Optical coherence tomography and gray scale digital analysis as noninvasive techniques for evaluating molar-incisor hypomineralization severity: A comparative study with microcomputed tomography.

Molar-incisor hypomineralization (MIH) is a qualitative defect of dental enamel characterized by demarcated opacities present in permanent first molars and other teeth. It is considered a major clinical challenge in dentistry because it makes affected teeth more susceptible to fractures and dental caries. Its diagnosis is mainly clinical and there are few technological resources that allow for a more accurate diagnosis, especially with respect to the depth of the defect in the dental enamel. In this context, optical coherence tomography (OCT), which is routinely used in ophthalmology, can produce images of the depth of the dental enamel, making it a promising method. In this study, 33 teeth with different MIH severities were evaluated using OCT and microcomputed tomography (microCT). Semi-quantitative methods of grayscale pattern analysis were used to compare images obtained from different severities of MIH with the mineral density obtained through microCT. MicroCT evaluation revealed that hypomineralized enamel had a significantly lower mineral density than intact enamel. However, this difference was not observed between the mild and severe MIH lesions. In the OCT evaluation, significant differences were observed between the intact and hypomineralized enamel, and the gray value comparison provided a method for quantitative differentiation between the two. This study suggests that OCT could be a useful adjunct to traditional diagnostic methods for MIH, offering a noninvasive approach to evaluate enamel defects. RESEARCH HIGHLIGHTS: Combining optical coherence tomography with grayscale digital analysis shows potential as a promising method for diagnosing molar-incisor hypomineralization and assessing its level of severity.

Use of Optical Coherence Tomography for Differential Diagnosis of Severity of Molar Incisor Hypomineralization (MIH).

Purpose: To evaluate descriptively and quantitatively teeth affected by enamel hypomineralization (EH) using optical coherence microtomography (OCT). Methods: Twenty teeth were classified according to the European Academy of Pediatric Dentistry's molar incisor hypomineralization (MIH) index and separated into groups according to the degree of EH severity. For each tooth, scans were performed on both the affected and the non-affected areas, and their corresponding optical images were captured. Results: In the qualitative analyses, in most of the images bright lines were observed in relation to the enamel surface and a high level of photon scattering immediately below the enamel surface. This showed that the shading distribution can be identified as hypomineralized areas in which the scattering signal can be used as a diagnostic criterion. In the quantitative analyses, Tukey's test was performed to evaluate the means of the optical attenuation coefficient, which did not present significant differences. However, considering the correlation, homogeneity and contrast analyses, a statistically significant difference was observed between the groups. The group with severe MIH showed greater homogeneity and correlation, but less contrast. Conclusion: Currently, MIH has its severity measured by essentially clinical means. OCT processing techniques reveal advances in the diagnostic imaging of MIH, showing that image texture analysis can be a promising and useful method to aid in its diagnosis.

Use of Images and Clinical Experience to Calibrate Dental Surgeons for the Diagnosis of Molar Incisor Hypomineralization

ABSTRACT Objective: To evaluate an imaging protocol for use as a diagnostic and calibration tool for dentists before and after practical activity. Material and Methods: Thirty photos of children's teeth with or without changes in dental enamel were selected and evaluated by a group of experienced dentists previously calibrated to establish the diagnosis defined as the gold standard. After instructions, the images were shown to a group of postgraduate dentists for free identification of dental changes. Subsequently, a lecture on molar incisor hypomineralization (MIH) was carried out, and, at 14 days and all calibration was performed using the criteria previously. The retest was performed at 28 days. After experience in clinical activity in the following two weeks, the post-test was performed at 49 days. Data were analyzed using Cohen's kappa coefficient. Results: Theoretical learning on the subject showed low inter-examiner agreement when the diagnosis of defects was made from images obtained from intraoral photographs. After clinical practice, there was greater intra-examiner agreement. After theoretical training, dentists started to identify different types of enamel alteration, although with low agreement between them. Conclusion: Clinical experience in theoretical and imaging training favored the identification of defects. However, it is necessary to improve the protocol to establish a reliable and viable diagnostic method for calibration in MIH.

