Orthopantomographic Study Research Articles

Root canal widths of mandibular molars in predicting the legal age threshold 18 years in a sample of juveniles and sub-adults of south-indian origin: an orthopantomographic study.

Pursuing a proficient age estimation methodology introducing novel radiographic methods remains an ongoing and demanding aspect of forensic and medicolegal research. In 2017, Roberts GJ et al. (J Forensic Sci 62(2):351-4, 2017) described a new radiographic method, i.e., root canal width (RCW) patterns to assign a subject to above 18-year-age threshold. Since then, few researchers have investigated the validity of this radiographic method in other populations. The present study aimed to test the usefulness of these RCW patterns in predicting 18 years in a sample of South Indian juveniles and sub-adults aged between 16 and 23. Descriptive analysis revealed that pattern-A was initially observed at a minimum age of 16.08 and 16.22 years in males and females. Pattern-B at 16.31 years in males and 16.22 years in females, while pattern-C was initially recorded at 18.73 years in males and 19.01 years in females, respectively. In summary, if an individual, regardless of sex, exhibits a fully-formed (apex closed) mandibular first, second, and third molars and concurrently displays RCW-C, there is a strong likelihood that the person has exceeded the legally relevant age of 18 years. However, due to higher rate of technically unacceptable errors (adults wrongly identified as individuals below 18 years), reliance on this method alone should be restricted, and it is advisable to combine it with other methods.

Inter-Rater Reliability to the Assessment of Ramus Relationship of Mandibular Impacted Third Molar Among Denitsts: An Orthopantomographic Study

Objective: To find the inter-rater reliability to the assessment of ramus relationship of mandibular impacted third molar among denitsts. Methodology: A cross sectional comparative study was conducted in College of Dentistry, Sharif Medical and Dental College, Lahore after obtaining ethical clearance from ethical committee of Sharif Medical Research Centre (SMRC) in which dentists from three different specialties namely; Oral Pathology, Endodontics and Prosthodontics were included as raters. The study was conducted from December 2020 to February 2021. A total of 21 Orthopantomograms were assigned to each rater for assessing the ramus relationship of impacted third molar. The classification for angle of impaction used was Winter`s classification. The raters were provided with the OPGs and a proforma for recording their observations. Results: The level of agreement regarding the ramus relationship of impacted third molars observed on the Orthopantomograms between rater 1 and rater 2 was fair (κ=0.366 ,p=0.022). The agreement was also fair between rater 1 and rater 3 (κ=0.300, p=0.094). Conclusion: There was a fair agreement in assessment of ramus relation of the impacted mandibular molars of rater 1 with rater 2 and 3 where majority of the class 2 and class 3 relations were rated similarly by both the raters as Keywords: Inter-rater reliability, Cohen Kappa, Impacted third molar, Orthopantomogram, Ramus relationship

Is there any difference in the development of mandibular third molars according to the type of impaction: An orthopantomographic study in south Indian children and adolescents

Development of third molars and their influence on the dental arch is a major concern in clinical dentistry especially, orthodontics and oral surgery. Lately, their position, eruption potential and development has become a subject of interest in forensic practice. The present study was aimed to determine whether if there is any difference in the development of the mandibular third molars according to the impaction type. Orthopantomographs (n = 1112) from 478 males and 634 females between 15 and 22 years old were analysed. In each radiograph, impaction status and the developmental stage of mandibular third molars were determined. Descriptive statistics were performed at developmental stages D to H. For stage G, there was a delay by 0.74 and 0.62 years for mesioangular impaction, 0.89 and 0.33 years for horizontal impaction, 1.43 and 0.9 years for distoangular impaction and 1.74 and 1.1 years for vertical impaction, in males and females. For stage H, delay by 0.17 and 0.74 years, 0.05 and 0.06 years, 0.48 and 1.48 years and 0.62 and 0.62 years, respectively for all impaction variants in both sexes. Mean chronological age of the distoangular and vertically impacted mandibular third molars were higher in certain developmental stages than mesioangular and horizontal impactions. Our findings concluded that distoangular and vertical impaction variants mineralize more slowly than mesioangular and horizontal variants, however these differences were smaller. Therefore, no distinction is required between impaction types for dental age estimation especially in the prediction of the age of majority (18 years).

