Carabelli's trait is a morphological feature that can occur on the protocone of human maxillary molars. This study tests the hypothesis that Carabelli's trait is correlated statistically with the dimensions of the crown's four principal cusps or whether, as a cingular feature, the trait truly accretes onto an otherwise unaffected crown. Computer-assisted image analysis was used to measure the 6 intercusp distances and 12 angular relationships among cusp tips on the permanent first molar of 300 young adult American whites. Carabelli's complex was scored using an 8-grade ordinal scheme. Crown size was quantified in three ways, namely as 1) maximum mesiodistal and buccolingual diameters, 2) the 6 intercusp distances, and 3) the 12 angular cusp arrangements. There was no sex difference in the morphological expression of Carabelli's trait in this sample. Overall crown size and intercusp distances were significantly and progressively larger in molars with larger Carabelli's trait expressions. There are graded size responses between crown size (mesiodistal and buccolingual diameters), sizes of the four principal cusps, and morphological stage of Carabelli's complex, though the statistical relationships are appreciably stronger in males than females. Carabelli's trait occurs preferentially in larger molars. In contrast, angular (shape) relationships among cusp tips are not discernibly affected by trait size in either sex. There is the situation, then, that Carabelli's trait is developmentally correlated with crown size, but with no apparent alteration of cusp arrangements, suggesting that the increases are isometric across the occlusal table. Why the association is much weaker in females remains speculative, but these data provide yet another line of evidence that, within a population, tooth size is associated in a positive fashion with crown complexity.
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