Tooth dimensions in hypodontia with a known PAX9 mutation.

AIM: Congenital absence of teeth is a complex condition affecting several parameters of oral development. This is the first study to measure tooth crown dimensions using image analysis in a family with hypodontia in whom the mutation has been identified, and compare them with a control group. METHODS AND RESULTS: Study models were obtained from 10 family members from three generations affected by severe hypodontia with a missense mutation in PAX9 and 10 unaffected, unrelated controls. Using established image analysis techniques all teeth up to and including the first permanent molars were digitally imaged by two operators from the occlusal (O) and buccal (B) aspects three times and an average made for the mesio-distal (MDO and MDB) bucco-lingual (BL), area (A) and perimeter (P) measurements. Intra-class correlation coefficients (ICCC) were calculated to assess intra- and inter-operator reliability. Two-sample t-tests were then used to compare these dimensions with those of the controls. Reliability of the technique was high (mean r>0.95). The majority of tooth types throughout the dentition were significantly smaller in the family members with hypodontia than in the control group for all parameters measured. The levels of significance were very high for upper lateral incisors (p<0.0001) whilst the canines and first molars were less different. The greatest number of significant differences were found in BL and P, closely followed by MD and A measurements. CONCLUSIONS: The significantly smaller tooth crown dimensions recorded in the affected family members show that the effect of the PAX9 mutation is seen not only in the congenitally missing teeth but also in smaller crown size throughout the dentition.

Gingival inflammation assessment by image analysis: measurement and validation.

AIM: Gingival inflammation may be caused by injury or plaque-related diseases and reduction in inflammation can be a useful indicator of gingival recovery. There has been little research on development of non-index methods to measure gingival condition. The aims of the study were to investigate the reliability of the measurement of changes in gingival redness and swelling, using image analysis, and to compare this approach with an established method for assessing gingival overgrowth [J Clin Periodontol 28 (2001) 81]. METHOD: Twenty volunteers with gingival inflammation were recruited and digital images were taken. Duplicate measurements were made on the first visit by two examiners. At a subsequent visit following periodontal treatment, second images were taken. Gingival changes were determined by assessing redness and tooth surface area visible between the level of the inter-proximal papillae and the gingival margin. Tooth area measurements were compared with the established gingival overgrowth method. RESULTS: The method showed excellent reliability for both intra- and inter-examiner measurements of 0.968-0.998 and 0.769-0.947, respectively, according to the classification by Donner and Eliasziw of the Fleiss coefficient of reliability (repeat measures taken during the patients' first attendance). High correlation was found for gingival encroachment when compared with the established gingival overgrowth method. CONCLUSION: This technique proved a reliable method for investigating changes in gingival redness. High correlation was found for gingival encroachment when compared with an established method.

The clinical measurement of tooth colour and stain.

There are many contributory factors to tooth colour and different techniques for its measurement. The aim of this paper is to evaluate methods of tooth colour and stain measurement, with an emphasis on recent advances in objective clinical measurement techniques. The overall colour effect of natural teeth is created by a combination of light which is reflected and scattered by tooth enamel and the underlying dentine. Developmental defects of the dentition can affect the intrinsic discolouration of teeth, for example, amelogenesis imperfecta and dentinogenesis imperfecta. Extrinsic discolouration is predominantly caused by stain build up on a tooth surface from bacteria, foodstuffs or metalic compounds. Tooth colour and stain measurement are currently assessed using a wide range of measurement methods divided into subjective (visual shade matching) and objective instrumental assessment such as by colourimetry, spectrophotometry and digital image analysis. The most popular method of assessing tooth colour clinically is visual shade matching, as this approach is quick and simple to use. However, variation in results can occur as a consequence of the subjective nature of this method. The instrumental approaches including quantitative light-induced fluorescence remove or significantly reduce the subjective component. Image analysis appears to be the most suitable method for tooth colour measurement and further work is being carried out to establish this approach.

Measurement of stain on extracted teeth using spectrophotometry and digital image analysis.

