WO2022108554A1 - A system for early diagnosis of skeletal class iii malocclusion - Google Patents

A system for early diagnosis of skeletal class iii malocclusion Download PDF

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Publication number
WO2022108554A1
WO2022108554A1 PCT/TR2021/051011 TR2021051011W WO2022108554A1 WO 2022108554 A1 WO2022108554 A1 WO 2022108554A1 TR 2021051011 W TR2021051011 W TR 2021051011W WO 2022108554 A1 WO2022108554 A1 WO 2022108554A1
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Prior art keywords
point
class iii
person
points
diagnosed
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PCT/TR2021/051011
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French (fr)
Inventor
Banu KILIC
Tugba SUZEK
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Bezmialem Vakif Universitesi
Mugla Sitki Kocman Universitesi
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Publication of WO2022108554A1 publication Critical patent/WO2022108554A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00—Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/002—Orthodontic computer assisted systems
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H30/00—ICT specially adapted for the handling or processing of medical images
    • G16H30/20—ICT specially adapted for the handling or processing of medical images for handling medical images, e.g. DICOM, HL7 or PACS
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H30/00—ICT specially adapted for the handling or processing of medical images
    • G16H30/40—ICT specially adapted for the handling or processing of medical images for processing medical images, e.g. editing
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
    • G16H40/67—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for remote operation
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/70—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for mining of medical data, e.g. analysing previous cases of other patients

Definitions

  • the present invention relates to a computer-based system and method for class III malocclusion diagnosis.
  • Class III malocclusion is a condition characterized by sagittal directional growth deficiency of the upper jaw and/or back positioning of the upper jaw or over-development of the lower jaw and/or forward positioning of the lower jaw.
  • Orthodontic/orthopedic interventions which are to be realized to these patients in the early period, affect on unclosed active sutures and can provide re-correction of the harmony between the lower jaw and the upper jaw. In case the problem is detected at early ages, it is possible to mask by means of orthodontic treatment, however, at older ages, the only option can be surgical intervention.
  • the present invention relates to a system for a class III malocclusion diagnosis, for eliminating the abovementioned disadvantages and for bringing new advantages to the related technical field.
  • An object of the present invention is to provide a system which provides diagnosis or estimation of class III malocclusion without visiting a doctor and without needing an expert.
  • Another object of the present invention is to provide a system and method which provide class III malocclusion diagnosis where accuracy is increased.
  • the present invention is a system comprising a user terminal for diagnosis of class III malocclusion.
  • said user terminal comprises a camera for capturing the lateral side diagnosis image of the person to be diagnosed, a processor unit associated with said camera, said processor unit is configured to detect pluralities of points such that at least one point is detected at the lower jaw and at least one point is detected at the upper jaw in the diagnosis image received from the camera and to generate a signal indicating that the person, to be diagnosed and whose images are taken, suffers from class III malocclusion or does not suffer from class III malocclusion in accordance with the angles formed by the points with respect to an axis and in accordance with the deviations of the distances between the points when compared with predetermined criteria.
  • diagnosis of class III malocclusion can be realized without needing an expert.
  • a user interface is provided, and the processor unit is configured to provide presenting of the produced signal to the user on the user interface.
  • FIG 3 a representative view of the user terminal is given.
  • Figure 4 a representative view of an image of the person, who is to be diagnosed, taken by the camera and of the detected points is given.
  • the present invention is a system for providing class III malocclusion diagnosis in individuals.
  • the system comprises a user terminal (100).
  • the user terminal (100) comprises a camera (130) for photographing the lateral side of the face of the person, who shall be diagnosed for class III malocclusion, by the user, and a processor unit (110) which controls said camera (130) and which receives as input the diagnosis image (400) captured by the camera (130).
  • Said processor unit (110) is associated with a memory unit (120) in a manner realizing data reading and writing.
  • the memory unit (120) can also comprise software formed by command lines executed by the processor unit (110). Said software provides realization of the process steps which provide diagnosis by the subject matter system when said software is executed by the processor unit (110).
  • Said user terminal (100) can comprise a user interface (150) and can provide the user to enter command to the processor and present data to the user by the processor.
  • the user terminal (100) can be connected to a communication network (300) by means of a communication unit (140) and can realize data exchange with a server (200).
  • the user terminal (100) can be a mobile telephone, tablet computer, general-purpose computer, etc.
  • the processor unit (110) which realizes the characterizing steps of the subject matter system can be provided at the server (200) or at the user terminal (100). An image taken from the user terminal (100) is sent to the server (200) and can be processed in the server (200).
  • the processor unit operates as follows: The processor unit (110) receives as input a diagnosis image (400), where the lateral side of the user is displayed, from the display unit.
  • the processor unit (110) detects predetermined points in the diagnosis image (400) received as input. While the processor unit (110) realizes this process, it can use the image processing, face recognition algorithms known in the art. In more details, an algorithm is trained by means of the images of the persons who have been diagnosed as class III malocclusion or who has not been diagnosed as class III malocclusion by orthodontists, and the predetermined points on the face which exists in the image can be detected. Said points are selected from the end points of the face of the person seen in the image. At least one point exists at the upper jaw and at least one point exists at the lower jaw.
  • these points can be as follows.
  • the processor unit (110) determines said points, it makes classification with one of the machine learning methods with respect to the positions of these points and produces an output indicating that there is class III malocclusion or there is no class III malocclusion.
  • the produced output is displayed at the user interface (150).
  • the processor unit (110) detects that the person suffers from class III malocclusion in case G - Sn - Pg > 173.99.
  • the G - Sn - Pg describes the angles made by the first point (G), the third point (Sn) and the seventh point (Pg) with respect to an axis.
  • the processor unit (110) realizes the following steps:
  • the processor unit (110) realizes the following steps:

