Dental Panoramic Tomograms Research Articles

Prevalence of condylar findings and their association with TMD and missing teeth - a study of 1915 dental panoramic tomograms among 46-year-old cohort subjects

ABSTRACT Objective To investigate the prevalence of radiological findings of condyles and their association with temporomandibular disorders (TMD) and missing teeth in the Northern Finland Birth Cohort 1966 study population. Methods Altogether 1915 subjects volunteered clinical and radiological examination and answered questionnaires. Condylar changes were evaluated using dental panoramic tomograms (DPT). Association of condylar changes with TMD diagnosis, missing teeth and rheumatic diseases was analysed using Pearson’s chi-square test and Fisher’s exact test. Odds ratio (OR) and 95% confident intervals (CI) were estimated using a binary logistic regression model. Results Most common condylar change was flattening (32.8%). Associations were found between unilaterally flattened condyle and myalgia and arthralgia. No statistically significant associations were found between condylar changes and missing teeth or missing molars. Erosive and deform changes in condyles were associated with juvenile idiopathic arthritis and rheumatoid arthritis. Conclusion Condylar changes in DPTs were not associated with TMD diagnosis or missing teeth among 46-year-old study population. Erosive and deform changes of condyle were shown in patients with rheumatic disease.

Association of Periodontal Disease with Activity of Crohn's Disease.

Crohn's disease (CD) is a chronic inflammatory granulomatous disease that can affect the entire gastrointestinal tract. It is characterized by various extraintestinal manifestations (EIMs), of which oral manifestations (OMs) are often possible. One of the possible OMs is periodontal disease (PD), a chronic inflammatory condition of the supporting tissues of the teeth. This study aimed to show the existence of a mutual relationship between the clinical activity of PD and the clinical and endoscopic activity of CD. One clinical and two endoscopic indexes were used for the assessment of CD activity and clinical attachment loss (CAL), bleeding on probing (BOP), pocket probing depth (PPD), and radiographic bone loss (RBL) in a dental panoramic tomogram to assess PD in CD patients. A total of 38 patients underwent the entire study process, of which 20 patients had CD and 18 patients had CD and PD. Considering all CD activity scores, there were 26 patients with active disease; half of them had PD, and 85.7% of operated patients had active CD. The values of CAL, PPD, BOP, and RBL were higher in active CD patients than those in remission, except for BOP when comparing to the CDAI score, which was higher in those in remission of CD. The results of this study indicate that there is a connection between the activity of CD and worse conditions of the supporting tissues of the gums in the oral cavity, so it is important to keep in mind the necessity of referring patients with CD to a dentist for timely and adequate therapeutic measures.

Prevalence of apical periodontitis in patients with autoimmune diseases: A case-control study.

The purpose of this case-control study was to compare the prevalence of apical periodontitis (AP) in patients affected by autoimmune disorders (AD) (inflammatory bowel disease [IBD], rheumatoid arthritis [RA] and psoriasis [Ps]) with the prevalence of AP in subjects without AD. The prevalences of AP in patients taking biologic medications, conventional medications and no medication were also compared. Eighty-nine patients (2145 teeth) with AD were investigated and the control group included 89 patients (2329 teeth) with no systemic diseases. Full dental panoramic tomograms were used to determine the periapical status of the teeth. Additional variables investigated included patient's socio-demographic characteristics, medications taken by AD patients, the decayed, missing and filled teeth (DMFT) index. The chi-square test and logistic regression analysis were used to evaluate the correlation between AD and AP. p-Values lower than .05 were considered to be statistically significant. The prevalence of AP was 89.9% in AD patients and 74.2% in control subjects (odds ratio [OR]=3.75, p=.015). The DMFT score was found to be significantly higher in the AD group (p=.004). Patients with RA had the highest risk of being affected by AP, whereas those with IBD had the lowest risk. Multiple binary logistic regression analysis indicated that the teeth of AD patients who were not taking any medication or were being treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) had a higher risk of being affected by AP than did the teeth of the control subjects (OR=1.42 and OR=2.03, respectively; p=.010). The teeth of patients taking conventional DMARDs (cDMARDs) were less affected by AP compared with those of patients taking bDMARDs. Patients with AD, whether treated or not with biologic medications, showed a higher prevalence of AP than did those in the control group. The DMFT index score, which was higher in AD patients compared with controls was identified as a significant predictor of AP prevalence.

