The scoring of defects of the alveolar process in human crania

A probable case of hypophosphatasia in St Bride's Lower Churchyard (1770-1849, London, UK)

OBJECTIVES

The objective of this study was to analyse an individual whose remains are characterised by early deciduous tooth loss and multi-focal lesions on the post-cranial skeleton.

MATERIALS

Skeletal remains of an immature individual buried between 1770 and 1849 in London.

METHODS

The remains were examined by visual macroscopic inspection, supplemented by radiographic examination of the mandible and maxillae. A differential diagnosis with possible conditions, frequent in this archaeological context, was conducted. A comprehensive examination of dental lesions was performed to investigate the aetiologies of deciduous tooth loss.

RESULTS

The individual exhibited a mosaic of skeletal and dental pathological changes, including premature loss of deciduous dentition, premature eruption of permanent teeth generalised bone loss in both the mandible and maxilla; osteomyelitis of the left radius; osteolytic lesion on the body of the second lumbar vertebra, and marked expansions of the rib shafts due to sub-periosteal new bone formation.

CONCLUSION

A differential diagnosis considered indicates that the pathological changes of the individual were most likely associated with a comorbidity involving hypophosphatasia and tuberculosis.

SIGNIFICANCE

We present in this study several oral signs that could alert paleopathologists and bioarcheologists to systematically consider the potential of a condition that is rarely encountered in archaeological contexts.

LIMITATIONS

Due to poor preservation, this study was confined to the analysis of a partial maxilla and mandible, a left radius shaft and the axial skeleton (rib heads and vertebrae) of the individual.

SUGGESTIONS FOR FURTHER RESEARCH

Further radiographic, histological and genetic analyses would confirm the diagnosis.

A study of the periodontal state of a late Medieval United Kingdom population

OBJECTIVE

To study the severity of bone loss in a Medieval UK population, and compare this with other ancient UK populations from different time periods.

DESIGN

Skulls from a burial site in York (XI-XV century) were investigated. Skulls with a minimum of 17 teeth were included and were divided from childhood into five age groups. Direct measurements from the cement enamel junction (CEJ) to the alveolar crest (AC) were undertaken at six points around each tooth with a UNC 15 probe. The mean bone loss was calculated for each tooth type.

RESULTS

Seventy five skulls were included in the study (12-60 years of age). Bone loss was found to increase with age, but stabilized in older individuals (>45 years). The mean CEJ-AC distance varied from 2.1mm in the youngest group to a maximum of 4.1mm in 36-45 year olds. Results were compared with a Roman-British population (Whittaker et al., 1982) where comparable values for mean bone loss were 2.2mm and 5.4mm respectively, and a population of XVIII century Londoners (Whittaker et al., 1998) where bone loss of 1.1mm and 4.0mm was reported for the youngest and oldest age groups respectively.

CONCLUSION

Measuring the CEJ-AC distance in dried skulls from ancient populations may be used as a proxy for the levels of periodontal disease irrespective of tooth wear. The findings from the current study suggest that the severity of periodontitis as determined by measurements of alveolar bone loss on dried skulls from this ancient population, seems to have declined in the United Kingdom from the III-V century to XVIII century. This may be due to changes in environmental factors including living conditions and diet, together with individual characteristics including systemic illness and genetic make up.

Successful dental implant placement surgeries with buccal bone fenestrations

This is the first comprehensive review of the classification, preventative measures, diagnosis, treatment methods, and determination of success criteria of buccal bone plate fenestrations (BPFs) secondary to posterior implant surgeries. The purpose of this review is to present and discuss the current literature from peer-reviewed journals, recent studies, and international implantology guidelines and to provide practitioners with guiding points to identify and understand whether BPFs are complications or accidents of implant surgeries. In addition, this review sets forth a detailed set of criteria for the evaluation and diagnosis of BPFs and for the subsequent classification of BPFs as either complications or accidents of posterior implant surgeries. From the literature analyzed, it is clear that BPFs are disqualified from the class of implant treatment failures because BPFs neither impair nor significantly delay treatment. A comprehensive outline of preventative measures and surgery aids to avoid fenestrating the buccal bone plate during implant placement, and a variety of repair methods are included in this review. Considerations of treatment outcomes and patient sensitivities are also included in this comprehensive review.

Calculus deposits and bone loss on the teeth of Romano-British and eighteenth-century Londoners

The relation between dental calculus and periodontal disease is not clear but it is generally recognized that calculus is a significant pathogenetic factor. Skeletal material has previously been used to study some aspects of chronic adult periodontitis but few studies have quantified the extent of calculus in ancient populations and its relation to changes in alveolar bone height. This study records the presence and extent of calculus and its relation to alveolar bone loss in a Romano-British and eighteenth-century London population. There were significant differences in calculus deposition in the two populations but this appeared to have little effect on changes in alveolar bone contour. It is suggested that the amount of calculus may be related to diet but that changes in alveolar bone height seem to be independently controlled.

The effect of geochemical factors on prevalences of dental diseases for prehistoric inhabitants of the state of Missouri

In previous epidemiological studies, it has been suggested that geochemical factors besides fluoride may affect the prevalences of dental diseases. Our objective in this study was to determine whether the prevalences of periodontal diseases, coronal caries, and root caries for prehistoric inhabitants vary between geochemical regions of the state of Missouri. Burial sites were located on unique maps that depict geochemical variation among regions of the state. Data on dental caries and alveolar bone loss were gathered from 179 of the best preserved skeletal remains of the Late Woodland (A.D. 400-900) and Mississippian (A.D. 900-1700) periods. Mean caries scores and proportions of individuals with caries were calculated for these geochemical regions. Average alveolar bone loss was regressed on age for the individuals of these regions. Significant differences in caries and bone loss were found between several regions. These differences cannot be adequately explained by fluoride concentrations or by diet. It is suggested that geochemical factors, in addition to fluoride, may have affected the prevalences of dental diseases.

Tooth attrition and continuing eruption in a Romano-British population

Cement-enamel junction to alveolar crest (CEJ-AC) distances were measured in Romano-British skulls. Measurements were also made of attrition patterns. The patterns of the two measurements were similar in each group, suggesting that teeth continued to erupt and CEJ-AC alone is misleading as a measurement of bone loss and may not relate to the extent of chronic inflammatory periodontal disease. Estimated bone loss was minimal, confirming that measurements of this nature on dried skulls should only be related to periodontal conditions with caution.