Molar Mineralization Research Articles

Evaluation of the Midpalatal Suture and its Correlation with the Cervical Vertebral Maturation Stages and Second Molar Mineralization Stages: A CBCT Study

Objectives To evaluate and correlate the maturation stage of the midpalatal suture, CVM stages, mandibular left second molar mineralization stages of the subjects by CBCT. Materials and Methods One hundred subjects (55 males and 45 females) with a mean age of 13.56 ± 4.46 years, were divided into five midpalatal suture maturational stage groups (A to E). Cervical vertebral maturational stages on lateral cephalograms and second molar mineralization stages on orthopantograms from the CBCT images obtained from Carestream CS 9300C 3D system were analyzed and correlation among them were calculated by Spearman’s coefficient of correlation and midpalatal suture maturation stage prediction accuracy estimated with sensitivity, specificity, positive predictive value, and likelihood ratio. Results Spearman’s correlation analysis showed a highly significant ( p value < .001) and positive correlation between MPS stage and CVM Stage ( r = 0.930), MPS stage and mandibular left second molar mineralization stage ( r = 0.757), and CVM stage and mandibular left second molar mineralization stage ( r = 0.760). Conclusion Cervical vertebral maturation stages 1,2, and 3 can be used clinically to predict the midpalatal suture maturation stages A, B, and C, respectively, as their likelihood ratios were more than 10. Second molar mineralization stages had less predictive value for MPS stages.

Does third molar agenesis influence the second lower molar mineralization?

Different studies have established that the mineralization stages of the second mandibular molar can be used in forensic age estimation. Nowadays, the estimate’s accuracy is an ethical concern, producing as few false positives (individuals incorrectly classified as older than a determined threshold) and false negatives (individuals incorrectly classified as younger than a determined threshold) as possible. Some have hypothesized that changes in teeth number may influence tooth mineralization, altering the age estimate process. This paper analyzes whether third molar agenesis affects the second mandibular molar mineralization time frame. To do so, 355 orthopantomograms were evaluated for third molar agenesis, and the second mandibular molar mineralization stage was assessed using the Demirjian stages. Student’s t-test was used to compare the difference in the mean age at which the various stages of 37 mineralization were reached in the groups with and without third molar agenesis. The level of statistical significance was set at 5%. The results pointed to a delay in second mandibular molar mineralization in the case of agenesis, suggesting the need to consider this when estimating age using dental techniques.

Correlation Between Third Molar Mineralization and Midpalatal Suture Maturity: A Cone Beam Computed Tomography Study.

BACKGROUND Midpalatal suture ossification varies in patients of different ages, which can lead to making inaccurate presumptions when considering effective treatment timing based on chronological age. Chronological age provides only general information, whereas dental development correlates with skeletal growth, which suggests that tooth mineralization could be considered to be a precise criterion for determining the midpalatal suture's maturity. The present study was conducted to investigate the association between third-molar mineralization and midpalatal suture's maturation stages using cone-beam computed tomography (CBCT) images. MATERIAL AND METHODS The study involved 97 CBCT images of patients aged 8-37 years with normal growth and development. Subjects with cleft lip and palate, caries treatment, or present cavities in the third molars were not included in the study. The stages of midpalatal suture ossification were evaluated according to the protocol suggested by Angelieri et al, and the third-molar mineralization degree was measured by the Demirjian index. Statistical analysis was performed to evaluate correlations between the variables. RESULTS Patients with advanced third-molar mineralization stages were found to have greater midpalatal suture maturity. A statistically significant positive correlation was found between the stages of third-molar mineralization and midpalatal suture maturation (R=0.814, P<0.01). Third-molar development was also found to be associated with chronological age (R=0.883, P<0.01). CONCLUSIONS A measure of third-molar mineralization does not allow for accurate determination of the midpalatal suture maturation stage.

