Browsing by Author "Hartsfield, James K., Jr."

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    A Comparison of Radiographic, Photographic and Anthropometric Assessments of Craniofacial Asymmetry
    (2002) Reese, Steven A.; Hartsfield, James K., Jr.; Everett, Eric T.; Hohlt, William F.; Shanks, James; Ward, Richard E.
    A series of 56 orthodontic patients from the ages of 9 to 48 were involved in a prospective study on craniofacial asymmetry at Indiana University Department of Oral Facial Development. Each of the 56 individuals had fourteen bilateral anthropometric facial measurements made which were used to quantify asymmetry based on the anthropometric technique. Standard orthodontic records were taken and routine clinical exams were performed. Fourteen bilateral landmarks similar to the anthropometric landmarks were identified and measured from posterior-anterior cephalometric radiographs. Asymmetry scores for each individual were calculated using the same mathematical method as with the anthropometric data. The correlation of the two methods was calculated statistically using Pearson Product Correlation Coefficient. In addition, 26 clinicians evaluated the same patients from frontal photographs and gave each individual an overall score based on his or her apparent asymmetry. These average scores from the examiners were compared statistically to the total asymmetry scores from both the radiographic and the anthropometric data. The hypothesis was that the anthropometric data and the radiographic data would be more closely correlated with each other than either would be with the photographic data (examiner's scores). Data in this study support the hypothesis. Although some significant correlations exist between radiographic and anthropometric methods, the correlation is not high. Neither of the methods shows a correlation with the photographic data. Different measurement techniques measure different aspects of asymmetry with different errors associated with it, and clinical decisions based only on one method must be interpreted with caution.
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    A Study of Craniofacial Asymmetry in Monozygotic and Dizygotic Twins Using Posteroanterior Radiographs
    (2002) Russell, Jennifer A.; Hartsfield, James K., Jr.; Everett, Eric T.; Roberts, W. Eugene; Shanks, James C.; Ward, Richard E.
    This project investigated craniofacial asymmetry in a prospective study among monozygotic (identical) versus dizygotic (fraternal) twins and sibling pairs. Posteroanterior radiographs that had previously been collected were used in this study and the zygosity of the twins had previously been determined. We hypothesized that in this study measuring craniofacial asymmetry there would be a greater concordance between monozygotic twins than between dizygotic twins for each of the variables measured. If there were some genetic component to asymmetry, we would expect to find a greater correlation between monozygotic versus dizygotic twins and sibling pairs since monozygotic twins are genetically identical and the dizygotic twins and siblings share on average fifty percent of their genes. If there are no statistically significant differences between the monozygotic and dizygotic twin correlations as shown from the heritability value, one could conclude that genetic factors are not important in the development of craniofacial asymmetry. This information is clinically significant. If we find that environment plays the predominant role in the development of asymmetry, one would conclude that clinicians should be vigilant about employing a treatment plan that will modify the environment while an asymmetry is developing. Since the zygomatico-frontal sutures and crista galli were found to be relatively symmetrical landmarks in a previous investigation by Harvold, a horizontal axis was constructed through the zygomatico-frontal sutures and a perpendicular vertical axis was constructed through crista galli. Perpendicular distances of ten bilateral structures were measured from the vertical reference line. Two methods of evaluating subjects' head positioning were used and compared. Any subject that was found to have excessive rotation of their head was excluded from the sample. After a preliminary analysis it was found that the horizontal distances were strongly correlated to patient positioning even after subjects determined to have excessive rotation of the head were eliminated from the sample. For this reason, vertical measurements of eight bilateral landmarks were made perpendicular to the reference line constructed through the zygomatico-frontal sutures. Using Statistical Package for the Social Sciences, the magnitude of craniofacial asymmetry was evaluated by calculating the absolute (non-signed) asymmetry values (IL-RI) for each of the ten horizontal and eight vertical variables. The horizontal and vertical variables were evaluated for any directional asymmetry to determine if the right or left side is consistently larger by calculating signed asymmetry values (L-R) for each of the ten horizontal and eight vertical variables. Since the subjects vary in size, relative