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Background: This study aims to propose the combinations of image processing and machine learning model to segment the maturity development of the mandibular premolars using a Keras-based deep learning convolutional neural networks (DCNN) model., Methods: A dataset consisting of 240 images (20 images per stage per sex) of retrospect digital dental panoramic imaging of patients between 5 and 14 years of age was retrieved. In image preprocessing, abounding box with a dimension of 250 × 250 pixels was assigned to the left mandibular first (P1) and second (P2) permanent premolars. The implementation of dynamic programming of active contour (DP-AC) and convolutions neural network on images that require the procedure of image filtration using Python TensorFlow and Keras libraries were performed in image segmentation and classification, respectively., Results: Image segmentation using the DP-AC algorithm enhanced the visibility of the image features in the region of interest while suppressing the image's background noise. The proposed model has an accuracy of 97.74%, 96.63% and 78.13% on the training, validation, and testing set, respectively. In addition, moderate agreement (Kappa value = 0.58) between human observer and computer were identified. Nonetheless, a robust DCNN model was achieved as there is no sign of the model's over-or under-fitting upon the learning process., Conclusions: The application of digital imaging and deep learning techniques used by the DP-AC and convolutions neural network algorithms to segment and identify premolars provides promising results for semi-automated forensic dental staging in the future., (© 2022. The Author(s).)

Introduction: The determination of skeletal maturity stages is very important in orthodontic treatment planning, especially skeletal discrepancies in growing individuals. A hand-wrist radiograph is considered the most accurate approach for skeletal maturity detection. Dental calcification stages have been suggested as an alternative diagnostic method to decrease radiation exposure. The recent study is aimed at detecting the efficacy of dental calcification stages in assessing skeletal maturity during the prepubertal and pubertal growth periods., Methods: Patients' records were collected from the Aleppo Orthodontic Center. Dental maturity stages were assessed from a panoramic radiograph using the Demirjian method, while skeletal maturity stages were determined using the Björk method. Four permanent left mandibular teeth were included (canine, 1st premolar, 2nd premolar, and 2nd molar) for the study., Results: From 517 records, 295 records (145 males and 150 females) were included. The Spearman rank-order correlation coefficients between skeletal maturation and dental maturation were strong and statistically significant (ranging from 0.789 to 0.835). The highest correlation was between skeletal stages and the second molar ( r = 0.829 and 0.88 in males and females, respectively). Receiver operating characteristic (ROC ) curve suggested a high validity of the sum of dental stages for the four teeth in identifying MP3= stage (sensitivity was 70%, specificity was 92.77%, and ROC area was 0.81) but not for MP3cap (sensitivity was 50.85%, specificity was 81.36%, and ROC area was 0.66)., Conclusions: The correlation between the skeletal maturity stages and the dental calcification stages was high. The orthodontist can use the dental stages as a definite diagnostic tool for prepubertal growth period., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Ayah Jourieh et al.)

Background: The timing of eruption of permanent teeth can be a precious help to the pediatric practitioner in identifying an appropriate treatment plan. Usually, it presents a more precise sign of an early or late growth of the child., Aims: It is to determine whether the timing of the permanent teeth eruption in Lebanese pediatric population can be considered as standard Lebanese values, since no other study was previously performed., Materials and Methods: A cross-sectional study is conducted, and the clinical emergence data are collected for a sample of 2317 Lebanese children aged between 5.5 years and 13 years (1129 girls and 1188 boys) from different socioeconomic groups in rural and urban communities spread over different regions in Lebanon. The study investigates dental emergence patterns., Results: Statistical analysis is performed with the SPSS Software. A confidence interval of 95% and significance level of 5% are adopted. The trend is for males to begin their permanent teeth eruption later than girls. Emergence of all permanent mandibular teeth is earlier than maxillary ones. Symmetry is found between the right and left teeth in the maxilla, as well as in the mandibula., Conclusion: In this study, the results indicate that premolars and second permanent molars erupt earlier in the Lebanese children compared to children of other countries reflected in several studies., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Nahla Nassif and Elia Sfeir.)

