|Year : 2016 | Volume
| Issue : 2 | Page : 115-119
Rugae pattern determination in periodontitis patients: A descriptive study
Vikas Jindal, Atin Mahajan, Neha Mahajan, Amit Goel, Rupinder Kaur, Chahat Puri
Department of Periodontology and Implantology, Himachal Dental College, Sunder Nagar, Himachal Pradesh, India
|Date of Web Publication||15-Jul-2016|
Dr. Chahat Puri
Department of Periodontology and Implantology, Himachal Dental College, Sunder Nagar, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Forensic sciences, a well-established branch in the field of medicine and dentistry always aids in revealing person identity by various methods. Commonly used techniques are analysis of teeth, fingerprints, and DNA comparison, which allowing fast and secure identification processes. However, these techniques cannot always be applied, in some cases, it is necessary to apply different and less known techniques. Aim: The aim of the present study was to determine the uniqueness of palatal rugae pattern in Himachal ethnicity population and whether there is any relation between pattern of rugae in gingivitis, chronic periodontitis, and aggressive periodontitis.
Settings and Design: The present study includes maxillary impressions cast in dental stone of patients attending and were divided into three groups of gingivitis, aggressive periodontitis, and chronic periodontitis. Materials and Methods: In our study, palatal rugae pattern were then evaluated on maxillary casts for the number and shape using calcorrugoscopy. Statistical Analysis: Comparison of means of number of rugae in three groups was done using independent sample t-test, and comparison of mean of different shapes was done employing analysis of variance. The level of significance was fixed at P< 0.05. Results: The most prevalent palatal rugae shape in aggressive periodontitis was found to be angle followed by Sinuous and in chronic and aggressive periodontitis was sinuous followed by line pattern. Conclusions: The differences in rugae shape between the three groups may be attributed to genetic factors, disease progression, and recent shared ancestry has probably rendered their differences to moderate levels.
Keywords: Aggressive periodontitis, calcorrugoscopy, gingivitis, rugae
|How to cite this article:|
Jindal V, Mahajan A, Mahajan N, Goel A, Kaur R, Puri C. Rugae pattern determination in periodontitis patients: A descriptive study. J Int Clin Dent Res Organ 2016;8:115-9
|How to cite this URL:|
Jindal V, Mahajan A, Mahajan N, Goel A, Kaur R, Puri C. Rugae pattern determination in periodontitis patients: A descriptive study. J Int Clin Dent Res Organ [serial online] 2016 [cited 2019 Nov 11];8:115-9. Available from: http://www.jicdro.org/text.asp?2016/8/2/115/186425
| Introduction|| |
Human identification, which is a mainstay of civilization, has become a fundamental in all aspects of human relationship both as social and legal levels. For identifying an individual, various procedures have been combined.
Arbenz stated that person identification is through demonstration of characters that are same now and as observed previously.
One of the most difficult tasks during traffic accidents, terrorist attacks, or in mass disaster situations is always the person's identification. Most common techniques used for identification are visual identification, use of dental records, fingerprints, and DNA comparisons. However, we always strive for that which allows us fast and secure reliable identification. However, limitations associated with visual identification and use of fingerprints are postmortem changes occurs with passage of time, temperature, and humidity.
Therefore, we require an accurate method for identification in those circumstances, one of among them is palatal rugae as it possesses unique characteristics. Filho et al. in 2009 stated that the rugae pattern is as unique to humans as are his or her fingerprints and it retain its shape throughout life, hence it can be useful as an identification method.
Pattern of palatal rugae all through the life remains unchanged. They are not altered by chemicals, heat, diseases, or trauma due to its anatomical position inside the mouth, surrounded by cheeks, lips, tongue, buccal pad of fat, teeth, and bone. Hence, they can be used as an important landmark for forensic identification.
Allen in 1889 was the one who first used palatal rugae for personal identification.
Rugae performs numerous function as physiologically it is involved in the act of deglutition, improve the relationship between food and taste receptors, and contributes to perception of taste, help in speech, and aids in suckling in children.
Silva (1997) and Lysell  presented a system of recording the palatal rugae and incisive papillae. Sassouni  tested the classification; he was able to identify a person without difficulty.
Many researchers pointed out the possibility of changing in rugae pattern with age as well as other outside influences. Changes in pattern may be attributed to any orthodontic treatment, teeth exfoliation or extraction, any surgeries in oral cavity as cleft palate or periodontal surgery or any periodontal disease as gingivitis, chronic periodontitis, and aggressive periodontitis are some of the concerns. Peavy and Kendrick  in 1967 stated that either by the eruption of the teeth or by their loss, not significant changes in form and layout of palatal rugae had been observed, but sometimes following tooth extraction palatal rugae slightly changed their position. However, certain forces and pressure such as pressure exerted by sucking finger/thumb in childhood and during orthodontic treatment may change the pattern of PR. As stated by Limson and Julian, direction of palatal rugae may be locally effected by extractions. Kapali et al. (1997) also observed denture wear, tooth malposition, and palatal pathology could cause alterations in rugae pattern.