Prevalence of Developmental Dental Anomalies in A Sample of Adult Libyan Patients: Orthopantomographic Study

Objectives: This research was aimed to investigate the prevalence of dental anomalies among a selected adult Libyan sample using panoramic radiographs.
 Materials and Methods: Retrospective study of digital panoramic radiographs of (412) Libyan adult patients of both sexes (males and females). The data was collected from different Clinics in Benghazi district over six months period of time. The radiographs were studied on a computer screen to find out the developmental dental anomalies. Descriptive statistics and bivariate analysis by age and gender were conducted using SPSS software.
 Results: A total of 412 panorama radiographs were used in the data analysis. The majority were females (273, 66%), aged between 18 and 70 years old. The most common type of dental anomalies was dilaceration (130,31.6%), followed by impaction of wisdom teeth (66, 16%) and impaction of other teeth (23, 5.6%). A few cases of other anomalies were reported; these included one case of odontome, ectopic eruption of left upper 8 and one mesiodens. 
 Conclusions: Dilaceration and impaction were the most common types of developmental dental anomalies among study population, with rare cases of supernumerary teeth and odontome. Multiple anomalies are common in the present study, suggestion genetic origin. The study showed that the prevalence of dental anomalies increases with the age of participants.

Does high gonial angle increases the risk of mandibular angle fracture? A digital orthopantomographic study.

Fracture of mandibular angle comprises up to one third of mandibular fractures. Many local anatomical factors may increase the risk of such fractures. This study was conducted to investigate the risk of angle fractures with gonial angle measurements. A retrospective cross-sectional study was conducted on digital panoramic radiographs of 120 patients with isolated mandibular fractures. The patients were categorized into mandibular angle and other nonangle fracture groups. The gonial angle, antegoneal angle, ramus height was measured using Image J software. Out of 120 isolated mandibular fractures, 40 (33.33%) are angle fractures and 80 (66 .67%) are other nonangle isolated fractures. Seventy- five percent of angle fractures and 85% of non-angle fractures occurred in males. The average age of angle fracture patients was 28.34±5.2 years and 27.37 ±4.9 years for the non-angle fractures with no significant difference (p=0.31). The gonial angle of the angle fractures was 127.60 º ±4.93 º which is 6 degrees greater than the non-angle fractures. The antegonial angle of the angle fractures was 160.67±5.38º which is 5.2 º less than the non-angle fractures. The ramus height in the angle fractures was 18.97±3.7 mm which is 2.5 mm shorter than the nonangle fractures. The difference in these three measurements was highly significant (p<0.0001). About 45% of angle fractures and 19% of non-angle fractures occurred in the high gonial angle. The presence of high mandibular angle doubles the risk of mandibular angle fracture. Key words:Angle fracture, gonial angle, Image J, mandiblular fractures, orthopantomograph.

An epidemiological study of elongation of styloid process in the saurashtra population: A retrospective radiographic digital orthopantomographic study

Introduction: The styloid process (SP) is a cylindrical bony structure emerging from the lower surface of the petrous temporal bone, its normal length is from 20 mm to 30 mm and those with more than 30 mm length are considered elongated. Calcification in stylohyoid ligament or calcification of SP is termed Eagle's syndrome. The aim of this study is to conduct an epidemiological survey of SP on digital orthopantomogram (OPG) in the Saurashtra population with an age range of 5–90 years. Materials and Methods: This is a retrospective study of 1088 OPG radiographs randomly selected from the database of 2019–2020 from the oral medicine and radiology department of our institute, which was taken on the OPG model CS 8100 Carestream digital panoramic system. Measurements of SP were done from the temporal bone to the tip. Those with more than 30 mm in length were considered to be elongated. The study sample was divided into four different age groups and was compared according to gender and sides. The Chi-square test and t-test were performed. Results: Elongated SP was noted in 354 (32.53%) out of 1088 subjects. Among age groups, subjects of more than 50 years showed a maximum number of elongated SPs. Conclusion: Subjects showing elongated SP and their mean length are increased with age, which indicates chronic development of calcification. No statistical significance was found in the elongation of SP in correlation with the cohort's gender and sides (bilateral or unilateral).

Dental age estimation using the Willems method in children with mixed and permanent dentition: a digital orthopantomographic study

Dental age estimation using the Willems method in children with mixed and permanent dentition: a digital orthopantomographic study

Legal age determined by a new threshold value of third molar maturity index in subjects with impacted mandibular third molars: An orthopantomographic study in south Indian adolescents.