differences were subsequently calculated. The relative difference was calculated by dividing the right-left absolute difference by half the sum of the right and left measurements [IL-Rlf.5(L+R)]. The relative difference of each of the ten horizontal and eight vertical variables was calculated for each individual. Using SAS software correlation coefficients were calculated for the relative asymmetry values of the monozygotic and dizygotic twin groups for each of the ten horizontal and eight vertical variables. Subsequently heritability values of craniofacial asymmetry were calculated for each of the eighteen variables using the standard formula h2= 2(rMz-rDz). The data revealed that head positioning had significantly affected our horizontal asymmetry values. We found a significant directionality in the horizontal and vertical dimension with the left side being larger horizontally and the right side being larger vertically. However the horizontal asymmetry values must be interpreted with caution as they are significantly affected by the rotation. After analyzing the data collected, the hypothesis was rejected. We were unable to demonstrate a significant difference in correlation values between monozygotic and dizygotic twins/sibling pairs for most craniofacial asymmetry values. The few variables that did show high heritability were in the horizontal plane. The results of the horizontal data must be interpreted with caution due to the significant effect of head rotation. In contrast it was found that vertical asymmetry values were not significantly correlated to rotation and none of these had notable estimates of heritability. These findings suggest that craniofacial asymmetry is more strongly influenced by environmental factors than genetics. This finding supports treatment by clinicians to improve or prevent developing asymmetries. While genetically controlled malformations can often be improved with treatment, environmentally induced malformations may respond well to treatment that changes the faulty developmental environment. Still it will be the capability of the patient to respond to the change in environment (treatment) that will determine the efficacy of the treatment. The interaction of genetic factors with this change in environment at a particular time as represented by the treatment may have a greater influence on the outcome of the treatment than how the problem was produced in the first place. Future studies analyzing asymmetry need to take extreme care in patient positioning and calibration of the x-ray machine, for they may lead to errors which overpower the data already subject to the error of a two-dimensional representation of a three dimensional object. Keeping these technical caveats in mind, future studies should focus on whether there are genetic factors that influence a patient's response (or the difference in response among patients) to the treatment of asymmetry.
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    Analysis of a TNFRSF11A Gene Polymorphism and External Apical Root Resorption During Orthodontic Treatment
    (2005-07) French, Michael; Hartsfield, James K., Jr.; Al-Qawasmi, Riyad A.; Foroud, Tatiana M.; Roberts, W. Eugene; Shanks, James
    External Apical Root Resorption (EARR) can be an undesirable side effect of orthodontic treatment. Several studies have already recognized a genetic predisposition to EARR, and some have suggested possible candidate genes that may be involved. The objective of this prospective study was to explore one possible candidate gene that may predispose individuals to EARR during orthodontic treatment. The TNFRSF11A gene encodes the receptor activator of nuclear factor-kappa β (RANK). Together with the RANK ligand, RANK mediates cell signaling that leads to osteoclastogenesis. A diallelic marker was used to investigate the possible relationship between a nonsynonymous TNFRSF11A (RANK) polymorphism and the individuals' development of EARR concurrent with orthodontic treatment. Buccal swab cells of 112 patients who had completed orthodontic treatment were collected for DNA isolation and analysis. EARR of the maxillary central incisors was calculated based on measurements from pre and post treatment occlusal radiographs. Linear regression analysis indicated that length of treatment, overjet, and molar classification are significant predictors of EARR (p=0.05). Other factors, including age, gender, and overbite, were not found to be significantly associated with EARR. An ANOVA was performed to examine the relationship of the genotyped TNFRSF11A marker with the dependent variable EARR. When individuals having at least one copy of allele 2 (1,2 and 2,3 genotypes) were pooled together, a marginally significant association was found between EARR and the marker. Further analysis using logistic regression revealed that individuals with a (1,1) genotype are 4.3 times more likely to be affected by EARR than a person with a (1,2) or (2,2) genotype. From these findings it was concluded that EARR is a complex condition influenced by several treatment variables with the TNFRSF11A gene and its product (RANK) contributing to the individuals' predisposition.