Literature search revealed no study in relation to rugae pattern determination in periodontal patients with gingivitis, chronic periodontitis, and aggressive periodontitis. Hence, the aim of present study was to determine the uniqueness of palatal rugae pattern in Himachal ethnicity population and whether there is any relation between pattern of rugae in gingivitis, chronic periodontitis, and aggressive periodontitis.
| Materials and Methods|| |
The present study was conducted at Himachal Pradesh, India. All individuals of the study were from the same geographical population from Himachal Pradesh. The study sample consisted of 120 patients with age group of 20–40 years, divided into three groups as Group I Aggressive periodontitis, Group II chronic periodontitis, and Group III gingivitis with each group consisting of 40 individuals. The approval for the study had been obtained from Institutional Review Board. All subjects were informed about the nature of the study and their informed consent was taken in accordance with the Helsinki Declaration of 1975 as revised in 2000. All the patients were in the age group of 20–40 years. The patients with congenital abnormalities of palate, history of surgery, and trauma in palate were excluded from the study.
Alginate impressions of the maxillary arch of the selected subjects were made in stock trays and poured in Type III dental stone according to the manufacturer's instructions. The rugae seen as elevated impressions were marked on these casts using a fine lead pencil. The rugae pattern was classified on the basis of their shape. The information obtained was recorded in a rugoscopy record or rugograma. The palatal rugae were traced by the principal investigator using Trobo classification [Table 1]. The rugae number also calculated separately on the left side and right side. Number and shape analysis were done with calcorrugoscopy using classification system.
Each identification and measurement was done by one examiner and the readings were repeated three times for each cast. The data thus collected were subjected to statistical analysis.
| Results|| |
The present study investigated the differences in the number and shape of rugae pattern in 120 stone models which were used as ante-mortem record due to simplicity in analysis and minimum fabrication cost. Due to the subjective nature of observation and interpretation in and between observers, examiners have found difficulty in the task of classification of rugae pattern. In our study, angle pattern was seen to be more prevalent on both the left and right side of rugae in aggressive periodontitis followed by sinuous. In chronic periodontitis and gingivitis, the sinuous is more prevalent followed by line pattern. The P value showed a significant difference in the number of rugae pattern in all the groups. According to this study, chronic periodontitis were shown to have less number of rugae than gingivitis, which was statistically insignificant. This result contraindicates with those studies which relates that rugae patterns fixed throughout the life because due to the changes in periodontium, the pattern and number also vary, though we did not find any study correlating or contraindicated it. These findings indicate some racial and disease process differences in rugae pattern.
[Table 2] shows the mean number of rugae pattern of aggressive periodontitis, chronic periodontitis, and gingivitis. For aggressive periodontitis, the mean number of rugae was found to be 6.98 ± 0.74, for chronic periodontitis it was 7.69 ± 0.87, and for gingivitis, it was 8.94 ± 0.09. Mean number of rugae was found to be highest in gingivitis followed by chronic and aggressive periodontitis.
|Table 2: Number of rugae in aggressive periodontitis, chronic periodontitis and gingivitis|
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[Table 3] shows comparison between mean number of rugae pattern of aggressive periodontitis, chronic periodontitis, and gingivitis, which was done using one-way analysis of variance. The analysis showed that there were statistical significant differences in the mean rugae values of different groups. The post hoc analysis showed that the mean number of rugae in gingivitis was higher than that of aggressive periodontitis and chronic periodontitis (P < 0.001). In addition, the mean number of rugae of chronic periodontitis was found to be higher than that of aggressive periodontitis (P < 0.001). The P value was found to be highly significant on comparison for aggressive periodontitis, chronic periodontitis, and gingivitis. However, intra- and inter-group comparison showed nonsignificant findings.
|Table 3: Comparison of mean rugae pattern for aggressive periodontitis, chronic periodontitis and gingivitis|
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[Table 4] shows the mean and standard deviation of shape of rugae pattern on the left side of palate. Two significant findings have been seen in the pattern of angle and sinuous on the left side. In aggressive periodontitis, angle pattern was found to be highest followed by sinuous, which is a significant finding. In chronic periodontitis and gingivitis, sinuous pattern was found to be highest followed by line, which is not significant. The P value on the left side of rugae showed the significant finding in case of aggressive periodontitis.