Background: The innate immune activation which promotes inflammation responses in the dental pulp tissue leads to the progression of dentin caries. Accordingly, toll-like receptors (TLRs) are key molecules of the innate immune system that identify pathogen-associated molecular patterns (PAMPs) on microorganisms and may have a critical role in a dental injury. Therefore, this study aimed to investigate the expression of TLR2, TLR3, and TLR4 in the human dental pulp of opened and closed apex teeth., Methods: Human dental pulps were derived from the healthy opened and closed apex premolar, in which extraction was indicated for orthodontic reasons. The extraction of RNA was performed and the gene expression determined by real-time polymerase chain reaction (RT-PCR). The result from real-time PCR was confirmed using western blot analysis., Results: Real-time PCR data analysis showed that the expression TLR2 and TLR4 were significantly increased in closed apex premolar teeth compared to open apex teeth, whereas TLR3 expression was not significantly different in these two groups (p < .05)., Conclusion: The results of the present study suggested increased expression of TLR2 and TLR4 by the maturation of the apex, which may be due to the presence of microorganisms in the normal or destructed dental pulp tissue. Thus, identifying the expression of TLRs molecules in dental pulp tissue helps to develop a deeper knowledge of the immune responses in the oral cavity., (© 2020 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals LLC.)

The mandibular third premolar (P 3 ) exhibits substantial differences in size and shape among hominoid taxa, and displays a number of discrete traits that have proven to be useful in studies of hominin taxonomy and phylogeny. Discrete traits at the enamel-dentine junction (EDJ) can be accurately assessed on moderately worn specimens, and often appear sharper than at the outer-enamel surface (OES). Here we use microtomography to image the P 3 EDJ of a broad sample of extant apes, extinct hominins and modern humans (n = 100). We present typologies for three important premolar discrete traits at the EDJ (transverse crest, marginal ridge and buccal grooves), and score trait frequencies within our sample. We find that the transverse crest is variable in extant apes, while the majority of hominins display a transverse crest which runs directly between the two major premolar cusps. Some Neanderthals display a unique form in which the transverse crest fails to reach the protoconid. We find that mesial marginal ridge discontinuity is common in Australopithecus anamensis and Australopithecus afarensis while continuous marginal ridges largely characterize Australopithecus africanus and Paranthropus. Interrupted mesial and distal marginal ridges are again seen in Homo sapiens and Neanderthals. Premolar buccal grooves, previously identified at the OES as important for hominin systematics, are again found to show a number of taxon-specific patterns at the EDJ, including a clear difference between Australopithecus and Paranthropus specimens. However, their appearance may be dependent on the morphology of other parts of the crown such as the protoconid crest, and the presence of accessory dentine horns. Finally, we discuss rare variations in the form of dentine horns that underlie premolar cusps, and their potential homology to similar morphologies in other tooth positions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to examine the applicability of the pulp/tooth area ratio in the lower premolar teeth using panoramic radiography in age estimation of Korean adults., Methods: 402 digital panoramic images of Korean adults between 20 and 78 years were analyzed. Following Cameriere et al.'s method, two observers measured the pulp and tooth areas of the lower second premolar on digital panoramic images, and the ratio of pulp to tooth area in the whole tooth (PTR) was calculated. In addition, the whole tooth was divided into coronal and root parts at the cementoenamel junction, and the ratios in the coronal part (PcCR) and root part (PrRR) were also calculated separately. Independent t-test, Analysis of covariance, linear regression, and the standard error of the estimate (SEE) were computed using statistical software. To justify the use of linear regression models for purposes of prediction, diagnostic tests of principal assumptions were also performed., Results: Independent t-test revealed significant differences in genders. PrRR produced the best age correlation (male, SEE=10.8; female, SEE=9.8; total, SEE=10.4 years), followed closely by PTR (male, SEE=11.1; female, SEE=10.3; total, SEE=10.7 years) and a relatively lower accuracy for PcCR (male, SEE=14.7; female, SEE=14.4; total, SEE=14.6 years). Model assumptions and accuracy for purposes of prediction in PTR and PrRR were satisfied., Conclusions: The pulp/tooth area ratio using panoramic radiography has the potential as an effective tool for age estimation in the Korean adult population, and the pulp/tooth area ratio in the root part is more accurate than that of the whole tooth. Notably, female has shown higher accuracy compare to male subject., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To evaluate and compare the eruption rates of lower second premolars (LPm2) at different developmental stages using cone-beam computed tomography (CBCT)., Materials and Methods: Retrospectively, 31 individuals (9.77 ± 1.25 years) had their LPm2 scored according to the Demirjian method, and afterwards they were split into three groups according to developmental stage, as follows: D = complete-formed crowns; E = root length less than crown height; and F = root length greater than or equal to crown height. Linear distances from the LPm2 crown tip to the anatomical reference line (ARL) and to the occlusal plane line (OPL) were measured in paired CBCT scans (T1, T2), taken with an average interval of 8.6 months between them. Eruption rates (mm/y) were calculated and then compared between groups., Results: Eruption rates were greater for LPm2 at stage F than at stages D or E (P < .01) regardless of whether they were measured from the ARL (D = 2.84 mm/y; E = 2.55 mm/y; F = 5.38 mm/y) or from the OPL (D = 1.82 mm/y; E = 2.02 mm/y; F = 5.26 mm/y). Eruption rates evaluated from the ARL and the OPL had no statistically significant differences (P = .052), and a positive correlation (r = .79, P < .001) between them was observed., Conclusions: LPm2 at Demirjian stage F showed greater eruption rates than at stages D or E, regardless of whether rates were measured from the ARL or the OPL. Faster eruption is expected for LPm2 at stage F. Evaluation of the LPm2's developmental stage using CBCT can aid in clinical decision making regarding the correct timing for intervention.