Morphological, histological, and chemical analysis of first permanent molars with molar incisor malformation.

PURPOSE: Molar incisor malformation (MIM) is a dental anomaly rendering first permanent molar pulps inflamed/necrotic at a young age. It often affects permanent incisors, primary second molars and less frequently other teeth. The purpose of this study was to investigate the anatomy and histology of MIM in seeking insight into its pathogenesis. METHODS: Five MIM first permanent molars were examined with micro-computed tomography (micro-CT) for 3D morphology, with scanning electron microscopy for microanatomy, with energy-dispersive X-ray spectrometer (EDS) for chemical composition and for histology with optical microscopy. Composition differences were statistically determined using one-way ANOVA. RESULTS: Micro-CT confirmed dentin abnormalities in the middle and cervical third of the crown in the form of the radiodense 'cervical mineralized diaphragm' (CMD). This was peripherally intertwined with enamel fjords and projections severely disrupting the integrity of pulp chamber and its continuity with root canals. EDS showed increased Ca in CMD compared to dentin. The histological examination revealed anomalous osteodentin-like hard tissue with denticles in the CMD. CONCLUSION: An interconnection of anomalous cervical enamel with crown CMD dentin preceded to the severe pulp chamber and root dysplasias in MIM molar teeth.

Artificial intelligence-based diagnostics of molar-incisor-hypomineralization (MIH) on intraoral photographs.

OBJECTIVE: The aim of this study was to develop and validate a deep learning-based convolutional neural network (CNN) for the automated detection and categorization of teeth affected by molar-incisor-hypomineralization (MIH) on intraoral photographs. MATERIALS AND METHODS: The data set consisted of 3241 intraoral images (767 teeth with no MIH/no intervention, 76 with no MIH/atypical restoration, 742 with no MIH/sealant, 815 with demarcated opacity/no intervention, 158 with demarcated opacity/atypical restoration, 181 with demarcated opacity/sealant, 290 with enamel breakdown/no intervention, 169 with enamel breakdown/atypical restoration, and 43 with enamel breakdown/sealant). These images were divided into a training (N = 2596) and a test sample (N = 649). All images were evaluated by an expert group, and each diagnosis served as a reference standard for cyclic training and evaluation of the CNN (ResNeXt-101-32 × 8d). Statistical analysis included the calculation of contingency tables, areas under the receiver operating characteristic curve (AUCs) and saliency maps. RESULTS: The developed CNN was able to categorize teeth with MIH correctly with an overall diagnostic accuracy of 95.2%. The overall SE and SP amounted to 78.6% and 97.3%, respectively, which indicate that the CNN performed better in healthy teeth compared to those with MIH. The AUC values ranging from 0.873 (enamel breakdown/sealant) to 0.994 (atypical restoration/no MIH). CONCLUSION: It was possible to categorize the majority of clinical photographs automatically by using a trained deep learning-based CNN with an acceptably high diagnostic accuracy. CLINICAL RELEVANCE: Artificial intelligence-based dental diagnostics may support dental diagnostics in the future regardless of the need to improve accuracy.

Dental age and tooth development in children with molar-incisor hypomineralization: A case-control study.

OBJECTIVE: The aim of the study was to determine the dental age for the evaluation of tooth development in children with molar-incisor hypomineralization (MIH) by using the Willems method, Cameriere-European formula, and London Atlas. DESIGN: Panoramic radiographs of 308 children between the ages of 6-13 diagnosed with MIH and the same number of sex- and age-matched children without MIH were evaluated by two different examiners using the Willems method, Cameriere-European formula, and London Atlas. The mean difference between chronological age and dental age in both groups was calculated for each sex and age. The mean absolute error was used to determine the accuracies of the Willems method, Cameriere-European formula, and London Atlas. RESULTS: There was a statistically significant difference found only in Willems method in dental age estimation between the groups with and without MIH (P = 0.001). In the evaluation performed with Cameriere-European formula and London Atlas, which are more accurate methods for dental age estimation in both groups, no statistically significant difference was found in dental age estimation between the two groups (P = 0.322, P = 0.290, respectively). There was a statistically significant intense linear correlation for three methods in both groups (P < 0.001). CONCLUSIONS: MIH, which is a developmental enamel defect, does not affect dental age and tooth development since there was no significant difference between groups with and without MIH according to the evaluations made with accurate dental age estimation methods.