Third Molar Development Reliability for Radiographic Age Estimation (Demirjian's Method)

Background: The determination of age after a person has died is a potential stage in the postmortem profiling process that leads to definitive identification. Demirjian's method, designed for use with children, establishes maturity scores as a function of age using eight developmental stages and polynomial functions to estimate age as a function of the score. Aim: This study's purpose was to examine the accuracy of age estimate by employing Demirjian's eight teeth approach following French maturity scores & an Indian-specific formula generated from third molar growth phases by use of orthopantomograms. Materials and Methods: 30 participants, each with a known chronological age and gender, had dental panoramic tomograms taken, which were then assessed using Demirjian's standards. The Indian method and the Demirjian formula were used to calculate ages. The P values obtained from the statistical analysis, which included the Chi-square test and the ANOVA test, were statistically significant. Results: Both Indian and Demirjian's formulations had an average underestimate of age. Since the Indian method had a reduced mean absolute error, it may be used to estimate ages Additionally, females complete dental development sooner than boys do since they were faster to reach dental maturity. Conclusion: If population-specific formulae are developed using regression analysis and ethnic and environmental variance is taken into account, more accuracy may be attained. Keywords: chronological age, dental maturity, panoramic, radiographs, third molar,

Image Quality Optimization of Dental Panoramic Tomogram and Lateral Cephalogram: A Pilot Study on Human Skull

Purpose: The purpose of this study was to investigate the effects of varying scanning parameters of DPT and LC on diagnostic performance and quality of the images. Materials and Methods: Clinical evaluations of image quality were performed using an adult human skull with permanent dentition. Dental panoramic tomogram (DPT) and lateral cephalogram (LC) images were obtained using two different radiographic machines Instrumentarium 300OP taken at Sungai Buloh (SB) and Sirona Orthophos 3D taken at Puncak Perdana (PP) by varying tube voltages. Two orthodontic residents assessed images based on overall quality using a five-point rating scale and diagnostic performance by detection of anatomical landmarks. The correlations between radiation doses and diagnostic value of the images were analyzed using Pearson’s Correlation Test. Univariate analysis was calculated for the evaluation for image quality. Intra-class Correlation Coefficient (ICC) was used to test for intra-rater and inter-rater reliability. Results: Both modalities taken at both centers showed negative correlation between dosage and detection of anatomical landmarks except for LC SB. All images were rated at least with median of 3= more than adequately presented regardless of the radiation dosage except for DPT PP (median 5= inadequately presented). Conclusion: Lower dosage parameters should be used when taking DPT and LC as images appeared darker, lower in quality and less anatomical landmarks can be detected at higher scanning parameter.

Predictors of osteoradionecrosis following irradiated tooth extraction

BackgroundTooth extraction post radiotherapy is one of the most important risk factors of osteoradionecrosis of the jawbones. The objective of this study was to determine the predictors of osteoradionecrosis (ORN) which were associated with a dental extraction post radiotherapy.MethodsA retrospective analysis of medical records and dental panoramic tomogram (DPT) of patients with a history of head and neck radiotherapy who underwent dental extraction between August 2005 to October 2019 was conducted.ResultsSeventy-three patients fulfilled the inclusion criteria. 16 (21.9%) had ORN post dental extraction and 389 teeth were extracted. 33 sockets (8.5%) developed ORN. Univariate analyses showed significant associations with ORN for the following factors: tooth type, tooth pathology, surgical procedure, primary closure, target volume, total dose, timing of extraction post radiotherapy, bony changes at extraction site and visibility of lower and upper cortical line of mandibular canal. Using multivariate analysis, the odds of developing an ORN from a surgical procedure was 6.50 (CI 1.37–30.91, p = 0.02). Dental extraction of more than 5 years after radiotherapy and invisible upper cortical line of mandibular canal on the DPT have the odds of 0.06 (CI 0.01–0.25, p < 0.001) and 9.47 (CI 1.61–55.88, p = 0.01), respectively.ConclusionExtraction more than 5 years after radiotherapy, surgical removal procedure and invisible upper cortical line of mandibular canal on the DPT were the predictors of ORN.

Exploring the relationship between COVID-19 and oral health by radiographic examination.

