Tomislav Lauc

Cameriere's third molar maturity index in assessing age of majority

Estimation of chronological age of an individual is one of the main challenges in forensic science. Legally to be able to treat a person as a minor or an adult, it is necessary to determine whether their age of majority (if they are older or younger than 18, in most countries). Methods for estimating age are especially important when an individual in question lacks personal documents or other means of identification. As the dental age differs in various populations, the aim of this study was to evaluate applicability of third molar method for assessing age of majority in Croatia. Camerieres third molar maturity index (I3M) value of 0.08, measured by the open apices of the teeth, was verified in sample of 1336 panoramic images aged between 14 and 23 years. Chronological age gradually decreased as I3M increased in both genders. Males showed statistically significant advanced maturation when I3M was between 0.0 and 0.3 value. The results indicate that the sensitivity of the test for 0.08 value was 84.3% (95%CI 80.6%, 87.5%) for females and 91.2% (95%CI 88.7%, 93.1) for males. Specificity was 95.4% (95%CI 92.5%, 97.5%) and 91.9% (95%CI 88.8%, 94.3%). The proportions of accurately classified males were 88.8% and that of females 91.5%. The estimated post-test probabilities, of individuals, in other word the probability that a Croatian individual with an I3M<0.08 is 18 years or older is 94.5% for females, and 96.5% for males. With high accuracy, the third molar maturity index should be used as a determinant of the age of majority in Croatia.

Characteristics of the craniofacial complex in Turner syndrome

OBJECTIVE To identify characteristics of the craniofacial complex in Turner syndrome (TS) patients from Croatian population, to investigate the interrelationship among craniofacial variables and to assess their correlation with age. DESIGN Cephalometric analysis was carried out on lateral cephalograms of 36 TS patients, aged 10-33 years. Cephalograms of 72 age-matched healthy females with class I occlusion served as control. RESULTS Logistic regression analysis sorted out two variables as predictors of TS: shorter posterior cranial base length (sella-basion) and reduced mandibular prognathism angle (sella-nasion-supramentale). Sixty-four percent of TS patients and 92% of the controls were classified correctly. After exclusion of the variable sella-nasion-supramentale, three variables were significant predictors of TS: shorter sella-basion, larger cranial base angle (nasion-sella-basion) and shorter subspinale-basion distance. Retrognathic position of the jaws in TS subjects was not correlated with the shape of the cranial base. Correlations with age revealed lack of maxillary longitudinal growth with persistent retrognathism and posterior rotation along with reduced mandibular growth. CONCLUSION Shorter posterior length and increased cranial base angle along with bimaxillary retrognathism were characteristics of TS patients. Results indicated that deficiency of the X chromosome genes had a direct influence on all three anatomic parts - cranial base, maxilla and mandible - causing irregular growth.

Sphenoid sinus types, dimensions and relationship with surrounding structures.

The human sphenoid sinus is an extremely variable cavity and an important landmark in hypophyseal surgery. The aim of this study was to investigate the relationship between the sphenoid sinus type, size, extent of pneumatization and occurrence of protrusions of the adjacent neurovascular structures. A total of 51 randomly selected skulls (≥20 years of age, 33 male; 102 sinuses) were analyzed using cone beam computed tomography to estimate pneumatization extension beyond the body of the sphenoid (planum sphenoidale, pterygoid process, greater wings, clivus, dorsum sellae) and protrusions of the maxillary, mandibular, optic or pterygoid nerve or the internal carotid artery. Difference in pneumatization type between the left and the right-sided sinus was observed in 45% of the skulls. Conchal pneumatization was registered in 2%, presellar in 24%, sellar in 41% and postsellar in 33% of total sinuses. Presellar sinuses frequently pneumatized planum sphenoidale and sporadically other structures, and were characterized by sporadic optic nerve protrusions. Sellar and particularly postsellar sinuses were characterized by simultaneous pneumatization extensions and neurovascular protrusions. In the case of postsellar-type sinuses, the probability of these multiple interactions was not affected by their actual size, while it increased with the increasing sinus dimensions in the case of sellar-type sinuses. A more detailed analysis indicated that increasing sinus height, length or width increased the probability of interactions and pneumatization of particular surrounding structures. Data suggest that the sphenoid sinus pneumatization type and dimensions might be used to estimate the risks of iatrogenic injury during transsphenoidal surgical procedures.

Dental Age in Orthodontic Patients with Different Skeletal Patterns.

Objective. To evaluate the difference between chronological and dental age, calculated by Willems and Cameriere methods, in various skeletal patterns according to Steiners ANB Classification. Methods. This retrospective cross-sectional study comprised the sample of 776 participants aged between 7 and 15 years (368 males and 408 females). For each participant, panoramic images (OPT) and laterolateral cephalograms (LC) were collected from the medical database. On LC ANB angle was measured; on OPT dental age (DA) was calculated while chronological age (CA) and sex were recorded. The sample was divided into three subgroups (Class I, Class II, and Class III) with similar distribution based on the chronological age and ANB angle. CA was calculated as the difference between the date of OPT imaging and the date of birth, while DA was evaluated using Willems and Cameriere methods. ANB angle was measured on LC by two independent investigators using the cephalometric software. Differences between sexes and the difference between dental and chronological age were tested by independent and paired samples t-test, respectively; one-way ANOVA was used to test differences among ANB classes with Tukey post hoc test to compare specific pairs of ANB classes. Results. The significant difference was found between Class III and other two skeletal classes in males using both dental age estimation methods. In Class III males dental age was ahead averagely by 0.41 years when using Willems method, while Cameriere method overestimated CA for 0.22 years. Conclusion. In males with Class III skeletal pattern, dental development is faster than in Classes I and II skeletal pattern. This faster development is not present in females.

