Left Mandibular Teeth Research Articles

Applicability of Demirjian’s Method and Modified Cameriere’s Methods for Dental Age Assessment in Children

Tooth development is extensively used for age estimation as a part of forensic science. The purpose of this study was to evaluate the reliability of Demirjian's, Cameriere's and modified Cameriere's population-specific regression equation methods in the dental age estimation of West Godavari children. The study included orthopantomograms (OPG) of 60 children of West Godavari district with age group between 9 to 14 years on whom all the three methods were used for age estimation. The OPG were traced with the help of a tracing paper and lead pencil and the appropriate dimensions were measured. Age estimation was done based on canine calcification stage as per Demirjian's method and measurements of the seven permanent left mandibular teeth using Cameriere's formula and modified population-specific regression equation obtained for the South Indian population from Cameriere's formula. The resultant data were subjected to statistical analysis by student's paired t-test. The estimated age was closer to the chronological age when the modified Cameriere's population-specific regression equation was used (p=0.68); whereas, the difference was more in Demirjian's method (p=0.008) followed by Cameriere's method (p<0.001). The method using modified Cameriere's population-specific regression equation exhibited a least significant difference in chronological and dental age assessment in children of West Godavari district as compared to the other two methods.

Lateral Mandibular Incisor Impacted: First Case Report and Literature Review

The presence of a lateral mandibular impacted tooth is quite strange. In the systematic literature review no other cases observed with the same characteristics. Is reported the case of a patient of 16 years with the left mandibular lateral tooth impacted near the apexes of adjacent teeth, which is decided to remove using the surgical technique of labial approach.

Northern Chinese dental ages estimated from southern Chinese reference datasets closely correlate with chronological age.

While northern and southern Chinese are genetically correlated, there exists notable environmental differences in their living conditions. This study aimed to evaluate validity of the southern Chinese reference dataset for dental age estimation applied to northern Chinese. Dental panoramic tomographs of 437 northern Chinese aged 3 to 21 years were analysed. All the left maxillary and mandibular permanent teeth plus the 2 third molars on the right side were scored based on Demirjian’s classification of tooth development stages. Mean and standard error of dental age were obtained for each tooth development stage, followed by random effect meta-analysis for mean dental age estimation. Validity of the method was examined through measures of agreement (95% limits of agreement, standard error of measurement, and Lin’s concordance correlation coefficient) and measure of reliability (Intraclass correlation coefficient). On average, the estimated dental age overestimated chronological age by only around 1 month in both females and males. The Intraclass correlation coefficient values were 0.99 for both sexes, suggesting excellent reliability of the method. Reference dataset for dental age estimation developed on the basis of southern Chinese was applicable for use among the northern Chinese.

Influence of experimental periodontitis on cardiac oxidative stress in rats: a biochemical and histomorphometric study.

The role of oxidative stress in the process of cardiac remodeling, hypertrophy and heart failure is a current topic. The purpose of this experimental study was to investigate the influences of periodontitis on levels of cardiac oxidative stress. Twenty rats were separated into two groups: control and experimental periodontitis (EP). Periodontitis was induced by placing a 3.0 silk suture in the cervix of the left and right mandibular first molar teeth for 5 wk. At the end of the experiment, the animals were killed and blood samples and mandibular and ventricular cardiac tissue samples were collected. Levels of alveolar bone loss were determined using measurements performed on histological slices and radiographies. Left ventricular tissue 8-hydroxy-2'-deoxyguanosine, malonylaldehyde, glutathione peroxidase, total oxidant status, total antioxidant status (TAS) levels and serum paraoxonase-1 activity were evaluated biochemically. Measurements performed on the histological slices and radiographies demonstrated that applying the ligature caused obvious alveolar bone loss. Oxidative damage markers (malonylaldehyde, 8-hydroxy-2'-deoxyguanosine, oxidative stress index: total oxidant status/TAS) were significantly higher, and antioxidant markers (glutathione peroxidase, TAS) were statistically insignificantly higher, in the hearts of rats with EP when compared to the controls. In addition, reduced serum paraoxonase-1 activity was also detected in the EP group. The pronounced increase in cardiac oxidative stress caused by periodontitis was due to an excessive increase in the production of reactive oxygen species, rather than due to decreased antioxidant capacity. The results indicate that periodontitis-related cardiac oxidative stress might be one of the mechanisms that contribute to the pathological process that leads to heart failure.