AIM: The aim of this study was to assess the reliability and validate a customized image analysis system, designed for use within clinical trials of general dental hygiene and whitening products, for the measurement of stain levels on extracted teeth and to compare it with reflectance spectrophotometry. METHOD: Twenty non-carious extracted teeth were soaked in an artificial saliva, brushed for 1 min using an electric toothbrush and a standard toothpaste, bleached using a 5.3% hydrogen peroxide solution and cycled for 6 h daily through a tea solution. CIE L* values were obtained after each treatment step using the customized image analysis system and a reflectance spectrophotometer. A statistical analysis was carried out in SPSS. RESULTS: Fleiss' coefficient of reliability for intra-operator repeatability of the image analysis system and spectrophotometry was 0.996 and 0.946 respectively. CIE L* values were consistently higher using the image analysis compared with spectrophotometry, and t-tests for each treatment step showed significant differences (P < 0.05) for the two methods. Limits of agreement between the methods were -27.95 to +2.07, with a 95% confidence of the difference calculated as -14.26 to -11.84. The combined results for all treatment steps showed a significant difference between the methods for the CIE L* values (P < 0.05). CONCLUSION: The image analysis system has proven to be a reliable method for assessment of changes in stain level on extracted teeth. The method has been validated against reflectance spectrophotometry. This method may be used for pilot in vitro studies/trials of oral hygiene and whitening products, before expensive in vivo tests are carried out.

A digital image analysis system for the assessment of tooth whiteness compared to visual shade matching.

OBJECTIVE: To assess tooth whiteness clinically using an image analysis system and a whiteness algorithm to compare with visual shade matching. METHODOLOGY: Images of the maxillary anterior teeth of 20 subjects were obtained using an image analysis system adapted for tooth whiteness measurement. Red, green, and blue values from each image, and Commision Internationale de l'Eclairage whiteness index (CIE WI) values were calculated. A visual shade match was also carried out using a Vitapan 3D Master 26-tab shade guide. RESULTS: The range of CIE WI values for image analysis and visual shade matching was 32.86-85.91 and 32.68-79.84, respectively. Limits of agreement between methods were +17.71 and -14.60 CIE WI units. The 95% confidence interval of the difference was calculated as -0.176 to +3.083. A two-tailed Student t-test with a 95% confidence level showed significant differences (p = 0.028) between the paired CIE WI values of each tooth for the two measurement techniques. As the accuracy and reliability of the image analysis system was found to be high in previous in vitro studies, the differences between the two methods were probably related to the inherent subjectivity of visual shade matching. CONCLUSION: The adapted digital image analysis system could be used as an alternative to, or in conjunction with visual shade matching.

Colour effects on extracted teeth after a tooth whitening regime: assessment in an artificial oral cavity.

The purpose of this study was to assess the reliability of a digital image analysis system and to assess its suitability for quantifying the colour (including whiteness) of extracted teeth in a purpose built artificial oral cavity after a whitening regime. Extracted teeth were treated with a scale and polish and a bleaching solution. The Image analysis system showed excellent intra operator repeatability. Significant tooth colour and whiteness changes occurred after the bleaching treatment. The digital image system has been shown to be a reliable and valid method for assessing colour and whiteness changes on extracted teeth after whitening treatments.

Measurement of stain removal in vitro: a comparison of two instrumental methods.

AIM: The aim of this study was to compare an established spectrophotometrical approach for the measurement of stain removal in vitro with a new digital image analysis system. METHOD: Eighteen acrylic blocks were stained by cycling them through human saliva (2 min), chlorhexidine (2 min) and tea (1 h), rinsed with deionized water and left to air dry. The absorbance of each block was then measured at 395 nm using a single-beam spectrophotometer. The lightness (L-value) of the stained blocks (after a baseline correction) was measured using digital image analysis. Image acquisition and L-values were obtained using Adobe Photoshop software. The stain removal ability of two whitening toothpastes and deionized water was tested by immersing each stained block in a test slurry (15 g paste/60 ml deionized water) for 1 min, rinsing and finally left to air dry. This cycle was repeated until the blocks had 5 min exposure to the slurry. Absorbance values from spectrophotometry and L-values by image analysis were obtained after each cycle. RESULTS: Fleiss' coefficient of reliability for intra-operator repeatability of the image analysis system and spectrophotometry was 0.999 for both methods which shows excellent reliability. Pearson's correlation coefficients for the two methods (stain build-up) were 0.976. Test products A, B and C gave correlations of 0.962, 0.998 and 0.817 respectively (stain removal), significant at the 0.01 level. CONCLUSION: The image system is a reliable alternative measurement method validated here against spectrophotometry for stain removal in vitro, and can provide full colour measurement.

Visual whiteness ranking of a Vitapan 3D Master shade guide by untrained assessors.