Design Analytical retrospective study aimed at revealing the relationship between dental damage stage (DD Stg) and the severity of COVID-19 disease. This study was conducted over four months between 10 March 2020 and 15 July 2020 at the University of Health Sciences department at the Abdulhamid Han Training and Research Hospital Dental Services in Turkey.Sample selection A total of 137 patients were included in this study taken from a cohort of 1,516 patients with a positive polymerase chain reaction (PCR) COVID-19 test. In order to meet the inclusion criteria, patients must have been referred to the dental outpatient department and have a dental panoramic tomogram available for examination.Data analysis A new radiographic staging tool was developed by the authors, informed by previous tools. Following radiographic analysis, participants were allocated to a DD Stg (0-3). Multiple statistical analyses were conducted on the data including Pearson correlation analysis, Spearman correlation analysis and a multiple regression analysis.Results Those participants in DD Stg 3 were significantly older than the other groups; those in DD Stg 2 and 3 had significantly higher presence of chronic disease and evidence of more carious teeth. Those in DD Stg 2 and 3 had a statistically higher number of hospitalisations due to COVID-19 when compared to those in DD Stg 0 and 1, with DD Stg 3 having the highest number overall as well as having a significantly higher mortality rate. Furthermore, those in DD Stg 0 had fewer symptoms associated with COVID-19 compared to the other groups.Conclusions The results show there may be a remarkable association between severity of COVID-19 symptoms and oral health; however, care must be taken when interpreting these results as age is clearly a serious confounding factor and no clinical examination was undertaken.

Development of a Radiographic Index for Periodontitis.

The use of radiographic indices is noticeably diminished due to the lack of simplicity and standardisation among the existing ones. The aim of this study was to introduce a radiographic index to aid clinicians in determining the extent and severity of interproximal alveolar bone loss (iABL), in relation to individual root lengths, among patients suffering from periodontitis. A retrospective analysis of 50 anonymised dental panoramic tomograms (DPTs) of patients with periodontitis was conducted. Visual interpretation of iABL was recorded by a single investigator and by 20 volunteering clinicians for the ‘worst site’ in each quintet. Results were compared to a gold standard quantification method. Intra-examiner and inter-examiner agreement were measured using the Kappa coefficient and the intra-class correlation coefficient, respectively. Validity was assessed using Cramér’s V test. The mean intra-examiner agreement on the severity and pattern of iABL was 0.808 (K) and 0.802 (K), respectively. A stronger overall inter-examiner agreement was noted when the severity in contrast to the pattern of iABL and presence/absence of furcation involvement were analysed. The statistically significant total mean agreement values from this correlation coefficient were 0.892 and 0.739, respectively. A very strong association between all the visual interpretations carried out by all participants and the gold standard measurements was evident. Within the limitations of this study, the proposed radiographic index may serve as a simple, yet valid and reliable, adjunctive screening tool to further assist clinicians in determining the extent and severity of iABL in patients with periodontitis.

Effects of scanning parameters reduction in dental radiographs on image quality and diagnostic performance: A randomised controlled trial.

To investigate the effect of reducing scanning parameters of digital dental panoramic tomogram (DPT) and lateral cephalometric (LC) radiographs on quality and diagnostic performance of the images. Single-centre prospective two-arm parallel randomised controlled trial. Orthodontic Clinic, Faculty of Dentistry, Universiti Teknologi MARA, Selangor, Malaysia. Adult orthodontic patients aged 18-35 years, indicated for DPT and LC, who were fit and healthy with a body mass index of 18.5-25.0, not contraindicated to radiographic examination, not pregnant, and did not have a history of facial or skeletal abnormalities or bone diseases were included. Thirty-eight adult orthodontic patients were randomised into control and intervention groups. DPT and LC radiographs in the control group were obtained using standard scanning parameters as prescribed by the manufacturer using Orthopantomograph® OP300 by Instrumentarium. Scanning parameters in the intervention group were reduced by 60% for DPT (60 kV, 3.2 mA) and 30% for LC (85 kV, 8 mA). A five-point rating scale was used for the assessment of image quality. Images were evaluated for diagnostic performance by detection of anatomical landmarks. Mann-Whitney test was performed to compare the quality and diagnostic performance of the images and the observer agreement was assessed using the intraclass correlation coefficient (ICC). For image quality, the control group produced slightly lower median scores (DPT 2.0, LC 2.0) compared to the intervention group (DPT 2.0, LC 3.0). For diagnostic performance, both groups showed similar median scores (DPT 21.0, LC 32.0). The differences between control and intervention groups for both modalities were not statistically significant. The average scores for intra-observer agreement were excellent (ICC 0.917) and inter-observer agreement was good (ICC 0.822). Minimising radiation exposure by reducing scanning parameters on digital DPT by 60% and LC by 30% on Intsrumentarium 300 OP did not affect the quality and diagnostic performance of the images. Thus, scanning parameters on digital DPT and LC should be reduced when taking radiographs.