Effect of impaction on third molar development and age estimation—A study in a Lebanese population

The effect of impaction on third molar development is disputable as the scientific literature is not uniform. In parallel, population-specific studies have been encouraged in dental age estimation. This study aimed to investigate the effect of impaction on third molar formation in a sample of Lebanese individuals. The sample consisted of 518 panoramic radiographs of females (n=229) and males (n=289) between 15 and 23.9 years. Mandibular third molars were classified based on their position as non-impacted and impacted (with horizontal, vertical, mesioangular, and distoangular impaction). Dental development was classified according to Demirjian's 8-level staging system. Most teeth presented mesioangular impaction (#38=29.7%, #48=33%). Developing third molars were predominantly distributed between stages D and G. The mean age of most developmental stages was higher among impacted teeth, meaning that third molar mineralization could be slower in the presence of impaction. In general, the delayed dental development did not have statistically significant effects (P<0.05). However, descriptive data pointed out differences between (impacted and non-impacted) mean ages of >12 months-suggesting a potential clinical significance (despite the lack of a statistical one). Furthermore, differences changed based on sex and side (#38/#48). Therefore, dental age estimation from third molars in the selected Lebanese population should preferably be performed in non-impacted third molars whenever available.

Dental Age Estimation with Special Emphasis on Age Limits of 12/15 and 18 Years: Detailed Analysis According to Governing Law

Objective: The aim of this study is to investigate the potential of Demirjian method in estimation of age groups with limits of 12, 15, and 18 years, according to ages of legal responsibilities.&#x0D; Methods: The panoramic radiographs of the study population aged between 6 to 22 were assessed for third molar (3M) mineralization with Demirjian method with four subgroups. Group 1 consisted of individuals aged between 6 to and 12 years of age, Group 2 were aged between 12 to 15 (Group 2, ≥12,

Combining the third molar mineralization to further improve the accuracy of the Kvaal's method in dental age estimation of subadults in northern China.

The decrease in the dental pulp cavity based on deposition of secondary dentin is a useful variable for assessing age.A total of 340 orthopantomographs were used in this research, including 278 in training groups and 62 in testing groups.Original Kvaal's method underestimated the dental age for subadults in northern China.The equation of combined specific method constructed in our study was proved more suitable to calculate dental age for subadults in northern China.

Fetal Age Assessment From Primary Teeth and Long Bones.

This study evaluated traditional and expedited methods for assessing the age of fetal remains. Because of their rare occurrence, the discovery of fresh, decomposing, disfigured, or skeletal fetuses engenders heightened awareness by forensic pathologists primarily tasked with age estimation in relation to viability. With decomposed complete or isolated fetal remains, dentists focus on primary molar mineralization, whereas anthropologists perform long bone measurements along with discernment of other indicators of skeletal maturity to obtain an age estimation.The results of this study are 4-fold: (1) The "best" technique for harvesting fetal tooth buds and long bones is the dissection of the developing tooth buds with maceration for the long bones. (2) Metric analysis was applied to the tooth buds and long bones for age estimation, and the findings were correlated. (3) There is a statistically significant difference between known age and dental age and between dental age and long bone age. The difference between known age and long bone age is not statistically significant, but a type II error exists because of the small sample size. (4) A central incisor staging technique for fetuses younger than 26 weeks was developed as a supplement to the molar staging system of Kraus and Jordan (1965).

Аналіз ефективності профілактики карієсу у дітей 6–7 років, які постійно проживають в умовах біогеохімічного дефіциту фтору та йоду

