Age estimation in adults by canine teeth: a systematic review of the Cameriere method with meta-analysis on the reliability of the pulp/tooth area ratio

The age estimation of an adult using methods accessible to the forensic routine is a goal pursued by forensic experts. Cameriere, Ferrante and Cingolani (2004) proposed the use of the pulp/tooth area ratio of canine teeth as a promising variable, but its reliability has shown conflicting results in the scientific literature. This article aimed to carry out a systematic review with meta-analysis to verify whether the pulp/tooth area ratio of canine teeth includes a variable that can be used alone to estimate dental age in adults. A systematic search was carried out in six databases using keywords related to the theme in Portuguese, English, and Spanish. The study selection process followed pre-established eligibility criteria. Assessments were carried out regarding risk of bias and publication bias of selected studies, and meta-analysis was carried out considering Pearson's correlation coefficient between pulp/tooth area ratio and chronological age as effect measure. Most selected studies showed low risk of bias; no publication bias was found when all studies were considered, and potential publication bias was found when outliers were removed. Despite the high heterogeneity among studies and the need for more research, it could be observed that the pulp/tooth area ratio has strong negative correlation with chronological age, and the pulp/tooth area ratio could be derived from both periapical radiographs and orthopantomographs. Therefore, it is suggested that there is scientific evidence that the pulp/tooth area ratio obtained from canine teeth is reliable for dental age estimation in adults.

A comparison of estimated age based on pulp volume from cone beam computed tomography (CT) images and panoramic radiography data with chronological age

This retrospective study was conducted to evaluate different methods for dental age estimation in children and to examine the feasibility of using cone beam computed tomography (CBCT) data for age estimation. A total of 200 radiographic records (both digital panoramic radiographs and CBCTs) were acquired from 100 children aged 9 to 16 years, all taken on the same dates. Radiographic data was acquired from archived records and included both panoramic radiography and CBCT data belonging to the same individual. CBCT was used when panoramic radiographic data was insufficient. The pulp volume and pulp/tooth volume ratio of the left first molar teeth in the mandible were calculated from the CBCT data using MIMICS software. In addition, age was estimated by the Demirjian and Willems methods from data obtained from panoramic radiography images. Statistical analyses and linear regression analysis were performed as necessary. There was a statistically significant difference between the mean difference between the Demirjian method and chronological age, and between the Willems method and chronological age (p < 0.001). Statistically significance was achieved in a linear regression model created from pulp volume (R2 = 0.098) and pulp/tooth volume ratio (R2 = 0.395) data for the estimated dental age analysis (p < 0.001) and a negative correlation was observed with chronological age. When compared estimated dental age from CBCT data with chronological age, the pulp/tooth volume ratio method yielded results closer to chronological age than using only pulp volume data. When considering both panoramic radiographic age estimation methods and age estimation methods using CBCT data, we found that the results obtained with the Willems method, a panoramic radiographic age estimation technique, provided the closest results to the chronological age. More contributions should be made to the literature regarding the feasibility of age estimation using pulp and tooth volume as an alternative method.

Dental age estimation: development and testing of a reference data set for Qatari children, adolescents, and young adults aged between 5 and 25 years

The purpose of this study is to establish and test a reference data set of dental development of Qatari subjects aged between 5 and 25 years. Radiographs of individuals aged between 5 and 25 years were re-used to establish a reference data set (RDS). A scheme comprising 8 tooth development stages (TDS) was used to assess all the teeth on the left side of the maxilla and mandible. The accuracy of dental age estimation (DAE) was tested with a separate sample of radiographs - the validation sample (VS) comprised 50 females and 50 males of known chronological age (CA). Dental panoramic tomographs (DPT) of 1,597 Qataris were assessed. The summary data for the individual TDS comprising the number (n-tds), mean ( x ¯ -tds), standard deviation (sd-tds), 0th%-ile (the minimum), 25th%-ile, 50th%-ile (the median), 75th%-ile, and 100th%-ile (the maximum) were used to estimate the age of the VS subjects using the simple average method (SAM). There is a significant difference in dental age of 4.8 months in the female group when compared to the CA. The difference in the male group is 4.5 months. This shows similar differences to assessments of other ancestral or ethnic groups.

