Bevel: Research Article

Prevalence of Cusp of Carabelli in Health Professional Students: An Institutional Based Study

Durga Susmitha Vaddi, Pallavi, Kiran Kumar Kattappagari, Ramana Reddy

Abstract

Cusp of carabelli (CC) is a non-functional cusp present on the mesiopalatal cusp of maxillary molar. It is separated from mesiopalatal cusp by a groove which is termed as carabelli groove. Popularization is generally leanings in the evaluation of hominoid dentition. This CC trait can be considered one of the parameter in dental anthropology. This morphological variation makes it very important in anthropological studies and related to forensic odontology. This cusp of the carabelli also can be used for ethnicity of population. Aim and Objectives: Prevalence of CC found in permanent maxillary first molar teeth in health professional students. Materials and Methods: A total of 100 Bachelor of Dental Surgery students were included for this study. Assessment of CC was done using Synder simplified index. Results: The subjects included were 50 males and 50 females. The age distribution among maximum male subjects with mean age was 23.22 years, maximum female subjects with mean age was 22.42 years. Small tubercles were the highest in males whereas both small vertical ridge grooves and small tubercles were more in females. Males were shown high prevalence in both right and left sides. Conclusion: The expression of CC in the health professional was more in males as compared with females. The bilateral presence of CC was high in males.CC variation in both males and females a similar study should be carried out with a large sample for standardization of the methodological approach and this can be compared in future.

 

Key Words: Anthropology; Cusp of Carabelli; Dentition; Ethnicity; Gender Identity; Molar Tooth.

 

Durga Susmitha Vaddi, Pallavi, Kiran Kumar Kattappagari, Ramana Reddy. Prevalence of Cusp of Carabelli in Health Professional Students: An Institutional Based Study. International Journal of Oral & Maxillofacial Pathology; 2019:10(2):02-05. International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved.

 


Introduction

Cusp of carabelli (CC) was first described by Carabelli in 1842. It is also called as the fifth cusp, located in the mesiopalatal cusp of maxillary first and second molars.1 But cusp of carabelli will be prominent in first molar when compared with second molar. Cusp of carabelli can be used in forensic research for identification of gender, anthropological and ethnic studies. In 1842 first literature description in a plethora of studies was done in different populations living and archeological.2Development of cusp of carabelli has numerous predilection among one is that patterning cascade model of tooth morphogenesis and accounts for shape development through the interaction of a small number of genes.3

 

Gene expression both directs development and is controlled by the shape of developing teeth. Enamel knots (zones of no proliferating epithelium) mark the future sites of cusps. Cusp of carabelli mainly occurs due to enamel knot which will escape the inhibitory fields and are surrounded by other enamel knots before crown portion partially become morphological outlined. During morphogenesis knot placement and tooth size are limited in that particular point and that predicts the cuspal expression with inter cuspal spacing comparative to tooth size.4 Irrespective of the clinical, anthropological and forensic point of view, several studies have been carried out in different parts of the world and racial differences in the representation of this trait had been reported in the literature.5 Racial classification of Caucasoid, Negroid, and Mongoloid, though an outdated system is still followed by the forensic odontologist based on skull shape, cusps of Carabelli, shovel-shaped incisors, and multi-cusped premolars to determine anancestry.6 So, the factors responsible for the representation of this trait and its distribution in various populations are very important. Therefore, the main aim was to analyze the prevalence of the cusp of carabelli in health professionals in an institutional setup.

 

Materials and Methods

The study was conducted in the Department of Oral Pathology and Microbiology. The study includes 100 health professional students and was approved by institutional ethics committee. Completely erupted both right and left maxillary molars (till 2nd molar) was the part of inclusion criteria. Subjects with any form of pathology, developmental anomalies, amalgam-composite restorations, ceramic crowns, attrition and cusp fractures were excluded from the study.

 

All the included subjects were explained about the procedure and written consent was obtained. Direct intra oral examination was done to see morphological details such as crown position, number of cusps, presence or absence of cusp of carabelli and gender of the subjects were recorded on customized form. All the observational procedure was carried out by a single examiner in order to avoid inter-observer variability. Later, maxillary impressions were taken using alginate (Alginoplast; Heraeus Kulzer, Hanau, Germany) impression material and casts were prepared with dental stone type III (Model stone, paras D dandan Co., Tehran, Iran). Examination of maxillary first and second molar, both right and left side was done using magnifying glasses. The pattern of carabelli was categorized using Snyders Classification (Figure 1) as mentioned below.

 

Statistical Analysis: The obtained data was analyzed using Statistical Package for the Social Sciences (SPSS) version 20.0. Students t-test will be used for comparison of Carabelli with gender and different patterns.

