Performance and comparison of the London Atlas technique and Cameriere's third molar maturity index (I3M) for allocating individuals below or above the threshold of 18 years.

Age estimation is an important procedure in the forensic practice, especially when it comes to the criminal imputability of juvenile offenders. This study aimed to compare two radiographic methods for dental age estimation in a population of subadults from Northeast Brazil considering their performance on allocating individuals below or above the age threshold of 18 years. A cross-sectional observational study was designed. The sample consisted of 1200 panoramic radiographs of Northeastern Brazilian females (n = 600) and males (n = 600) aged between 16 and 21 years. Dental age estimation was performed using the London Atas technique and Cameriere's third molar maturity index (I3M). Statistical tests were performed to assess the sensitivity, specificity and accuracy of the two methods on distinguishing individuals below or above the legal age threshold of 18 years. Considering the total sample, the London Atlas technique reached sensitivity of 92.3%, specificity of 56% and accuracy of 79.9%. I3M revealed sensitivity of 94.1%, specificity of 55.4% and accuracy of 79.8%. Specificity rates systematically decreased when the sample was progressively stratified based on age groups that narrowed close to 18 years. The methods performed very similar (0.878). The combination of methods did not improve the performance on dental age estimation. The London Atlas and the I3M methods similarly distinguished Brazilian individuals as minors or not. Their performance, however, was suboptimal because of the low rates of specificity that could negatively influence on Court decisions. In other words, the methods could wrongly classify minors into the age of legal majority (culminating in false positives). In practice, the misleading classification could restrict individual rights (in the civil scenario) or even support more severe penalties (in the criminal scenario).

Applicability of 2 Dental Age Estimation Methods to Taiwanese Population.

The aim of this study is to assess the accuracy of Demirjian and Willems dental age estimation methods on a population of 8- to 15-year-old Taiwanese children. A total of 799 digital panoramic radiographs (404 boys, 395 girls) of children aged from 8.00 to 15.99 years are evaluated. All panoramic films are assessed by 2 examiners using Demirjian and Willems methods. We randomly select 48 panoramic films to evaluate the reproducibility of dental age measurements. The intraobserver and interobserver Cohen's kappa values are 0.733 and 0.762, respectively.The difference between chronological age and dental age is calculated for each individual using both methods. The result shows that Demirjian method slightly overestimates the chronological age of children. The mean age difference is 0.12 years for boys (standard deviation [SD], 0.80) and 0.21 years for girls (SD, 0.95). Willems method slightly underestimates the chronological age of children. The mean age difference is -0.22 years for boys (SD, 0.80) and -0.12 years for girls (SD, 0.92).In conclusion, Demirjian and Willems methods are both accurate for assessing dental age in the Taiwan region of China. The mean age differences of both methods are within ±1 year, which is acceptable at forensic odontology level. However, although the discrepancy between chronological age and dental age is frequently observed between -0.5 and 0.5 years in both methods, there is no guarantee it will be accurate for any particular individual, further modifications to both methods are suggested.

Human closed and open apex premolar teeth express different toll-like receptor.

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.

Terapia regenerativa en un incisivo central superior permanente inmaduro: caso clínico / Regenerative therapy in an immature permanent upper central incisor: a clinical case

Objetivo: Presentar la terapia regenerativa como una al- ternativa para la resolución de un caso de traumatismo denta- rio en un diente permanente incompletamente desarrollado. Caso clínico: Se realizó el tratamiento de un incisivo central superior con mortificación pulpar y periodontitis api- cal aguda subsecuente a trauma dental en un paciente de 8 años de edad. Se aplicó el protocolo de regeneración pulpar recomendado por la Asociación Americana de Endodoncia. Se estimuló la formación de un coágulo en el interior del con- ducto a partir de los tejidos periapicales, previa desinfección con la pasta triple antibiótica, y finalmente se colocó mineral trióxido agregado coronal a este. Se obtuvo así una matriz es- teril que permitió el crecimiento de nuevo tejido y se realiza- ron controles periódicos durante 4 años. Se constató silencio clínico. Radiográficamente, se observó la formación de tejido sobre las paredes del conducto y el cierre apical. Conclusión: La terapia regenerativa como alternativa de tratamiento, en este caso, permitió la disminución de la luz del conducto por el depósito de tejidos calcificados y el cierre del foramen apical, mejorando el pronóstico de la pieza dentaria (AU)