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Medical Informatics (AREA)
  • Epidemiology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Primary Health Care (AREA)
  • Data Mining & Analysis (AREA)
  • Databases & Information Systems (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Business, Economics & Management (AREA)
  • General Business, Economics & Management (AREA)
  • General Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Dentistry (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
  • Image Processing (AREA)

Abstract

The present invention is a system comprising a user terminal (100) for diagnosis of class III malocclusion. Accordingly, said user terminal (100) comprises a camera (130) for capturing the lateral side diagnosis image (400) of the person (K) to be diagnosed, a processor unit (100) associated with said camera (130), said processor unit (110) is configured to detect pluralities of points such that at least one point is detected at the lower jaw and at least one point is detected at the upper jaw in the diagnosis image (400) received from the camera (130) and to generate a signal indicating that the person (K), to be diagnosed and whose images are taken, suffers from class III malocclusion or does not suffer from class III malocclusion in accordance with the angles formed by the points with respect to an axis and in accordance with the deviations of the distances between the points when compared with predetermined criteria.

Description

A SYSTEM FOR EARLY DIAGNOSIS OF SKELETAL CLASS III MALOCCLUSION
TECHNICAL FIELD
The present invention relates to a computer-based system and method for class III malocclusion diagnosis.
PRIOR ART
Class III malocclusion is a condition characterized by sagittal directional growth deficiency of the upper jaw and/or back positioning of the upper jaw or over-development of the lower jaw and/or forward positioning of the lower jaw. Orthodontic/orthopedic interventions, which are to be realized to these patients in the early period, affect on unclosed active sutures and can provide re-correction of the harmony between the lower jaw and the upper jaw. In case the problem is detected at early ages, it is possible to mask by means of orthodontic treatment, however, at older ages, the only option can be surgical intervention. Since amelioration of skeletal Class III malocclusion in the early period in a raising patient by means of an orthopedic tool can eliminate the surgical need in the future and since surgery can only be applied in adulthood, earlier treatment helps prevention of unfavorable effects of shape deterioration on the face on the social life of the patient in childhood.
In the present art, early diagnosis is realized by means of medical examination. The main sources of this problem are the high fees for orthodontic examination, the insufficiency of the number of present orthodontists when compared with the society population and the faulty and prevalent belief in the society to begin bringing children to dentist after permanent dentition of children. Thus, in the present art, lower-cost and easily accessible methods are needed for the diagnosis of class III malocclusion.
As a result, because of the abovementioned problems, an improvement is required in the related technical field. BRIEF DESCRIPTION OF THE INVENTION
The present invention relates to a system for a class III malocclusion diagnosis, for eliminating the abovementioned disadvantages and for bringing new advantages to the related technical field.
An object of the present invention is to provide a system which provides diagnosis or estimation of class III malocclusion without visiting a doctor and without needing an expert.
Another object of the present invention is to provide a system and method which provide class III malocclusion diagnosis where accuracy is increased.
In order to realize the abovementioned objects and the objects which are to be deducted from the detailed description below, the present invention is a system comprising a user terminal for diagnosis of class III malocclusion. Accordingly, said user terminal comprises a camera for capturing the lateral side diagnosis image of the person to be diagnosed, a processor unit associated with said camera, said processor unit is configured to detect pluralities of points such that at least one point is detected at the lower jaw and at least one point is detected at the upper jaw in the diagnosis image received from the camera and to generate a signal indicating that the person, to be diagnosed and whose images are taken, suffers from class III malocclusion or does not suffer from class III malocclusion in accordance with the angles formed by the points with respect to an axis and in accordance with the deviations of the distances between the points when compared with predetermined criteria. Thus, diagnosis of class III malocclusion can be realized without needing an expert.
In a possible embodiment of the present invention, a user interface is provided, and the processor unit is configured to provide presenting of the produced signal to the user on the user interface.
BRIEF DESCRIPTION OF THE FIGURES
In Figure 1 , a representative view of the system is given.
In Figure 2, a representative view of the system is given.
In Figure 3, a representative view of the user terminal is given. In Figure 4, a representative view of an image of the person, who is to be diagnosed, taken by the camera and of the detected points is given.
DETAILED DESCRIPTION OF THE INVENTION
In this detailed description, the subject matter is explained with references to examples without forming any restrictive effect only in order to make the subject more understandable.
With reference to Figure 1 , the present invention is a system for providing class III malocclusion diagnosis in individuals.