Binary decisions of artificial intelligence to classify third molar development around the legal age thresholds of 14, 16 and 18 years

Third molar development is used for dental age estimation when all the other teeth are fully mature. In most medicolegal facilities, dental age estimation is an operator-dependent procedure. During the examination of unaccompanied and undocumented minors, this procedure may lead to binary decisions around age thresholds of legal interest, namely the ages of 14, 16 and 18 years. This study aimed to test the performance of artificial intelligence to classify individuals below and above the legal age thresholds of 14, 16 and 18 years using third molar development. The sample consisted of 11,640 panoramic radiographs (9680 used for training and 1960 used for validation) of males (n = 5400) and females (n = 6240) between 6 and 22.9 years. Computer-based image annotation was performed with V7 software (V7labs, London, UK). The region of interest was the mandibular left third molar (T38) outlined with a semi-automated contour. DenseNet121 was the Convolutional Neural Network (CNN) of choice and was used with Transfer Learning. After Receiver-operating characteristic curves, the area under the curve (AUC) was 0.87 and 0.86 to classify males and females below and above the age of 14, respectively. For the age threshold of 16, the AUC values were 0.88 (males) and 0.83 (females), while for the age of 18, AUC were 0.94 (males) and 0.83 (females). Specificity rates were always between 0.80 and 0.92. Artificial intelligence was able to classify male and females below and above the legal age thresholds of 14, 16 and 18 years with high accuracy.

Three decades after the publication of the Lamendin method for adult age-at-death estimation: Methodological evolution of the procedure and interpretations

More than three decades have passed since the publication of Lamendin et al.'s proposal in 1992. Over this time, numerous investigations have been conducted to assess the applicability of the technique in different populations with acceptable results in terms of estimation errors. The proposal by Lamendin and colleagues remains relevant today, and has made a significant contribution to adult age-at-death estimation due to its simplicity, repeatability, replicability, and high performance. Indeed, significant progress towards systematizing and strengthening the procedure has been reported in the published literature. One noteworthy advancement is the development of an international database that supports the use of Bayesian statistics for age-at-death estimation. This resource plays a crucial role in standardizing the methodology and improving the reliability for obtaining more reliable results on a global scale. The aim of this study is to investigate the historical evolution of the technique, to assess the accuracy of the results obtained by different analytic procedures, and to explore its impact in forensic applications through a systematic analysis of the specialized literature on this field. The current state of research indicates that this type of methodological research is an ongoing process, far from being completed. Many questions and challenges that require further attention to address effectively these issues remain unanswered, such as the development of non-linear regressions and probabilistic approaches, the deepening of procedures that improve global approximations, and the intensification of research focused on achieving more accurate estimations among individuals over 70 years-old. However, studies generally agree that the Lamendin technique works well for individuals between the ages of 30-60 years. It is still in force today, although the method has been significantly perfected. Despite the degree of research development in this area, further efforts are needed to improve the understanding and performance of these kinds of procedures. This will ultimately lead to an improvement in the accuracy and reliability of forensic investigation results worldwide.

Automatic dental age calculation from panoramic radiographs using deep learning: a two-stage approach with object detection and image classification

BACKGROUND

Dental age is crucial for treatment planning in pediatric and orthodontic dentistry. Dental age calculation methods can be categorized into morphological, biochemical, and radiological methods. Radiological methods are commonly used because they are non-invasive and reproducible. When radiographs are available, dental age can be calculated by evaluating the developmental stage of permanent teeth and converting it into an estimated age using a table, or by measuring the length between some landmarks such as the tooth, root, or pulp, and substituting them into regression formulas. However, these methods heavily depend on manual time-consuming processes. In this study, we proposed a novel and completely automatic dental age calculation method using panoramic radiographs and deep learning techniques.