 

Results

The total number of 100 students was included with equal gender distribution. Both males46 (92%) and females 45 (90%) showed the maximum age distribution in 19-25 years of age group. The mean age distribution of males was 23.22 years, whereas in females it was 22.42 years. (Table 1 & Graph 1) In males the distribution of cusp of carabelli according to criteria, small tubercle (42%) was observed predominantly in both right and left side, followed by small vertical ridge and groove 14 (28%), double vertical ridges or slightly and incomplete cusp out line 12 (24%) in both right and left side of maxillary molars. Whereas broad cusp out line with moderate tubercle was observed minimum with 3 (6%) in both right and left side of the maxillary molars. (Table 2)

 

In females the distribution of cusp of carabelli according to the criteria was different in both right and left sides of the maxillary molars. On the right side small vertical ridge and groove 19 (38%) was observed predominantly on the right side followed by small tubercle 17 (34%), broad cusp outline moderately tubercle was 8 (16%) and minimum was in double vertical ridge or slight incomplete outline 6 (12%), whereas on the left both small vertical ridge and grooves and small tubercle 18 (36%) followed by broad cusp outline moderate tubercle 8 (16%) and double vertical ridge or slight incomplete outline 6 (12%) was observed. (Table 3) Distribution of cusp of carabelli in relation with gender showed maximum small tubercle in males whereas small vertical ridge and groove in females. (Table 4)

 

Figure 1: Scale for determination of degree and expression of cusp of carabelli cusps (Snyder et al., 1969)

 

Age Range

Male

Female

Total

19-25

46

45

91

26-30

4

5

9

Total

50

50

100

Table 1: Distribution of gender in relation with age groups (Years).

 

Graph1: Distribution of gender in relation with age group

Male

Criteria

Right (%)

Left (%)

1

14 (28)

14 (28)

3

12 (24)

12 (24)

5

21 (42)

21 (42)

6

3 (6)

3 (6)

Table 2: Distribution of patterns of cusp of carabelli in both right and left side in males.

 

Female

Criteria

Right (%)

Left (%)

1

19 (38)

18 (36)

3

6 (12)

6 (12)

5

17 (34)

18 (36)

6

8 (16)

8 (16)

Table 3: Distribution of patterns of cusp of carabelli in both right and left side in females.

 

Male

Female

Criteria

Right

left

Right

Left

1

14

14

19

18

3

12

12

9

6

5

21

21

17

18

6

3

3

8

8

Table 4: Distribution of number of cusp of carabelli on both right and left maxillary molars in different gender groups.

 

Discussion

The distribution of the cup of carabelli trait varies from population to population. Cusp of carabelli can used for identification of ethnicity.8 A cusp of carabelli trait was first recorded in early 1842 by carabelli9 it appeared as pit or small tubercle pattern and it has already been identified in Australopithecus, Neanderthal man and Dryopithecues rhenanus.10 Normally the cusp of carabelli present on the maxillary molars especially maxillary first molar followed by maxillary second molar and this cusp of carabelli observed in some very old fossils of Paleolithic man. After evolution changes in this cusp of carabelli was observed as simple groove to its present form such as well-developed cusp with deep developmental grooves. These findings evoke the researchers that the cusp of carabelli can be used as anthropological view and different racial groups.11

 

According to Jernvall and Jung in 2000, pattern of cusp of carabelli in the model. They suggested that it was involving in first formed paracone, protocone and carabelli cusp. This was due to main folding of enamel and dentin junction in molar teeth.12 Cusp of carabelli trait was observed as small shallow furrow or groove, pit and tubercles seen on cusp with hypo cone with different size and shapes.13 In 1944, Dietz described as carabelli tubercle are expressed in various morphological structures such as lobular, cuspid, ridged and sometimes it may appear as pitted.14 This criterion was modified by Snyder et al., in 2010 and is explained in Table1.

 

Prevalence of cusp of carabelli varies from population to population. The cusp of carabelli very prominent in white complex population with percentage of 17.4-90% followed by 37% of the Caucasoid. However, carabelli was very less in Asian population but literature suggests that very rarely it is appreciated in Asians.11 According to Yaacob H, et al., in 1996 who observed that cusp of carabelli was very prominent in Mogoloid population and also observed that this could be because of racial differences.15 These findings are accordance with our observation. Snyder classification is the most commonly applied method for cusp of carabelli expression and degree of determination.16 In the present study, prevalence of cusp of carabelli were prominent in males compared with females. 58.7% cusp of carabelli trait was observed in Saudi pediatric subjects, but these observations are diverse from our study.17

 

According to the present study, small tubercle was very prominent in males followed by cusp out-line moderate tubercle. There was study done by Kannapan JG, et al., (2001) observed that criteria 6 (broad cusp outline moderate tubercle) was most commonly observed with 28.4% followed by criteria 5 (Small tubercle) was least frequent i.e. 6.2%, this could be because of selection of population may varies that was observed why difference with our study.18 In the present study, females showed variation for the presence of cusp of carabelli in both right and left side. Right side showing no cusp but small line surface having a furrow interrupting its continue i.e small vertical ridge and groove was prominent followed by small tubercle in both right and left side. According to study done by Mosharraf R, et al., (2013) they concluded that cusp of carabelli was invariably bilateral symmetrical.19

 

Conclusion
Accessory cusp or cusp of carabelli was common morphological variation seen on mesiopalatal cusp of maxillary first or second molar. This study contributed in health professional students to see the prevalence of cusp of carabelli in those subjects. We observed that there was a variation in pattern of carabelli in both males and females and also there was a difference between right side and left of maxillary molars. Hence cusp of carabelli can be used as a significant tool in dental anthropology as well as identification of ethnicity.