Is juxta-apical radiolucency a reliable risk factor for injury to the inferior alveolar nerve during removal of lower third molars?

The aim of this study was to find out if juxta-apical radiolucency (JAR) is a reliable risk factor for injury to the inferior alveolar nerve (IAN) during removal of lower third molars. We designed a cohort study of patients whose dental panoramic tomograms (DPT) had shown JAR before complete removal of lower wisdom teeth. The outcome variable was postoperative permanent neurosensory disturbance of the IAN. A total of 39 patients (50 lower third molars) were identified and screened for permanent neurosensory disturbance. None reported any permanently altered sensation 18 months after the operation. Based on our group, the presence of JAR does not seem to be a reliable predictor of the risk of permanent injury to the IAN during removal of lower third molars.

The association between chronological age, skeletal maturity and dental maturity

Abstract Aim The aim of this study was to analyse the correlation between skeletal and dental maturity. Materials and methods The Dental Panoramic Tomogram and Lateral Skull Radiographs of 381 subjects aged between 8.20 years and 17.96 years were examined. Calcification stages of all the teeth on the left hand side and all third molars were determined according to Demirjians 8-stages, whilst the Cervical Vertebral Maturation (CVM) Index was adopted for the assessment of skeletal maturity. Dental age (DA) was determined using the simple weighted average method. Results There was no significant difference between DA and chronological age (CA) of the male and female groups. The Spearman rank correlation between CA and CVM was moderate, whilst the correlation between DA and CVM was weak. A moderate correlation was found between the dental calcification stages and CVM for the upper right third molar in males. Conclusions The average CA of females at every CVM stage was below that of males, confirming that females undergo earlier skeletal maturation. The similarity between CA and DA confirms that CA can be closely approximated by DA. The low correlations between CA and DA with CVM suggest that these variables should not be used in determining the growth status or potential of the individual.

Accuracy of Different Dental Age Assessment Methods to Determine Chronological Age among Malay Children

Willems method is the most common method used for dental age assessment among Malaysian children. London Atlas method was recently introduced in 2010 and there was no study conducted using this method for Malaysian children. This study was conducted retrospectively by analyzing 150 digital dental panoramic tomograms of 5-, 10- and 15-year-old healthy Malay children attending Faculty of Dentistry, International Islamic University Malaysia within the period from 2012 to 2016. The mean age estimated using Willems method and London Atlas method were compared to the mean chronological age. All data were analysed using RStudio software. The results of the study showed that intra- and inter-examiner reliability were 0.75 and 0.82, respectively. The mean chronological age for 5, 10- and 15-year-old groups were 5.49, 10.22 and 15.39, respectively. Significant differences were observed for 5- and 10-year-old groups between London Atlas method (P<0.05) and Willems method (P<0.05) when compared to chronological age. However, no significant difference was observed for 15-year-old group (P>0.05). Willems method is more accurate in determining chronological age for the 5- and 10-year-old groups compared to London Atlas method.

Pathological Findings on Dental Panoramic Tomograms of Edentulous Patients Seen at a University Hospital

Pathological Findings on Dental Panoramic Tomograms of Edentulous Patients Seen at a University Hospital

Dental age estimation of children and adolescents: Validation of the Maltese Reference Data Set

The purpose of this study was to validate a Reference Data Set, developed from the radiographic archives of the Dental Department, Mater Dei Hospital, Malta, for Dental Age Estimation of the Maltese population and to assess the accuracy of the method. Dental Panoramic Tomograms of 100 male and 100 females were selected. Tooth Development Stages were recorded for all 16 permanent teeth on the left and both third molars on the right. Summary and percentile data were calculated for each Tooth Development Stage and the Dental Age of each subject estimated using the unweighted average method. The distribution of the differences between the Dental and Chronological age was analysed. There was no statistically significant difference between the means of the Dental and Chronological ages and the mean differences were within acceptable limits. The conclusion was that the Dataset is valid for the Maltese population and the method used gives adequate accuracy.