METHODS

Overall, 8,023 panoramic radiographs were used as training data for Scaled-YOLOv4 to detect dental germs and mean average precision were evaluated. In total, 18,485 single-root and 16,313 multi-root dental germ images were used as training data for EfficientNetV2 M to classify the developmental stages of detected dental germs and Top-3 accuracy was evaluated since the adjacent stages of the dental germ looks similar and the many variations of the morphological structure can be observed between developmental stages. Scaled-YOLOv4 and EfficientNetV2 M were trained using cross-validation. We evaluated a single selection, a weighted average, and an expected value to convert the probability of developmental stage classification to dental age. One hundred and fifty-seven panoramic radiographs were used to compare automatic and manual human experts' dental age calculations.

RESULTS

Dental germ detection was achieved with a mean average precision of 98.26% and dental germ classifiers for single and multi-root were achieved with a Top-3 accuracy of 98.46% and 98.36%, respectively. The mean absolute errors between the automatic and manual dental age calculations using single selection, weighted average, and expected value were 0.274, 0.261, and 0.396, respectively. The weighted average was better than the other methods and was accurate by less than one developmental stage error.

CONCLUSION

Our study demonstrates the feasibility of automatic dental age calculation using panoramic radiographs and a two-stage deep learning approach with a clinically acceptable level of accuracy.

Machine learning assessment of dental age classification based on cone-beam CT images: a different approach

OBJECTIVES

Machine learning (ML) algorithms are a portion of artificial intelligence that may be used to create more accurate algorithmic procedures for estimating an individual's dental age or defining an age classification. This study aims to use ML algorithms to evaluate the efficacy of pulp/tooth area ratio (PTR) in cone-beam CT (CBCT) images to predict dental age classification in adults.

METHODS

CBCT images of 236 Turkish individuals (121 males and 115 females) from 18 to 70 years of age were included. PTRs were calculated for six teeth in each individual, and a total of 1416 PTRs encompassed the study dataset. Support vector machine, classification and regression tree, and random forest (RF) models for dental age classification were employed. The accuracy of these techniques was compared. To facilitate this evaluation process, the available data were partitioned into training and test datasets, maintaining a proportion of 70% for training and 30% for testing across the spectrum of ML algorithms employed. The correct classification performances of the trained models were evaluated.

RESULTS

The models' performances were found to be low. The models' highest accuracy and confidence intervals were found to belong to the RF algorithm.

CONCLUSIONS

According to our results, models were found to be low in performance but were considered as a different approach. We suggest examining the different parameters derived from different measuring techniques in the data obtained from CBCT images in order to develop ML algorithms for age classification in forensic situations.

Prevalence of abnormalities seen on orthopantomograms performed for forensic age estimation in unaccompanied minor asylum seekers

OBJECTIVES

Evaluate the prevalence of radiological anomalies on orthopantomograms (OPT) performed as part of forensic age estimation in unaccompanied minors.

METHODS

This is a retrospective study conducted on 208 OPT examinations requested by a magistrate. These OPTs were interpreted independently by two readers to establish the number of missing teeth (MT), presence of dental fillings (DF), and dental anomalies (DA). The presence of radiolucent (RL), radiopaque, and mixed lesions was also assessed.

RESULTS

Most radiologic anomalies were RL, detected on 41% and 39% of the subjects evaluated for R1 and R2, respectively, with a mean of 1.3 ± 2.4 (1-16) and 1.1 ± 2 (1-13) RL lesions per subject. Among the RL identified, the majority were dental (70% for R1 and 65% for R2), all of which had a suspected infectious origin. Among readers, 43% and 41% of the subjects evaluated presented MT, 21% and 15% presented DF, and 22% and 20% presented DA for R1 and R2, respectively. The inter- and intra-observer reproducibility for OPT classification was considered excellent (Kappa = 0.84, 95% CI 0.78-0.90, and Kappa = 0, 95, 95% CI 0.86-0.99).

DISCUSSION

There was a non-negligible prevalence of radiological anomalies in OPT studies performed for forensic age estimation. Most of these lesions were suspected to be infectious in origin, potentially requiring medical care. This constitutes an ethical dilemma inherent in the judicial expertise injunction requiring a limited specific response.

