Impacted mandibular third molars (IMTM) are often excluded from dental age estimation due to limited accessibility and morphological variability. This study aimed to develop an age estimation model based on the apical surface area (ASA) of IMTM roots using cone-beam computed tomography (CBCT). A total of 446 CBCT images of Malaysians aged 15-25 years (243 females, 203 males) from Malay and Chinese ethnicities were retrospectively analyzed. ASA measurements were obtained using Mimics and 3-matic software (Materialise NV, Belgium). Impaction levels were classified via a modified Pell and Gregory system, and impaction types using Quek's modification of Winter's classification. IMTM angulation, root number, and orientation across three planes were assessed. ASA means were compared by sex and ethnicity using t-tests, and ANOVA was used to evaluate differences across impaction levels, types, and root numbers. General linear regression was applied to identify significant predictors of chronological age and to develop the model, which was validated using an additional 123 CBCT scans. ASA showed a strong inverse correlation with age (r = -0.73). Significant sex-based differences in ASA were observed (male: p = 0.02; female: p = 0.03), with no significant differences between ethnicities. ASA, sex, number of roots, and impaction type were significant predictors of age. The model achieved an R2 of 0.607 and mean absolute error ranging from 0.85 to 4.87 years across age groups. This study underscores the use of IMTM from CBCT data as a feasible method for legal age estimation in the Malaysian population, particularly in distinguishing juveniles from adults.

Northern Pakistani population specific dental age estimation regression model was developed for children based on the 3D surface area analysis of maxillary canine root apices. Regression model was also compared with the Malaysian population specific formula. Three-dimensional models of 237 permanent maxillary canines belonging to northern Pakistani children aged 7 to 14 years old were analysed using MIMICS and 3-Matics software. One hundred and forty-eight CBCT images were used as the training sample to develop a regression model and 89 images were used as a validation sample. Northern Pakistani population specific formula showed higher accuracy in estimating the chronological age as compared to the Malaysian population specific formula.

Introduction For the rehabilitation of the edentulous anterior maxilla, implant surgeons need to take precautions regarding the nasopalatine canal and its contents. However, another important anatomical structure in this area, i.e., the canalis sinuosus, can sometimes be easily overlooked.Case Presentation In this case report, a well-corticated, small radiolucency was noted adjacent to the palatal aspect of the alveolar process in an edentulous area. Initially, it was hypothesized that the nasopalatine canal was positioned laterally due to aberrant embryonic development. Image manipulation of the Cone Beam Computed Tomography (CBCT) scan revealed that the structure was indeed canalis sinuosus.Conclusion CBCT technology can offer the implant surgeon not only the chance of increased accuracy but also the avoidance of surgical and restorative complications. However, implant surgeons need to be aware of identifying key anatomical canals and foramen variations during implant planning. In addition, surgery for the placement of dental implants in the anterior maxilla is often complicated due to biomechanical, phonetic, and aesthetic requirements. Therefore, there is a need to make practical adjustments when anatomical limitations exist in the anterior maxilla. Hence, CBCT scans are mandatory before any implant placements, as any interference with the canal may cause non-osseointegration of the implant, sensory dysfunction, and even haemorrhage.

Statement of the Problem: The implementation of a quality management system in healthcare is critical for improving clinical performance. In dentistry, assessing the quality of intraoral periapical (IOPA) radiological reporting is vital for ensuring accurate diagnosis and treatment planning. Aim of the Study: This study aimed to evaluate the quality of IOPA radiological reports produced by dental students over the past 5 years in a faculty of dentistry in Malaysia, focusing on completeness and identifying areas for improvement. Materials and Methodology: A retrospective clinical study was conducted to assess the IOPA reports using predefined radiological criteria. These reports were evaluated for essential factors such as patient information, type of radiograph, justification for the radiograph, and specific findings like resorption, supernumerary teeth, and proximity of roots to anatomical structures. Results: The audit found that 100% of the reports correctly included details like patient age, radiograph type, and evidence of justification. However, deficiencies were noted in other areas, with a 65% retake rate and complete omission of the ICDAS radiological scoring system (0%). Conclusion: Despite high accuracy in certain areas, the findings revealed several shortcomings. Further training is required for both undergraduate and postgraduate students, along with yearly audits using a larger sample size to ensure adherence to recommended criteria.