Orthodontic treatment of children with class II division 1 with severe MIH involving first permanent molars extractions: A case report.

BACKGROUND: Class II division 1 is the most common malocclusion in Europe. When the overjet is severe, the risk of trauma on anterior maxillary teeth as well as the risk of being bullied at school is increased. From this point of view, early treatment reduces the risk of dental fracture and increases patient self-esteem. In another hand, MIH is frequent with a prevalence of around 15% in children with country specificity, and molars in particular are difficult to treat endodontically with good long-term results when the MIH is severe. In many cases when the third molars are present, the extraction of the affected teeth followed by an orthodontic treatment remains the best solution but requires adequate orthodontic mechanics. OBJECTIVE: The purpose of this article is to display one case of class II division1 with MIH treated by orthopaedic therapy and followed by molar extractions and fixed appliance.

Quantifying linear enamel hypoplasia in Virunga Mountain gorillas and other great apes.

OBJECTIVE: Linear enamel hypoplasia (LEH) is a condition marked by localized reductions in enamel thickness, resulting from growth disruptions during dental development. We use quantitative criteria to characterize the depth of LEH defects and "normal" perikymata in great apes. We test the hypothesis that mountain gorillas have shallow defects compared to other taxa, which may have led to their underestimation in previous studies. MATERIALS AND METHODS: Previous attempts to characterize LEH morphology quantitatively have been limited in sample size and scope. We generated digital elevation models using optical profilometry (Sensofar PLu Neox) and extracted 2D coordinates using ImageJ to quantify depths in canines from three great ape genera (N = 75 perikymata; 255 defects). RESULTS: All defect depths fall outside the distribution of perikymata depths. Mountain gorilla defects are significantly shallower than those of other great ape taxa examined, including western lowland gorillas. Females have significantly deeper defects than males in all taxa. The deepest defect belongs to a wild-captured zoo gorilla. Virunga mountain gorilla specimens collected by Dian Fossey exhibit deeper defects than those collected recently. DISCUSSION: Shallow defect morphology in mountain gorillas may have led to an underestimation of LEH prevalence in past studies. Defect depth is used as a proxy for insult severity, but depth might be influenced by inter- and intra-specific variation in enamel growth. Future studies should test whether severe insults are associated with deeper defects, as might be the case with Haloko, a wild-captured gorilla. Ongoing histologic studies incorporating associated behavioral records will test possible factors that underlie differences in defect morphology.

Objective and subjective aesthetic performance of icon® treatment for enamel hypomineralization lesions in young adolescents: A retrospective single center study.

OBJECTIVES: An evaluation method is proposed to qualitatively and quantitatively evaluate the clinical outcome of the enamel hypomineralization treatment with infiltrative resin in young adolescents. The aesthetic outcome is assessed before and after treatment by visual evaluation using FDI-colour match criteria and by spectrophotometric analysis using the CIEDE2000 colour difference formula. The visual (subjective) results are compared with the spectrophotometric (objective) approach. MATERIALS AND METHODS: 76 teeth of patients of Sapienza University (Rome, Italy) presenting early caries lesions and/or developmental defect of enamel on the labial surface of clinical crown were subjected to resin infiltration. Three observers evaluated the aesthetic appearance of the teeth before and after treatment using FDI-colour match criteria. The spectrophotometric colour difference between the affected and sound enamel in each tooth was calculated before and after resin infiltration. A correlation between FDI criteria and the calculated CIEDE2000 colour difference (ΔE00) was performed. RESULTS: Mean FDI scores and ΔE00, evaluated before and after treatment, were large in all sample. A clear correlation was detected between visual inspections and spectrophotometric colour difference of clinical outcomes. CONCLUSIONS: On the basis of the present study results, the aesthetic outcome of resin infiltration proved to be highly effective, both with visual qualitative and spectrophotometric quantitative assessment. CLINICAL RELEVANCE STATEMENT: Hypomineralized enamel colour abnormalities affect patients' quality of life, therefore tissue preservative cosmetic treatments are requested. An evaluation method of resin infiltration clinical outcome by visual evaluation and spectrophotometry is proposed.