Prevention of bisphosphonate-related osteonecrosis of the jaws in patients with prostate cancer treated with zoledronic acid - A prospective study over 6 years.

To explore the preventive effect of a prophylactic oral and maxillofacial treatment to reduce bisphosphonate associated necrosis of the jaws (BRONJ) in metastatic prostate cancer (PC) patients treated with zoledronic acid (4.0mg i.v./months). 253 PC patients with bone metastases were prospectively randomized. All patients received baseline assessments including a dental panoramic tomogram. Group A was monitored and treated where deemed necessary by the patient's dentist and were re-evaluated once a year. In group B patients were monitored and treated where necessary by the authors at 12week intervals. We compared the incidence rate per year (IR) and incidence proportion (IP) in both cohorts and assessed independent risk factors for BRONJ. Patients in group A were evaluated 3.2 (range 2-4) vs. 6.8 times (range 4-24) in group B. A significantly higher proportion of dental extractions was performed in group B vs. A (26.7% vs. 22.7%, p=0.006). A BRONJ was detected with an IP of 23.3% vs. 2.2% in group A vs. B, revealing a 2.59 fold higher relative risk for group A (p=0.01, 95% CI 0.01-0.56). The IR in group A was 0.073cases/year while the IR in group B was significantly decreased by 82% to 0.0131 (p<0.001). Extraction therapy was the only independent risk factor for BRONJ (p<0.0001; 95% CI 21.22-189.06). Preventive oral and maxillofacial treatment before bisphosphonate application combined with 3-monthly dental follow-ups significantly reduces the occurrence and risk of BRONJ in PC patients. Therefore this approach should be implemented in the specific treatment algorithms.

Dental age assessment of Maltese children and adolescents. Development of a reference dataset and comparison with a United Kingdom Caucasian reference dataset

The purpose of this study was to develop and validate a Reference Data Set for Dental Age Assessment of the Maltese population and compare the mean Age of Attainment to a UK Caucasian Reference Data Set.The Maltese Reference Data Set was developed from 1593 Dental Panoramic Tomograms of patients aged between 4 and 26 years, taken from the radiographic archives of the Dental Department, Mater Dei Hospital, Malta. Tooth Development Stages were recorded for all 16 maxillary and mandibular permanent teeth on the left side and both permanent third molars on the right, according to Demirjian's staging method. Summary and percentile data were calculated for each Tooth Development Stage, including the mean Age of Attainment. These means were used to estimate the Dental Age of each subject in the study sample using the simple unweighted average method. The estimated Dental Age was compared to the gold standard of the Chronological Age. Comparison of the Maltese and UK Caucasian Reference Data Set was by a series of t-tests, carried out for each paired Tooth Development Stage by gender.The mean Age of Attainment was slightly higher for the Maltese than the UK Caucasians in both males and females. However there was no statistically significant difference between the Chronological Age and Dental Age for either sex.

A study to evaluate the changes in 3rd molar angulation with extraction of four premolars in class II malocclusion therapy

Aim: The objectives of the study are to evaluate the changes in third molar angulation during orthodontic treatment with extraction of premolars in Class II malocclusions, and to evaluate the relationship between the angulation of third molars and positional changes of incisors and molars. Materials and Methods: This study was conducted on lateral cephalograms and dental panoramic tomograms of 30 patients (mean age 13.48 years) with skeletodental Class II malocclusion treated with four first premolar extractions. Twenty-four cases were treated with edgewise, and six were treated with Begg technique. The changes in the eruption pattern of the third molars were observed at the beginning of the treatment (T1) and at the end of the treatment (T2). The changes in the anteroposterior position of the incisors and molars, original molar space, and mesiodistal third molar angulation were tested by paired t-test. Results: The positional changes of the upper/lower incisors and first molars and original molar space were found similar in edgewise and Begg technique. Original molar space was increased in both jaws during orthodontic treatment. Long axis angle of the upper right third molar due to occlusal plane was increased nonsignificantly. Lower right third molars uprighted significantly. A positive correlation was found between the inclination of the lower right third molars and position of lower incisors and first molars. Conclusion: Treatment with extraction of premolars result in a greater space in the third molar region as a result of the mesial movement of the molars during space closure.

