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Dental paleoradiology: applications in paleoanthropology and paleopathology

Kurt W. Alt, DMD; Carlos H. Buitrago-Tllez, MD

Objective: To study the emergent role of computed tomography (CT) in the evaluation of ancient human dental remains. Methods: We conducted a paleoradiologic study of the skeletal remains of 4 individuals dating from the Pliocene to the Medieval Period. The specialized software used permitted comprehensive analyses of the bone structures of the dental remains and the performing of three-dimensional stereolithographic reconstructions. Results: Paleoradiology helps demonstrate the detailed anatomy of fossil specimens, which permitted us to assign 1 of the specimens that we studied to the genus Homo, and not Australopithecus. Tooth and mandibular disease were identified in 2 specimens. Conclusion: CT is an essential noninvasive and nondestructive tool for the evaluation of human dental remains. Objectif : tudier le rle mergent de la tomodensitomtrie dans lvaluation des restes dentaires humains anciens. Mthodes : Nous avons procd une tude palo-radiologique des restes squelettiques de quatre corps datant de lpoque pliocne la priode mdivale. Le logiciel spcialis utilis a permis lanalyse dtaille de la structure osseuse des restes dentaires et la ralisation de reconstructions strolithographiques en trois dimensions. Rsultats : La palo-radiologie aide dmontrer lanatomie dtaille des spcimens fossiles, ce qui nous a permis dattribuer un des spcimens que nous avons tudis au genre Homo et non laustralopithque. Une maladie des dents et de la mandibule a t dcele chez deux spcimens. Conclusion : La tomodensitomtrie est un outil non effractif et non destructeur essentiel lvaluation des restes dentaires humains. Alt Institute of Anthropology, University of Mainz, Mainz, Germany; Buitrago-Tllez University Institute of Radiology, University Hospitals Basel, Basel, Switzerland. Address for correspondence: Dr. Kurt W. Alt, Institute of Anthropology, University of Mainz, Mainz, Germany; fax 496131-3925132; altkw@mail.unimainz.de Submitted Apr. 7, 2004 Accepted May 19, 2004
Can Assoc Radiol J 2004;55(4):258-63.

ince the discovery of x-rays by Roentgen in 1895, radiologic methods have been used as an important diagnostic medium in the study and display of anthropological findings. Radiologic methods allow the nondestructive evaluation of human remains or even cultural objects.16 The noninvasive nature of radiologic studies, especially since the introduction of computed tomography (CT), has been of special advantage in the study of prehistoric populations and mummies and in paleopathology.710 We have used modern radiologic techniques and software developments for the following purposes:1114 Noninvasive analysis of valuable archeological objects or finds (e.g., mummies); Further study and confirmation of findings in paleopathologic diagnosis (e.g., osseous tumours); Finding of diagnostic clues concerning healed diseases or signs of the healing process during life (e.g., healed holes made by trepanation); and Use of spiral CT data to obtain 3-dimensional (3D) stereolithographic models from important finds or objects (e.g., skulls). Dental anthropology provides an excellent view into biologic, ecologic and cultural aspects of the past, which helps us detect and understand individuality, human behaviour, living conditions and environments. Ancient teeth studies have contributed tremendously to progress in the study of human phylogenic and ontogenic development, co-evolution of
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form and function, and dental paleopathology.15 Among these studies, paleoradiology plays a significant role by enabling noninvasive analyses, primarily of human remains (fossil specimens, skeletons, mummies) but also of extant and extinct primates, as well as other mammals. Dental paleoradiology includes classic conventional radiology (e.g., panoramic radiography16) and computed tomographic studies. Serial CT data permit 3D morphometry and computer-assisted reconstruction of skulls, jaws and bones.1720 The application of dental CT in anthropology enables the display and measurement of the bone structure of jaws, especially the evaluation of the size of the maxillary sinuses, the thickness of the jawbone and the course of the alveolar canal. Of further interest are aspects of dental development (e.g., crown formation, root extension, stages of deciduous and permanent dentition), quantitative analyses of crown and root dimensions, the interradicular distance, and the topography and morphology of roots. In addition to ontogeny and phylogeny, dental CT is helpful for the extension and validation of results in paleopathologic diagnostics, such as anomalies, post-traumatic changes, periapical lesions, osteomyelitis, bone cysts and malignancies, and also for the calculation of CT data for the preparation of 3D stereolithographic duplicates.