Enamel Pit Defects and Taurodontism in a Patient with Ring Chromosome 14 and 47,XXX.

The purpose of this paper is to describe the clinical findings and management of a case involving a patient with co-occurring ring chromosome 14 syndrome and 47,XXX presenting with enamel pit defects and taurodontism. Ring chromosome 14 syndrome is an unusual condition with uncontrolled seizure disorder as its most significant finding; 47,XXX (trisomy X; triple X) is a more common condition and has characteristic physical and behavioral findings. Neither condition has been associated with enamel pit defects.

Validation of quantitative light-induced fluorescence-digital in the quantification of demarcated hypomineralized lesions of enamel.

AIM: The aim of the present study was to determine the validity of quantitative light-induced fluorescence-digital (QLF-D) in regard to the detection and quantification of developmental demarcated hypomineralized lesions of enamel in vitro when compared to micro-computed tomography (CT) determination of lesion characteristics. A secondary aim was to develop a protocol for 3-D analysis using micro-CT. METHODS: Twenty-four hypomineralized defects were classified as cream/white (CW), yellow/brown (YB), and post-eruptive breakdown. Teeth were scanned using micro-CT. Grayscale and chromatic vertical sections were constructed. Mineral density and porosity percentage were calculated. Fluorescence loss and red fluorescence were determined from images. Linear mixed models were computed. RESULTS: Mineral density and porosity mean values by lesion type were statistically different (P<.001). CW lesions had lower fluorescence loss than YB and broken lesions. Red fluorescence was emitted by the majority of the defects, and the means between lesion types were statistically different (P<.001). The mixed model indicated that mineral density was not correlated with fluorescence loss and lesion type. CONCLUSION: The present findings support QLF-D as a method to detect hypomineralized lesions of different clinical presentation, with red fluorescence putatively related to the severity of the defects. The micro-CT 3-D approach is a reliable method to analyze structural changes in hypomineralized enamel.

A novel quantitative light-induced fluorescence device for monitoring molar-incisor hypomineralization.

BACKGROUND: The FluoreCam system is based on an innovative approach to the quantification of enamel health termed fluorescence enamel imaging (FEI). Enamel is both highly mineralized and semi-translucent. Because of its mineral composition, enamel will fluoresce when exposed to certain light wavelengths. The semi-translucent nature of enamel results in different enamel densities emitting different levels of fluorescence. As a result, with FEI technology, one can measure the density of tooth enamel by measuring its fluorescence when subjected to specific light wavelengths. PURPOSE: To determine the ability of visual examination and the instrumental procedures of the FluoreCam to monitor molar-incisor hypomineralization (MIH) lesions. SUBJECTS AND METHODS: This study involved children with MIH at the Department of Paediatric Dentistry, Marmara University. In total, 11 patients with MIH were diagnosed on a visual MIH scale and evaluated with the FluoreCam. The equipment, data processing, and interaction between the equipment and operator were evaluated. RESULTS: Fluorescent images recorded with the custom software, the clinical view, and digital numeric values were evaluated to assess the potential for use of the device in clinical practice. CONCLUSION: These preliminary data from an ongoing clinical study suggest that measurements with the FluoreCam are useful in monitoring MIH. This technique also provides visual and quantitative feedback to patients.

Analysis of human dentition from Early Bronze Age: 4000-year-old puzzle.