Accurate three-dimensional (3D) age estimation relies on cone beam computed tomography (CBCT) image quality. This study investigated the effect of voxel size on age estimation using 3D surface area analysis (3D SAA) of developing tooth apices from different CBCT systems. CBCT scans of 128 developing maxillary second premolars from children aged 7-14 years of Malay and Chinese ethnicities were retrospectively collected using a voxel size of 76 μm. The surface area of the developing apex was measured using the 3D SAA method. A previously developed regression formula, based on 300 μm voxel size data, was applied to calculate the mean absolute error (MAE) for the 76 μm voxel data. A strong negative correlation (r = 0.960) was found between chronological age (CA) and root surface area of apex (RSAA). An MAE value of 0.51 was obtained, demonstrating the high accuracy of the existing regression model. RSAA and root development status significantly contributed to age estimation (p < 0.05), except for sex (p = 0.37) and ethnicity (p = 0.49). No significant differences in the correlation strength between CA and RSAA (p = 0.09), the correlation coefficient (p = 0.08), and the MAE values (p = 0.13) were observed when tested against the previous 300 μm findings. This study demonstrated that the 3D SAA-based age estimation model performs consistently across both voxel sizes. As smaller voxel sizes did not significantly improve accuracy, the use of larger voxel sizes may be preferred to reduce radiation exposure, especially in pediatric populations.

Background/purpose Variations in tooth and mandibular morphometry exist among ethnic groups and may have clinical and anthropological implications. This study compared the tooth length and root-to-crown ratio (RCR) of mandibular first (M1) and second (M2) molars in Han Chinese and Malays, and assessed the root length relative to mandibular height (Root-Mandible Ratio @ R: Mand). Materials and methods One hundred twenty-one cone-beam computed tomography (CBCT) images were included. Relevant measurements were made using the CBCT software to obtain anatomical and clinical crown and root lengths. The measurements of the mesial and distal roots were averaged and used to calculate the RCR and R: Mand. Sixty-one CBCT scans of Malay patients were retrieved, and another 60 scans were of Han Chinese ethnicity. Results There was a statistical difference in the tooth morphometry and their RCRs, with the Malays’ findings being significantly higher than the Han Chinese; the exception being the clinical-RCR (c-RCR) of M2 and the R: Mand at M2. Most parameters were generally significantly larger at M1 than at M2. The mandible height at M1 was similar in both ethnic groups, but the R: Mand of M2 was significantly higher (50.69 %) in the Han Chinese because of their low mandibular height. The Han Chinese have shorter crowns and roots for M1 and M2, and mandible height compared to the Malays at M2. Conclusion The observed morphometric differences may reflect underlying genetic and/or environmental factors and possible clinical impacts on facial morphology and occlusion between the two ethnic groups.

We investigated the suitability of dental age estimation surveys based on modified Chaillet and Demirjian's method using artificial multilayer perceptron neural network (ANN) for Malaysian Malays and Chinese juveniles. A total of 199 dental panoramic tomographs of Malays and Chinese ranging in age from 5.00 to 17.99 years old were evaluated. The difference between chronological age (CA) and dental age from the maturity score (DA) was computed, as well as the mean and standard deviation. Comparison of the estimated DA with CA showed that DA for Malays was significantly overestimated by 0.42 +/- 0.91 years (paired t-test, p < 0.05) and for Chinese was marginally overestimated by 0.02 +/- 0.68 years (paired t-test, p >= 0.05). This shows that DA estimation by using the modified survey of ANN does not differ significantly from CA for the Chinese but for Malays (especially females) a difference was noted.