Dental maturity is associated with skeletal maturity, which is advanced in girls with central precocious puberty (CPP). We investigated the performance of dental maturity as a screening method for CPP using mandibular second premolar and molar calcification stages, assessed the associated anthropometric and laboratory factors, and evaluated pubertal response predictors using the gonadotropin-releasing hormone stimulation test (GnRHST) in prepubertal and pubertal girls. A prospective case-control study was conducted in girls, aged 7.0-8.9 years, classified into pubertal (peak luteinizing hormone [LH] after GnRHST ≥ 5 IU/L), prepubertal (peak LH < 5 IU/L), and control groups. Auxological and biochemical tests, panoramic radiographs, and GnRHSTs in participants with breast development were conducted. Dental maturity was assessed using the Demirjian index (DI). We included 103 girls (pubertal, 40; prepubertal, 19; control, 44). Chronological age (CA) was not significantly different between groups. Bone age (BA) and BA advancement was higher in the pubertal and prepubertal groups. Increased DI values at the mandibular second premolar and molar were significantly associated with CA, BA, BA advancement, height standard deviation score (SDS), peak LH after GnRHST, and insulin-like growth factor-I (IGF-I) (all P < 0.05). Moreover, odds ratio (OR) of the mandibular second premolar and molar (a DI value of ≥ E) for predicting a positive response to GnRHST was 8.7 (95% confidence intervals [CI], 2.9-26.1) and 5.2 (95% CI, 2.2-12.7), respectively. Dental maturity was a strong predictor for diagnosing CPP. Determining dental maturity in girls with suspected precocious puberty might help determine the performance of GnRHSTs., Competing Interests: The authors have no potential conflicts of interest to disclose.

Hypodontia, or tooth agenesis, is the most prevalent craniofacial malformation in humans. It may occur as part of a recognised genetic syndrome or as a nonsyndromic isolated trait. Excluding third molars, the reported prevalence of hypodontia ranges from 1.6 to 6.9%, depending on the population studied. Most affected individuals lack only one or two teeth, with permanent second premolars and upper lateral incisors the most likely to be missing. Both environmental and genetic factors are involved in the aetiology of hypodontia, with the latter playing a more significant role. Hypodontia individuals often present a significant clinical challenge for orthodontists because, in a number of cases, the treatment time is prolonged and the treatment outcome may be compromised. Hence, the identification of genetic and environmental factors may be particularly useful in the early prediction of this condition and the development of prevention strategies and novel treatments in the future.