Reliability of Third Molar Development for Age Estimation in Gujarati Population: A Comparative Study

Background: Age assessment may be a crucial step in postmortem profiling leading to confirmative identification. In children, Demirjian’s method based on eight developmental stages was developed to determine maturity scores as a function of age and polynomial functions to determine age as a function of score. Aim: Of this study was to evaluate the reliability of age estimation using Demirjian's eight teeth method following the French maturity scores and Indian-specific formula from developmental stages of third molar with the help of orthopantomograms using the Demirjian method. Materials and Methods: Dental panoramic tomograms from 30 subjects each of known chronological age and sex were collected and were evaluated according to Demirjian’s criteria. Age calculations were performed using Demirjian’s formula and Indian formula. Statistical analysis used was chi-square test and ANOVA test and the Pvalues obtained were statistically significant. Results: There was an average underestimation of age with both Indian and Demirjian’s formulas. The mean absolute error was lower using Indian formula hence it can be applied for age estimation in present Gujarati population. Also, females were ahead of achieving dental maturity than males thus completion of dental development is attained earlier in females. Conclusion: Greater accuracy can be obtained if population-specific formulas considering the ethnic and environmental variation are derived performing the regression analysis.

A novel method of dental panoramic tomogram analysis: A perspective tool for a screening test for osteoporosis

ObjectiveThe purpose of this study was to test a new method of dental panoramic tomogram (DPT) analysis to show the differences of mandibular bone volume and relative bone density (RBD) in order to detect osteoporosis. Materials and methodsA case–control study compared 62 women with osteoporosis (O) and 24 women with osteopenia (o) to a control group of 33 women with normal bone mineral density (N). DPTs were analyzed using an original method resulting in anatomic and RBD indexes as well as using previously described methods: panoramic mandibular index (PMI) and mandibular cortical width (MCW). ResultsOne anatomic and four RBD indexes differed statistically significantly between the group O and N and three RBD indexes differed statistically significantly between o and N. PMI did not show statistically significant differences between the groups. The MCW differed significantly at two measured sites between O and N. ConclusionsAverage values of RBD indexes were statistically significantly different between O and N and also between o and N. Important differences regarding RBD were confirmed using a new and original method of common DPT analysis. This method could serve as a screening tool for osteoporosis.

Radiographic study of delayed tooth development in patients with dental agenesis

The aims of this study were to compare the radiographic development of permanent teeth in a group of children affected by dental agenesis with an unaffected control group and to determine the effects of confounding factors including the severity of the dental agenesis, age, sex, ethnicity, and the number of stages used to estimate dental age. A single-center retrospective cross-sectional study of dental panoramic tomographs was undertaken between July 2007 and April 2008 in a postgraduate teaching school. A total of 139 patients (aged 9-18 years) were recruited from the orthodontic clinic on the basis of predetermined inclusion and exclusion criteria to either a dental agenesis group or a control group. Dental panoramic tomograms were assessed, and the stages of development of the permanent teeth in the left maxillary and left mandibular regions were scored by using the 12 stages of Haavikko and the 8 stages of Demirjian and Goldstein. For each tooth scored, the mean dental age and standard error were determined by using the dental age assessment method, and an estimated dental age for each subject was derived by using the weighted average method. A statistically significant delay in dental age was found in the patients with dental agenesis compared with the control group. The dental age assessment method of Haavikko showed a delay of 1.20 years (SD, 1.74), and the method of Demirjian and Goldstein showed a delay of 1.64 years (SD, 1.75). It was also observed that older patients with dental agenesis had greater delays in tooth formation (P <0.001). With the Haavikko method, for every year of chronologic age, the delay in dental age increased by 0.53 year; with the Demirjian and Goldstein method, the delay increased by 0.48 year. A significant association was seen between the severity of dental agenesis and the delay in dental age (P <0.01). With both methods, for each additional developmentally absent tooth, the dental age was delayed by 0.13 year (lower confidence interval, -0.22; upper confidence interval, 0.35). There was no evidence that sex or ethnicity has an effect on the delay in dental age in patients with dental agenesis. The development of permanent teeth in children with dental agenesis is delayed when compared with a matched control group. The severity of dental agenesis affected the magnitude of the delay (P <0.01). This delay has implications in orthodontic treatment planning and in the estimation of age for legal, immigration, archaeological, and forensic purposes.