BACKGROUND:This study aimed to investigate whether the presence of 2 palatal roots on permanent maxillary second molars (MSMs) can affect the crown size and the crown's buccolingual and mesiodistal diameters. MATERIALS AND METHODS:A retrospective study was conducted using 592 CBCT scans to investigate 1120 MSMs of Mongoloid Malaysians. 3D models were created to assess the 4-rooted MSMs and other related teeth carefully. Crown size and the crown's buccolingual and mesiodistal diameters were measured for the 4-rooted MSM, the adjacent maxillary first molar (MFM), and their antimeres, to investigate the effect of the presence of an extra root on the size and morphological features of the crown of these associated teeth. RESULTS:Only 6 of the 1120 MSMs displayed 4 roots (0.53%). The incidence was 0.67% (2/298) for the Malay males and 0.4% (1/247) for the Malay females, with the Malay male having a bilateral occurrence of 4-rooted MSM. The incidence was 0.34% (1/294) for the Chinese males, while 0.71% (2/281) was detected in Chinese females. Interestingly, the 4-rooted MSMs showed a wider mesiodistal distance than their 3-rooted antimeres in 3 out of 4 cases. The presence of 2 palatal roots may also increase the crown's buccolingual diameter. CONCLUSIONS:The presence of anatomical variations and the dramatic change in crown measurements can be good indicators of the presence of extra roots, including in some of their related neighbours. This might help dentists to take precautionary measures when performing tooth extractions and endodontic therapy.

Three-dimensional surface area analyses of developing root apices for age estimation in children and young adults have shown promising results. The current study aimed to apply this three-dimensional method to develop a regression model for estimating age in Malaysian children aged 7 to 14 using developing maxillary second premolars. A training sample of 155 cone-beam computed tomography scans (83 Malays and 72 Chinese) was analysed, and the formula was subsequently validated on an independent sample of 92 cone-beam computed tomography scans (45 Malays and 47 Chinese). The results showed a strong correlation (r = 94 %) between the chronological age as a dependent variable and the predictor variables, including root surface area of the apex, sex, ethnicity, and root development status (open/closed apices). For this model, the predictor variables accounted for 88.4 % of the variation in age except sex and ethnicity. A mean absolute error value of 0.42 indicated that this model can be reliably used for Malaysian children. In conclusion, this study recognises the method of three-dimensional surface area analyses as a valuable tool for age estimation in forensic and clinical practice. Further studies are highly recommended to assess its effectiveness across different demographic groups.

Closely linked groups of markers on the X chromosome are very useful for testing complex kinship relationships involving X-STR transmission. The Argus X-12 kit, a unique commercially available kit, can obtain haplotypes of 4 linkage groups (LGs) consisting of 3 markers. Although many population data have been reported for forensic purposes, differences in discrimination ability exist between LG1 and LG2, 3, and 4 in East Asian populations, and the data of this kit would become more useful if the discrimination ability of the latter groups were increased. Therefore, for matches found using this kit for some linkage group data, then to increase the identification ability, we additionally introduced 13 X-STR loci and established a method allowing comparison using data from 25 loci. The 13X-STRs add two locus data to each of LG2, 3, and 4, and also add two closely linked group (CLG) data between LG2 and 3 and LG3 and 4 in one multiplex PCR. Assessment of this method for a Malay population for which data by Argus X-12 had already been reported showed that the frequencies of distinct haplotypes in LG2, 3, and 4 were increased by 33.0-42.6 %, and frequencies of unique haplotypes increased by 45.4-59.2 %. The respective haplotype diversity values of the additional 3-locus and 4-locus CLGs were 0.9838 and 0.9939, which helps to improve discriminatory power and to predict recombination locations on the X chromosome. Although we have been testing these loci with Japanese subjects, this system would also be useful for the Malay population.