Between 1999 and 2003, we conducted a paleoradiologic study of the human skeletal remains of 4 individuals, dating from the Pliocene to the Early Middle Ages. This report emphasizes the usefulness of a specialized dental CT software program in the analysis of dentoskeletal relations in multiplanar anatomical overviews. This CT software (Dental CT, Siemens Medical Solutions, Erlangen, Germany) enables comprehensive qualitative and quantitative analyses of bone struc-

tures from dental remains.21 Moreover, 3D reconstructions may be performed. Axial computed tomographic image data were generated with single-slice helical CT scanners (Somatom Plus S, Siemens Medical Solutions, or CT I-Pro, GE Medical Systems, Milwaukee, Wis.). Single-slice spiral CT was performed using a thin-slice collimation technique (1-mm slice collimation, 2-mm table increment, pitch 2, 1-mm reconstruction interval, 120 kV, 80mA). Secondary 2-dimensional (2D) multiplanar reconstructions were available based on the most suitable 3D reference images. 3D computed tomographic reconstructions were documented using the surface rendering technique.22 The threshold value was set according to the surface density of the object and lay between 100 Hounsfield units (HU) and 800 HU. In a further processing of CT data, files using dental CT software, reformation of panoramic views and paraxial slices of the lower and upper jaw were obtained.21 Special software was developed for the analysis of implantation surgery. A random curve generated by marking points along the mandibular arch defines the central panoramic slice, parallel to which up to 7 more panoramic slices were selected (Fig. 1A). The paraxial slices were reconstructed perpendicular to the central curve based on thin 1-mm computed tomographic imaging performed with the gantry positioned upright and parallel to the alveolar margin (Fig. 1B). The presentation of final images can be selected as a panoramic view or as a multi-image parasagittal display with reference markings (Fig. 1C, Fig. 1D).

Case 1. The australopithecines jaw and teeth
In 1996, members of the Hominid-Corridor-ResearchProject discovered a 2.5 million-year-old maxilla fragment of a hominid fossil (RC 911) in Malema, Malawi. The measurements of the teeth and jaws showed

FIG. 1: Computed tomographic (CT) images of a mandible specimen with a healed fracture. A: Axial reference image with a display of panoramic lines according to the defined case-specific arch line. B: Axial reference slice with a display of paraxial cutlines. C: Single panoramic view shows the healed fracture on the mandibular body on the left and a retained third molar on the right side. D: Multi-image display of paraxial cutlines at the level of the mental foramen on the right. CARJ VOL. 55, NO. 4, OCTOBER 2004 259


significant affinities to the taxon Paranthropus (Australopithecus) boisei.23 Scanning electron microscope studies of microwear features of the teeth, such as enamel pits and scratches, did not reveal a specific wear pattern that would support the classification of Australopithecus. Because of the poor preservation of the occlusal surfaces, it was not possible to recon-

struct the thickness of the enamel. At 56 m, the diameter of the enamel prisms lies within the range of variation of modern humans. The space between 2 CT sections was 1 mm for the maxilla fragment.24 PAN 3 is a panoramic view of the jaw, which runs directly through the alveoli of the 4 buccal roots and shows their shapes and sizes (Fig. 2A). An axial slice of the

FIG. 2: Maxilla fragment (RC 911) from Malema, Malawi. A: Panoramic views of the maxilla based on an axial slice of the roots (buccal view). B: Axial slice through the molars. C: Parasagittal orthoradial 2D reconstructions. D: 3D reconstruction using the surface rendering technique (buccal view). Reproduced with permission from Cuvillier.24 260 JACR VOL. 55, No 4, OCTOBRE 2004


mandible specimen (Fig. 2B) shows the situation of the root region of the second molar. The compact bone is substantially thicker on the palatal side as opposed to the vestibular side, according to the parasagittal reconstructions (Fig. 2C). The palatal and distobuccal roots are represented. The interradicular distance between the root tips measures 15 mm, the length of the distobuccal root (measured from the root tip to the bifurcation) is 17 mm and that of the palatine root is 16 mm. The distobuccal diameter of the roots measures 7 mm and the palatal diameter, 8 mm (at the bifurcation). All the dimensions of the third molar (not pictured) are smaller. The 3D reconstruction of the maxilla provides information about the fossils shape and size and the decomposition

processes on the fossil. The 3D data were used to prepare a stereolithographic replica of the original find (Fig. 2D).

Case 2. The Homo erectus mandible

In 1991, a well-preserved human mandible was found at the site of Dmanisi, Georgia, in the Caucasus (85 km south-west of Tiblisi).25 The assumed maximum age of 1.8 million years, based on archaeological and stratigraphic results, contradicts the morphological patterns or, to say it unscientifically, the morphology of the mandible and the teeth looks too young or modern.20 The CT investigation of the Dmanisi fossil was performed on a precise plastic cast, because there was no

FIG. 3: Mandible from Dmanisi, Georgia, the Caucasus. A: Parasagittal orthoradial 2D reconstructions of the mandible cast show the shape of the mandible and indicate buccolingual measurements. B: Frontal view of the 3D reconstruction of the mandible using the surface rendering technique. C: Occlusal view of the 3D reconstruction of the mandible using the surface rendering technique. Reproduced with permission (Beitr Archozool Prhist Anthrop 1997;1:124-33).27

