maxillary incisor roots were positioned close to the buccal cortical plate and had a thin buccal bone wall. Significant relationships were observed between the root position in the alveolar bone, the angulation of the tooth in the alveolar bone, and buccal bone thickness. CBCT analyses of the buccal bone and sagittal root position are recommended for the selection of the appropriate treatment approach.

Morphological analysis of the lower second premolar for age estimation of Korean adults

OBJECTIVES This study aimed to examine the applicability of the pulp/tooth area ratio in the lower premolar teeth using panoramic radiography in age estimation of Korean adults. METHODS 402 digital panoramic images of Korean adults between 20 and 78 years were analyzed. Following Cameriere et al.s method, two observers measured the pulp and tooth areas of the lower second premolar on digital panoramic images, and the ratio of pulp to tooth area in the whole tooth (PTR) was calculated. In addition, the whole tooth was divided into coronal and root parts at the cementoenamel junction, and the ratios in the coronal part (PcCR) and root part (PrRR) were also calculated separately. Independent t-test, Analysis of covariance, linear regression, and the standard error of the estimate (SEE) were computed using statistical software. To justify the use of linear regression models for purposes of prediction, diagnostic tests of principal assumptions were also performed. RESULTS Independent t-test revealed significant differences in genders. PrRR produced the best age correlation (male, SEE=10.8; female, SEE=9.8; total, SEE=10.4 years), followed closely by PTR (male, SEE=11.1; female, SEE=10.3; total, SEE=10.7 years) and a relatively lower accuracy for PcCR (male, SEE=14.7; female, SEE=14.4; total, SEE=14.6 years). Model assumptions and accuracy for purposes of prediction in PTR and PrRR were satisfied. CONCLUSIONS The pulp/tooth area ratio using panoramic radiography has the potential as an effective tool for age estimation in the Korean adult population, and the pulp/tooth area ratio in the root part is more accurate than that of the whole tooth. Notably, female has shown higher accuracy compare to male subject.

Strut analysis for osteoporosis detection model using dental panoramic radiography

OBJECTIVES The aim of this study was to identify variables that can be used for osteoporosis detection using strut analysis, fractal dimension (FD) and the gray level co-occurrence matrix (GLCM) using multiple regions of interest and to develop an osteoporosis detection model based on panoramic radiography. METHODS A total of 454 panoramic radiographs from oral examinations in our dental hospital from 2012 to 2015 were randomly selected, equally distributed among osteoporotic and non-osteoporotic patients (n = 227 in each group). The radiographs were classified by bone mineral density (T-score). After 3 marrow regions and the endosteal margin area were selected, strut features, FD and GLCM were analysed using a customized image processing program. Image upsampling was used to obtain the optimal binarization for calculating strut features and FD. The independent-samples t-test was used to assess statistical differences between the 2 groups. A decision tree and support vector machine were used to create and verify an osteoporosis detection model. RESULTS The endosteal margin area showed statistically significant differences in FD, GLCM and strut variables between the osteoporotic and non-osteoporotic patients, whereas the medullary portions showed few distinguishing features. The sensitivity, specificity, and accuracy of the strut variables in the endosteal margin area were 97.1%, 95.7 and 96.25 using the decision tree and 97.2%, 97.1 and 96.9% using support vector machine, and these were the best results obtained among the 3 methods. Strut variables with FD and/or GLCM did not increase the diagnostic accuracy. CONCLUSION The analysis of strut features in the endosteal margin area showed potential for the development of an osteoporosis detection model based on panoramic radiography.

Change in Image Quality According to the 3D Locations of a CBCT Phantom.

A patient’s position changes in every CBCT scan despite patient alignment protocols. However, there have been studies to determine image quality differences when an object is located at the center of the field of view (FOV). To evaluate changes in the image quality of the CBCT scan according to different object positions, the image quality indexes of the Alphard 3030 (Alphard Roentgen Ind., Ltd., Kyoto, Japan) and the Rayscan Symphony (RAY Ind., Ltd., Suwon, Korea) were measured using the Quart DVT_AP phantom at the center of the FOV and 6 peripheral positions under four types of exposure conditions. Anterior, posterior, right, left, upper, and lower positions 1 cm offset from the center of the FOV were used for the peripheral positions. We evaluated and compared the voxel size, homogeneity, contrast to noise ratio (CNR), and the 10% point of the modulation transfer function (MTF10%) of the center and periphery. Because the voxel size, which is determined by the Nyquist frequency, was within tolerance, other image quality indexes were not influenced by the voxel size. For the CNR, homogeneity, and MTF10%, there were peripheral positions which showed considerable differences with statistical significance. The average difference between the center and periphery was up to 31.27% (CNR), 70.49% (homogeneity), and 13.64% (MTF10%). Homogeneity was under tolerance at some of the peripheral locations. Because the CNR, homogeneity, and MTF10% were significantly affected by positional changes of the phantom, an object’s position can influence the interpretation of follow up CBCT images. Therefore, efforts to locate the object in the same position are important.

The impact of reorienting cone-beam computed tomographic images in varied head positions on the coordinates of anatomical landmarks

Purpose The aim of this study was to compare the coordinates of anatomical landmarks on cone-beam computed tomographic (CBCT) images in varied head positions before and after reorientation using image analysis software. Materials and Methods CBCT images were taken in a normal position and four varied head positions using a dry skull marked with 3 points where gutta percha was fixed. In each of the five radiographic images, reference points were set, 20 anatomical landmarks were identified, and each set of coordinates was calculated. Coordinates in the images from the normally positioned head were compared with those in the images obtained from varied head positions using statistical methods. Post-reorientation coordinates calculated using a three-dimensional image analysis program were also compared to the reference coordinates. Results In the original images, statistically significant differences were found between coordinates in the normal-position and varied-position images. However, post-reorientation, no statistically significant differences were found between coordinates in the normal-position and varied-position images. Conclusion The changes in head position impacted the coordinates of the anatomical landmarks in three-dimensional images. However, reorientation using image analysis software allowed accurate superimposition onto the reference positions.