 

Author Affiliations

1.Dr. Durga Susmitha Vaddi, Internee, 2.Dr. T Pallavi, Internee, 3.Dr. Kiran Kumar K, Professor, 4.Dr. B.V. Ramana Reddy, Professor and HOD, Department of Oral Pathology, SIBAR Institute of Dental Sciences, Guntur 560009, Andhra Pradesh.

 

References

1.     Mavrodisz K, Rozsa N, Budai M, Sos A, Pap I, Tarjan I. Prevalence of accessory tooth cusp in a contemporary and ancestral Hungarian population. Eur J Orthod. 2007;29(2):166-9.

2.     Mitchell WH. Case report. Dental Cosmos 1892;34:1036.

3.     Salazar-Ciudad I, Jernvall J. A gene network model accounting for development and evolution of mammalian teeth. Proc Natl Acad Sci USA. 2002;99:811620.

4.     Jernvall J. Linking development with the generation of novelty in mammalian teeth. Proc Natl Acad Sci USA. 2000;97:26415.

5.     King NM, Tsai JS, Wong HM. Morphological and numerical characteristics of the southern Chinese dentitions. Part II: Traits in the permanent dentition. Open Anthropol J. 2010;3:7184.

6.     Pretty IA, Sweet D. A look at forensic dentistry-Part 1: The role of teeth in the determination of human identity. Br Dent J. 2001;190:35966.

7.     Snyder RG, Dahlberg AA, Snow CC, Dahlberg T. Trait analysis of the dentition of the Tarhumara Indian and Mestizos of the Sierra Madre Occidental, Mexico. Am J Phys Anthropol.1969;31:65-76.

8.     Scott GR. Population variation of carabellis trait. Hum Biol. 1980;52:63-78.

9.     Mellor JK, Ripa LW. Talon cusp: A clinically significant anomaly. Oral Surg Oral Med Oral Pathol. 1970;29:225-8.

10.  Mavrodisz K, Rozsa N, Budai M, Soos A, Pap I, Tarjan I. Prevalence of accessory tooth cusps in a contemporary and ancestral Hungarian population. EurJ Orthodontics. 2007;29:166-9.

11.  Levitan ME, Himel VT. Dense evaginatus literature review. Pathophysiology and comprehensive treatment regimen. J Endod. 2006;32:1-9.

12.  Jerwall J, Jung HS. Genotype, phenotype and development biology of molar teeth characteristics. Year Phys Anthropol. 2000;48:171-90.

13.  Hunter JP, Steinberg GD, Weston TC, Durner R, Betsinger TK. Model of tooth morphogenesis predicts carabelli cusp expression, size and symmetry in humans. PolS One. 2010;5(7):1184-8.

14.  Kraus BS. Carabellis anomaly of the maxillary teeth- observation on Mexicans and Papago Indians and an interpretation of the inheritance. Am J Human Genet. 1951;3(4):348-55.

15.  Yaacob H, Narnibar P, Naidu MDK. Racial characteristics of human teeth with special emphasis on the Mongoloid dentition. Malaysian J Pathol. 1996;18(1):1-7.

16.  Dablberg A. Analysis of the American Indian dentition: In Brothwell D, Editior: Dental Anthropology, New York: Pergamon; 1963. pp. 149-77.

17.  Salako NO, Bello LL. Prevalence of the carabelli trait in Saudi Arabian children. Oodonto Stomatologic Tropical. 1998;21(84):11-4.

18.  Kannapan JG, Swaminathan S. A study on a dental morphological variation tubercle of carabelli. Indian J Dent Res. 2001;12:145-9.

19.  Mosharraf R. Prevalence of the carabelli trait in Iranian adolescents. SRM J Res Dent Sci. 2013;4(1):12-5.

 

Corresponding Author:

Dr. Kiran Kumar Kattappagari,

Professor, Department of Oral Pathology,

SIBAR Institute of Dental Sciences,

Guntur 560009, Andhra Pradesh,

Ph: +91 9493825758

E-mail: drkirankumark123@gmail.com


 

 

 

 

 

Source of Support: Nil, Conflict of Interest: None Declared.

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Indexed In Ebscohost Index Copernicus UlrichsWebOpenJGateGoogle Scholar DOAJ Gale Cengage Learning Research Gate
line
System Developed By Stanford University Arizona State University Simon Fraser University Canadian Centre For Studies In Publishing University of British Columbia - Faculty of Education
W3C XHTML v1.0 Verified W3C verified Valid CSS v2.1 PHP5 Enabled Made On Mac Apache Enabled MySQL Powered
Published by Celesta Software Pvt Ltd