The system comprises a user terminal (100). The user terminal (100) comprises a camera (130) for photographing the lateral side of the face of the person, who shall be diagnosed for class III malocclusion, by the user, and a processor unit (110) which controls said camera (130) and which receives as input the diagnosis image (400) captured by the camera (130). Said processor unit (110) is associated with a memory unit (120) in a manner realizing data reading and writing. The memory unit (120) can also comprise software formed by command lines executed by the processor unit (110). Said software provides realization of the process steps which provide diagnosis by the subject matter system when said software is executed by the processor unit (110). Said user terminal (100) can comprise a user interface (150) and can provide the user to enter command to the processor and present data to the user by the processor. The user terminal (100) can be connected to a communication network (300) by means of a communication unit (140) and can realize data exchange with a server (200). The user terminal (100) can be a mobile telephone, tablet computer, general-purpose computer, etc. The processor unit (110) which realizes the characterizing steps of the subject matter system can be provided at the server (200) or at the user terminal (100). An image taken from the user terminal (100) is sent to the server (200) and can be processed in the server (200).
As the innovative characteristic of the present invention, the processor unit operates as follows: The processor unit (110) receives as input a diagnosis image (400), where the lateral side of the user is displayed, from the display unit. The processor unit (110) detects predetermined points in the diagnosis image (400) received as input. While the processor unit (110) realizes this process, it can use the image processing, face recognition algorithms known in the art. In more details, an algorithm is trained by means of the images of the persons who have been diagnosed as class III malocclusion or who has not been diagnosed as class III malocclusion by orthodontists, and the predetermined points on the face which exists in the image can be detected. Said points are selected from the end points of the face of the person seen in the image. At least one point exists at the upper jaw and at least one point exists at the lower jaw.
In more details, these points can be as follows. A first point (G) between the two eyebrows of the person (K) to be diagnosed; a second point (Prn) in the vicinity of the peak point of the nose of the person (K) to be diagnosed; a third point (Sn) where the wall between the nose holes joins with the upper jaw of the person (K) to be diagnosed; a fourth point (Ls) which is the beginning point at the side of the upper lip which faces the nose of the person (K) to be diagnosed; a fifth point (Li) at the beginning point of the lower lip which faces the jaw; a seventh point (Pg) in the vicinity of the peak point of the jaw and a sixth point (Sm) which is at the bottom of the pit between the seventh point (Pg) and the fifth point (Li). Here the peak describes the furthest point of the nose with respect to the head and the furthest point of the jaw with respect to the head. After the processor unit (110) determines said points, it makes classification with one of the machine learning methods with respect to the positions of these points and produces an output indicating that there is class III malocclusion or there is no class III malocclusion. The produced output is displayed at the user interface (150).
In a possible embodiment of the present invention, the processor unit (110) detects that the person suffers from class III malocclusion in case G - Sn - Pg > 173.99. Here, the G - Sn - Pg describes the angles made by the first point (G), the third point (Sn) and the seventh point (Pg) with respect to an axis.
In a possible embodiment of the present invention, the processor unit (110) realizes the following steps:
- forming warning at the user interface (150) indicating that there is class III malocclusion in case at least two of the following conditions are met by the angles which exist at the detected points: G - Sn - Pg > 173.99; G - Prn - Pg > 142.35 + 5.36 and G - Pg - Ls < 13.75 - 3.01.
- adding 2 degrees to the angles with conditions of G-Sn-Pg and G-Prn-Pg in case it is detected that the length between Sn’ - Pg' covers 55% or more of the length between G’ - Pg’.
In a possible embodiment of the present invention, the processor unit (110) realizes the following steps:
- classifying as class III malocclusion in case the angles of the detected points meet at least two of the conditions of G - Sn - Pg > 173.99; G - Prn - Pg > 142.35 + 5.36 and G - Pg - Ls < 13.75 - 3.01 and meet the condition of Li - Sm - Pg > 130.19 + 8.50, - adding 2 degrees to the angles with conditions of G-Sn-Pg and G-Prn-Pg in case it is detected that the length between Sn’ - Pg' covers 55% or more of the length between G’ - Pg’.
The protection scope of the present invention is set forth in the annexed claims and cannot be restricted to the illustrative disclosures given above, under the detailed description. It is because a person skilled in the relevant art can obviously produce similar embodiments under the light of the foregoing disclosures, without departing from the main principles of the present invention.
REFERENCE NUMBERS
100 User terminal
110 Processor unit
120 Memory unit
130 Camera
140 Communication unit
150 User interface
200 Server
300 Communication network K Person to be diagnosed 400 Diagnosis image G First point
Pm Second point
Sn Third point
Ls Fourth point
Li Fifth point Sm Sixth point Pg Seventh point