Abstract Background: A study was carried out to get an updated overview of the applications of radiographic/imaging techniques, types of dental X-ray machines, and radiation hygiene tendencies among private dental practitioners. Materials and Methods: A survey was carried out to obtain an overview of the application of radiographic techniques by sending a questionnaire (Google Forms) to more than 1000 private dental practitioners in all states of Malaysia. In addition, several questionnaires were also completed by visiting many dental clinics in person. Results: A total of 410 responses were received. Results indicated that a majority of the practitioners owned at least an intraoral radiographic machine (90.9%). A relatively high number had panoramic machines (76.1%) and cone-beam computed tomography (CBCT) machines (42.5%). Intraoral images were acquired by private dentists at a rate of 11–20 per month (34.3%, n = 116 respondents), with only 13.6% ( n = 46 respondents) acquiring more than 50 per month. With regard to panoramic and CBCT imaging, most of them took between 1 and 30 panoramic images and 1–20 CBCT scans, respectively, in a month. Conclusion: General dental practitioners in Malaysia are very dependent on various dental imaging techniques that can be performed in their own clinics. The demographic status indicated that most of the advanced imaging machines were owned by young practitioners as they are better exposed to these imaging modalities. Moreover, although the respondents graduated from universities in different countries, they had a high level of knowledge of radiation protection (>80%) when practicing oral and maxillofacial radiography.

BACKGROUND:The purpose of this study was to identify and classify the anatomic variation of mandibular canal among Malaysians of three ethnicities.MATERIALS AND METHODS:The courses of the mandibular canal in 202 cone-beam computed tomography scanned images of healthy Malaysians were evaluated, and trifid mandibular canal (TMC) when present, were recorded and studied in detail by categorizing them to a new classification (comprising of 12 types). The diameter and length of canals were also measured, and their shape determined.RESULTS:Trifid mandibular canals were observed in 12 (5.9%) subjects or 16 (4.0%) hemi-mandibles. There were 10 obvious categories out the 12 types of TMCs listed. All TMCs (except one) were observed in patients older than 30 years. The prevalence according to ethnicity was 6 in Malays, 5 in Chinese and 1 in Indian. Four (33.3%) patients had bilateral TMCs, which was not seen in the Indian subject. More than half (56.3%) of the accessory canals were located above the main mandibular canal. Their mean diameter was 1.32 mm and 1.26 mm for the first and second accessory canal, and the corresponding lengths were 20.42 mm and 21.60 mm, respectively. Most (62.5%) canals had irregularly shaped lumen; there were more irregularly shaped canals in the second accessory canal than the first branch. None of the second accessory canal was oval (in shape).CONCLUSIONS:This new classification can be applied for the variations in the branching pattern, length and shape of TMCs for better clinical description.

Purpose:This review aimed to assess the incidence, anatomical characteristics, identification, and clinical management using conventional techniques and advanced tools to manage MMCs successfully. Methods:Medline/PubMed and Scopus databases were searched using "Middle mesial canal," "Middle mesial root canal," OR "Accessory mesial canal" keywords from 1 January 1970 and 1 February 2023. The most pertinent articles were chosen for the review from the retrieved articles. In addition, relevant articles were added by manually searching the list of references. Results:The incidence of MMC is noticeable in younger people, and the confluent canal is the most common type. The majority of MMCs merged with mesiobuccal (MB) canals rather than mesiolingual (ML) canals. Clinical management could be employed using the standard endodontics protocol, and recent radiography technologies, magnification, rotary, and obturation materials can facilitate the procedures. Conclusion:The possibility of the incidence of MMC is not unusual. Detection and thorough debridement followed by obturation of the canal could increase the success rate of clinical outcomes.

Aim: Variation in dental structures is widely accepted as a combination of multiple factors such as gender, environmental effects and genetics. However, the characterization of similarities and differences in dental morphology has been lacking in relation to the factors mentioned. This study aims to assess and compare the variations in traits in mandibular molars and the influence of gender and ethnicity in affecting these traits amongst the Malaysian population of Mongoloid ancestry. Materials and Methods: Our study population was 180 dental casts of patients, from 15 to 40 years old, comprising 56 Malays and 124 Chinese; 60 were males and 120 were females. Traits like groove pattern, number of cusps, protostylids and deflecting wrinkles were observed, scored, and recorded. Results: This study revealed that the most common mandibular first molar (M1) was characterized by 5 cusps and displayed ‘Y’ groove pattern, while the most common mandibular second molar (M2) had 4 cusps and exhibited a groove pattern that resembled a ‘+’. Notably, all the traits studied were bilaterally symmetrical, except for the groove pattern of M1, while sexual dimorphism was observed in groove patterns of M2. Conclusions: This study found that M1 had a preponderance of 5 cusps with ‘Y’ groove pattern, while M2 were typically 4-cusped with ‘+’ groove pattern. Keywords: Malaysia; Asian people; Ethnicity; Gender; dental anatomy; molar.