This paper presents the first ever paleodontological investigation of human remains from an archeological site in Central Europe dating from the Early Bronze Age and attributed to the Strzyzow Culture. It corroborates the knowledge gained from archeological, anthropological and genetical investigations. Our study aimed to assess dental status, dental morphology and dental pathologies as well as tooth wear and enamel hypoplasia based on visual inspection and stereomicroscopic investigation. The research was supported by CBCT imaging to obtain digital images and 3D reconstructions as well as 2D radiographs essential for dental age estimation. All of the 191 teeth discovered showed morphological similarity, with adult teeth showing similar color, shape and size. A maxillary molar presenting with a unique root morphology and a mandibular molar with a rare occlusal surface were found. Both permanent and deciduous dentition presented significant tooth wear. A few specimens displayed signs of dental caries, periapical pathology and antemortem tooth loss. Three individuals exhibited linear enamel hypoplasia. CBCT provided high-quality 2D images useful for dental age estimation by non-destructive methods. Estimated dental age correlated with the age estimated by other anthropological methods. In one case, this was crucial because of insufficient material for anthropological analysis. The presented studies have proved that besides the skeleton, teeth can be used as a fundamental tool in assessing the overall health and living conditions of paleopopulations. It would seem that there is potential for considerable development to be made in the research and investigation of paleodontological material using CBCT.

Disturbances and noise: Defining furrow-form enamel hypoplasia.

OBJECTIVES: The investigation of the record of growth locked in dental enamel provides a unique opportunity to build a comprehensive picture of growth disruption episodes during childhood. This study presents a new methodological basis for the analysis of enamel growth disruptions (enamel hypoplasia) using incremental microstructures of enamel. METHODS: A three-dimensional technique based upon use of an Alicona 3D Infinite Focus imaging microscope and software is used to record developmental features in the enamel of human permanent mandibular lateral incisors of one individual from the Neolithic site of Çatalhöyük (Turkey). Using this new technique, perikymata are measured down the longitudinal axis of the crown from the incisal margin to the cervix and perikyma spacing profiles are constructed with this new technique. A mathematical basis for the detection of spacing anomalies, which serve as indicators of enamel hypoplasia is presented based upon these profiles. RESULTS: Three clearly delineated defects were identified visually, then matched and confirmed metrically using the enamel surface and perikyma spacing profiles. DISCUSSION: Human growth has often been used as an indicator of health in past societies because of developmental sensitivity to fluctuations in nutritional status and disease load. Hence, standardization of furrow-form defect identification is of crucial importance for reducing the amount of current subjectivity in the determination of a threshold for the identification of defects among individuals of past populations. The method presented here, which is based on microscopic images of the tooth crown as well as recorded measurements of incremental structures, represents a combined visual-metric approach using LOWESS residuals, and as such provides a substantial advancement to previous methods. It is therefore recommended that additional studies be carried out with this methodology to determine whether this method improves the reliability of enamel defect identification among individuals recovered from bioarchaeological contexts.

Optical coherence tomography use in the diagnosis of enamel defects.

Molar incisor hypomineralization (MIH) affects the permanent incisors and molars, whose undermineralized matrix is evidenced by lesions ranging from white to yellow/brown opacities to crumbling enamel lesions incapable of withstanding normal occlusal forces and function. Diagnosing the condition involves clinical and radiographic examination of these teeth, with known limitations in determining the depth extent of the enamel defects in particular. Optical coherence tomography (OCT) is an emerging hard and soft tissue imaging technique, which was investigated as a new potential diagnostic method in dentistry. A comparison between the diagnostic potential of the conventional methods and OCT was conducted. Compared to conventional imaging methods, OCT gave more information on the structure of the enamel defects as well as the depth extent of the defects into the enamel structure. Different types of enamel defects were compared, each type presenting a unique identifiable pattern when imaged using OCT. Additionally, advanced methods of OCT image analysis including backscattered light intensity profile analysis and enface reconstruction were performed. Both methods confirmed the potential of OCT in enamel defects diagnosis. In conclusion, OCT imaging enabled the identification of the type of enamel defect and the determination of the extent of the enamel defects in MIH with the advantage of being a radiation free diagnostic technique.