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    Analysis of the Relationship Between Growth Hormone Receptor Polymorphism rs6180 and Craniofacial Morphological Changes Associated with Herbst Appliance Therapy
    (2007) Ellis, Lawrence Charles; Hartsfield, James K., Jr.; Baldwin, James J.; Foroud, Tatiana M.; Roberts, W. Eugene; Shanks, James C.
    Craniofacial growth results from both environmental and genetic factors over time. It would be exciting to isolate genetic factors that influence treatment responses from patients undergoing orthodontic treatment. Genetic genotyping and analysis of orthodontic patients is a new technologic advancement. The aim of this retrospective study is to examine the relationship of a specific single nucleotide polymorphism (SNP), rs6180, of the Growth Hormone Receptor (GHR) gene with various craniofacial length parameters in patients who have received Herbst appliance therapy as part of orthodontic treatment. An initial lateral cephalometric radiograph was taken along with two buccal cheek swabs. The cells obtained have undergone DNA isolation with the Puregene method in microcentrifuge tubes (Gentra Systems, Minneapolis, MN). Upon termination of functional appliance therapy (post-Herbst), a final lateral cephalometric radiograph was taken. To analyze the genetic polymorphism and determine genotype, polymerase chain reaction (PCR) and allelic discrimination were done using the 7000 Sequence Detection System (Applied Biosystems). Lateral cephalometric radiographs (initial, post-Herbst) of 25 patients were digitized and measured using the Dolphin Imaging program. Cephalometric measurements (S-N, S-A, Co-Go, Go-Gn, Ar-Gn, Go-Gn) were used to identify mandibular and craniofacial morphologic changes. Changes in Z-scores based on standards from the Michigan Growth Study were then converted to slow or normal growth status by slow being when the Z-score difference between the initial and final measurements is less than zero. The number of subjects with a slow versus normal growth status was compared to GHR polymorphism genotype. Statistical analysis of Hardy-Weinberg equilibrium and the changes in craniofacial length Z-scores in relation to a patient's genotype were performed using chi-square analysis. Results: The genotype frequencies were in Hardy-Weinberg equilibrium. Z-score differences for the S-A measurement was the only one found to be significant (p=0.005).
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    Assessment of Dental Asymmetry Utilizing Orthodontic Study Casts Comparing Tooth Positions to the Midpalatal Raphe and Tooth Size Among Antimeres
    (2002) Sprowls, Matthew W.; Hartsfield, James K., Jr.; Baldwin, James; Everett, Eric T.; Hathaway, Ronald; Shanks, James C.; Ward, Richard E.
    Several studies have been conducted in relation to the treatment and etiologies of craniofacial and dental asymmetries in the orthodontic scientific literature. However, limited research has attempted to correlate asymmetry in dental traits to each other. The purpose of this research study was to develop a better understanding of the correlations between dental arch asymmetry and dental tooth size asymmetry and their underlying causes. Understanding asymmetries is essential in orthodontic diagnosis and treatment planning. An orthodontist cannot obtain an optimal occlusal and functional result without properly balancing skeletal and dental relationships. Pretreatment dental study casts of 86 sequential patients from the postgraduate orthodontic clinic at the Indiana University School of Dentistry were used for the analysis. Each patient was analyzed in a single blind fashion to minimize bias. The Adobe Photoshop® ruler and Chicago® brand electronic digital calipers accurate to the nearest tenth of a millimeter were used for digital measurements. Measurements were made to determine the amount and direction of asymmetry along the dental midlines relative to the median palatine raphe. Transverse and sagittal measurements were made to record asymmetries in canine and molar positioning. Furthermore, three sets of antimeric maxillary teeth were measured for length and width. These included the central incisors, the canines, and the first molars. Fluctuating asymmetry was present in all measurements, except molar distance to median palatal raphe. This was found to be directional to the left in the entire sample group. Statistical analysis was subsequently performed and the results showed significant correlations in the individuals in the subsample dentition group. Subjects belonging to this group with a measurable degree of fluctuating asymmetry had a greater tendency toward transverse maxillary discrepancies as measured from the canines and first maxillary molars relative to the median palatal raphe. Moreover, individuals in the subsample group with above average total weighted fluctuating asymmetry values according to the parameters analyzed in this study appeared more likely to have decreased developmental stability leading to the clinical expression of more severe malocclusions.