The purpose of the study was to evaluate the effectiveness of remineralizing prevention of dental caries in children living in conditions of biogeochemically deficient trace elements in the period of eruption and mineralization of the first permanent molars, by introducing a treatment and prevention complex. Materials and methods. 73 first-graders of Uzhhorod secondary schools with different general health conditions were selected. The control group consisted of 26 healthy children of the same age. Indicators of caries prevalence, intensity and activity (CP + CPV index), changes in hygienic and periodontal indices (I. G. Green, I. R. Vermillion, Fedorova-Volodkina, PMA) in the dynamics of treatment (after 12 months) were determined and compared with the control group. Results and discussion. 12 months after the use of treatment and prevention complex there was an improvement in dental status, a decrease in the prevalence (p &gt;0.05), intensity (p &gt;0.05) of caries, no permanent teeth were removed, the number of carious temporary and permanent teeth significantly reduced, the percentage of decompensated caries decreased in all clinical groups relative to pre-treatment rates in children of all observation groups (p &lt;0.05). After using treatment and prevention complex in determining the effectiveness of the clinical group a significant increase in patients without caries (6.80±0.01; 16.42±0.09; p &lt;0.05), an increase in the percentage of patients with compensated degree of caries activity (15.10±0.51; 38.36±0.12; p &lt;0.05), and a decrease in the percentage of subcompensated (46.60±2.07; 34.25±0.10; p &lt;0.05) and decompensated (31.50±1.08; 10.97±0.01; p &lt;0.05) course were found. The average values of the OHI-S index in children improved and corresponded to the indicators of satisfactory hygiene in all groups, the Fedorov-Volodkina index corresponded to good hygiene, the PMA index normalized, which indicates the effectiveness of the proposed treatment and prevention complex in children of all clinical groups. Conclusion. Our research has established the relationship between magnesium content and dental status, taking into account the burden of somatic pathology, which complicates the absorption of such essential element as magnesium in the gastrointestinal tract. Normalization of magnesium content after 12 months leads to improved nervous system and dental health in children of 6-7 years old, who live permanently in the region of biogeochemical deficiency of fluoride and iodine. The use of the developed treatment and prevention complex in children of primary school age with high reliability leads to the improvement of the level of dental health

A test to study the influence of impaction on mandibular third molar development and forensic age estimation in a sample of south Indian children and young adults

It has been argued that the impaction of the third molars could result in delayed maturation, which, in turn, could affect age estimations in criminal proceedings. In view of this, the present study was undertaken to determine whether the impaction status could delay the chronological process of third molar mineralization in a sample of south Indian children and young adults. The orthopantomograms (OPGs) of 915 children and young adults of south Indian origin aged between 15 and 22 years were evaluated. Mineralisation stage and impaction status were determined for all lower third molars. Descriptive statistics were performed at stages D to H of Demirjian staging system. The results of independent t-test show that the impaction resulted in statistically significant slower mineralization in impacted lower third molars at stages D to F in both sexes. It was ascertained that the mean ages with the impacted lower third molars at stage G were 0.98–1.38 years higher in males and 0.50–0.80 years higher in females than those with non-impacted lower third molars. For stage H, the mean ages were 0.14–0.21 years higher in males and 0.25–0.44 years higher in females. The probabilities of being 18 years and above is higher for non-impacted lower third molars at stages G and H than those with impacted ones. It is concluded that the impaction could result in delayed maturation in the lower third molars of the studied sample. Further studies are warranted in a more diverse sample.

Evaluation of the effect of impaction on the mineralization of mandibular third molars and forensic age estimation in a sample of south Indian children.

Assessment of third molar mineralization is a basic forensic odontological method available for age estimation in children and adolescents. Due to their protracted development into the late adolescence, their development has become the subject of interest and acquired great forensic importance. It is clearly evident in the literature that impaction factor has an influence on the rate of maturation of the third molars. In this regard, the present study was undertaken to test the relationship between impaction and its concomitant effect on the mineralization of the third molar and forensic age estimation. A total of 520 digital orthopantomograms (OPG) of 260 males and 260 females of south Indian origin were assessed retrospectively. Maturation of the third molars (I3M) was assessed using the method of Cameriere et al. (Int J Leg Med 122 (6):493-497, 2008). Impaction status was determined according to the position of lower right and left third molars in relation to the long axis of the second molars. Out of the total sample, 68.1% of lower left third molars and 71.2% of lower right molars were impacted. Statistical measures for I3M were calculated in the males and females for both impacted and non-impacted third molars. It was ascertained that the mean age and I3M values were higher in impacted third molars, indicating the slower rate of maturation than non-impacted ones. The sensitivity and specificity of the test (I3M < 0.08) was 96.2% and 72.4% for non-impacted third molars and 46.2% and 87% for impacted third molars, respectively. Our findings indicate that the cut-off value of I3M < 0.08 resulted in greater number of age misclassifications (false negatives) for impacted molars, highlighting the need for new cut-off value of I3M to meet the legal standards. It was concluded that the mineralization of impacted third molars was slower compared to non-impacted ones in south Indian males and females. Further studies are warranted to validate these findings among a larger and more diverse sample.