CLINICAL RELEVANCE STATEMENT

This study highlights a non-negligible prevalence of supposedly infectious radiological abnormalities. The restricted possibility for the legal expert to declare these abnormalities raises ethical and medical questions.

KEY POINTS

• Orthopantomograms can be performed as part of forensic age estimation. • Results indicate the majority of radiological anomalies detected on OPTs were of suspected infectious origin. • These findings give rise to ethical and medical questions about the way in which these forensic examinations are carried out.

Using cementochronology to assess the seasonality of catastrophic events in medieval mass graves (Kutná Hora-Sedlec, Czechia, 14th century): Preliminary results

While season-of-death estimation using cementochronology is routine in archaeozoology, its use is much less frequent in bioarchaeology. Based on the character of the outermost increment (bright or dark), two seasons (spring/summer, autumn/winter) can be distinguished. Although many studies mention its potential and possible use in forensic anthropology or bioarchaeology, few exist with estimation results. This study aimed to apply cementochronology-a histological method based on counting and assessing regular circa-annual acellular cementum increments-to 42 individuals from medieval mass graves from Kutná Hora-Sedlec (Czechia, 14th century) to estimate the season-of-death. The mass graves belong to two stratigraphically distinct groups; written and archaeological sources relate them to two catastrophic events (the famine of 1318 and the plague epidemic of 1348-1350). Using cementochronology, we distinguished two distinct seasons corresponding to the two groups of graves, with individuals from the first group dying predominantly in spring/summer, while those from the second group died in autumn/winter. Taking into account the typical seasonal dynamics of epidemics, the results would be more in line with written sources. However, during the evaluation, we faced difficulties identifying the outermost increment and detecting the dark (thinner) increment; we recommend including only young and middle-aged adults in future studies, due to the difficulty of evaluation, and to consider the readability of the tissue (often affected by diagenesis). In conclusion, cementochronology has potential in the context of estimating the season-of-death, but the technical possibilities for enhancing the outermost increment need to be addressed, and the amount of data analysed expanded.

Estimating chronological age through learning local and global features of panoramic radiographs in the Korean population

This study suggests a hybrid method based on ResNet50 and vision transformer (ViT) in an age estimation model. To this end, panoramic radiographs are used for learning by considering both local features and global information, which is important in estimating age. Transverse and longitudinal panoramic images of 9663 patients were selected (4774 males and 4889 females with a mean age of 39 years and 3 months). To compare ResNet50, ViT, and the hybrid model, the mean absolute error, mean square error, root mean square error, and coefficient of determination (R2) were used as metrics. The results confirmed that the age estimation model designed using the hybrid method performed better than those using only ResNet50 or ViT. The estimation is highly accurate for young people at an age with distinct growth characteristics. When examining the basis for age estimation in the hybrid model through attention rollout, the proposed model used logical and important factors rather than relying on unclear elements as the basis for age estimation.

Skeletal, dental, and sexual maturation as an indicator of pubertal growth spurt

OBJECTIVES

The aims of this study were to determine the skeletal, dental, and sexual maturation stages of individuals at the peak of the pubertal growth spurt and to analyze the correlations between these parameters.

METHODS

The study included 98 patients, 49 females (mean chronological age 12.05 ± 0.96 years) and 49 males (mean chronological age: 13.18 ± 0.86 years), in the MP3cap stage. Skeletal maturation stages were determined using the cervical vertebral maturation (CVM) method on lateral cephalometric radiographs. The Demirjian index was used to determine dental maturation stages and dental ages on panoramic radiographs. The sexual maturation of the patients was evaluated in the pediatric endocrinology clinic by a pediatrician according to the Tanner stages. The frequencies of the variables were determined, and the Spearman rank correlation coefficients were used to analyze the correlations between the variables.