Introduction: The aims of the study were; to evaluate the applicability of the Moyers and Tanaka-Johnston Methods to individuals with a Spanish ancestry, to propose new regression equations using the lower four permanent incisors as predictors for the sum of the widths of the lower permanent canine and premolars, and to compare the new data to those from other populations., Methods: A total of 359 Spanish ancestry adolescents were selected. Their dental casts were measured using a 2D computerized system. Real teeth measurements were compared with those predicted using Moyers probability tables and Tanaka and Johnston equations, and standard regression equations were then developed., Results: Results showed that Upper and Lower Canine and Premolar (UCPM, LCPM) predictions are quite different depending on the used method. Moyers tables can only be validly applied to a 75% percentile for the mandible in both, males and females, 85% in males and 90-92% in females., Conclusions: Moyers predictions tend to underestimate UCPM and LCPM whereas Tanaka-Johnston predictions tend to overestimate them. Equations for estimating the combined width of the unerupted canine and premolars were; Male: UCPM = 12.68 + 0.42 LI and LCPM = 11.71 + 0.44 LI. Female: UCPM = 12.06 + 0.43LI and LCPM = 10.71 + 0.46 LI.

The present meta-analysis initially evaluates the reliability of dental maturation in the identification of the circumpubertal growth phases, essentially for determining treatment timing in orthodontics. A literature survey was performed using the Medline, LILACS and SciELO databases, and the Cochrane Library (2000 to 2011). Studies of the correlation between dental and cervical vertebral maturation methods were considered. The mandibular canine, the first and second premolars, and the second molar were investigated. After the selection, six articles qualified for the final analysis. The overall correlation coefficients were all significant, ranging from 0.57 to 0.73. Five of these studies suggested the use of dental maturation as an indicator of the growth phase. However, the diagnostic performance analysis uncovered limited reliability only for the identification of the pre-pubertal growth phase. The determination of dental maturity for the assessment of treatment timing in orthodontics is not recommended.

Clinically the condition Molar Incisor Hypomineralization (MIH),varies considerably between individuals, where any number of molars, from one to all four permanent first molars, may be affected with different degrees of hypomineralized enamel within the same dentition. An explanation to these variations could be that the start of the enamel mineralization differs between homologues teeth. The aim of this study was to compare the dental development between homologues teeth in digital panoramic radiographs (PRs),from children aged 7 to 11 years, using the Gleiser & Hunt method on second and third molars and to calculate the crown/root ratio for the mandibular premolars.77 PRs, from individuals between 7.3 and 11.0 years of age, were studied. Differences in developmental stages between homologues teeth (second and third molars) were studied. In 72 of these PRs, the crown/root ratio of mandibular premolars was also compared. In 31 of the PRs, a difference in development was found between the right and left maxillary second molar. In 22 PRs, a difference in development between the right and left mandibular second molar was found. In 17 of the PRs, a difference in development was found between the right and left maxillary third molars. In 26 PRs,a difference in-between the right and left mandibular third molar was found. In 72 PRs, the crown/root ratio of mandibular premolars was measured and differences were found. All these differences were significant. A possible explanation to the variations in expressivity of MIH may be a result of differences in the start of mineralization between homologues teeth. Timing of mineralization of homologues permanent teeth--An evaluation of the dental maturation in panoramic radiographs.

Objective: To evaluate the relationship between the stages of dental formation and the timing of eruption of mandibular second premolars., Materials and Methods: The sample comprised panoramic radiographs of 25 children, 7 to 12 years old, observed by space supervision during development of dentition. The initial radiograph (T1) was taken in the mixed dentition period and the progress radiograph (T2) close to the eruption of mandibular second premolars. The stages of dental formation were determined by the proportion between crown length and total length (CL/TL) as well by the Simpson and Kunos index. Average values between right and left sides (35, 45) were correlated to the time elapsed until dental eruption (T2-T1). Statistical analysis was performed by Pearson correlation analysis., Results: The proportion CL/TL presented higher correlation index with time to eruption than the Simpson and Kunos index. The linear regression equation for prediction of timing of eruption showed high coefficient of determination, low deviation, and good accuracy. According to survival analysis, mean deviation at 95% confidence level was between 3.6 and 6.4 months. There was no difference in contralateral measurements, with high intraclass correlation coefficient for both CL/TL proportion and Simpson and Kunos index., Conclusions: More advanced stages of dental formation indicate less time until dental eruption. The strong correlation with crown length/total length proportion (CL/TL) provides a linear regression equation for prediction of the timing of eruption of mandibular second premolars.