Molecular and morphological findings in a sample of oral surgery patients: What can we learn for multivariate concepts for age estimation?

It has already been proposed that a combined use of different molecular and morphological markers of aging in multivariate models may result in a greater accuracy of age estimation. However, such an approach can be complex and expensive, and not every combination may be useful. The significance and usefulness of combined analyses of D-aspartic acid in dentine, pentosidine in dentine, DNA methylation in buccal swabs at five genomic regions (PDE4C, RPA2, ELOVL2, DDO, and EDARADD), and third molar mineralization were tested by investigating a sample of 90 oral surgery patients. Machine learning models for age estimation were trained and evaluated, and the contribution of each parameter to multivariate models was tested by assessment of the predictor importance. For models based on D-aspartic acid, pentosidine, and the combination of both, mean absolute errors (MAEs) of 2.93, 3.41, and 2.68years were calculated, respectively. The additional inclusion of the five DNAm markers did not improve the results. The sole DNAm-based model revealed a MAE of 4.14years. In individuals under 28years of age, the combination of the DNAm markers with the third molar mineralization stages reduced the MAE from 3.85 to 2.81years. Our findings confirm that the combination of parameters in multivariate models may be very useful for age estimation. However, the inclusion of many parameters does not necessarily lead to better results. It is a task for future research to identify the best selection of parameters for the different requirements in forensic practice.

An analysis of third molar mineralization in Brazilian patients with cleft lip and palate

Purpose: This study investigated the third molar mineralization in patients with cleft lip and palate.Materials and methods: From a total of 253 digital panoramic radiographs from patients with cleft lip and palate within the age range of 7–21 years, 97 radiographs were selected (cleft group). A control group was formed from same sex individuals, without malformation and chronological age matched within 30 days. The analysis of third molar mineralization was carried out by three calibrated examiners using Demirjian’s and Nolla’s methods. McNemar and Wilcoxon test for paired samples were used for pairwise comparisons between the groups. The Likelihood Ratio test was used to check for an association between the type of cleft and tooth calcification.Results: In both methods, the mineralization means were smaller in the case group than in the control, with significant differences for all third molars (p < .05). The type of cleft affected dental mineralization. There was no significant difference when comparing the left or right sides, but maxillary molars showed earlier mineralization.Conclusions: A significant delay in third molar mineralization was observed in patients with cleft lip and palate according to Demirjian’s and Nolla’s methods.

Preliminary analysis testing the accuracy of radiographic visibility of root pulp in the mandibular first molars as a maturity marker at age threshold of 18years.

Forensic age estimation, after completion of third molar mineralization, regressive features such as apposition of secondary dentin, which is seen as narrowing of the pulp space in the radiographs, can be used as an alternative. In the present study, we explored the radiographic visibility of the root pulp of mandibular first molars using stage classification of Olze et al. (Int J Legal Med 124(3):183-186, 2010) in a sample of 901 orthopantomograms (404 males and 497 females) of south Indian origin with age ranging from 14 to 22years. Descriptive statistics for the stages according to age was performed for both sexes separately. The strength and direction of the relationship between the chronological age and pulp visualization stages was tested using spearman's rho correlation statistics. The relationship between age and stage attainment showed statistical significance for both sexes. A strong, positive correlation was seen between the stage and chronological age. All males and females presenting stage 0 of root pulp visibility were younger than 18years. If stage 1 is determined, it is highly possible that an individual regardless of sex is younger than 18years. Stage 2 was attained in 79.6% males and 83.1% females who were at least 18years. One hundred percent males and 92.8% females with stage 3 were at least 18years. The accuracy of this method in mandibular first molars for estimating age threshold of 18years ranged from moderate to high. However, it is recommended to use this method in conjunction with other age estimation methods.