Third molars are one of the few biological markers available for age estimation in juveniles, especially for the estimation of the 18-year-age threshold. Literature has indicated that impaction has an influence on the development of third molars, which could possibly result in age misclassifications. The present study is intended to identify an alternative cut-off value of the third molar maturity index (I3M) in impacted mandibular third molars and also to evaluate its applicability in estimating the major (≥ 18years)/minor (< 18years) status. A total of 1330 digital orthopantomograms (OPGs) of 665 male and 665 female south Indian adolescents aged from 15 to 22years were collected and assessed. Eight hundred forty OPGs (63.1%) represented test sample, and 490 OPGs (36.9%) represented validation sample. I3M was measured for the total sample. Logistic regression, receiver operating characteristic (ROC) curve analysis, and Youden's index were used to test the performance of the method in the test sample. An alternative cut-off value of I3M < 0.17 was established for the highest value of the Youden's index of 0.598 for both sexes. When tested in validation sample, it has resulted in sensitivity and specificity values of 0.91 (95% CI; 0.86-0.95) and 0.90 (95% CI; 0.78-0.91) in males and 0.86 (95% CI; 0.80-0.92) and 0.90 (95% CI; 0.83-0.95) in females. In conclusion, cut-off value of I3M < 0.17 could accurately discriminate adults from minors with impacted mandibular third molars. However, more work is needed to be done among a more diverse sample to confirm these findings.

Above or below 14years? An orthopantomographic study based on chronological course of eruption of mandibular premolars and second molars in a sample of south Indian children.

In the context of dental age assessment, two significant factors can be studied; tooth mineralisation and tooth emergence. Little is known about the role of a second molar eruption in forensic age estimation. This paper aims to contribute to forensic age estimation using an age threshold of 14years, studying the eruption stages of permanent mandibular premolars and second molars. Totally 640 orthopantomograms (OPGs) of south Indian children, aged between 10 and 18years, were evaluated using Olze et al. staging of tooth eruption stages (A-D). Spearman's rho correlation showed a strong, positive, and statistically significant correlation between the chronological age and the eruption stages of both sexes' teeth. Accuracy, sensitivity, specificity, likelihood ratios, and post-test probability values were calculated for all tested teeth. The best performance to discriminate individuals above or below 14years showed stage D in second molars. The sensitivity varied between 89% and 94% and specificity between 75% and 84%, respectively. Receiver operating characteristic curve analysis revealed high diagnostic performance for stage D, with area under the ROC curve (AUC) values of 84% and 85% for tooth 37 and 85% and 83% for tooth 47 in males and females, respectively. In conclusion, it is possible to predict age over 14years in south Indian children using tooth emergence stages from OPGs with a relatively high interobserver agreement and good diagnostic accuracy. However, there are some limitations and, therefore, must be used in conjunction with other methods.

Prevalența și distribuția anomaliilor dentare de dezvoltare – studiu ortopantomografic

Prevalența și distribuția anomaliilor dentare de dezvoltare – studiu ortopantomografic

Location of mental foramen in a group of Libyan patients: An orthopantomographic study

Background and Objective: The mental foramen (MF) is a crucial landmark because the mental nerves and vessels exit through it. Therefore, marking its location is important when performing surgeries, placement of dental implants, or administering anesthesia and hence avoiding nerve damage. As the exact location and shape of the MF is not similar in different population groups, this study was the first one conducted to determine MF shape and position in a group of Libyan patients. Aim: The aim of this study was to determine the vertical and horizontal positions of the MF, in addition to its size and shape as seen in orthopantomogram (OPG) radiograph of Libyan patients. Age and gender differences in relation to the position and shape of MF were also evaluated. Materials and Methods: Out of 200 digital OPGs studied by two examiners, 123 fulfilled the inclusion criteria. Scanora Lite software (Palodex, Tuusula, Finland) program was used to measure the size of the MF as well as to determine its vertical and horizontal positions. The shape of the foramen was determined visually using the magnification tool of the software. Chi-square and t-test were applied. Results: The most common position of the MF was between first and second premolar, being closer to the second premolar for females and under the second premolar for males. The vertical location of the MF varied drastically with no statistical significant difference in both sides or between males and females. The difference in dimensions on the left and right sides was not statistically significant. The most common shape of MF was of the continuous type, and the tests showed significant difference with age and gender. Conclusion: The position and shape of MF is a crucial landmark for consideration of mental nerves and vessels when performing surgeries or administering anesthesia. The location of the MF on OPGs of Libyan patients regardless of gender is commonly below and between the mandibular premolar teeth closer to the second premolar, and the most common shape is a continuous type.