Determination of the skeletal maturation is extremely important in clinical orthodontics. Cervical vertebral maturation is an effective diagnostic tool for determining the adolescent growth spurt. The aim of this study was to investigate the correlation between the stages of calcification of teeth and the cervical vertebral maturity stages.

The purpose of the study was to investigate the relationship between Demirjian's method and the improved cervical vertebrae maturation (CVM) method. The material consisted of the clinical files and panoramic and lateral cephalometric radiographs of 718 children (431 girls and 287 boys) aged from 6 to 17 years, inhabitants of the Mazovia region (Central Poland). Dental age according to Demirjian was estimated using panoramic radiographs and the cervical stages (CS) of the CVM were evaluated on cephalometric radiographs. Descriptive statistics of the chronological and dental ages of the patients for a particular CS of skeletal maturity was calculated for girls and boys separately. Linear regression analysis and correlation (Pearson's r coefficient), as well as the Spearman rank correlation coefficient (R) were applied to measure the association between CS and dental calcification stages of all analysed teeth. A consistently earlier occurrence (by about 6 months) for each CS was observed in females. A moderate, but statistically significant, correlation between Demirjian's dental developmental stages and CS was determined. The level of the correlation was different for individual teeth: the teeth showing the highest relationship with CVM were the second premolars and canines (in female and male subjects, respectively). The central incisor demonstrated the poorest correlation in both genders. The findings confirmed that both dental and skeletal maturity should be assessed if the maturity stage of a growing child is to be relevant to clinical practice. The results indicate the usefulness of dental calcification stages as a simple first-level diagnostic test to determine the skeletal maturity status of a subject.

The aim of this study was to determine if Häävikko's maturation standards are applicable to Italian children. The sample included 500 healthy Caucasian children 3.9-15.4 years of age: 267 girls [mean age 9.6 years, standard deviation (SD) 2.1] and 233 boys (mean age 9.9 years, SD 2.1), living in Italy. All dental ages were assessed from panoramic films by one examiner using Häävikko's method. A second examiner independently scored 48 panoramic films to evaluate the reproducibility of the dental age measurements. A good correlation (0.95) was found, as shown by Cohen's kappa. To evaluate the relationship between dental age estimated by Häävikko's standards and the chronological age of the Italian sample, Bland and Altman's graphical method was employed. Moreover, centiles of dental age were constructed both for girls and boys using the LMS (L=skewness, M=median, S=coefficient of variation) method of Cole and Green. It was found that Häävikko's standards tended to underestimate chronological age in this Italian sample. Dental maturation standards as described by Häävikko do not appear suitable for Italian children; instead, centile curves constructed for girls and boys using the LMS method could be used for the estimation of dental age in the Italian population.

A recent study demonstrated that variation in enamel cap crown formation in the anterior teeth is greater than that in the molars from two geographically distinct populations: native indigenous southern Africans and northern Europeans. Eighty southern African and 69 northern European premolars (P3 and P4) were analyzed in the present study. Cuspal, lateral, and total enamel formation times were assessed. Although cuspal enamel formation times were not consistently different between the two populations, both lateral and total enamel formation times generally were. Bonferroni-corrected t-tests showed that southern Africans had significantly shorter lateral enamel formation time for five of the six cusps, as well as significantly shorter total enamel formation time for these same cusps. An analysis of covariance performed on the lingual cusps of the upper third and fourth premolars showed that differences in enamel formation times between these populations remained when crown height was statistically controlled. A further goal of this study was to ascertain, based on perikymata counts, what Neandertal periodicities would have to be in order for their teeth to have lateral enamel formation times equivalent to either southern Africans or northern Europeans. To this end, perikymata were counted on 32 Neandertal premolars, and the counts were inserted into regression formulae relating perikymata counts to periodicity for each population and each tooth type. Neandertal enamel formation times could be equivalent to those of southern Africans or northern Europeans only if their hypothetical periodicities fall within the range of periodicities for African apes and modern humans (i.e., 6-12 days). The analysis revealed that both populations could encompass Neandertal timings, with hypothetical periodicities based on the southern African population necessitating a lower range of periodicity (6-8 days) than those based on the northern European population (8-11 days).

