Finite element analysis of equine incisor teeth. Part 2: Investigation of stresses and strain energy densities in the periodontal ligament and surrounding bone during tooth movement

Three-Dimensional Segmentation Assisted with Clustering Analysis for Surface and Volume Measurements of Equine Incisor in Multidetector Computed Tomography Data Sets

Dental diagnostic imaging has progressed towards the use of advanced technologies such as 3D image processing. Since multidetector computed tomography (CT) is widely available in equine clinics, CT-based anatomical 3D models, segmentations, and measurements have become clinically applicable. This study aimed to use a 3D segmentation of CT images and volumetric measurements to investigate differences in the surface area and volume of equine incisors. The 3D Slicer was used to segment single incisors of 50 horses' heads and to extract volumetric features. Axial vertical symmetry, but not horizontal, of the incisors was evidenced. The surface area and volume differed significantly between temporary and permanent incisors, allowing for easy eruption-related clustering of the CT-based 3D images with an accuracy of >0.75. The volumetric features differed partially between center, intermediate, and corner incisors, allowing for moderate location-related clustering with an accuracy of >0.69. The volumetric features of mandibular incisors' equine odontoclastic tooth resorption and hypercementosis (EOTRH) degrees were more than those for maxillary incisors; thus, the accuracy of EOTRH degree-related clustering was >0.72 for the mandibula and >0.33 for the maxilla. The CT-based 3D images of equine incisors can be successfully segmented using the routinely achieved multidetector CT data sets and the proposed data-processing approaches.

Temporomandibular joint biomechanics and equine incisor occlusal plane maintenance

In equine dentistry, the physiological incisor occlusal surface is visually perceived as a plane with a distinct inclination to the head's coronal plane, extending rostro-ventrally to caudo-dorsally. To better understand the formation of this inclined plane and its connection to dental wear, we investigated the hypothesis that it arises from masticatory movements and the considerable distance between mandibular articular heads and the incisor occlusal surfaces, acting as the three points of support for the mandibles. Leveraging data from a large-scale clinical study involving static and dynamic orthodontic measurements in horses, we approximated the mandibular movement range where incisor occlusion and dental wear occur. By introducing and testing a segment coordinate system, we explored possible angular deviations from the occlusal plane caused by mandibular roll and pitch rotations during two lateral mandibular movement patterns, protrusion and retrusion. Theoretical biomechanical calculations and simulations confirmed the visual perception of the incisor occlusal surface as a plane. To further examine our assumptions, we employed a simple mechanical simulator to assess incisor normal occlusion and provoked malocclusions (diagonal, smile, and frown bite) by modifying temporomandibular joint (TMJ) movement patterns. The results from clinical investigations were corroborated by both the theoretical analysis and mechanical simulations, strengthening our understanding of the biomechanical basis behind the physiological incisor occlusal plane maintenance in horses. These findings have significant implications for equine dental health and contribute to a thorough understanding of TMJ dynamics.

Equine odontoclastic tooth resorption and hypercementosis (EOTRH): microspatial distribution of trace elements in hypercementosis-affected and unaffected hard dental tissues

Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) is a common, painful and poorly understood disease. Enamel, dentin and cementum accumulate both essential and toxic trace elements during mineralization. Characterization of the spatial accumulation pattern of trace elements may provide insight into the role that toxic elements play and inform biological processes affecting these hard dental tissues for future research. Laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) was used to map the distribution of multiple trace elements and heavy metals across equine healthy and diseased (hypercementosis-affected) hard dental tissues among four teeth extracted from horses with EOTRH. Results showed banding patterns of some trace elements (lead, strontium, barium), reflecting the temporal component of accumulation of trace elements during dentin mineralization. Essential elements zinc and magnesium did not show banding patterns. Comparison to the unaffected cementum and dentin adjacent to the hypercementosis region showed that there is an underlying incremental pattern in the uptake of some metals with spatial irregularities. This supports a possible metabolic change involved in hypercementosis lesion development. This represents the first use of LA-ICP-MS to study the microspatial distribution of trace elements in equine teeth, establishing a baseline for elemental distribution in normal and EOTRH impacted dental hard tissue.

Early incisor lesions and Equine Odontoclastic Tooth Resorption and Hypercementosis: Reliability of radiographic findings

BACKGROUND

In clinical practice, early diagnosis of Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) and other resorptive incisor diseases is difficult to achieve. The radiographic appearance of subtle pathological changes has not been described in detail and might be confused with age-related changes.