Aim:The present study was to investigate the root canal morphology of mandibular premolars in Malaysian population using cone-beam computed tomography (CBCT) and microcomputed tomography (micro-CT) scanned images.Materials and Methods:Sixty selected mandibular premolars were evaluated in vitro and the root canal morphologies of the samples were categorized based on Vertucci's classification. The position of apical foramen, presence, and location of lateral canal, as well as prevalence of apical delta, were also determined.Results:Invariably, Type I variety (Vertucci's classification) was the most frequent root canal morphology followed by Type V and Type III after micro-CT imaging. CBCT investigation also revealed Type I as the most numerous; however, the second most common configuration was Type III followed closely by others. There was a moderate agreement in Vertucci's classification of root canal configuration and also prevalence of apical delta (kappa: 0.516 and 0.550, respectively). However, only a fair agreement (kappa: 0.289) was observed between CBCT and micro-CT on the prevalence of lateral canal.Conclusion:CBCT should be cautiously used in determining root canal configuration as deficiencies were evident and revealed during micro-CT imaging.

The suspension culture of Stevia was conceived as a means of establishing a stevioside-producing cell line in vitro. The highest callus induction rate (90%) was achieved using the Stevia leaf explants in modified MS medium supplemented with 1 mg/L BAP and 2 mg/L NAA. Friable and rapidly growing suspension cells were established in this media. The growth curve of suspension culture was studied by determining its biomass accumulation in PCV where the maximum biomass was obtained after 3 weeks. The suspension culture was preferred over callus culture for the biotransformation. The results indicated the simplicity, relatively inexpensive, eco-friendly nature of the process by showing 37.5% conversion of stevioside to rebaudioside A. As a result, it appears to be a potential method for the large-scale industrial synthesis of rebaudioside-A. This high biotransformation efficiency will be useful in substituting sucrose in functional foods. In the current study, the sensory characteristics and energy values of the biscuits containing Stevia, as a sugar replacement, were investigated. According to our findings, Stevia extract may be utilized as a natural sweetener in a variety of food products such as biscuits. In addition, these functional biscuits may be beneficial in maintaining good health, managing obesity and diabetes in patients.

BACKGROUND:Recognising the importance of dental age (DA) estimation in forensic investigations, a variety of methods abound in the literature due to population-specific attributes. A reference eight-tooth method developed by Chaillet and Demirjian estimated the DA of children and adolescents. AIM:This study aims to investigate the applicability of Chaillet and Demirjian's method among Malaysian Indians aged 5.00-17.99 years. SUBJECTS AND METHODS:Dental panoramic tomographs of Malaysian Indians aged 5.00-17.99 years were statistically analysed using paired t-test and artificial neural networks multilayer perceptron (ANN-MLP). RESULTS:A total of 1015 dental panoramic tomographs were analysed. Paired t-test analysis against the reference dental maturity scores revealed underestimation of DA in boys of 1.68 years and girls of 2.56 years indicating inaccurate age estimation. A population-specific prediction model with a new set of dental maturity scores was established on Chaillet and Demirjian's scores using ANN-MLP. The new dental maturity scores showed accurate estimation of DA with differences between CA and DA being 12 and 25 days for boys and girls, respectively. Furthermore, a new DA prediction formula was developed using regression analysis following the establishment of new dental scores based on ANN-MLP. CONCLUSION:A novel Malaysian Indian-specific prediction model that demonstrated accurate DA estimation was established.