Evaluation of chronological age based on third-molar development in the Serbian population

Background/Aim. Persons identification and their age assessment is necessary in vast number of cases and there are different methods used for such purposes. Numerous studies indicate that the third molar development could play a crucial role in identifying an individual`s age. The aim of this study was to determine the possibility for estimating the chronological age based on the third molar development stages in children and young adults in the Serbian population. Methods. A total of 570 Serbian patients aged 6?27 years were included in this study. Out of the total number of subjects, there were 248 males with an average age of 12.21 ? 3.91 years, and 332 females with an average age of 12.88 ? 4.06 years. Stages of dental formation were determined on orthopantomograms by comparing with standard Demirjian radiographic appearances. Results. Third molars mineralization occured more rapidly in males than in females. Most of the persons with third molar (the stage H development according to the Demirjian method) were older than 18 years. Conclusion. ?hird molar mineralization stages determination on orthopantomograms is useful additional method for determination of chronological age in living individuals. This finding might be important for forensic studies, focusing on the determination of the legally important ages. Variability among different ethnic groups has to be taken into consideration when applying this method. It is necessary to carry out extensive surveys on a larger sample in order to determine the norms for assessing the dental and chronological age of Serbian population.

Dental age estimation: The chronology of mineralization and eruption of male third molars with 3T MRI

Forensic age estimation has recently become an important topic due to a steady increase of cross border migration. Dental age assessment is one pillar of the forensic age estimation in living persons. Currently it is done by evaluating an orthopantomogram, which is generated using ionizing radiation. Nevertheless, the use of X-ray without medical indication is ethically questionable. Therefore, the aim of the study was to provide reference values for dental MRI to have an alternative radiation-free method for the assessment of dental age. In this cross-sectional study, 316 adolescent, male individuals were investigated. Two dentists evaluated the stage of mineralization and eruption of the third molars of the upper and lower jaws, according to the staging systems established by Demirjian and Olze. Following data analysis and the creation of reference tables, the likelihood ratios to be over specific age limits were calculated. In the mineralization evaluation mainly stages D–H were seen (range A–H); regarding eruption, all four stages (A–D) appeared. A significant difference between the teeth was only found for eruption stage A. However, the evaluation of participants who had all four third molars, showed partly different stages for the individual teeth as well for mineralization as for the eruption. Therefore, it seems to be important to include all available teeth in the age estimation. The likelihood ratios showed about 99% probability to be 18 years or older for stage H (mineralization), but only about 93% for stage D (eruption). In summary, it can be concluded that dental MRI holds promise as an alternative to conventional orthopantomogram based age assessment.

The third molars for indicating legal adult age in Montenegro.

From a medico-legal and penalty point of view, it is essential to conclude if an individual is a minor or an adult (18 years of age). Methods based on the third molar development have been used for this purpose. The present article aims to verify the Nolla's stages of mineralization of the third molars and a third molar maturity index (I3M) which is based on the measures of the projections of open apices normalized by their height in the sample of Montenegrins. The sample consisted of 683 panoramic radiographs (324 males and 359 females) between 13 and 24 years of age. The specific mineralization stages of Nolla and the cut-off value of I3M < 0.08 was used to discriminate adults and minors. The best performance in discriminating adults and minors was for I3M < 0.08 followed by the Nolla stage 9. For I3M < 0.08 the results demonstrated high sensitivity of 0.92 and 0.82 and specificity of 0.94 and 0.96 in males and females, respectively. The proportions of correctly classified individuals were 0.93 in males and 0.89 in females. The Nolla stage 9 demonstrated the sensitivity of 0.95 and 0.85 and the specificity of 0.84 and 0.90 in males and females, respectively. The proportions of correctly classified individuals were 0.90 in males and 0.87 in females. The suggested value of I3M < 0.08 followed by Nolla stage 9 can be used to discriminate adults from minors with high specificity.

Third molar mineralization in relation to chronologic age estimation of the Han in central southern China.