New models for age estimation and assessment of their accuracy using developing mandibular third molar teeth in a Thai population.

Age estimation using developing third molar teeth is considered an important and accurate technique for both clinical and forensic practices. The aims of this study were to establish population-specific reference data, to develop age prediction models using mandibular third molar development, to test the accuracy of the resulting models, and to find the probability of persons being at the age thresholds of legal relevance in a Thai population. A total of 1867 digital panoramic radiographs of Thai individuals aged between 8 and 23years was selected to assess dental age. The mandibular third molar development was divided into nine stages. The stages were evaluated and each stage was transformed into a development score. Quadratic regression was employed to develop age prediction models. Our results show that males reached mandibular third molar root formation stages earlier than females. The models revealed a high correlation coefficient for both left and right mandibular third molar teeth in both sexes (R = 0.945 and 0.944 in males, R = 0.922 and 0.923 in females, respectively). Furthermore, the accuracy of the resulting models was tested in randomly selected 374 cases and showed low error values between the predicted dental age and the chronological age for both left and right mandibular third molar teeth in both sexes (-0.13 and -0.17years in males, 0.01 and 0.03years in females, respectively). In Thai samples, when the mandibular third molar teeth reached stage H, the probability of the person being over 18years was 100% in both sexes.

Age Assessment in Children: A Novel Cameriere's Stratagem.

AimAge is one of the essential factors in establishing the identity of a person, especially in children. Age estimation plays an important part in treatment planning, forensic dentistry, legal issues, and paleodemographic research. The present study was an attempt to estimate the chronological age in children of Davangere population by using Cameriere’s India specific formula.Materials and methodsThis was a retrospective observational study to estimate the chronological age in children of Davangere population. A total of 150 panoramic radiographs of patients aged between 6 and 15 years, including both sexes, were selected. Age was calculated by measuring open apices of seven right or left mandibular teeth using Adobe Photoshop software.ResultsStatistical analysis was performed to derive a regression equation for estimation of age, which showed that, of the variables X1, X2, X3, X4, X5, X6, X7, s, N0, the variables N0 and X4 were statistically noteworthy. Hence, these two variables were used to derive the linear regression formula:Age = 10.522 + 0.712(N0) - 5.040(X4). The model was found to be statistically significant, F(2, 147) = 207.96, p < 0.001, and accounted for approximately 74% of the variance of age (R2 = 0.739, adjusted R2 = 0.735).ConclusionCameriere’s method can be used for age assessment in children for forensic as well as legal contexts and based on these variables a reliable age estimation equation could be proposed specifically for Davangere population.How to cite this articleAttiguppe PR, Yavagal C, Maganti R, Mythri P. Age Assessment in Children: A Novel Cameriere’s Stratagem. Int J Clin Pediatr Dent 2016;9(4):330-334.

Use of the Tooth Coronal Pulp Index for Recognition of the Pubertal Growth Period.