Normal and abnormal jaw growth and tooth eruption are topics of great importance for several dental and medical disciplines. Thus far, clinical studies on these topics have used two-dimensional (2D) radiographic techniques. The purpose of the present study was to analyse normal mandibular growth and tooth eruption in three dimensions based on computer tomography (CT) scans, extending the principles of mandibular growth analysis proposed by Björk in 1969 from two to three dimensions. As longitudinal CT data from normal children are not available (for ethical reasons), CT data from children with Apert syndrome were employed, because it has been shown that the mandible in Apert syndrome is unaffected by the malformation, and these children often have several craniofacial CT scans performed during childhood for planning of cranial and midface surgery and for follow-up after surgery. A total of 49 datasets from ten children with Apert syndrome were available for study. The number of datasets from each individual ranged from three to seven. The first CT scan in each of the ten series was carried out before 1 year of age, and the ages for the 49 scans ranged from 1 week to 14.5 years. The mandible and the teeth were segmented and iso-surfaces generated. Landmarks were placed on the surface of the mandible, along the mandibular canals, the inner contour of the cortical plate at the lower border of the symphysis menti, and on the teeth. Superimposition of the mandibles in the longitudinal series was performed using the symphysis menti and the mandibular canals as suggested by Björk. The study supported the findings of stability of the symphysis menti and the mandibular canals as seen in profile view previously reported by Björk & Skieller in 1983. However, the mandibular canals were, actually, relocated laterally during growth. Furthermore, the position of tooth buds remained relatively stable inside the jaw until root formation started. Eruption paths of canines and premolars were vertical, whereas molars erupted in a lingual direction. The 3D method would seem to offer new insight into jaw growth and tooth eruption, but further studies are needed.

In the early developmental stage of the mandibular second premolar (MnP2), it is not unusual to find the tooth extremely angulated to the lower border of the mandible, as seen in the panoramic roentgenogram. On eruption, the tooth, in most cases, is close to being upright. However, impaction or other types of malocclusions due to its ectopic eruption are not rare. This study follows the angular changes of the MnP2 during development. Two hundred two panoramic roentgenograms of 101 patients were retrospectively analyzed. All patients had two sequential films with a minimal time interval of nine months. Each MnP2 was traced, and its developmental stage as well as its angulation to the lower border of the mandible was registered. We found that normally more MnP2 are distally (56.5%) than mesially (25%) inclined. There is a statistically significant difference in the inclination of the teeth during their development from stage D to stage F (D = 75.17 degrees +/- 15.25 degrees, E = 79.35 degrees +/- 12.18 degrees, F = 83.38 degrees +/- 10.79 degrees). The average amount of total angular change rate of the MnP2s from stage D to stage G is 0.09 +/- 0.25 degrees/mo, and the absolute angular change rate is 0.19 +/- 0.25 degrees/mo.

One-hundred-and-eighteen premolars transplanted at a stage with 3/4 to 4/4 root development with an open apical foramen were followed using a standardized clinical and radiographic technique for signs of periodontal ligament healing, root development, and tooth eruption. Root growth was unimpeded in 26 per cent, impaired in 55 per cent, and arrested in 19 per cent. Eruption of transplants occurred at the time of periodontal and alveolar healing, and before any significant root growth. Furthermore, autotransplanted premolars created growth of the alveolar process along with the eruption process.

Dental developmental status of the permanent canines, premolars and second molars were studied in one hundred and two twelve-year-old Southern Chinese girls born and brought up in Hong Kong. Eruption of these teeth were defined as gingival emergence during the clinical examination while the root development was assessed from orthopantomographs. Root resorption pattern of the primary canines and molars were also studied with the aid of the orthopantomographs. Two-thirds of girls presented with permanent dentition stage. The root resorption patterns of the primary teeth were different from their order of exfoliation. The mandibular permanent teeth were in advanced in both eruption and root development than the corresponding maxillary teeth, except the first premolars.