OBJECTIVES

The study was performed to define typical radiographic signs of early incisor lesions and to evaluate the reliability of the radiographic findings.

STUDY DESIGN

Descriptive and comparative study using post mortem clinical, radiographic, macroscopic and µCT examination.

METHODS

The incisor region of 20 cadaveric horse heads, divided into three different age groups, was examined visually and by palpation. Intraoral radiographs were taken. After extraction, each incisor was macroscopically evaluated. Micro-computed tomography (µCT) scans were obtained. These scans were processed with Scry (v6.0, Kuchel & Sautter GbR) to obtain surface meshes which then were transferred to Meshlab (ISTI-CNR, version 2016.12). Attached tissues were virtually removed and surface curvature was computed to visualise and evaluate the quantity of unevenness (roughness) of the teeth's surface. Scoring systems for each diagnostic modality were developed. Scores were compared to describe and evaluate the radiographic appearance of early incisor lesions.

RESULTS

The prevalence and severity of incisor lesions increased with age. Early, subtle lesions develop on the palatal/lingual side of incisors. While radiographically detected lesions were confirmed macroscopically and on the µCT scans, numerous teeth which were radiographically classified as healthy displayed lesions by macroscopic inspection (13.7%) and µCT analysis (58.1%).

MAIN LIMITATIONS

Cadavers were studied and dental history was unknown.

CONCLUSIONS

The detection of early and subtle incisor lesions indicating first signs of EOTRH on dorsoventral intraoral radiographs is limited due to the typical localisation of the lesions on the palatal/lingual side of the incisors.

Equine Odontoclastic Tooth Resorption and Hypercementosis

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a recently described painful and progressive condition of unknown etiology that occurs in middle-aged and geriatric equines. It predominantly affects the permanent incisor and canine teeth and, less commonly, the premolar and molar dentition. EOTRH was first reported in peer-reviewed literature in 2008, with subsequent publications of case reports, histological studies and retrospective case series. There have been few significant research developments related to this disease. The existing studies have primarily involved single case studies or small sample sizes, without control groups. This review aimed to report current information about EOTRH in terms of clinical, histopathological, diagnostic, radiological, and therapeutic aspects, by searching the available peer-reviewed scientific literature.

Intra- and Interexaminer Measurement Variability Analysis of an Orthodontic Gauge Device to Determine Incisor Occlusal Surface Angles in the Horse

Simple Summary

Annual tooth rasping is integral to prophylaxis work in equine dentistry. The procedure begins with a thorough examination of the oral cavity, including assessment of incisor occlusal surface angles. Any dental misalignment should be corrected or reduced to prevent abnormal forces from acting on teeth and supporting tissues and to maximize functionality of the masticatory apparatus. Thus far, clinical methods for dental angle assessment are scarce and not validated in terms of data reproducibility and comparability. These parameters are vital to objectively assess treatment needs and outcome, obtain population data, and establish data comparability among studies. However, this is the first study systematically validating a commercial dental angle measuring device. The data indicate high device performance and its applicability in practice.

Abstract

Incisor malocclusions are common in horses. As yet, an evidence-based understanding of incisor occlusal surface angle dynamics and normocclusal range is missing. Orthodontic measuring devices could help unravel this information objectively but imply measurement validation. We evaluated intra- and interexaminer variability of repeated sagittal and transversal incisor occlusal surface angle measures using a commercial orthodontic gauge device (MaPHorse1). Five examiners (two experienced, three inexperienced) measured six cadaver heads on 2 consecutive days in a blinded block-randomization design, resulting in 16 measures per examiner*head. Sagittal and transversal angle measures revealed low intraexaminer variability at scale-level independent mean SDs of α 0.58° and α 0.69°, respectively. Sagittal angle measures associate with low interexaminer variability, showing small mean angle differences (max. α 0.51° ± 0.35°), small scatter, and more consistent data reproducibility. Despite comparable mean interexaminer differences, the spread of transversal angle measures was relevantly higher using the proposed landmarks (average 2.2-fold higher interquartile range). The measurement performance of experienced and inexperienced examiners did not systematically differ. The time required for individual measurements was already comparable after 24/96 repetitions. This instrument may help deciphering sagittal angle normocclusal range and orthognathic dynamics and, with a proposed procedural amendment, transversal angle as well.