An Orthopantomographic study of hypodontia in permanent teeth of Iraqi patients

The congenital lack of one or more permanent teeth is a common anomaly in man .By definition, congenitally missing teeth are those that fail to erupt in the oral cavity and remain invisible in a radiograph, which implies this caused by disturbance during the early stages of tooth development.389 orthopantomograms of healthy patients were used the number of males were 194 and the number of females were 195.The patients has visited the hospital of college of dentistry of Baghdad university between 2006 and 2008.Thy were aged between 13 and 27years at the time the OPGs were taken .All OPGs were analyzed by viewer .The congenitally missing teeth were identify first clinically and confirm by the OPGsThe hypodontia mostly seen in upper lateral incisors, and lower second premolar, flowed by lower central incisors, upper central incisors, and lastly the lower lateral incisor, there were gender difference in hypodontia, but both genders show high percentage of upper lateral incisors hypodontia, 60.31%for males, and 72.30%for females. The hypodontia of lower second premolar in males 18.56%,and in females 14.5%.The hypodontia of upper central incisors in males 2.577%,and 0%in females. The hypodontia for lower central incisor in males 12.89%, and 13.3%in females. The hypodontia for lower lateral incisors in males 5.67%, and in females 0%.From these percentages it was clear that there were difference in hypodontia of upper and lower arches.To evaluate the frequency of hypodontia and compare its appearance between males and females and between upper and lower jaw.

An orthopantomographic study of prevalence of hypodontia and hyperdontia in permanent dentition in Vadodara, Gujarat.

Developmental anomalies in the number of teeth can result from disturbances in the developing dental lamina of the tooth. The dental lamina may become hyperactive leading to the formation of a supernumerary tooth or may fail to proliferate leading to the congenital absence of a primary or permanent tooth. The aim of the study was to assess the prevalence and distribution of hypodontia and hyperdontia in permanent dentition, excluding the third molars in children in Vadodara, Gujarat. A descriptive, analytical, and cross-sectional study was conducted to determine the above-mentioned aims. In the study, panoramic radiographs of 1816 children (967 girls and 849 boys), aged 8 to 14 years were recorded and inspected for anomalies in the number of teeth. The data was analyzed using SPSS version 10.00 (Statistical Package for the Social Sciences, Chicago, USA). Descriptive statistics and Chi-square-test were used to compare the results. The level of significance was set at 0.05. The prevalence of hypodontia was 11.01%, and the most frequently absent tooth was the maxillary lateral incisor. There was an increased prevalence of hypodontia in females and in the mandibular arch of the permanent dentition. The prevalence of hyperdontia was 2.97% and the most common supernumerary tooth was mesiodens. There was an increased prevalence of hyperdontia in males and in the maxillary arch of the permanent dentition. There was a high prevalence of hypodontia and a low incidence of hyperdontia in the studied population. Prompt diagnosis of these anomalies can help plan treatment modalities at an early age to establish a functional and esthetic dentition.

An orthopantomographic study of hypodontia in permanent teeth of Japanese pediatric patients

Hypodontia of permanent teeth was evaluated from orthopantomograms of 2072 apparently healthy pediatric patients at The Hospital of Nihon University School of Dentistry at Matsudo. The prevalence of congenitally missing teeth (CMT) was 8.7% in boys and 10.8% in girls, and 9.4% for both sexes combined. Most cases (67.8%) involved either one or two missing teeth. There were in total 574 CMT, and on average 2.8 teeth were missing per child. The most commonly absent tooth was the mandibular second premolar. On the other hand, no first molars were missing in any case. A high frequency of CMT mandibular incisors (18.82%) was observed, and this seems to be a characteristic peculiar to individuals of Asian ethnicity. Oligodontia (6 or more CMT excluding the third molar) ranged from 6 to 14 teeth, with a prevalence of 1.4% in general: 1.8% for girls and 0.9% for boys. Symmetry of CMT was predominant: 214 pairs for bilateral symmetry and 107 pairs for symmetry between two antagonistic quadrants. The distribution of CMT between maxillary and mandibular hypodontia in the right and left quadrants for boys and girls no had significant association (P < 0.05).