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    Assessment of Orthodontic Treatment Results and Comparison between Fixed Lingual and Labial Appliances
    (2001) Pinskaya, Yuliya B.; Roberts, W. Eugene; Baldwin, James J.; Hartsfield, James K., Jr.; Hohlt, William F.; Shanks, James C.
    Interest in objective assessment of orthodontic treatment outcomes and in quality control of orthodontic treatment is increasing. In recent years, the evaluation of orthodontic treatment results has been carried out with the help of various indices or different rating systems. No published studies have used the ABO Objective Grading System for evaluation of orthodontic treatment outcomes for all cases in the clinical series. There are also very few studies, conducted mainly in Europe, that have assessed treatment results in postgraduate orthodontic clinics. There is one known study comparing treatment results between fixed lingual and labial appliances. The objectives of the present study were: first, to assess treatment outcomes in the IUSD Graduate Orthodontic Clinic for three years (1998, 1999, and 2000); and second, to compare treatment results achieved with the use of fixed lingual and labial appliances. Pre and posttreatment records (study casts, panoramic and lateral cephalometric radiographs, and extraoral and intraoral photographs) of 521 patients treated in the IUSD Graduate Orthodontic Clinic were evaluated. Treatment outcomes were assessed for a 3-year period using the ABO Grading System and IUSD Comprehensive Clinical Assessment Criteria. Statistically significant differences were found for the majority of the evaluation criteria between the selected three years. The overall quality of finished cases decreased from 1998 to 2000. This trend may reflect preferential finishing of the cases that were going well and transferring all the other cases. No assumptions regarding the overall performance of the Clinic should be made based on the results of this study. It should be remembered that these three years were selected for a particular reason. In the fall of 1997, a clinical grading program was initiated. All active cases (1997-98 academic year) were to be finished within three years. The year 2000 was the deadline to finish all active long treatment time cases. Most of the cases that were in treatment for a long time were progressing poorly and were not finally finished until 2000. This group of difficult cases contributed to the decreased quality of the finished cases and longer treatment time during the year 2000 compared to 1998 and 1999. It is anticipated that treatment outcomes will improve in 2001 since the backlog o flong treatment time cases has been cleared. The evaluation of this three-year period (1998-2000) was the baseline evaluation for comparison of finished cases for subsequent years. When comparing treatment results between fixed lingual and labial appliances, significant differences were found for only 4 of 24 parameters. These outcome differences were, mainly, due to the inherent characteristics of the lingual appliance rather than to the treatment approach of the supervising instructor. Even though statistically significant differences were found for a few parameters between two types of appliances, they did not indicate the advantages of one appliance over the other. The present study suggests that the treatment results can be as good with lingual as with labial appliances. This study also has established a baseline for comparison of clinical outcomes in the IUSD Orthodontic Clinic for subsequent years.
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    Association Analysis of Class II Division 2 Malocclusion and Two Genes Linked to Hypodontia (MSX1 and PAX9)
    (2009) Wall, Matthew D.; Kula, Katherine S.; Hartsfield, James K., Jr.; Shanks, James C.; Baldwin, James J. (James Joseph), 1925-; Stewart, Kelton T.
    Purpose of the Study: Determine if there is an association of the CII/D2 malocclusion and genes linked to hypodontia, namely PAX9 and MSX1. Methods and Materials: One hundred probands with CII/D2 and one hundred non-CII/D2 with no hypodontia were enrolled in this study. Clinical exam, photographs, models, radiographs, and saliva were gathered. DNA was isolated from the saliva and sent for genetic analysis. Single Nucleotide Polymorphisms (SNPs) from the PAX9 and MSX1 genes were analyzed using the LightCycler® 480 to verify the presence of each with the CII/D2 malocclusion. A Hardy-Weinberg test was used to screen for genotyping errors, then a chi-square test was used to evaluate the association of the SNP genotypes. A p-value of 0.05 was considered significant. Results: The Hardy-Weinberg test showed no significant differences between observed and expected counts thus we used them for association analysis. Chi-square analysis indicated no significant association between CII/D2 and the MSX1 rs3821949 and the PAX9 1955734 genotypes. Although a p-value of 0.06 for the PAX9 rs8004560 suggested association, it was considered a grey area and insufficient to conclude that there was significant association. Since the SNP PAX9 rs8004560 was insufficient, additional statistical analysis was also performed on the PAX9 rs8004560 genotype of the CII/D2 affected subjects reported to have hypodontia of any tooth including third molars and excluding third molars. A chi-square test yielded a p-value of 0.08 on the analysis of CII/D2 with hypodontia for any permanent tooth except third molars, which suggested association, but insufficient to conclude a significant association. All other analyses indicated a lack of association of the PAX9 rs8004560 SNP. Conclusions: There is no significant association of CII/D2 and the SNPs MSX1 rs3821949 and PAX9 rs1955734. There is a suggestion that there is an association of the SNP PAX9 rs8004560 and CII/D2. There is a suggestion that there is an association of SNP PAX9 rs8004560 and CII/D2 subjects with hypodontia of any tooth except third molars.