Equine Incisor Lesions: Histologic Confirmation of Radiographic, Macroscopic, and Micro-Computed Tomographic Findings

Simple Summary

Incisor diseases are a common problem in equine medicine. However, Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) and other lesions are often only diagnosed in advanced stages. In this study, the incisors of 20 horses were examined. The findings of X-rays, macroscopical inspection, and micro-computed tomography (µCT) were compared. Five categories from healthy to severely affected teeth were formed and selected teeth from each category were additionally examined by means of histology. Odontoclastic resorption of dental hard substances, infiltration of inflammatory cells, areas of irregular dental cementum, and formation of granulation tissue were observed. Resorptive lesions previously detected by µCT were confirmed by microscopical imaging, however, not all resorptive lesions were regarded as a pathological condition like EOTRH. Detailed microscopical inspection revealed the presence of so-called surface resorptions which represent repaired resorptive lesions without any pathological consequence for the horse. Nevertheless, some incisors which appeared healthy on the X-rays featured histological findings related to EOTRH. Therefore, the detection of early incisor lesions in equine medicine remains challenging.

Abstract

Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) and other incisor lesions are often diagnosed only in advanced stages. The incisors of 20 horses were examined radiographically, macroscopically, and via micro-computed tomography (µCT) to discriminate EORTH-affected teeth. Five categories from healthy to severely affected teeth were formed and teeth from each category were examined histologically to evaluate the opportunity of earlier radiographic diagnosis. Histologically, odontoclastic resorptive lesions, leukocytic infiltrations, and areas of irregular cementum and granulation tissue were observed. The extent and severity of histological findings were correlated to the µCT data. Micro-CT imaging was suitable to detect subtle irregularities in the dental substances which were referred to as resorptive lesions. Although histological examinations confirmed the presence of resorptive lesions, not all of them were classified as pathological conditions. Instead, repaired surface lesions were documented which were regarded as a physiological condition. Nevertheless, incisors which were radiographically regarded as healthy can also feature histological signs of EOTRH. Therefore, due to the possibility of misinterpreting radiographic findings combined with superimpositions on intraoral radiographs, the detection of early resorptive lesions remains challenging.

Equine odontoclastic tooth resorption and hypercementosis: investigating individual incisor disease patterns using radiological classification

BACKGROUND

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a destructive, painful, and underdiagnosed dental disorder. Radiography is necessary to fully assess the disease as early stages occur on clinically normal teeth.

OBJECTIVES

To investigate the distribution pattern of appearance of EOTRH within the incisor arcade. In particular, we aimed to determine the influence of tooth position and age on the severity and its frequency of the individual tooth.

STUDY DESIGN

Retrospective cross-sectional radiographic case study.

METHODS

Digital radiographs of 142 horses (10 years and older) presented for routine dental examination at our Equine Hospital were obtained and evaluated for changes related to EORTH. Radiological findings were classified in terms of EOTRH severity and each tooth was evaluated individually (tooth stage).

RESULTS

The tooth stages of EOTRH showed a bilateral symmetrical distribution pattern over the entire incisor arcade. There was a significant positive correlation between age and tooth stages (P<0.001, rho=0.48, 95% CI 0.43-0.51), and the frequency of higher tooth stages increased from central incisors to middle and corner incisors.

MAIN LIMITATIONS

Individual head anatomy in some male horses lead to superimposition of the lower jaw corner incisors and canine teeth. The radiographic technique proved difficult in smaller and uncooperative horses. Differentiating between mild pathological signs of EOTRH and age-related radiological changes was not possible in all cases.

CONCLUSION

These results reconfirm an age correlated progression of EOTRH. EOTRH affects the incisor arcade in a bilaterally symmetrical pattern with the corner incisors being the most severely affected.

Update on Equine Odontoclastic Tooth Resorption and Hypercementosis

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a progressive, painful disease, affecting incisors, canines, and cheek teeth. Examination findings include gingival inflammation, gingival recession and/or hyperplasia, subgingival swelling, bulbous enlargement of teeth, associated periodontal disease, pathologic tooth fracture, and/or tooth mobility and loss. Current hypotheses include biomechanical stresses and secondary bacterial involvement. Early recognition allows case management, but it is a progressive disease. Owner education is crucial; horses with complete or multiple extractions have a favorable prognosis. Human oral and dental health may be affected by bisphosophonate use; long-term effects of these drugs are currently unknown in horses.