Claims

7 CLAIMS
1. A system comprising a user terminal (100) for diagnosis of class III malocclusion, wherein said user terminal (100) comprises a camera (130) for capturing the lateral side diagnosis image (400) of the person (K) to be diagnosed, a processor unit (100) associated with said camera (130), said processor unit (110) is configured to detect pluralities of points such that at least one point is detected at the lower jaw and at least one point is detected at the upper jaw in the diagnosis image (400) received from the camera (130) and to generate a signal indicating that the person (K), to be diagnosed and whose images are taken, suffers from class III malocclusion or does not suffer from class III malocclusion in accordance with the angles formed by the points with respect to an axis and in accordance with the deviations of the distances between the points when compared with predetermined criteria.
2. The system according to claim 1 , wherein said points are least two of a first point (G) between the two eyebrows of the person (K) to be diagnosed; a second point (Prn) in the vicinity of the peak point of the nose of the person (K) to be diagnosed; a third point (Sn) where the wall between the nose holes joins with the upper jaw of the person (K) to be diagnosed; a fourth point (Ls) which is the beginning point at the side of the upper lip which faces the nose of the person (K) to be diagnosed; a fifth point (Li) at the beginning point of the lower lip which faces the jaw; a seventh point (Pg) in the vicinity of the peak point of the jaw and a sixth point (Sm) which is at the bottom of the pit between the seventh point (Pg) and the fifth point (Li).
3. The system according to claim 2, wherein the processor unit (110) is configured to generate a signal indicating that the person suffers from class III malocclusion in case it detects that the mathematical transaction of G - Sn - Pg, defined as the angles of the first point (G), the third point (Sn) and seventh point (Pg) with respect to an axis, is greater than 173.99 degrees.
4. The system according to claim 2, wherein the processor unit (110) is configured to realize the steps of:
- forming warning at the user interface (150) in the direction of diagnosis of class III malocclusion in case at least two of the following conditions are met by the angles, made by the detected points, with respect to an axis: G - Sn - Pg > 173.99; G - Prn - Pg > 142.35 + 5.36 and G - Pg - Ls < 13.75 - 3.01 , 8
- adding 2 degrees to the angles with conditions of G-Sn-Pg and G-Prn-Pg in the prior step in case it is detected that the length between Sn’ - Pg' covers 55% or more of the length between G’ - Pg’.
5. The system according to claim 2, wherein the processor unit (110) is configured to realize the steps of:
- generating signal classified as class III malocclusion in case the angles of the detected points with respect to an axis meet at least two of the conditions of G - Sn - Pg > 173.99; G - Prn - Pg > 142.35 + 5.36 and G - Pg - Ls < 13.75 - 3.01 and meet the condition of Li - Sm - Pg > 130.19 + 8.50,
- adding 2 degrees to the angles with conditions of G-Sn-Pg and G-Prn-Pg in the prior step in case it is detected that the length between Sn’ - Pg' covers 55% or more of the length between G’ - Pg’.
PCT/TR2021/051011 2020-11-23 2021-10-04 A system for early diagnosis of skeletal class iii malocclusion WO2022108554A1 (en)