Aim: To present pulp regeneration therapy as an alter- native to resolve dental trauma in immature permanent teeth. Clinical case: We report a clinical case of an immature central superior incisor with pulp mortification and acute api- cal periodontitis subsequent to dental trauma, in an 8 year old patient. The pulp Regeneration protocol recommended by the American Endodontics Association was applied. We stimulated a clot formation inside the duct from periapical tissues and after disinfection with a mixture of three antibi- otics mineral trioxide aggregated was finally place coronal to the clot. Thus a sterile matrix was obtained that allowed new tissue's growth. Periodic check-up visits were carried out over a 4 years period. Clinical silence was observed. Tissue formation on duct walls and apical closure were radiograph- ically detected (AU) Conclusion: Regenerative therapy is an alternative for the treatment of immature permanent teeth, in ths clinical case it allowed the reduction of the width of the duct by the opposition of hard tissues and the closure of the apical fora- men improving the forecast of these teeth.

Applicability of the third molar maturity index for assessment of age of majority in Eastern China.

From a legal and penalty point of view, it is essential to conclude if an individual has reached the legal age (also known as age of majority). Although Cameriere's third molar maturity index (I3M) has been used to discriminate between adults and minors, no study has tested the applicability of I3M in the Eastern Chinese population. The aim of this study was to assess the validity of the region-specific cut-off value of I3M for discriminating minors from adults in an Eastern Chinese population. Five hundred fifty-six subjects (276 males and 280 females) aged 14-24 years participated in this study. A logistic regression analysis was conducted by considering the adult and minor ages as dichotomous dependent variables and I3M and sex as predictor variables. The results showed that sex was not statistically significant in distinguishing adults and minors. The receiver operating curve analysis showed the best performance of the cut-off value of I3M < 0.08 in discriminating adults from minors. Furthermore, the diagnostic test showed the proportion of accuracy was 90.22% in males and 86.43% in females. The sensitivity and specificity for males were 88% and 94.06%, respectively, while those for females were 83.71% and 91.18%, respectively. The estimated Bayes post-test probability was 97.18% and 96.01% in males and females respectively. Therefore, I3M < 0.08 may be a useful tool for indicating the legal age in Eastern Chinese population.

A comparison of the accuracy of Willems' and Cameriere's methods based on panoramic radiography.

Tooth development evaluation is majorly the current approach to identify age and maturity. Dental age (DA) is therefore considerably emphasized in forensic and pediatric dentistry. The aim of this study was to assess the applicability of Willems and Cameriere methods for Turkish children. Panoramic images of 636 Turkish healthy children (319 male; 317 female) aged between 6 and 15 years were assessed. DA of the subjects was determined by using Willems and Cameriere methods. The seven right and left permanent lower teeth were valued using these two methods. The mean chronological age (CA) of the subjects was 11.53±2.25 (min:6, max:14.99) years (boys: 11.29±2.34 years, girls: 11.77±2.15 years). Willems method overestimated the CA (p≤0.001), in contrast, Cameriere method underestimated the CA (p≤0.001) for both sexes. In different age groups the mean difference between the CA and DA calculated by Cameriere method (CADA) ranged from 0.86 to -0.41 years for boys and from 1.00 to -0.21 years for girls, while the mean difference between the CA and DA calculated by Willems method ranged from -0.26 to -0.71 years for boys and from 0.19 to -0.76 years for girls. Cameriere method provided a better percentage of accuracy (84.6% and 77.3% for males and females, respectively) in the absolute difference values within 1 year compared to Willems method. Cameriere method performed slightly better but, both methods may be used for DA estimation in the Turkish population.

Validation of the Third Molar Maturation Index to estimate the age of criminal responsibility in Northeastern Brazil.