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    Cephalometric Similarity Among Parents of Individuals with Sporadic Isolated Cleft Palate : Is There Evidence for an Inherited Predisposition?
    (1999) Sammons, Edward M.; Ward, Richard E.; Hartsfield, James K., Jr.; Avery, David R.; Hathaway, Ronald R.; Garetto, Lawrence P.
    Isolated cleft palate is one of the most frequent congenital conditions that affect the oral and facial structures, yet its etiology remains obscure. Previous studies of both cleft palate (CP) and cleft lip and/ or palate [CL(P)] have shown that there may be unusual facial characteristics among the parents of such sporadic cases. Such findings have been used to support the possibility that there are predisposing familial (genetic) factors for both conditions. However, previous studies have generally not controlled for the possibility of genetic heterogeneity or for different contributions from each of the parents. The objective of this study is to examine parents of individuals with CP in order to test the hypothesis that these "non cleft" individuals have abnormal facial structures. Lateral (LA) and Posterior-Anterior (PA) cephalograms were examined from thirty parents of fifteen individuals with sporadic CP. Seventeen LA and twenty-five PA variables were obtained on each subject and converted to standardized "z-scores" through comparison to published age and sex matched reference data. Multivariate cluster analysis was used to define groupings of individuals who shared similar patterns of facial features. Results demonstrate that as a group, relatives of CP individuals show significantly different patterns of facial measurements compared to reference norms. Values significantly larger (p < 0.05) from parental data included: ANS-Me, PNS-ANS, S-N-Pg, Ar-Go-Me, MoL-MoR, NSR-NCR. Values significantly smaller (p < 0.05) from parents included: N-ANS, S-Ba, PNS-ANS / N-ANS, PNS-ANS/ N-Pg, N-S-Ba, ZyLZyR, GoL-GoR, GoNL-GoNR, CRO-CNS, CNS-SD, CNS-Me, ID-Me, MxR-ZyR, MeGoR. These findings were not entirely consistent with those few previously reported findings. Additional analysis of the present data demonstrated that such inconsistencies may be due in part to the presence of distinct phenotypic subgroupings within the parental sample. Cluster analysis identified two such subgroups. Significant findings (p < 0.05) that were smaller for Cluster 1 relative to Cluster 2 included: N-Me, ANS-Me, S-Go, PNS-ANS, Ar-Go, CNS-SD, MxR-ZyR. Significant variables that were larger for Cluster 1 included: S-N-Pg. In addition, gender was significantly different across clusters with Cluster 1 containing 75 percent female individuals and Cluster 2 containing 67 percent male individuals. These results extend those reported in other studies by demonstrating that unusual facial patterns, when present are not uniformly distributed in parents of sporadic cases of CP. Phenotypic assessment in conjunction with multivariate analysis may help to identify families in which there is a significant heritable component for CP.
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    Cephalometric similarity among parents of individuals with sporadic isolated cleft palate: is there evidence for an inherited predisposition?
    (1999) Sammons, Edward M.; Ward, Richard E.; Avery, David R.; Hathaway, Ronald R.; Garetto, Lawrence P.; Hartsfield, James K., Jr.