Computed Tomography (CT)-Assisted 3D Cephalometry in Horses: Interincisal Angulation of Clinical Crowns

The angle encompassed between opposing incisors in horses is assumed to decline with age. Previous studies merely consider the overall profile view of clinical crowns presuming a generalized angle, neglecting potential tooth position-dependent differences. Cephalometric measurements from 3D computed tomographic thick-slab reconstructions of single incisors within a global reference frame were used to determine clinical crown interincisal angulation (IIA) of 48 horses. Based on predefined dentoalveolar landmarks, IIA was defined as the angle enclosed by the respective labial axis of the clinical crown (LACC). A measurement repeatability analysis was conducted including a comparison of third incisor teeth IIA with data obtained by cephalometric implementation of previously described landmarks for third incisor teeth (lingual/palatal border). The age-related angle course and differences between tooth positions were investigated considering LACCs of permanent incisors. Determining IIA by LACCs exhibited a high level of reproducibility applying for all tooth positions (mean coefficient of variation = 0.65 %; mean SD ± 0.89°). The comparison method for third incisor teeth revealed two times higher mean dispersion of repeated measurements, P = 0.017. A non-linear model slightly increased predictability of angular changes over time as against linearity assumption. The angle decline was more distinctive in younger horses and appears to approach a final value in older ones. Third incisor teeth exhibited significantly higher angle decline compared to first and second incisor teeth, P < 0.0001. According to the results, age determination of horses using clinical crown IIA is not recommended. Rather, 3D cephalometry may provide a promising tool to determine interdental and dentofacial angles of distinct tooth positions in health and disease.

Molecular Characteristics of the Equine Periodontal Ligament

The equine periodontal ligament (PDL) is a fibrous connective tissue that covers the intra-alveolar parts of the tooth and anchors it to the alveolar bone-it, therefore, provides a similar function to a tendinous structure. While several studies have considered the formation and structure of tendons, there is insufficient information particularly on the molecular composition of the PDL. Especially for the equine PDL, there is limited knowledge concerning the expression of genes commonly regarded as typical for tendon tissue. In this study, the gene expression of, e.g., collagen type 1 alpha 1 (COL1), collagen type 3 alpha 1 (COL3), scleraxis (SCX), and fibrocartilage markers was examined in the functional mature equine PDL compared with immature and mature equine tendon tissue. PDL samples were obtained from incisor, premolar, and molar teeth from seven adult horses. Additionally, tendon samples were collected from four adult horses and five foals at different sampling locations. Analyses of gene expression were performed using real-time quantitative polymerase chain reaction (qRT-PCR). Significantly higher expression levels of COL1 and 3 were found in the mature equine PDL in comparison with mature tendon, indicating higher rates of collagen production and turnover in the mature equine PDL. The expression levels of SCX, a specific marker for tenogenic-differentiated cells, were on a similar level in functional mature PDL and in mature tendon tissue. Evidence of chondrogenic metaplasia, often found in tendon entheses or in pressurized regions of tendons, was not found in the mature equine PDL. The obtained results justify further experiments focused on the possible use of equine PDL cells for cell-based regenerative therapies.

Occlusal Angles of Equine Incisors

The angulation of equine incisors is frequently used as a parameter for dental corrections. However, the term incisor angle is only vaguely defined, and no studies exist presenting a series of reliable measurements in individual incisors of multiple horses. The aim of this study was to establish an exact method to determine incisor angles and to test whether clinically accessible landmarks (facial crest and bars) are suitable to estimate incisor angles. Eighteen horses were used to create 3-dimensional (3D) reconstructions of the skulls from computed tomography (CT) data sets. Reference planes (median and transverse plane) were calculated using defined anatomical landmarks. Subsequently, occlusal planes for incisors and for incisor quadrants were calculated. Occlusal table angles were measured in relation to the reference planes. For each incisor, sagittal and transverse angles were measured. Mean values of individual incisor angles ranged from 3.5° to 6.8° (transverse angle) and from 32.6° to 44.9° (sagittal angle). No significant differences were detected in mean between the left and the right side when teeth in same Triadan positions were compared. However, in individual horses, marked differences between the left and the right side of the jaws occurred. Mandibular incisors showed significantly steeper sagittal angles than maxillary incisors. Furthermore, angles of opposing incisors were correlated with each other. The facial crest and the upper jaw bars featured a curved shape and were therefore of limited use to estimate the angulation of the upper incisors. In contrast, the lower jaw bars were suitable to determine the angulations of lower incisors.