The estimation of the age of majority is crucial to determine the legal accountability of an individual. With this purpose, the analysis of the dental development process has proven to be an effective, elucidatory method. This study investigated the applicability of the Third Molar Maturation Index (I3M), proposed by Cameriere et al. (2008), to estimate the age of majority in a sample of Northeastern Brazilians using panoramic radiographs. Adobe® Photoshop® CS4 (Adobe Systems Incorporated, San Jose, California, USA) software was used to obtain the I3M index measurements in a sample of radiographs from a dental radiology clinic located in Northeastern Brazil. Radiographs of individuals aged between 14 and 23 years were included in the sample, except if showing absence, distortions, pathological alterations or suspected pulp impairment of the tooth #38 (third lower left molar), as the method applies exclusively to this element. Of the total sample of radiographs previously obtained for diagnostic and/or orthodontic purposes (n=394), 185 were from males and 209 from females, of which 217 corresponded to 18 year-olds or older and 177 were from minors. Logistic regression and predictive values of sensitivity, specificity and Receiver Operating Characteristic (ROC) curve (α=0.05) were used. The cutoff point originally proposed for the I3M index (0.08) presented a sensitivity of 88.4% and a specificity of 73.2%, with accuracy (area under the ROC curve) of 80.8% (95%CI: 76.4-85.3%) for the Northeastern Brazilian population, as well as a correct age classification in 80.2% of the sample. The method estimated accurately 73.7% of the cases corresponding to "18 years or older" and 88.1% of the cases "under 18years" (p=0.000). Among the sexes, the correct age classification rate of the method was 84.3% for males and 76.6% for females, with no statistically significant difference between the match and error rates and between the sexes (p≥0.05). In conclusion, the Third Molar Maturation Index could accurately distinguish the age of adolescents and young adults of both sexes aged 18 years or under/older in a Brazilian population.

Age estimation by measuring open apices in teeth: a new formula for two samples of South African black and white children.

In this cross-sectional study, the accuracy of Cameriere's European formula was tested and a new specific model was developed for two samples of black and white South African children with known age and sex. For these purposes, 970 children of black South African ethnicity (girls 491, boys 479) and 974 with European ethnicity, living in South Africa (girls 493, boys 481), were retrospectively analyzed. The application of the European formula showed that there is a trend in the error estimates: the ages of the younger children are overestimated and those of the older children are underestimated, in both white and black children. A new model, based on the relationship between the apical width and the tooth length (maturity index) of the seven permanent mandibular teeth, was therefore constructed. The new developed equation for the South African population was able to explain 76% of total variance in white girls and 80% in white boys' subgroup. On the other side, the model explained 76% of total variance in black girls and 78% in the black boys' subgroup. The mean absolute error of the residuals (residuals = predicted age minus observed age) ranged from 0.718 to 0.769 years, with the interquartile range (IQRres) ranging from 1.19 to 1.31 years. Differently from the Cameriere's European formula, the plot did not tend to underestimate the chronological age significantly as the age increases. Cameriere's maturity index is reproducible in both samples of South African black and white children, for forensic purposes, and the Bayesian calibration approach is useful for a more accurate and precise estimation.

Three-dimensional image analysis of developing mandibular third molars apices for age estimation: A study using CBCT data enhanced with Mimics & 3-Matics software.

Three-dimensional imaging has improved the method of analysis in many forensic science investigations. The study aimed to derive regression equation for age estimation by investigating the relationship between chronological age and surface area of the developing mandibular 3rd molars apices. Furthermore, other predictor variables: ethnicity (Malay and Chinese), gender and status of the root development completion (open/closed apices) were also investigated in terms of fit to the age estimation model. One hundred and twenty eight training and 55 validation samples of intact mandibular 3rd molars were selected from 183 CBCT scans. The samples comprised of 93 Malays and 90 Chinese, ranging in age from 13 to 24 years. Three-dimensional image modeling and surface area analysis of the developing mandibular 3rd molars apices were performed using Mimics and 3-Matics software. Multiple linear regression analysis was used to derive age estimation model using chronological age as a dependent variable and surface area of the apices, ethnicity, gender and status of the root development completion (open/closed apices) as predictor variables. A strong inverse correlation (r = 0.95, SD = 1.144) was observed between chronological age and all the predictor variables. The results showed that 89.6% of the variation in age can be explained by the predictor variables. Mean absolute error (MAE) value of 0.8223 was observed when the derived regression equation was tested on the independent validation sample. In conclusion, three-dimensional surface area analysis of the developing mandibular 3rd molars apices can be used as a reliable method for age estimation.

