LAMINA DURA: BUNDLE BONE OR RADIOGRAPHIC ARTIFACT By GASTON BERENGUER A ...

45 Pages·2005·0.96 MB·English

LAMINA DURA:
BUNDLE BONE OR RADIOGRAPHIC ARTIFACT

By

GASTON BERENGUER

A THESIS PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE

UNIVERSITY OF FLORIDA

2005
Copyright 2005

by

Gaston Berenguer
To Carlos Berenguer, Vilma L. Bornot, and Candice Bean
ACKNOWLEDGMENTS
I would like to thank my family and friends for their support in all of my
endeavors. I appreciate the opportunity Drs. Herbert J. Towle and Frederic Brown have
given me and the guidance Drs. Jonathan Gray and Gregory Horning provided. I am also
grateful to Dr. Arthur Vernino for his commitment to the profession of periodontics. I
am indebted to my supervisory committee (Dr. Gregory Horning, Dr. Herbert J. Towle,
Dr. Katherine Karpinia, and Dr. Donald Cohen). I would also like to acknowledge Dr.
Linda Young, Dana Lucas, Lisa L. Booher, and Solomon Abraham.

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TABLE OF CONTENTS

page
ACKNOWLEDGMENTS.................................................................................................iv
LIST OF TABLES............................................................................................................vii
LIST OF FIGURES.........................................................................................................viii
ABSTRACT.......................................................................................................................ix
CHAPTER
1 INTRODUCTION........................................................................................................1
2 BACKGROUND..........................................................................................................3
3 AIM OF STUDY..........................................................................................................8
4 NULL HYPOTHESIS..................................................................................................9
5 METHODS AND MATERIALS...............................................................................10
6 RESULTS...................................................................................................................15
Radiographic Osteotomy Results (Phase I)................................................................15
Overall Radiographic versus Histological Results for LD and PDL (Phase II).........15
Statistical Correlation Analysis for LD (Radiographic versus Histological).............16
Statistical Correlation Analysis for PDL (Radiographic versus Histological)...........17
7 DISCUSSION.............................................................................................................22
APPENDIX
A PROTOCOL FOR PHASE I......................................................................................24
Protocol for Obtaining and Drilling Osteotomies into Cadaver Sections...................24
Drilling the Pine Wood, Plaster of Paris and Polyvinyl Siloxane Impressions..........24
Evaluation of Samples................................................................................................24
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B PROTOCOL FOR PHASE II.....................................................................................26
Protocol for Mid-Root Digital Radiography Data Gathering.....................................26
Protocol for Sectioning and Preparation of Cadaver Samples....................................26
Protocol for Hematoxylin and Easin (H & E) Staining..............................................27
C LAMINA DURA ANALYSIS...................................................................................28
D PERIODONTAL LIGAMENT ANALYSIS..............................................................30
LIST OF REFERENCES...................................................................................................32
BIOGRAPHICAL SKETCH.............................................................................................35

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LIST OF TABLES
Table page

1 Percent negative (-) responses to false LD images due to method used..................18
2 Percent negative (-) responses to false LD images due to individual examiners.....18
3 Mean LD recorded by principal investigator...........................................................18
4 Mean PDL recorded by principal investigator.........................................................18

vii
LIST OF FIGURES
Figure page

1 Osteotomy being created..........................................................................................12
2 Radiographic jig.......................................................................................................12
3 Pine wood block.......................................................................................................12
4 Plaster of Paris impression.......................................................................................13
5 Polyvinyl siloxane impression.................................................................................13
6 Digital radiograph with osteotomy...........................................................................13
7 Section embedded in paraffin before staining..........................................................14
8 Hematoxylin and Eosin stained samples in notebook..............................................14
9 Pine wood block radiograph.....................................................................................19
10 Plaster of Paris impression radiograph.....................................................................19
11 Polyvinyl siloxane impression radiograph...............................................................19
12 Osteotomy................................................................................................................20
13 Straight radiograph...................................................................................................20
14 Close up of interproximal #19 and 20......................................................................20
15 Corresponding histologic section tooth #20.............................................................21
16 Corresponding histologic section tooth #19 (mesial root).......................................21

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Abstract of Thesis Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Master of Science
LAMINA DURA: BUNDLE BONE OR RADIOGRAPHIC ARTIFACT
By
Gaston Berenguer
May 2005
Chair: Gregory Horning
Major Department: Periodontics
The clinical significance and implication of lamina dura (LD) has long been
controversial. Some clinicians think the absence or diminution of LD is diagnostic of
such pathoses as hyperparathyroidism, osteoporosis, and periapical or periodontal
inflammation. Others suggest the radiographic density increase of the LD indicates
occlusal traumatism. In a landmark 1963 article, Manson concluded that the LD about
teeth could be a radiographic artifact. The aim of our study was to correlate the presence
or absence of radiographic LD with histologic findings.
In Phase I, we tried to create artifactual LD. We evaluated holes (osteotomies)
drilled into a pine wood block and cadaver specimens, and also evaluated holes created
with Plaster of Paris and polyvinyl siloxane impression materials. In all, 63 cadaver
osteotomies were drilled. In Phase II, we examined 18 preserved human-mandibular
alveolar-arch dentate sections. Digital radiographs were taken from the straight
(perpendicular to the teeth), -5°, and +5° angles of the cadaver specimens. Measurements
were taken of the LD and periodontal ligament (PDL) images. These measurements were
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compared to histomorphometric measurements made of mid-root alveolar bone proper
and PDL from Hematoxylin and Eosin (H &E) stained sections. In all, 50 surfaces were
evaluated.
False images of LD were observed 7 out of 72 (9.7%) possible times. False images
were observed in the wood block 2 out of 3 (66.7%) possible times. No false images
were noted for the impression materials. False images were observed in the cadaver
specimens 5 out of 63 (7.9%) possible times. Radiographic LD images were observed
135 out of 150 (90%) possible times. Corresponding alveolar bone proper was observed
150 out of 150 (100%) possible times. Radiographic image of PDL were observed 130
out of 150 (86.7%) possible times. Corresponding histological PDL were observed 150
out of 150 (100%) possible times. Mean radiographic LD was 386.8 + 198.2 µm. The
range was 0 to1398.0 µm. Corresponding mean mid-root alveolar bone proper width was
277.0 + 196.7 µm. The range was 82.0 to 1279.0 µm. Mean radiographic PDL was
109.5 + 45.7 µm. The range was 0 to 297.0 µm. Corresponding mean mid-root
histological PDL width was 141.4 + 50.0 µm. The range was 41.0 to 350.0 µm. There
was no statistically significant correlation (P<0.05) between LD and corresponding
alveolar bone proper. There was a weak correlation (P<0.05) between radiographic and
corresponding histological PDL images.
The radiographic lamina dura does not appear to be an artifact, and could not be
readily created in specimens. Lamina dura measurements did not significantly correlate
(P<0.05) with corresponding alveolar bone proper. There was a weak correlation
(P<0.05) for radiographic and histological PDL images.

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