The present study aimed to investigate the association between the tooth coronal index (TCI) and the pubertal growth stages (PGS) for children and adolescents. A cross-sectional study was performed using retrospectively collected panoramic and hand-wrist radiographs of 262 individuals (125 males, 137 females). The coronal height (CH) and the coronal pulp cavity height (CPCH) of the left mandibular teeth were measured. Then the TCI for which was calculated according to Ikeda et al (1985). The estimated TCI for individuals with the following PGS after Fishman (1987) are: SMI 4 (S), SMI 5 (DP3 cap), SMI 6 (MP3 cap) and SMI 7 (Mp5 cap). The associations between the TCI and the PGS were investigated by correlation coefficient of Spearman's rho, and the validity values for the PGS were computed. Significant correlations were noted between the simple TCI values for premolars and molars and the PGS, and the highest correlation was for the summed TCI for both first and second molars. Utilizing the validity values of the summed TCI for both first and second mandibular molars, the PGS can be predicted as follows: S stage when TCI is 49.17 or lesser, DP3cap stage when TCI is 43.52 or lesser, MP3cap stage when TCI is 36.73 or lesser, and Mp5cap stage when TCI is 26.84 or lesser. The TCI values declined along with the maturational process in children and adolescents. The TCI for both first and second molars was the best predictor of the PGS. Panoramic photographs can be beneficial for prediction of the skeletal maturity and treatment planning without resorting to hand-wrist radiographs.

Demirjian approach of dental age estimation: Abridged for operator ease.

Background:Present times have seen an alarming increase in incidence of crimes by juveniles and of mass destruction that Highlight the preponderance of individual age estimation. Of the numerous techniques employed for age assessment, dental age estimation (DAE) and its correlation with chronological age (CA) have been of great significance in the recent past. Demirjian system, considered as gold standard in DAE is a simple and convenient method for DAE, though,, although, referring to multiple tables make it cumbersome and less eco friendly due to excessive paper load.Aim:The present study was aimed to develop a comprehensive chart (DAEcc) inclusive of all Demirjian tables and developmental stages of teeth and also to as well as to test the operator ease of 50 undergraduate dental students in performing DAE using this chart.Materials and Methods:The study was performed in two stages, wherein the first stage was aimed at formulation of the comprehensive chart (DAECC) which included pictorial representation of calcification stages, the Federation Dentaire Internationale notation of the teeth, and the corresponding scores for each stage with a concluding column at the end to enter the total score. The second stage assessed the applicability of the ease of DAE by DAECC, whereby fifty 2nd year BDS students were asked to trace the calcification stages of the seven permanent left mandibular teeth on a panorex, identify the correct stage, assign the corresponding score, and to calculate the total score for subsequent dental age assessment.Results and Conclusions:showed that average time taken by the students for tracing seven mandibular teeth was 5 min and for assessment of dental age was 7 min. The total time taken for DAE was approximately 12 min, thus making the procedure less time consuming. Hence, this study proposes the use of DAEcc for age estimation due to ease in comprehension and execution of Demirjian system.

Age estimation in children by measurement of open apices in teeth: a study in North Indian population

Age estimation is a prerequisite in forensic medicine, paediatric endocrinology and orthodontic treatment. Dental development has been proven to be suitable for age determination in children because of its lower variability. The aim of this study was to evaluate the applicability of using the open apex method proposed by Cameriere et al. for age estimation in Indian children. Digitalized panoramic radiographs were retrieved from the Department of Oral Medicine & Radiology of 558 Indian children (261 girls, 297 boys) with an age range from 5 to 15 years. The seven left permanent mandibular teeth were evaluated for length and open apices. Dental maturity was evaluated using measurements of the seven left permanent mandibular teeth (xi = Ai/Li, i = 1,...,7), the sum of the normalized open apices (s) and the number (N0) of teeth with root development complete. Using a stepwise multiple regression model, a relationship between open apices, N0 and age was evaluated. Statistical analysis revealed high accuracy with the morphological variables explaining 88.5% of the variations in estimated chronological age. This research suggests an open apex method could be successful for age estimation in Indian children and could be applied in legal issues pertaining to forensic medicine.