|Table 4: Mean and standard deviation of shape of rugae pattern on left side for aggressive periodontitis|
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[Table 5] shows the mean and standard deviation of shape of rugae pattern on the right side of palate. Two significant findings have been seen in the pattern of angle and sinuous on right side. All other patterns were nonsignificant. In aggressive periodontitis, angle pattern was found to be highest followed by sinuous, which is a significant finding. In chronic periodontitis and gingivitis, sinuous pattern was found to be highest followed by line, which is not significant. The P value on the right side of rugae showed the significant finding in case of aggressive periodontitis.
|Table 5: Mean and standard deviation of shape of rugae pattern on right side for aggressive periodontitis|
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| Discussion|| |
In population identification, palatal rugae have been widely used due to their special features. Out of the several ways to analyze palatal rugae, we choose intraoral inspection, which is probably the most common, the easiest, and the cheapest method. There are other detailed and complex techniques that include oral photography, calcorrugoscopy, stereoscopy, and stereophotogrammetry. However, because of its simplicity, cost-effectiveness, and reliability, the study of maxillary cast is the most widely used technique.
Although there are many classifications of rugae patterns which are based on shape, size, and length, but difficulties in observing, classifying, and interpreting minute variations in palatal rugae is a serious concern and thus there we need to have a simple and reliable method for classification of palatal rugae. Hence, the classification based on the shape was used for the study. Rugae shape observation is a subjective process, but it is as compared to other methods easy to record and also there is no need of complex instrumentation. In some studies, it has been mentioned among rugae shape and rugae length for rugae determination and discrimination. Rugae shape is better suited which is a discrete variable than the length which is a continuous variable. Hence, in our study, number and shape analysis were done. Number of rugae analysis was done on all the casts for aggressive periodontitis, chronic periodontitis, and gingivitis. We found that average number mean for aggressive periodontitis was 6.98 ± 0.74, for chronic periodontitis it was 7.69 ± 0.87, and for gingivitis, it was 8.94 ± 0.09, which was highest in gingivitis group followed by chronic periodontitis and aggressive periodontitis group. This study is first of its kind.
In our study, angle and sinuous pattern were found prevalent. Angle was seen maximum in aggressive periodontitis followed by sinuous whereas in case of chronic periodontitis and gingivitis, sinuous was maximum followed by line. We did not find any study in relation to chronic and aggressive periodontitis groups. However, gingivitis which corresponds to normal sample in various studies had done on rugae pattern determination. There were various studies on normal sample population as study by Shetty and Premalatha, Hermosilla et al., Balgi et al., and Arora et al. for detection of rugae shape, size, and position.,, Study done on rugae pattern in gender identification by Balgi et al. in 2014.
Arora et al. who compared two different populations and found that there were significant differences seen between rugae pattern of two different populations.
In our study, we compare three groups of same population and we also find significant findings among three groups.
Our study used Trobo classification for shape analysis, which was also used by Hermosilla et al. and they found most prevalent shape of rugae was sinosus followed by curve, line, point, and other varieties. This was in favor of our study where we found sinosus pattern was maximum in gingivitis and chronic periodontitis. However, Hermosilla et al. do not use the term gingivitis anywhere. As there was no study on rugae pattern determination in aggressive population, our study has a significant finding in which angle pattern was seen in maximum in aggressive periodontitis patients and sinuous was in other groups.
Our study correlates the studies by Kapali et al. according to which denture wear, tooth malposition, and palatal pathology could cause alterations in rugae pattern. Similarly, Peavy and Kendrick also stated tooth extraction may sometimes slightly change the position of palatal rugae adjacent to the alveolar arch. However, some events such as finger/thumb sucking in childhood and persistent pressure due to orthodontic treatment may contribute to changes in the pattern of progesterone receptor. Limson and Julian, 2004, stated furthermore that extractions can produce a local effect on the direction of the palatal rugae. Hence, may be change in shape in rugae pattern in diseases conditions such as aggressive periodontitis and chronic periodontitis was the cause of it.
However, Lima conducted a study and concluded that there are no changes in the arrangement or even morphology of palatal rugae. Mild reduction of space among the rugae or even shortening or elongation seen in individuals' undergone surgery, but as such no remarkable damage was seen in any such case. As palatal rugae was thought to be changed by merely wearing complete dentures or trauma, surgical management as well as cleft palate. Presence of fibrous tissue and “calluses” may impair rugae pattern. However, these factors surely do not compromises with identification.
This was contraindicated to our study as the rugae pattern may be changed after the disease progression as chronic periodontitis and aggressive periodontitis were inflammatory conditions and may damage the rugae pattern identification, although we did not find any similar study in which there was a comparison done between these three study groups. Hence, this study should be done within a greater sample size. This was clearly evident from the study that rugae number was more in gingivitis and comparatively less in chronic and aggressive periodontitis group and also we find angle and sinosus pattern prevalent in aggressive and chronic periodontitis within the limits of the study.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]