A cut-off value of third molar maturity index for indicating a minimum age of criminal responsibility: Older or younger than 16 years?

Providing appropriate legal mechanisms, that evaluate the progression of development from the age of childhood innocence to maturity and full responsibility, considered one of the difficult areas of criminal justice policy. The minimum age of criminal responsibility (MACR) in children varies among countries and differs widely owing to history and culture. Due to rising and brutality of criminal offenses, particularly by juveniles, few countries have lowered the minimum age of criminal responsibility, and many have considered/considering to do the same. India is one such country in which is under the proposal of lowering the age of criminal responsibility to 16 years. As there is lack of useful age assessment methods, that can indicate whether if the individual in question is younger (<16 years) or older than MACR (≥16 years), the present study was undertaken to derive a specific cut-off value of the third molar maturity index (I3M) for this purpose. The sample consisted of 1078 orthopantomograms (OPTs) from Andhra Pradesh, India, aged between 11 and 20 years (45.4% males and 54.6% females). The reproducibility of I3M was calculated by intra-class correlation coefficients, which showed an intra-rater and inter-rater agreement of 0.912 and 0.891, respectively. The sample was divided into training dataset (819 OPTs), to test I3M and gender as independent variables and MACR as a dependent variable by logistic regression analysis, and test dataset (259 OPTs). A receiver operating curve (ROC) analysis was performed to evaluate the specific cut-off value of I3M for predicting MACR status. A logistic regression analysis showed that gender was not statistically significant for predicting MACR status while ROC analysis indicated a cut-off value of I3M = 0.293 as best for predicting MACR status. The performance of derived cut-off value was tested in a test data set. The sensitivity of the test was 90.6% and 90%, while specificity was 86% and 87.1% in males and females, respectively. The proportion of correctly classified individuals was 88.0% and 88.7% in males and females, respectively. The estimated Bayes post-test probability in males was 87.2% and while in females it was 88.3%. The results highlight the contribution of the derived cut-off value of I3M for discriminating individuals around MACR and should be evaluated in other populations.

Validation of Cameriere's third molar maturity index alone and in combination with apical maturity of permanent mandibular second molar for indicating legal age of 14 years in a sample of South Indian children.

The aims of the present study were to validate the discriminatory potential of Cameriere's third molar maturity index (I3M) cut-off value of I3M < 1.1 and whether closed apices of permanent second mandibular molar (I2M = 0.0) and I3M < 1.1 indicate the legal age of 14 years and older. A digital orthopantomograms of 804 healthy South Indian children, aged between 10 and 18 years, were collected retrospectively, and mineralization of the third and second left mandibular molars was analyzed by Cameriere's method. The proportion of accurately classified (Ac) individuals using the cut-off value of I3M < 1.1 was 79.4% for males, with Bayes post-test probability (Bayes PTP) of 68.8%. For females, Ac was 79.9% and Bayes PTP was 70.9%. The sensitivity was 94.8% and 98.2% for males and females, and the specificity was 58.7% and 62.8%, respectively. The combination of both variables, I3M < 1.1 and I2M = 0.0, increased the Ac to 87.2% and 94.4% in males and females, the specificity to 98.6% and 99.2%, and Bayes PTP to 98.2% and 94.4%, respectively. In conclusion, the suggested cut-off value of I3M < 1.1 is of moderate accuracy in discriminating individuals between 14 years or older from those under 14 years in the studied population. A combination of both variables, I2M = 0.0 and I3M < 1.1, the discriminating test achieves an excellent specificity and Bayes PTP, which is mandatory for the forensic and medicolegal purposes.