OBJECTIVE: This study was conducted to obtain the ranking order of a 29-tab (including three "bleaching tabs") Vita Shade Guide for perceived "whiteness" by untrained assessors, and to compare this ranking with both the shade guide manufacturer's rank order and a colorimetrically derived rank order. METHODOLOGY: A total of 85 people, not trained in color assessment by shade guides, were asked to rank order the tabs of a Vitapan 3D Master shade guide for perceived "whiteness" under standardized lighting conditions. A whiteness ranking was also obtained colorimetrically using a Minolta CM-2600d spectrophotometer calibrated to give CIE whiteness values. The data were analysed using means, standard deviations, and standard errors. RESULTS: The assessors varied more in their rankings for darker shades than the lighter ones. The order derived by the assessors and the colorimetry order did not match well with the manufacturer's order, especially toward the darker shades. CONCLUSION: For use in studies of whitening products, a new order of the Vitapan 3D Master shade guide tabs has been developed in relation to whiteness.

A digital SLR or intra-oral camera: preference for acquisition within an image analysis system for measurement of disclosed dental plaque area within clinical trials.

OBJECTIVES: The aim of this investigation was to compare the accuracy and reproducibility of images acquired from two types of camera (digital SLR camera, Kodak DCS410, KJP, UK and an intra-oral camera, Schick Technologies, UK) for application within an imaging system used for the quantification of disclosed dental plaque. METHODS: Subjects refrained from brushing their teeth for 24 h. Their teeth were then disclosed with Erythrosin FDC Red 3 and duplicate sets of images were obtained by each examiner of the upper central and lateral incisors. Images were then saved and measured for dental plaque area. These data were used to calculate reliability. RESULTS: No statistically significant bias in the measurements of plaque area was found. The reliability results showed the method was reliable. However, the image analysis system incorporating the 35 mm SRL camera was more reliable for both operators, as demonstrated by their intra-operator results. This was also collaborated by the inter-operator results. CONCLUSION: In this investigation the digital SLR camera combined with the image analysis system and frame permitted greater reliability of dental plaque surface area measurements than the digital intra-oral camera. This conclusion was derived both from the reliability data and from the perceived ease of use and flexibility of both camera types. When combined with the use of the custom-made frame, the images using the digital SLR camera were highly reproducible, confirming the systems application within clinical trials.

The measurement of tooth whiteness by image analysis and spectrophotometry: a comparison.

Digital image capturing and analysis techniques have been used to measure the colour of teeth and to compare with spectrophotometric results and visual observations. A non-linear image analysis approach was developed and, for the colour range of human teeth, allows device-dependant digital camera colour data to be quantitatively transformed to Commission Internationale de l'Eclairage (CIE) colorimetric values. With reference to a CIE standard illuminant, two different lighting arrays have been used. For flat and non-translucent white and yellow surfaces, spectrophotometric results showed that this transformation achieves required accuracy. It was found, in all of the present studies, which included measurements on the VITA Lumin Vacuum shade guide and extracted teeth, that spectrophotometry invariably underestimated values of the CIE whiteness index. However, the results from these two types of measurement correlated well. There was also a reasonably good correlation between earlier data obtained by visual assessment and the present data by the two instrumental methods. For extracted teeth, both instrumental methods used in this work did not confirm a whitening effect for 2-min brushing with toothpaste, but did show significant whitening results for bleaching with 15% hydrogen peroxide.

Quantification of dental plaque on lingual tooth surfaces using image analysis: reliability and validation.

AIM: The aim of this study was to increase the versatility and further validate the method reported by Smith et al. (2001) by testing the reliability of plaque measurement against two well-known dental plaque quantification methodologies using image analysis in a clinical trial. METHOD: The teeth of 40 subjects were disclosed before digital images of the labial and lingual surfaces of their upper and lower incisors were acquired. The amount of plaque present was quantified using a modification of the method described by Smith et al. (2001). The method was modified for obtaining images of the lingual surfaces by incorporating the use of orthodontic occlusal mirrors and 5-mm pieces of moistened blue articulating paper used to enable calibration. Plaque measurements were made from 320 upper and lower anterior teeth from the 40 subjects by two operators. Fliess' coefficient of reliability was used to assess intra- and inter-operator reliability and the independent sample t test was used to assess statistical significance between test and control groups after checking the data for normality. For validation, measurements were recorded using the Turesky et al. (1970) (modification of the Quigley & Hein (1962) plaque index and the Addy et al. (1983) plaque area index. The results were compared with the image analysis method using Pearson's correlation coefficient. RESULTS: The results for reliability were within Fliess' range of "excellent" for both intra-operator repeatability and inter-operator reproducibility. Pearson's correlation coefficients showed highly significant values indicating the close similarity between all three methods. CONCLUSIONS: This method for the measurement of dental plaque on lingual surfaces of anterior teeth proved reliable. The combined results from the labial and lingual surfaces of anterior teeth using image analysis produced trial conclusions comparable with the alternate plaque quantification methods used, with less clinician time and further producing a permanent database of images for future use.