    Isolated cleft palate is one of the most frequent congenital conditions that affect the oral and facial structures, yet its etiology remains obscure. Previous studies of both cleft palate (CP) and cleft lip and/ or palate [CL(P)] have shown that there may be unusual facial characteristics among the parents of such sporadic cases. Such findings have been used to support the possibility that there are predisposing familial (genetic) factors for both conditions. However, previous studies have generally not controlled for the possibility of genetic heterogeneity or for different contributions from each of the parents. The objective of this study is to examine parents of individuals with CP in order to test the hypothesis that these "non cleft" individuals have abnormal facial structures. Lateral (LA) and Posterior-Anterior (PA) cephalograms were examined from thirty parents of fifteen individuals with sporadic CP. Seventeen LA and twenty-five PA variables were obtained on each subject and converted to standardized "z-scores" through comparison to published age and sex matched reference data. Multivariate cluster analysis was used to define groupings of individuals who shared similar patterns of facial features. Results demonstrate that as a group, relatives of CP individuals show significantly different patterns of facial measurements compared to reference norms. Values significantly larger (p < 0.05) fro1n parental data included: ANS-Me, PNS-ANS, S-N-Pg, Ar-Go-Me, MoL-MoR, NSR-NCR. Values significantly smaller (p < 0.05) from parents included: N-ANS, S-Ba, PNS-ANS/ N-ANS, PNS-ANS/ N-Pg, N-S-Ba, ZyL-ZyR, GoL-GoR, GoNL-GoNR, CRO-CNS, CNS-SD, CNS-Me, ID-Me, MxR-ZyR, Me-GoR. These findings were not entirely consistent with those few previously reported findings. Additional analysis of the present data demonstrated that such inconsistencies may be due in part to the presence of distinct phenotypic sub groupings within the parental sample. Cluster analysis identified two such subgroups. Significant findings (p < 0.05) that were smaller for Cluster 1 relative to Cluster 2 included: N-Me, ANS-Me, S-Go, PNS-ANS, Ar-Go, CNS-SD, MxR-ZyR. Significant variables that were larger for Cluster 1 included: S-N-Pg. In addition, gender was significantly different across clusters with Cluster 1 containing 75 percent female individuals and Cluster 2 containing 67 percent male individuals. These results extend those reported in other studies by demonstrating that unusual facial patterns, when present are not uniformly distributed in parents of sporadic cases of CP. Phenotypic assessment in conjunction with multivariate analysis may help to identify families in which there is a significant heritable component for CP.
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    Comparison of the Incidence of Bolton Tooth Mass Discrepancy in African-American and Caucasian Populations
    (1998) Adelsperger, M. Jayme; Hartsfield, James K., Jr.; Dean, Jeffrey A.; Garner, LaForrest D.; Hathaway, Ronald R.; Hohlt, William F.; Shanks, James C.
    Tooth mass discrepancies have been studied extensively in Caucasian populations, but little has been done to compare differences between Caucasian and African-American populations. The objective of this study was to determine whether the incidence of tooth mass discrepancies between the maxillary and mandibular arches was greater in African-American populations than Caucasian populations. Pretreatment plaster orthodontic models of 100 African-American and 100 Caucasian patients from the Indiana University Orthodontic Clinic and from one private practitioner were measured with a Mitutoyo Digimatic® caliper accurate to 0.01 mm. Mesiodistal widths of all teeth from first molar to first molar were measured with the mesio-buccal and disto-buccal contact areas normally being the widest area. The investigator was blinded to the gender and ethnicity of the subject by assigning each model a random number which was matched to the patient profile only following statistical analysis. Anterior ratios and total (posterior+ anterior) ratios were calculated according to the methods described by Bolton and were compared to the Bolton means and standard deviations. Incidence of tooth mass discrepancy was also investigated according to gender and dental malocclusion classification of the individuals. Tooth mass discrepancies present a hurdle to the clinician in achieving an ideal occlusion. Reports of the incidence of significant discrepancies in defined populations alerts the practitioner to problems in finishing their patients' occlusions. Results of the study show nearly double the incidence of overall Bolton tooth mass discrepancy in the African-American sample than in the Caucasian. The overall tooth mass discrepancy was more severe in the African-American sample, while anterior tooth mass discrepancies were nearly identical in both populations.