The purpose of this study is to provide a forensic reference data about estimating chronologic age by evaluating the third molar mineralization of Han in central southern China. The mineralization degree of third molars was assessed by Demirjian's classification with modification for 2519 digital orthopantomograms (1190 males, 1329 females; age 8-23years). The mean ages of the initial mineralization and the crown completion of third molars were around 9.66 and 13.88years old in males and 9.52 and 14.09years old in females. The minimum ages of apical closure were around 16years in both sexes. Twenty-eight at stage C and stage G and 38 and 48 at stage F occurred earlier in males than in females. There was no significant difference between maxillary and mandibular teeth in males and females except that stage C in males. Two formulas were devised to estimate age based on mineralization stages and sexes. In Hunan Province, the person will probably be over age 14, when a third molar reaches the stage G. The results of the study could provide reference for age estimation in forensic cases and clinical dentistry.

Bayesian networks of age estimation and classification based on dental evidence: A study on the third molar mineralization

Not only does the Bayesian approach offer a rational and logical environment for evidence evaluation in a forensic framework, but it also allows scientists to coherently deal with uncertainty related to a collection of multiple items of evidence, due to its flexible nature. Such flexibility might come at the expense of elevated computational complexity, which can be handled by using specific probabilistic graphical tools, namely Bayesian networks. In the current work, such probabilistic tools are used for evaluating dental evidence related to the development of third molars. A set of relevant properties characterizing the graphical models are discussed and Bayesian networks are implemented to deal with the inferential process laying beyond the estimation procedure, as well as to provide age estimates. Such properties include operationality, flexibility, coherence, transparence and sensitivity. A data sample composed of Italian subjects was employed for the analysis; results were in agreement with previous studies in terms of point estimate and age classification. The influence of the prior probability elicitation in terms of Bayesian estimate and classifies was also analyzed. Findings also supported the opportunity to take into consideration multiple teeth in the evaluative procedure, since it can be shown this results in an increased robustness towards the prior probability elicitation process, as well as in more favorable outcomes from a forensic perspective.

Age estimation of Chinese children based on second molar maturity.

In forensic medicine and many other fields, age estimation by the use of teeth is of great importance for the purpose of individual identification. In the past, however, age estimation based on the second molar mineralization was scarcely performed. In this study, a total of 1657 panoramic radiographs taken from 834 males and 823 females of northern Chinese origin in the age bracket 5 to 25years were assessed. The mineralization status of the second molars was determined using the classification described by Demirjian et al. Results showed that the left and right, as well as maxillary and mandibular second molars were generally at similar stages of mineralization. The maxillary left second molars (27) at stage D, mandibular left second molars (37) at stages C, D, F, and G, and mandibular right second molars (47) at stages D, F, and G showed a significantly lower average age in female subjects than in male subjects. In males, fully developed second molars first appeared with 12years of age; in females, stage H occurred with 11years at the earliest. One male individual and one female individual with second molars showing stage G were 23years old. It was concluded that second molars showing stage H do not exclude an age under 14years and that second molars showing stage G do not exclude an age above 18years.

Three-dimensional analysis of third molar development to estimate age of majority

Third molars are one of the few biological markers available for age estimation in undocumented juveniles close the legal age of majority, assuming an age of 18years as the most frequent legal demarcation between child and adult status. To obtain more accurate visualization and evaluation of third molar mineralization patterns from computed tomography images, a new software application, DentaVol©, was developed. Third molar mineralization according to qualitative (Demirjian's maturational stage) and quantitative parameters (third molar volume) of dental development was assessed in multi-slice helical computed tomography images of both maxillary arches displayed by DentaVol© from 135 individuals (62 females and 73 males) aged between 14 and 23years. Intra- and inter-observer agreement values were remarkably high for both evaluation procedures and for all third molars. A linear correlation between third molar mineralization and chronological age was found, with third molar maturity occurring earlier in males than in females. Assessment of dental development with both procedures, by using DentaVol© software, can be considered a good indicator of age of majority (18years or older) in all third molars. Our results indicated that virtual computed tomography imaging can be considered a valid alternative to orthopantomography for evaluations of third molar mineralization, and therefore a complementary tool for determining the age of majority.