Synergy of binary poly(oxypropylene-oxyethylene) copolymers in reducing retention of Streptococcus sanguis to hydroxyapatite.

Binary poly(oxypropylene-oxyethylene) block copolymer systems have been investigated as a non-bactericidal approach to reduce the retention of an oral bacterium, Streptococcus sanguis. Using a previously validated hydroxyapatite-coated microtitre model to simulate the tooth, the performance of copolymer pairs was measured experimentally. A synergy index and an efficacy index were defined to describe the reduction of bacterial retention by the binary systems that comprise the copolymer pairs. Relationships between the synergy and efficacy indices and their associated compositions are given. The results obtained have been rationalised using a previously developed theoretical approach in conjunction with the binding energetics of species to surfaces.

Moderation of oral bacterial adhesion on saliva-coated hydroxyapatite by polyaspartate.

AIMS: Synthetic sodium alpha,beta-polyaspartate (PA) has been investigated as a moderator of adhesion and the subsequent biofilm formation by oral bacteria. METHODS AND RESULTS: The inhibition of bacterial adhesion by PA was assessed by (i) a 30-min incubation with Streptococcus sanguis in a microtitre assay with the wells coated with hydroxyapatite (HAP) and (ii) an 18-h challenge with human salivary microflora in a HAP disc assay. In contrast to HAP-coated surfaces, clean polystyrene surfaces in the microtitre assay exhibited no anti-adhesion properties. It has been found that PA significantly and similarly adsorbs onto HAP surfaces in the presence and absence of salivary coating. The HAP disc assay also showed that PA, both in aqueous solutions and in toothpaste, reduced the level of adhered microflora and this effect was enhanced by added propylene oxide-ethylene oxide copolymers. CONCLUSION: The principal finding from this work is the potential role for PA as an inhibitor of dental plaque formation. PA may significantly modify the salivary pellicle. SIGNIFICANCE AND IMPACT OF THE STUDY: This work indicates the use of PA in controlling the development of dental plaque and the formation of bacterial biofilm in general.

Molecular characteristics of some commercial high-molecular-weight hyaluronans.

Commercially available hyaluronan (HA) samples were investigated by the method of size exclusion chromatography (SEC). The fractions eluted from the SEC column were on-line molecularly characterized by using a multi-angle laser light scattering (MALLS) photometer. Along with the SEC-MALLS technique, the high-molecular-weight HA biopolymers were (off-line) analyzed by capillary viscometry.

Radical degradation of high molecular weight hyaluronan: inhibition of the reaction by ibuprofen enantiomers.

The antioxidative and/or free-radical-scavenging activities of R-(-)- and S-(+)-ibuprofen enantiomers, as well as of the drug racemate, were studied in vitro on measuring the kinetics of (uninhibited or drug-inhibited) degradation of high molecular weight hyaluronan by hydroxyl radicals. The continual flux of OH radicals at aerobic conditions was maintained by the H2O2 + Cu2+ system. The kinetics of hyaluronan degradation was monitored indirectly by capillary viscometry. Under experimental conditions, with no drug addition, the relative viscosity ([eta]rel) decreased continuously, reaching 13% of the initial [eta]rel. value in 4 h. Each drug tested exhibited a dose-dependent protective effect against hyaluronan degradation, however R-(-)-ibuprofen demonstrated a slightly greater activity than the drug S-(+)-enantiomer.

Selection of oral microbial adhesion antagonists using biotinylated Streptococcus sanguis and a human mixed oral microflora.

A microtitre assay has been developed using hydroxyapatite-coated wells and Streptococcus sanguis NCTC 10904 at 10(7) cells per ml. A number of models representing toothpaste and mouthwash usage were adopted to detect the anti-adherent efficacy of a polyvinylmethylether maleic acid copolymer (PVM/MA), polyoxypropylene/polyoxyethylene block copolymer (PO/EO), two casein-derived peptides and selected silicones. The results not only confirmed the anti-adherence property of the selected components but also indicated possible molecular interactions leading to the observed performance. To account for the diversity of oral microbial cells in vivo, a further testing system was developed. This involved submerging a hydroxyapatite disc in a mixed culture of human salivary microbial cells, and exposing it to different treatments using the active component either in an aqueous dispersion or in a toothpaste. The effect of toothpastes containing PO/EO, dimethicone copoyol or PVM/MA was investigated over a 4-h incubation with microflora. These tests showed that in a toothpaste formulation the anti-adherent efficacy may be reduced when compared with an aqueous dispersion containing the same or nearly the same concentration of the active component.