Effects of mechanical force application on the developing root apex in rat maxillary molars.

OBJECTIVES: We aimed to investigate the effects of mechanical force application on the developing root apex in vivo. DESIGN: Mechanical force was applied on the maxillary first molars of Sprague-Dawley rats at postnatal day 21 for 1, 3, 5, and 7 days to induce tooth movement. We observed the developing root apex of the mesial root of first molar by using micro-focus X-ray computed tomography, histological staining, immunohistochemistry and in situ hybridization to analyze apical cell proliferation and gene expression. Moreover, the force was released after 3 and 7 days of tooth movement, and root apical morphology at postnatal day 35 was subsequently observed. RESULTS: After 1 and 3 days of tooth movement, root apical morphology was altered by increasing immune-reactivity of laminin in the forming periodontal ligament. After 7 days of tooth movement, the root length decreased significantly with bending root apex, decreased cell proliferation and altered gene expression in developing root apex. At postnatal day 35, apical morphology showed no obvious abnormality when the force was released after 3 days of tooth movement, whereas root apical bending was not rescued when the force was released after 7 days. CONCLUSIONS: Relatively short-term force application had no obvious adverse effects on the developing root apex. However, relatively long-term force application altered root apex by affecting Hertwig's epithelial root sheath morphology and apical cellular behavior.

Age estimation by measurement of open apices in tooth roots: Study using Saudi Arabian samples.

The aim of this study was to verify Cameriere's regression formula to predict chronologic age in Saudi Population and if proven to be inaccurate, develop a new algorithm specific for Saudi children. A total of 788 Orthopantamographs(495 boys and 293 girls) were analyzed. The tooth measurement parameters were: number of teeth with closed apex (N0), open apex width (a), crown length (l), A/L ratio for each tooth (x1to x7) and summation of all open apex width (s). The radiographic measurements were substituted in the formula: Age = 8.971 + 0.375g + 1.631 x5 + 0.674 N0 - 1.034s-0.176s * N0 The mean dental age assessed by Cameriere's method was significantly lower than chronologic age in Saudi population and with both genders and total study population (p < 0.05). A stepwise linear regression showed all parameters gender, N0, x1 to x7 except x2significantly associated with age (R2 = 0.6334, F (6,779) = 168.28, p < 0.05). There was no statistically significant difference between predicted and actual chronologic age for 788 children using regression equation for Saudi population (p = 1). Cameriere's formula verified in Saudi children was found to underestimate the chronologic age in both genders. A prediction formula based on Cameriere's method specific to Saudi children has been developed for estimating chronologic age. The new regression formula developed will be more accurate for age assessment in Saudi children.

Magnetic resonance imaging of third molars in forensic age estimation: comparison of the Ghent and Graz protocols focusing on apical closure.

PURPOSE: To compare the Ghent and Graz magnetic resonance imaging (MRI) protocols for third molars, focusing on the assessment of apical closure. To study the influence of (1) voxel size and (2) head fixation using a bite bar. To compare both protocols with a ground truth of apical development. MATERIALS AND METHODS: In 11 healthy volunteers, 3T MRI was conducted, including four Ghent sequences and two Graz sequences, with and without bite bar. After removal, 39 third molars were scanned with 7T µMRI and µCT to establish the ground truth of apical development. Three observers in consensus evaluated assessability and allocated developmental stages. RESULTS: The Ghent T2 FSE sequence (0.33 × 0.33 × 2 mm3) was more assessable than the Graz T1 3D FSE sequence (0.59 × 0.59 × 1 mm3). Comparing assessability in both sequences with bite bar rendered P = 0.02, whereas comparing those without bite bar rendered P < 0.001. Within the same sequence, the bite bar increased assessability, with P = 0.03 for the Ghent T2 FSE and P = 0.07 for the Graz T1 3D FSE. Considering µCT as ground truth for staging, allocated stages on MRI were most frequently equal or higher. Among in vivo protocols, the allocated stages did not differ significantly. CONCLUSION: Imaging modality-specific and MRI sequence-specific reference data are needed in age estimation. A higher in-plane resolution and a bite bar increase assessability of apical closure, whereas they do not affect stage allocation of assessable apices.