Dental age assessment of 4–16 year old Western Saudi children and adolescents using Demirjian’s method for forensic dentistry

AimDeveloping teeth are used to assess maturity and estimate age in several disciplines such as pediodontic, orthodontic, pediatric endocrinology and forensic odontology. The aim was to determine the statistical adjustment needed when dental age is estimated using Demirjian’s method for Western Saudi children and adolescents between ages 4 and 16years of age. Also, to compare a Western Saudi population sample with the original French-Canadian. Methods and materialsThe most common standard for forensic age estimation or analysis of children and sub-adults of Demirjian et al. (1973) was used, with a total of 198 individuals (boys=88 and girls=110). The panoramic radiographs were used to score the seven left mandibular teeth. ResultsThe mean difference was 1.44 to 0.64 in girls and from 0.66 to 0.77 in boys. Among girls there was a statistically significant difference for 7, 11, and 15years (P<0.05). There was a statistically significant difference (P<0.05), in boys for age groups 8 and 13 only. On average for all ages, Western Saudi Arabia girls were 0.059 (sd=1.26) years and the boys 0.66 (sd=1.14) years ahead of the French-Canadian children. ConclusionNew tables were developed in order to convert dental maturity calculation according to Demirjian’s method into estimated age of contemporary Western Saudi population (significant overestimation). For future research, increase in the sample size for all age ranges to establish new maturity scores and logistic curves for the studied population group and comparison with other Saudi children in rural communities found in other regions in Saudi Arabia would be ideal.

Dental and Temporomandibular Joint Pathology of the Eastern Pacific Harbour Seal (Phoca vitulina richardii)

Skulls from 214 Eastern Pacific harbour seals (Phoca vitulina richardii) were examined macroscopically according to predefined criteria. The museum specimens were acquired from strandings along the west coast of the USA between 1909 and 2014. Ninety-eight skulls (45.8%) were from male animals, 108 (50.5%) from female animals and eight (3.7%) from animals of unknown sex. Their age varied from neonate to adult, with 101 adult animals (47.2%), 93 juvenile animals (43.5%) and 20 neonatal animals (9.3%). The majority of teeth were available for examination (90.0%); 7.5% of teeth were absent artefactually, 2.3% were deemed absent due to acquired tooth loss and 0.2% were absent congenitally. Males were no more likely than females to have either acquired tooth loss (P=0.492) or congenitally absent teeth (P=0.494). Adults had significantly more acquired tooth loss than juveniles (P<0.0001). All teeth were normal in morphology, except for four teeth from one skull that exhibited macrodontia. An unusual number of roots were found in most maxillary molar teeth; three roots were counted on six maxillary molar teeth and almost all other maxillary molar teeth available for examination had a fused root. Only 26 maxillary molar teeth exhibited two roots. Supernumerary teeth were associated with 13 normal teeth in nine specimens. The most common sites associated with supernumerary teeth were the left and right mandibular first premolar teeth (53.9% of all supernumerary teeth). No persistent deciduous teeth were found in any of the juvenile or adult specimens. Of the total number of teeth available for examination, 22.1% were abraded; six adult specimens showed attrition/abrasion on all of their teeth present. Adults were found to have a greater prevalence of abraded teeth than juveniles (P<0.0001). No significant difference was found in the appearance of attrition/abrasion between males and females (P=0.518). Tooth fractures were uncommon, affecting 11 teeth (0.2%) in seven animals. Periapical lesions were found in four skulls (2.1% of the total number of specimens). None of the specimens showed signs of enamel hypoplasia. More than half (55.6%) of alveoli, either with or without teeth, showed signs of alveolar bony changes consistent with periodontitis. A total of 178 specimens (91.8%) had at least one tooth associated with mild periodontitis. Lesions consistent with temporomandibular joint osteoarthritis (TMJ-OA) were found in 67 specimens (34.5%). The most common articular surface to be affected was the left mandibular fossa of the temporal bone, with lesions in 44 cases (32.8% of all lesions). In 13 specimens (6.7%) all articular surfaces were affected. Both periodontal disease and TMJ-OA were significantly more common in adults than in juveniles (P<0.0001). Although the significance of the high incidence of periodontitis and TMJ-OA in the Eastern Pacific harbor seal remains unknown, the occurrence and severity of these diseases as found in this study may play an important role in the morbidity and mortality of this species.