RESULTS

It was determined that the cervical vertebral maturation stage was CS3 in 81.6% (n = 40) of both female and male patients, and 81.6% of the female and 89.8% of the male patients were in stage G in terms of mandibular second molar tooth development. According to the Tanner pubic hair staging, 73.5% of the male and 51.0% of the female patients were in Stage 3. A significant correlation was found between the cervical vertebra stages and mandibular second molar tooth development stages in both sexes and between the cervical vertebra and Tanner pubic hair stages only among the male patients (r = 0.357; p < .05). There was also a significant and strong correlation between the Tanner pubic hair stages and breast development stages (r = 0.715; p < .05).

CONCLUSION

Cervical vertebral development in the CS3 stage and mandibular molar tooth development in the G stage can be considered the peak of the pubertal growth spurt. Tanner Stage 3 marks the peak of the pubertal growth spurt in males.

[Application of Demirjian and Chaillet method in age estimation of Uyghur and Han children and adolescents in Urumqi]

PURPOSE

To evaluate the applicability and accuracy of Demirjian and Chaillet method in estimating the actual age of Uygur and Han children and adolescents in Urumqi.

METHODS

A total of 1144 orthopantomograms were included in the study, and the seven permanent teeth in the left jaw were divided into different stages according to two dental age estimation methods, and the dental age was converted to tooth age after checking the table and assigning points, and the dental age and its chronological age were compared with t test or rank sum test using SPSS 21.0 software package, and the accuracy of the two methods was evaluated by comparing the mean absolute error of the two methods.

RESULTS

Demirjian method was overestimated by an average of 0.46 years (0.47 years for males and 0.43 years for women) in the Han population, 0.36 years for men and 0.26 years for women in Uyghur population, the difference was significant between Uyghur and Han boys (P＜0.05). Chaillet method yielded an average underestimate of 0.01 years (0.04 years for men and -0.08 years for women) in the Han population, and 0.08 years(0.02 years for men and -0.21 years for women) in the Uyghur population, there was no significant difference between Uyghur and Han boys and girls(P＞0.05).

CONCLUSIONS

When assessing the age of Uyghurhan children and adolescents in Urumqi, Chaillet method is more accurate than the Demirjian method. When applying dental age estimation method in different regions, it is necessary to evaluate the accuracy of the estimation method and revise it if necessary to improve the accuracy.

The accuracy of Cameriere methods in Turkish children: chronological age estimation using developing teeth and carpals and epiphyses of the ulna and radius

The aim of the present study was to develop a specific formula by measuring the developing teeth, carpal bones, and epiphyses of the ulna and radius to determine the chronological age in Turkish children. The left developing permanent mandibular teeth were evaluated, and the number of teeth with closed apex was recorded. The distance between the inner sides of open apex/apices was measured by using the ImageJ program and divided by the tooth length. The sum of the normalized open apices was also calculated. The carpal area (Ca), covering the epiphyses of ulna and radius and the carpal bones, was measured on the X-rays of left hand. The areas of each carpal bone and epiphyses of the ulna and radius were measured, and these measurements were added together to obtain the bone area (Bo). The Bo/Ca ratio between the total area of carpal bones and the carpal area was calculated to normalize the measurements. The accuracy of the equations formulated by Cameriere was evaluated, and a new regression equation was developed accordingly. The new formula showed no statistically significant difference between the chronological and the estimated age for females, males, and total sample. The new formula, which hit the age with 72.80% accuracy, was more successful in predicting chronological age than other adjusted regression equations. The new regression model, created for the Turkish children by using both developing teeth and hand-wrist bones, was considerably successful in estimating the chronological age.

Dental age assessment: scoring systems and models from the past until the present-how is it presented in the court?

OBJECTIVE

The aim of this study is to evaluate the accuracy of the methods from the past and present, such as Demirjian, Cameriere, and AlQahtani, as well as to determine the most reliable method for human age estimation under the request from the courts according to the effect size from each method in age estimation.

DESIGN

Four hundred eighty-three orthopantomographic images were selected from 318 patients from Centro Hospitalar Universitário Lisboa Norte aged between 6 and 15 years old. Several measurements of widths and lengths and classification of tooth development stages were performed, according to each age estimation method. The listing of patients and orthopantomographic images were consulted through SECTRA®. All data was entered and analysed using SPSS version 28. Observations' validity was verified through inter- and intraobserver validation.