Status of Mandibular Third Molar Development as Evidence in Legal Age Threshold Cases.

The completion of the third molar roots has played an important role in ascertaining whether individuals may be at or over a legal threshold of age, often taken as 18 years. This study demonstrates that root apex completion in the third molar is relatively uninformative regarding the threshold of age 18 years in a sample of 1184 males, where mean age-of-attainment of root apex completion for third mandibular molars is about 19.4 years. This paper also considers the legal age threshold problem for cases where the third mandibular molar is not completely formed, and outlines the use of parametric models and Bayes' factors to evaluate dental evidence in statistically appropriate ways. It attempts to resolve confusion over age-within-stage versus age-of-attainment, likelihood ratios versus other diagnostic tests, and prior odds for a case versus the prior density for an age distribution.

Testing and comparing the accuracy of two dental age estimation methods on saudi children: Measurements of open apices in teeth and the London Atlas of Tooth Development.

Evaluation of dental development is frequently performed to assess maturity and estimate age. The aim of this study was to test and compare the accuracy of two dental age estimation methods in a sample of Saudi children by using Cameriere's formula (measurements of mandibular teeth open apices) and The London Atlas of Tooth Development. Four hundred archived digital panoramic radiographs of healthy children (200 males and 200 females) between the ages of 6 to 15.99years attending the Pediatric Dental clinics of King Saud University, College of Dentistry, Riyadh, Saudi Arabia were used. The mean difference between the Estimated Age (EA) and Real Age (RA) was (-0.89years) for Cameriere's formula with a standard deviation of (±1.14years), and it was (-0.59years) with a standard deviation of (±1.45years) for The London Atlas. Both methods consistently underestimated the age. No statistically significant difference between the sexes was found in both methods In conclusion, the London Atlas was found to be slightly more accurate and easier to use than was Cameriere's formula.

Age estimation in 5-16-year-old children by measurement of open apices: North German formula.

The aims of this study were to test the accuracy of Cameriere et al.'s European formula on a sample of North German children based on dental age (DA) for chronological age (CA) assessment and to adapt the formula used, in case of regional peculiarities of this group of children. Orthopantomograms of 1000 children (444 males and 556 females) aged 5-16years were used. The roots of seven left mandibular teeth were evaluated. The number of teeth with complete root development (N zero (0)) was counted. Teeth with incomplete root development were examined and the distance between the inner sides of the open apex was measured and normalized by dividing it by the tooth length to avoid error due to magnification. Cameriere et al.'s European formula underestimated the mean CA of boys by 0.56±1.04years and of girls by -0.32±0.96. The results of the regression analysis showed that sex (g), the sum of normalized open apices (s), number of teeth with closed apices (N0) and the first-order interaction between the normalized apex width of the canine (x3) and N0 contributed significantly to the fit. All previously mentioned factors were included in the regression model, yielding to the following formula: DA=9.829+0.632 N0-1.037s+0.686g-1.582N0×x3, where g is a variable: 1 for males and 0 for females. The adapted formula explained 84.1% of the total deviance, with a median age of 0.070 years and 1.185 years interquartile range, (IQR).

Is the third molar maturity index (I3M) useful for a genetic isolate population? Study of a Sardinian sample of children and young adults.