Discrepancy between chronological age and evaluated dental age using the Demirjian system in Western Australian children

The aims of this work were to assess dental age using the Demirjian system and to evaluate the discrepancy between chronological and dental age among children residing in Western Australia. Forty panoramic radiographs of 5- to 11-year-old children taken at the paediatric clinic of a dental hospital in Western Australia were selected. The developmental stage of each left permanent mandibular tooth excluding the third molar was assessed by three trained examiners. Estimated dental age using the Demirjian system was compared with the chronological age of each child. The accuracy of the Demirjian system in this group of children was 42.5%. The difference between chronological age and dental age was significant (t = 4.066, df = 39, p < 0.001). Dental age estimation for Caucasian children had greater accuracy (χ2 = 5.013, df = 1, p = 0.025). Gender and orthodontic concerns were not related to the accuracy of the Demirjian system (p ≥ 0.481). The discrepancy between chronological and dental age using the Demirjian system was significant when assessing the Western Australian population although it was more accurate for Caucasian children. The accuracy was similar between subjects with and without orthodontic concerns.

Measurement of Open Apices in Teeth for Estimation of Age In Children

Background: Estimation of age has been a major factor in identification of an individual, either living or after death. Objective: To estimate and assess the dental age of children by measuring the open apices of the teeth using panoramic radiograph applying linear regression equation. Methods: This was a retrospective cross-sectional study conducted on 50 children (25 boys and 25 girls) aged between 5-15 years. The seven left permanent mandibular teeth were assessed using panoramic radiographs which were collected from Medical Record Department, Manipal University, taken during the course of diagnosis and treatment. The number of teeth with closed apical and with open apical end of roots were examined and measured. The values were tabulated and placed on the linear regression equation proposed by Cameriere et al for the estimation of dental age. Result: The result showed no significant difference between the dental age (10.13±1.69 years) and the chronological age (10.31±1.75 years) (p=0.26). The method underestimated the mean age by 0.11 years and 0.23 years for the boys and girls, respectively. The paired sample t- test showed no significant difference between dental age and chronological age for boys (p=0.546) as well as for girls (p=0.351) Conclusion: The estimated age of children by measuring the open apices of the teeth using panoramic radiograph linear regression equation used in the European subjects closely matches with the chronological age in Asian subjects also. Keeping in context to validate more accurately the significance of linear regression equation, there is a need of larger sample size belonging to variety of ethnic and socioeconomic background.DOI: http://dx.doi.org/10.3126/hren.v12i1.11983Health Renaissance 2014;12(1):33-37

Mandibular canine index: A reliable predictor for gender identification using study cast in Indian population.

Various methods are used for gender identification in anthropologic and forensic investigations. The canine tooth is widely used for gender determination because of its sexual dimorphism and durability in the oral cavity. Mandibular canine index (MCI) is one of the most reliable and valid predictor for gender identification. To assess the reliability of MCI in gender determination in Indian population. This was an experimental study involving the preparation of plaster models of 100 individuals residing in Udaipur, Rajasthan, India. Of these 45 were males and 55 were females. Both sexes were in the age group of 20-30 years. Study casts were prepared for all individuals and the measurements of mandibular canine teeth were taken. The MCI was calculated using standardized equation. In addition, the percentage of sexual dimorphism was calculated. Independent sample t-test was used. P < 0.05 was considered statistically significant. There was a significant difference (P < 0.05) observed between inter-canine distance, right and left canine width and right and left MCI between males and females. Sexual dimorphism is more on left permanent mandibular canine teeth than right permanent mandibular canine teeth. The overall percentage of accuracy observed was 85.5%. Study findings reveal that MCI can be used a reliable predictor for gender determination in Indian population and can form the basis of anthropologic and forensic investigations.