RESULTS

The correlation coefficients between age and age estimates by the three methods on both sides were close to 90%. Regarding the estimation error correlation coefficient, Demirjian and AlQahtani values were low, whereas Cameriere's was significantly negative; i.e., underestimation increases as age increases. Between left and right, any significant difference in age estimation in AlQahtani and Cameriere methods was not observed, but there were great variability and large effect for the Demirjian method. Comparing females and males, the statistical analysis showed no significant differences and quite small effects in the precision of the estimates for any of the methods. Finally, although significant differences were detected when comparing estimated values and age, small effects were revealed except for the Demirjian method which attained a medium effect and, therefore, less consistency of estimation.

CONCLUSIONS

Since it was not possible to determine the most reliable method for age estimation, a combined application of different age estimation methodologies is recommended to be use in the courts with relevant statistical data such as effect size.

Association between dental and skeletal maturation in Scandinavian children born between 2005 and 2010

OBJECTIVE

The aim of this cross-sectional study was to analyse the association between dental and skeletal maturation in children born between 2005 and 2010.

MATERIALS AND METHODS

Dental and skeletal maturation of 117 ethnic Scandinavian children born between 2005 and 2010 (70 girls, 47 boys, mean age 11.48 years) was analysed. Dental maturation (DM) was assessed on orthopantomographs (OPs) by using Demirjian's and Haavikko's methods while skeletal maturation was assessed on hand-wrist radiographs by use of Helm's method. The correlation between skeletal and DM was analysed using Spearman's rho (Rs). Additionally, the most frequent DM stage in relation to the skeletal maturation stage was analysed by logistic regression adjusted for age and sex.

RESULTS

The correlation between dental and skeletal maturation was significant for all teeth (Rs = 0.071-0.562; p < .000-p = .035) except for the first incisor and the first molar. Logistic regression analysis showed that when the mandibular and maxillary canines are ¾ mineralized, this is significantly associated with the beginning of the adolescent period before peak height velocity (PHV) (PP2= p < .005-< .05). Likewise, when the mandibular second premolars are ¾ mineralized, this is significantly associated with the maturation stage PP2= or S (PP2= p < .05, S: p < .005-< .05), both of which are before PHV at the beginning of the adolescent period.

LIMITATIONS

Limited sample size and the X-rays were taken before orthodontic treatment, which may have introduced a selection bias.

CONCLUSIONS

When the root of the canines or second premolars is ¾ mineralized, it may indicate the beginning of the adolescent period with increased skeletal growth intensity.

A systematic overview of dental methods for age assessment in living individuals: from traditional to artificial intelligence-based approaches

Dental radiographies have been used for many decades for estimating the chronological age, with a view to forensic identification, migration flow control, or assessment of dental development, among others. This study aims to analyse the current application of chronological age estimation methods from dental X-ray images in the last 6 years, involving a search for works in the Scopus and PubMed databases. Exclusion criteria were applied to discard off-topic studies and experiments which are not compliant with a minimum quality standard. The studies were grouped according to the applied methodology, the estimation target, and the age cohort used to evaluate the estimation performance. A set of performance metrics was used to ensure good comparability between the different proposed methodologies. A total of 613 unique studies were retrieved, of which 286 were selected according to the inclusion criteria. Notable tendencies to overestimation and underestimation were observed in some manual approaches for numeric age estimation, being especially notable in the case of Demirjian (overestimation) and Cameriere (underestimation). On the other hand, the automatic approaches based on deep learning techniques are scarcer, with only 17 studies published in this regard, but they showed a more balanced behaviour, with no tendency to overestimation or underestimation. From the analysis of the results, it can be concluded that traditional methods have been evaluated in a wide variety of population samples, ensuring good applicability in different ethnicities. On the other hand, fully automated methods were a turning point in terms of performance, cost, and adaptability to new populations.