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TR2020/18758 2020-11-23
TR2020/18758A TR202018758A1 (en) 2020-11-23 2020-11-23 A SYSTEM FOR THE EARLY DIAGNOSIS OF Skeletal CLASS III MALOCLUSION

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US6200278B1 (en) * 1997-10-16 2001-03-13 Arnett Facial Reconstruction Courses, Inc. Gender specific soft tissue cephalometric analysis for diagnosis and cephalometric treatment planning of facial imbalance
US20040197727A1 (en) * 2001-04-13 2004-10-07 Orametrix, Inc. Method and system for comprehensive evaluation of orthodontic treatment using unified workstation
US20170273646A1 (en) * 2014-06-03 2017-09-28 Ortho-Tain, Inc. System and method for determining an orthodontic diagnostic analysis of a patient
WO2020162845A1 (en) * 2019-02-07 2020-08-13 Koni Berk A system for informing its users about orthodontic treatment

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Publication number Priority date Publication date Assignee Title
US6200278B1 (en) * 1997-10-16 2001-03-13 Arnett Facial Reconstruction Courses, Inc. Gender specific soft tissue cephalometric analysis for diagnosis and cephalometric treatment planning of facial imbalance
US20040197727A1 (en) * 2001-04-13 2004-10-07 Orametrix, Inc. Method and system for comprehensive evaluation of orthodontic treatment using unified workstation
US20170273646A1 (en) * 2014-06-03 2017-09-28 Ortho-Tain, Inc. System and method for determining an orthodontic diagnostic analysis of a patient
WO2020162845A1 (en) * 2019-02-07 2020-08-13 Koni Berk A system for informing its users about orthodontic treatment

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Title
DEMIRCAN GUL SUDE: "Early Diagnosis and Prediction of Skeletal Class III Malocclusion from Profile Photos Using Artificial Intelligence", IFMBE PROCEEDINGS, vol. 80, 30 November 2020 (2020-11-30), pages 434 - 448, XP055940868 *
KRNETA BOJANA, ZHUROV ALEXEI, RICHMOND STEPHEN, OVSENIK MAJA: "Diagnosis of Class III malocclusion in 7- to 8-year-old children—a 3D evaluation", EUROPEAN JOURNAL OF ORTHODONTICS, CHURCHILL LIVINGSTONE, LONDON, GB, vol. 37, no. 4, 1 August 2015 (2015-08-01), GB , pages 379 - 385, XP055939749, ISSN: 0141-5387, DOI: 10.1093/ejo/cju059 *
STAUDT, C.B. ; KILIARIDIS, S.: "A nonradiographic approach to detect Class III skeletal discrepancies", AMERICAN JOURNAL OF ORTHODONTICS & DENTOFACIAL ORTHOPEDICS, ELSEVIER, AMSTERDAM, NL, vol. 136, no. 1, 1 July 2009 (2009-07-01), AMSTERDAM, NL , pages 52 - 58, XP026250189, ISSN: 0889-5406, DOI: 10.1016/j.ajodo.2007.07.025 *

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