Dental age assessment in 7–14-year-old Chinese children: Comparison of Demirjian and Willems methods

Several approaches have proven be valuable in estimating dental age in children. The Demirjian method, based on crown and root calcification, is the most frequently used tool. The Willems method is a modification of the Demirjian method. There are few studies regarding to compare the application of the two methods in China. This study aims to apply the two methods in a Han population as well as identify if there are some differences between two methods in estimating dental age versus chronological age. Nine hundred forty-one orthopantomograms of 410 boys and 531 girls between seven and 14 years of age were selected from our patient records database with defined standard, and the Demirjian and Willems methods of dental age estimation were applied. The seven left mandibular teeth were scored and calculated in order to obtain the Demirjian and Willems estimated dental ages. It is suggested that the Demirjian method overestimated chronological age by 1.68 years for boys and 1.28 years for girls. The discrepancy between the Demirjian estimate and the chronological age was most frequently observed between 1 and 3.5 years for boys and between 1 and 2 years for girls. While it is indicted that the Willems method overestimated chronological age by 0.35 years for boys and underestimated the age by 0.02 years for girls. The discrepancy between chronological age and Willems estimated age was most frequently observed between −0.5 and 0.5 years for boys and between −1 and 0.5 years for girls. It is demonstrated that the Willems method was more accurate in estimating dental age than the Demirjian method, with a mean absolute error of 0.98 years for boys and 0.93 years for girls. As a result, it is highly recommended that the Willems method should be applied when estimating dental age in Chinese Han population, further modifications to the method are suggested.

Non‐syndromic bilateral dentigerous cysts with significant root resorption: a case report

AbstractDentigerous cysts are the most common developmental odontogenic cysts and are associated with impacted teeth, usually third molars. Bilateral dentigerous cysts are rare and usually occur in patients with a known syndrome, such as cleidocranial dysplasia. In this study, we report a case of bilateral dentigerous cysts with associated significant root resorption in an otherwise healthy 38‐year‐old female patient. The patient presented with left‐sided non‐tender mandibular swelling and mobility of the left mandibular first and second molar teeth. Radiological investigations revealed two large, unilocular, well‐circumscribed, radiolucent lesions involving the impacted lower wisdom teeth. There was extensive root resorption of the lower molars. The patient underwent enucleation of both cysts and extraction of the involved teeth. Histological features were consistent with dentigerous cysts, with both lesions consisting of a fibrous wall lined by non‐keratinizing stratified squamous epithelium. Non‐syndromic bilateral dentigerous cysts are extremely uncommon. This case, with associated significant root resorption, reflects aggressive biological behaviour and shows that commonly encountered lesions can present as a diagnostic challenge, emphasizing the importance of histopathological analysis in the definitive diagnosis and the overall management.

Age estimation in northern Chinese children by measurement of open apices in tooth roots.

The aim of this study was to assess the accuracy of Cameriere's methods on dental age estimation in the northern Chinese population. A sample of orthopantomographs of 785 healthy children (397 girls and 388 boys) aged between 5 and 15 years was collected. The seven left permanent mandibular teeth were evaluated with Cameriere's method. The sample was split into a training set to develop a Chinese-specific prediction formula and a test set to validate this novel developed formula. Following the training dataset study, the variables gender (g), x 3 (canine teeth), x 4 (first premolar), x 7 (second molar), N 0, and the first-order interaction between s and N 0 contributed significantly to the fit, yielding the following linear regression formula: Age = 10.202 + 0.826 g - 4.068x 3 - 1.536x 4 - 1.959x 7 + 0.536 N 0 - 0.219 s [Symbol: see text] N 0, where g is a variable, 1 for boys and 0 for girls. The equation explained 91.2 % (R (2) = 0.912) of the total deviance. By analyzing the test dataset, the accuracy of the European formula and Chinese formula was determined by the difference between the estimated dental age (DA) and chronological age (CA). The European formula verified on the collected Chinese children underestimated chronological age with a mean difference of around -0.23 year, while the Chinese formula underestimated the chronological age with a mean difference of -0.04 year. Significant differences in mean differences in years (DA - CA) and absolute difference (AD) between the Chinese-specific prediction formula and Cameriere's European formula were observed. In conclusion, a Chinese-specific prediction formula based on a large Chinese reference sample could ameliorate the age prediction accuracy in the age group of children.