Accuracy of age estimation of radiographic methods using developing teeth

Developing teeth are used to assess maturity and estimate age in a number of disciplines, however the accuracy of different methods has not been systematically investigated. The aim of this study was to determine the accuracy of several methods. Tooth formation was assessed from radiographs of healthy children attending a dental teaching hospital. The sample was 946 children (491 boys, 455 girls, aged 3–16.99 years) with similar number of children from Bangladeshi and British Caucasian ethnic origin. Panoramic radiographs were examined and seven mandibular teeth staged according to Demirjian's dental maturity scale [A. Demirjian, Dental development, CD-ROM, Silver Platter Education, University of Montreal, Montreal, 1993–1994; A. Demirjian, H. Goldstein, J.M. Tanner, A new system of dental age assessment, Hum. Biol. 45 (1973) 211–227; A. Demirjian, H. Goldstein, New systems for dental maturity based on seven and four teeth, Ann. Hum. Biol. 3 (1976) 411–421], Nolla [C.M. Nolla, The development of the permanent teeth, J. Dent. Child. 27 (1960) 254–266] and Haavikko [K. Haavikko, The formation and the alveolar and clinical eruption of the permanent teeth. An orthopantomographic study. Proc. Finn. Dent. Soc. 66 (1970) 103–170]. Dental age was calculated for each method, including an adaptation of Demirjian's method with updated scoring [G. Willems, A. Van Olmen, B. Spiessens, C. Carels, Dental age estimation in Belgian children: Demirjian's technique revisited, J. Forensic Sci. 46 (2001) 893–895]. The mean difference (±S.D. in years) between dental and real age was calculated for each method and in the case of Haavikko, each tooth type; and tested using t-test. Mean difference was also calculated for the age group 3–13.99 years for Haavikko (mean and individual teeth). Results show that the most accurate method was by Willems [G. Willems, A. Van Olmen, B. Spiessens, C. Carels, Dental age estimation in Belgian children: Demirjian's technique revisited, J. Forensic Sci. 46 (2001) 893–895] (boys −0.05 ± 0.81, girls −0.20 ± 0.89, both −0.12 y ± 0.85), Demirjian [A. Demirjian, Dental development, CD-ROM, Silver Platter Education, University of Montreal, Montreal, 1993–1994] overestimated age (boys 0.25 ± 0.84, girls 0.23 ± 0.84, both 0.24 y ± 0.86), while Nolla [C.M. Nolla, The development of the permanent teeth, J. Dent. Child. 27 (1960) 254–266] and Haavikko's [K. Haavikko, The formation and the alveolar and clinical eruption of the permanent teeth. An orthopantomographic study, Proc. Finn. Dent. Soc. 66 (1970) 103–170] methods under-estimated age (boys −0.87 ± 0.87, girls −1.18 ± 0.96, both −1.02 y ± 0.93; boys −0.56 ± 0.91, girls −0.79 ± 1.11, both −0.67 y ± 1.01, respectively). For individual teeth using Haavikko's method, first premolar and second molar were most accurate; and more accurate than the mean value of all developing teeth. The 95% confidence interval of the mean was least for mean of all developing teeth using Haavikko (age 3–13.99 years), followed by identical values for Demirjian and Willems (sexes combined).

An orthopantomographic study of developmental mandibular bone defects (Stafne's idiopathic bone cavities)

The purpose of the present study was to investigate, on the basis of radiographs, the prevalence and special characteristics of developmental bone defects near the angle of the mandible among an adult population. Ten bone defects were observed in the 10,000 orthopantomograms studied, i.e. a prevalence of one per thousand in the total material. All defects were unilateral and occurred in men only. The mean age was 54 years and the age range 19 to 72 years. The diameter of the defects ranged from 8 to 22 mm, mean 12.8 mm. The largest cavities were seen in the oldest individuals of the series. In eight of the 10 cases the defect was above the inferior border of the mandible. One patient was followed-up for 3 years, and during this time neither the size nor the shape of the defect on the radiograph was seen to have changed.

Asymmetric tooth formation in the permanent dentition of cleft-affected children. An orthopantomographic study.

An investigation was made of asymmetric tooth formation in 54 children with cleft lip and alveolus and in 153 children with cleft palate, after which the findings were compared with the corresponding results obtained in an investigation of a group of 258 children with complete cleft lip and palate. Asymmetric growth was found in all the permanent teeth, but it was observed to occur most frequently in the upper incisors and the upper and lower premolars. In the cleftpalate group, asymmetry was seen to occur with equal frequency in both jaws, whereas in the cleftlip and alveolus and the cleftlip and palate groups, the condition was met with considerably more often in the upper jaw. The asymmetry varied from one to five developmental stages, though the difference registered mostly amounted to only one developmental stage. Certain other dental anomalies and etiological factors are also discussed in this paper.