Molar incisor hypomineralization: considerations about treatment in a controlled longitudinal case.

Molar incisor hypomineralization (MIH) is a defect in the tooth enamel of systemic origin and may affect one or all four first permanent molars frequently associated with the permanent incisors. This case reports a 7-year-old child with severe MIH in the permanent molars associated with tooth decay and intense pain. In the first stage of treatment, therapy was performed with fluoride varnish and restoration with glass ionomer cement (GIC). After 6 years of clinical and radiographic follow-up, the restorations presented wear and fractures on the margins, indicating their replacement with composite resin. Severe cases of MIH in the early permanent molars can be treated with varnish and GIC to restore the patient's comfort and strengthen the hypomineralized dental structures. The clinical and radiographic monitoring frequently indicated when the restoration with composite resin should be performed.

Turner's tooth with unique radiographic presentation: a case report.

Hypoplasia--the result of a disruption in the enamel matrix formation process--causes a defect in the quality and thickness of enamel. Enamel formation is a complex and highly regulated process. Enamel defects have been associated with a broad spectrum of etiologies, including genetic, epigenetic, systemic, local, and environmental factors. An enamel defect in the permanent teeth caused by periapical inflammatory disease in the overlying primary tooth is referred to as Turner's tooth (also known as Turner's hypoplasia). This article presents a case of Turner's hypoplasia of the first mandibular premolar, with an unusual radiographic presentation.

Progressive supra-aortic stenosis in a young adult with the findings of Singleton Merten Syndrome.

Singleton Merten Syndrome is an autosomal dominant disorder of unknown origin. Patients often present with muscular weakness, failure to thrive, abnormal dentition, glaucoma, psoriatic skin lesions, aortic calcification and musculoskeletal abnormalities. In this case, we present a young girl with a history of aortic root replacement, who had an unusual progressive supra-aortic stenosis managed with urgent surgery during the course of the syndrome. Cardiovascular involvement needs special attention, since it is the major cause of mortality along with rhythm disturbances in the course of Singleton Merten Syndrome.

A new type of dental anomaly: molar-incisor malformation (MIM).

A molar-incisor malformation (MIM) is a newly discovered type of dental anomaly of the permanent first molars, deciduous second molars, and permanent maxillary central incisors. MIM anomalies of the permanent first molars and deciduous second molars may include normal crowns with a constricted cervical region and thin, narrow, and short roots, whereas the affected maxillary central incisors may exhibit a hypoplastic enamel notch near the cervical third of the clinical crown. Although the etiology of MIM remains to be determined, it is thought to be attributable to an epigenetic factor linked to brain- and central nervous system-related systemic diseases at around age 1 to 2 years. MIM teeth are associated with clinical problems such as impaction, early exfoliation, space loss, spontaneous pain, periapical abscess, and poor incisor esthetics. Children with MIM teeth should be observed closely with respect to their medical history, and dentists should formulate a wider-ranging treatment plan.

Analysis of the enamel hypoplasia using micro-CT scanner versus classical method.

This article demonstrates the use of micro-CT scanning of the teeth surface for recognizing and evaluating severity of the enamel hypoplasia. To test capabilities of the microtomography versus classical method of evaluation hypoplastic defects of the enamel we selected two human teeth (C, M(2)) showing different types of enamel hypoplasia: linear, pits, and groove. Examined samples derive from archeological material dated on XVII-XVIII AD and excavated in Poland. In the current study we proved that micro-CT scanning is a powerful technique not only for imaging all kinds of the enamel hypoplasia but also allows to perform accurate measurements of the enamel defects. We figure out that contrary to the classical method of scoring enamel defects, the micro-computed tomography yields adequate data which serve for estimating the length of stress episode and length of interval between them.