Late Cretaceous chimaeroids (Chondrichthyes: Holocephali) from Alabama, USA

Tooth plates of three extinct species of callorhynchid holocephalans, Edaphodon mirificus, E. barberi, and Ischyodus bifurcatus have been collected from Upper Cretaceous strata of Alabama. Of the two species of Edaphodon, E. mirificus is represented by isolated tooth plates as well as associated dentitions. Edaphodon barberi was based on a small left mandibular tooth plate, but additional mandibular tooth plates in museum collections show that the diagnostic features seen on the E. barberi holotype are consistently present and therefore useful for species differentiation. Ischyodus bifurcatus is reported for the first time in Alabama and is known from a partial associated dentition and several isolated tooth plates. Most of the fossils are from the upper Santonian to lower Campanian Mooreville Chalk, but two specimens of Edaphodon from a lower Campanian component of the Tombigbee Sand Member of the Eutaw Formation and one from the lower Maastrichtian Ripley Formation represent the first holocephalan records from these lithostratigraphic units in Alabama.

Evaluation of dental maturation in children according to sagittal jaw relationship.

Objective:The aims of this retrospective study were to determine compliance with dental and chronological ages and to analyze the relationships between dental age and orthodontic sagittal anomalies.Materials and Methods:A total of 221 subjects between the ages of 7 and 15.9 years (165 girls and 156 boys) were included in the study. The dental age of seven left mandibular teeth was assessed according to the Demirjian method. The maxillary protrusion, mandibular protrusion, maxillo-mandibular and vertical plane angles were measured from cephalometric films.Results:The mean difference between the chronological age and dental age in female patients was 0.94 years and 0.33 years in male patients (P < 0.01). No differences between the sagittal classification groups were found. There was no relationship between dental age and the SNA° or the GoGn-SN°. A statistically significant negative relationship was found between dental age and the SNB° and there was a significant linear relationship between dental age and the ANB°.Conclusion:Dental age in girls and boys has been estimated to be more advanced than chronological age in all classes and dental maturation advanced in cases with a tendency to develop Class II malocclusions.

Diagnosis of mandibular premolar tooth with vertical root fracture using by cone-beam computed tomography

Vertical root fracture (VRF) may occur because of root canal treatment or extensive restoration. A 42-year-old woman applied to our clinic with complaint of pain on her left mandibular second premolar tooth. Radiologic examination by panoramic radiograph indicated that the teeth had a root canal treatment and there was a radiolucency through the mesial area of the root. This data was considered that there might be a root fracture, which cannot be detected on panoramic radiograph. Thus, the condition was told to the patient and after her permission, it was decided to take a CBCT image for definite diagnosis. The tooth was scheduled for extraction and socket preservation. A new CBCT image was taken from the extracted teeth with much more dosage to observe the fracture line every aspect. Also, the tooth was sent to the histology department for histologic investigation. The CBCT image demonstrated hardly visible VRF at the coronal, mid-root and apical levels in the axial views. Fracture line that extends through the long axis of the tooth was seen obviously on CBCT image which was taken after extraction and histologically with different zoom in (×25, ×40, ×100, ×200, and ×400). Different stages of endodontic treatment may cause VRFs. Symptoms of VRF are often not obvious, because of this diagnosis may be difficult for dentists. CBCT images could be helpful to evaluate VRFs which cannot diagnose.