FIG. 4: Skull from Bad Drrenberg, Merseburg-Querfurt, Germany. A: Radiograph of the frontal part of the maxilla. There are periapical granulomas on both central incisors. B: Panoramic radiograph of the skull. C: 2D coronal CT reconstruction shows the maxillary sinus. D: 3D reconstruction of the skull (lateral view). CARJ VOL. 55, NO. 4, OCTOBER 2004 261


possibility of studying the original in Georgia using this method. 26,27 This pilot study should indicate whether CT studies of casts, which are much more easily available than original fossils, give adequate and informative morphological and metrical results. A very detailed comparison of the final images in multiimage display with reference markings delivers much more information than that usually available (Fig. 3). The study of the morphological tooth features and the mandible itself (e.g., the chin region [mentum, symphyseal tuber], the thickness and height of the symphysis and the mandibular corpus, and the position of the mental foramen) allows a more or less clear distinction of the Dmanisi fossil from the genus Australopithecus and its definite classification as a member of the genus Homo.

shows periapical lesions on both gangrenous central incisors (Fig. 4A). Starting from the excessive attrition that penetrated the pulp cavity, the infection spread along the pulp canal into the periapical region involving the alveolar bone (local otitis). The focal bone resorption caudal to the spina nasalis anterior may possibly be a sequela of a nasolabial abscess. As also displayed in the panoramic radiograph (Fig. 4B), CT (Fig. 4C) shows another focal area of osteolysis at the right fossa canina that may be secondary to an infectious sinusitis. In this case, the diagnosis was more challenging because of the presence of soil matrix.

Case 4. Odontogenic infection of the mandible osteomyelitis in an Early Medieval skeleton

These female adult remains dating from the fifth to the seventh century AD were found in a medieval cemetery at Schretzheim, south Germany (grave 570). 30 Radiologic findings suggest a chronic osteomyelitis of the mandible, most likely secondary to carious teeth, as shown on the radiograph of the right mandible (Fig. 5A). Dental CT with 2D reconstructions demonstrated a chronic osteomyelitis affecting the alveolar canal. Panoramic reconstruction through the alveolar canal and the root of the second right molar showed an osteomyelitis of the mandible with periapical lesions and an involucrum on the right side (Fig. 5B). Osteomyelitis usually does not heal without treatment. Since antibiotics were not available in ancient times, severe complications of infection may have often occurred in early populations, more than even current reports from skeletal remains may suggest. Most of those individuals may have died because of the lack of antimicrobial treatment.28

Case 3. Oral pathology of a Mesolithic skeleton

In the past, when modern antibiotics were unknown, infectious diseases originating from periapical inflammations quite often progressed rapidly to lifethreatening situations with a (possibly) lethal outcome.28 Such a scenario became evident in the skull of a woman from Bad Drrenberg, Merseburg-Querfurt, Germany. The burial, excavated in 1934, dates from the Mesolithic period, ca. 6000 BC. The upper first incisors of the woman exhibit a form of attrition known as lingual surface attrition of the maxillary anterior teeth. It was first described by Turner and Machado,29 who defined it as the result of progressive wearing of upper anterior lingual tooth surfaces without corresponding wear on the lower teeth. The observed modifications by excessive attrition are regarded as an indicator of teeth having been used as a tool or third hand. The radiograph of the frontal part of the maxilla

FIG. 5: Skeleton from Schretzheim, south Germany. A: Radiograph of the right side of the mandible shows radiolucency without a radiopaque margin and resorption on the root tip suggesting the incidence of dental granulomas. B: Panoramic reconstruction shows the continuity of the periapical lesion with the mandibular canal on the right side. 262 JACR VOL. 55, No 4, OCTOBRE 2004


Conventional radiography and CT are useful tools in nonclinical applications such as paleoanthropology, physical anthropology, and the study of mummies, paleopathology and archaeological artifacts. Dental paleoradiology contributes to the investigation of teeth, jaw and skull fossils. We reviewed the emergent role of CT as an essential noninvasive and nondestructive tool for the evaluation of human dental remains. Our examples demonstrated the potential use of medical imaging in paleoanthropology and paleopathology. Paleoradiology helps to demonstrate the fine detailed anatomy of a fossil specimen. Computed tomographic data can be used to replicate fossil finds using stereolithographic techniques and for the study of comparative anatomy that allows a differentiation between apes and humans such as Homo sapiens or Homo neanderthalensis. Finally, paleoradiology is an essential diagnostic method for the detection of diseases of the teeth and jaw, such as infections, in ancient populations.

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