Dental Age and Tooth Development in Orthodontic Patients with Agenesis of Permanent Teeth

Objective. To compare the development of permanent teeth in a group of children with the congenitally missing permanent teeth (CMPT) and corresponding nonaffected group. Methods. The formation stages of all developing permanent teeth were determined on 345 panoramic radiographs (OPTs) by the method of Haavikko (1970), and dental age was calculated. The paired samples t-test was used to compare the differences between dental age (DA) and chronological age (CA) in those with CMPT and those not affected. Spearman test was used to evaluate the correlation between DA-CA and the number of missing teeth. The Wilcoxon signed rank test was used to compare the development of the teeth adjacent to the place of the agenesis with matched pair in corresponding nonaffected group. Results. Dental age was significantly delayed in CMPT children compared to the nonaffected group (p < 0.001). The mean differences were −0.57 ± 1.20 years and −0.61 ± 1.23 years in males and females, without difference between sexes (p = 0.763). The number of missing teeth affected the delay only in females (p = 0.024). Only mesial teeth in females were significantly delayed in development when compared to the nonaffected group (p = 0.007). Conclusion. Our findings show that the development of the permanent teeth is delayed when compared to the nonaffected group of the same sex and age.

Growth hormone positive effects on craniofacial complex in Turner syndrome.

OBJECTIVE Turner syndrome occurs in phenotypic females with complete or partial absence of X chromosome. The leading symptom is short stature, while numerous but mild stigmata manifest in the craniofacial region. These patients are commonly treated with growth hormone to improve their final height. The aim of this study was to assess the influence of long-term growth hormone therapy on craniofacial morphology in Turner syndrome patients. DESIGN In this cross-sectional study cephalometric analysis was performed on 13 lateral cephalograms of patients with 45,X karyotype and the average age of 17.3 years, who have received growth hormone for at least two years. The control group consisted of 13 Turner syndrome patients naive to growth hormone treatment, matched to study group by age and karyotype. Sixteen linear and angular measurements were obtained from standard lateral cephalograms. Standard deviation scores were calculated in order to evaluate influence of growth hormone therapy on craniofacial components. RESULTS In Turner syndrome patients treated with growth hormone most of linear measurements were significantly larger compared to untreated patients. Growth hormone therapy mainly influenced posterior face height, mandibular ramus height, total mandibular length, anterior face height and maxillary length. While the increase in linear measurements was evident, angular measurements and facial height ratio did not show statistically significant difference. Acromegalic features were not found. CONCLUSIONS Long-term growth hormone therapy has positive influence on craniofacial development in Turner syndrome patients, with the greatest impact on posterior facial height and mandibular ramus. However, it could not compensate X chromosome deficiency and normalize craniofacial features.

Dental stigmata and enamel thickness in a probable case of congenital syphilis from XVI century Croatia

OBJECTIVE To analyse the dental remains of an individual with signs of congenital syphilis by using macroscopic observation, CBCT and micro-CT images, and the analysis of the enamel thickness. DESIGN Anthropological analysis of human skeletal remains from the 16th century archaeological site Park Grič in Zagreb, Croatia discovered a female, 17-20 years old at the time of death, with dental signs supportive of congenital syphilis: mulberry molars and canine defects, as well as non-specific hypoplastic changes on incisors. The focus of the analysis was on three aspects: gross morphology, hypoplastic defects of the molars, canines and incisors, as well as enamel thickness of the upper first and second molars. RESULTS The observed morphology of the first molars corresponds to the typical aspect of mulberry molars, while that of the canines is characterised by hypomineralisation. Hypoplastic grooves were observed on the incisal edges of all incisors. The enamel of the first molars is underdeveloped while in the second molars a thick-enamelled condition is observed. CONCLUSIONS Our observations for the dental and skeletal evidence are supportive to a diagnosis of congenital syphilis for this specimen from XVI century Croatia. The use of CT imaging helped documenting the diagnostic features and quantifying the effect of the dental stigmata on first molars.

Anatomical variations of the frontal sinus and its relationship with the orbital cavity: Anatomical Variations of the Frontal Sinus

The anatomy of the frontal sinus is highly variable and its variations affect the occurrence/course of pathological processes. We investigated its size and relationship to the orbit, searching for patterns that would allow it to be classified anatomically. Cone beam computed tomography was applied to 91 skulls (age range 21–86 years) to determine sinus height, width, length, and length of contact with the orbit in the coronal and sagittal planes. In addition, orbital roof pneumatization in the coronal plane was categorized as: none; only medial part pneumatized; the medial and a portion of the central part pneumatized; roof predominantly pneumatized. Sinus dimensions varied widely (mm): height 6.2–50.0; width 3.7–54.0; length 2.4–45.0; frontal orbital contact 4.0–41.6; sagittal orbital contact 0.0–41.2. Pneumatization of the orbital roof (coronal plane) mostly affected the medial and a portion of the central part (50%), or the roof was predominantly pneumatized (32%). Three “types” of sinus (cluster analysis) were distinguished by the extent of pneumatization of the orbital roof in the coronal plane: “small”, pneumatization absent or only of the medial part; “medium‐sized”, pneumatization of the medial and a portion of the central part; “large”, roof predominantly pneumatized. All dimensions were significantly different among the types (P < 0.001). Sinus type was fairly predictive of the extent of contact with the orbit in the sagittal plane (not routinely assessed clinically). The data confirm the variability of frontal sinus anatomy and suggest a simple and straightforward classification with potential clinical relevance. Clin. Anat. 31:576–582, 2018.