This work aims to assess the validity of the cut-off value (0.08) of the third molar maturity index (I3M) for discriminating minors from adults in Sardinian population. A sample of 336 digital panoramic radiographs of healthy Sardinian children and young minors (165 females and 171 males), aged between 15 and 23 years (mean age, 19.35 years in females and 18.80 years in males), was retrospectively evaluated. The left lower third molars were analysed by applying a specific cut-off value of 0.08 determined by Cameriere et al. in 2008. The reliability and reproducibility of the test was also studied: the intra-class correlation coefficients (ICC) were 0.91 (95% CI, 0.89-0.93) and 0.88 (95% CI, 0.86-0.90), for the intra- and inter-observer reliability, respectively. The I3M gradually decreased as the real age gradually increased in both sexes. According to the pooled results of the diagnostic test, the accuracy (ACC) was 0.86 (95% CI, 0.82-0.89); the proportion of correctly classified subjects (Se = sensitivity) was 0.82 (95% CI: 0.76-0.86); and specificity (Sp = specificity) was 0.95 (95% CI, 0.89-0.97). The positive predictive values (PPV) and the negative predictive values (NPVs) were 0.97 (95% CI, 0.94-0.99) and 0.70 (95% CI, 0.62-0.77). The LR+ and the LR- were 17.12 (95% CI, 7.27 to 40.36) and 0.19 (95% CI, 0.14 to 0.25). In spite of this, significant differences in the early mineralisation of the third molar were found between sexes as well as in the results of the diagnostic test, showing a better sensitivity in males than in females. The results showed that, although the third molar teeth are highly variable in development, and with differences between females and males as compare to other teeth, the I3M is a reliable method to distinguish between minors and adults even in such a genetic isolate population.

Age estimation: Cameriere's open apices methodology accuracy on a southeast Brazilian sample.

Age estimation plays an important role in clinical and forensic dentistry. Cameriere's 2007 open apices method for age estimation was applied in a sample of 612 digital panoramic orthopantomographs from Brazilian subadult individuals of known age and sex. The sample was composed of 290 males and 322 females individuals aged between four and 16 years of age from São Paulo metropolitan area who had undertaken radiographs for clinical purposes. Participant's ethnicity data was not available. An open code computer-aided drafting software (ImageJ) was used to measure the variables according to the author's published guidelines. Subjects' age was firstly estimated under the application of the European formula (2007) showing under-estimation (-1.24yr). On the other hand, the linear regression analysis modeled for this specific population was able to explain 91.2% of the chronological age variation with a standard error of 0.91yr. Residual analyses confirmed independent errors and a normal distribution. In conclusion, the present results support Cameriere's method for age estimation in Brazilian subadults to be a reliable method, although correlations may vary between specific groups and, hence, specific formulae may be useful for an accurate prediction.

Effect of Bioceramic Materials on Proliferation and Odontoblast Differentiation of Human Stem Cells from the Apical Papilla.

INTRODUCTION: In regenerative endodontic treatment (RET), practitioners favor the placement of bioceramics as sealing materials over blood clots. It is important to understand the interaction between sealing material and cells in the root canal. The purpose of this study was to compare the effectiveness of various bioceramic materials (ProRoot MTA [Dentsply, Tulsa, OK], Biodentine [Septodont, Saint-Maur-des-Fossés, France], and RetroMTA [BioMTA, Seoul, Korea]) as sealing materials in RET for the proliferation and differentiation of stem cells from the apical papilla (SCAPs). METHODS: SCAPs were seeded at 20,000 cells/well and cultured with soluble agents of testing materials through a transwell culture plate. The proliferation of SCAPs was investigated using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay on days 1, 3, 7, and 14 of testing. Alizarin red staining and quantitative real-time polymerase chain reaction were used for SCAP differentiation at different time points (1, 7, 14, and 21 days). The odontoblast genes expressed are dentin matrix acidic phosphoprotein 1, dentin sialophosphoprotein, osteocalcin, and matrix extracellular phosphoglycoprotein, which were used in this study. The SCAPs were cultured in odonto/osteogenic induction medium and also contacted soluble agents from the testing materials. RESULTS: All 3 tested biomaterials induced SCAP proliferation. The Biodentine, ProRootMTA, and RetroMTA groups showed significant SCAP proliferation on days 7 and 14 compared with the control. In regard to odontoblastic differentiation, only Biodentine showed positive alizarin red staining. The highest expressions of dentin matrix acidic phosphoprotein 1, dentin sialophosphoprotein, and matrix extracellular phosphoglycoprotein were found on day 21 in the Biodentine group. The expression of osteocalcin was found to be significant on day 7. CONCLUSIONS: Biodentine, ProRootMTA, and RetroMTA can induce SCAP proliferation. Biodentine induced significant SCAP differentiation among the 3 materials.