Evaluation of Third Molar Maturity Index by Cone Beam Computed Tomography in Legal Age Estimation: A Preliminary Study

ABSTRACT

This retrospective study aimed to evaluate the accuracy and applicability of the third molar maturity index (I 3M ) for discriminating Turkish minors from adults, and its relationship with chronological age using cone beam computed tomography (CBCT). A total of 122 CBCT scans of Turkish individuals (55 boys and 67 girls) aged 13 to 23 years were evaluated using the I 3M cutoff value. Chronological age gradually decreased as the I 3M value increased. The overall accuracy was 95.9%. The sensitivity and specificity of this test were 93.5% and 97.4%, respectively. Positive predictive value was 95.6%. The intraclass correlation coefficient values of the I 3M for the intraobserver and interobserver agreements were 0.998 and 0.996, respectively. This study showed relatively higher reproducibility of measurements on CBCT scans than on panoramic radiographs in the literature. Cone beam computed tomography may be advantageous and preferred over panoramic radiographs in distinguishing the legal age threshold of 18 years according to Cameriere's method when a more extensive investigation is needed to support the solution of challenging and uncertain cases in forensic medicine.

Radiographic dental age estimation applying and comparing Demirjian's seven (1973) and four (1976) teeth methods

To apply Demirjian's seven (1973, D7) and four (1976, D4) teeth methods in a sample of Brazilian children and compare their performances for age estimation. Panoramic radiographs of 1200 children (600 females and 600 males) were collected from Southeast Brazil. The children were equally distributed (n = 60 females and 60 males) between age intervals of 1 year between 6 and 15.9 (mean age = 10.9; standard deviation [SD]: 2.9) years. D7 and D4 dental age estimation methods were applied by two observers and were compared based on their error rates (error = estimated age-chronological age). Both methods overestimated the chronological age (p < 0.0001). D7 led to overestimations of 0.71 (p < 0.0001) in females and 0.83 (p < 0.0001) in males, while the overestimations with D4 were 0.14 (p = 0.0067) and 0.73 (p < 0.0001) for females and males, respectively. The mean age estimated by D7 was 11.7 (SD: 3.1) years, while for D4, it was 11.3 (SD: 3.3) years. Intra- and interobserver agreement was ≥ 0.98. D4 optimized the performance of radiographic dental age estimation compared to D7. Improvements were reflected in the total sample and separately for female and male children from Southeast Brazil.

Age determination on panoramic radiographs using the Kvaal method with the aid of artificial intelligence

OBJECTIVES

This study aimed to assess and compare age estimation on panoramic radiography using the Kvaal method and machine learning (ML).

METHODS AND MATERIALS

554 panoramic radiographs were selected from a Brazilian practice. To estimate age using the Kvaal method, the following measurements were performed on the upper left central incisors and canines: tooth, pulp and root length; root and pulp width at three different levels: at the enamel-cementum junction (ECJ); midpoint between the enamel-cementum junction and; at the mid root level. For ML age estimation, radiomic, semantic and the radiomic-semantic attribute extractions were assessed. Nineteen semantic and 14 radiomic attributes and a single set of 33 semantic-radiomic attributes were extracted. Logistic Regression, Linear Regression, KNN, SVR, Decision Tree Reg, Random Forest Reg, Gradient Boost Reg e XG Boosting Reg were used for ML classification. For the Kvaal method, Mann-Whitney test, Spearman correlation coefficient, Student's t-test and linear regression with its respective coefficient of determination were used to estimate age and to assess data variability.

RESULTS

Mean absolute error (MAE) and standard error estimate (SEE) were assessed. For the Kvaal method, upper incisors presented higher precision than canines (R²: 0.335, SSE: 7.108). Males presented better MAE and SEE values (5.29,6.96) than females (5.69,7.37). The radiomic-semantic attributes presented superior precision (MAE: 4.77) than the radiomic and semantic (MAE: 5.23) attributes. The XG Boosting Reg classifier performed better than the other six assessed classifiers (MAE: 4.65). ML (MAE: 4.77 presented higher age estimation precision than the Kvaal method (MAE: 5.68).

CONCLUSION

The use of ML on panoramic radiographs can improve age estimation.

Application of the London Atlas of Tooth Development and Eruption in Panoramic Xrays for the Age Estimation

BACKGROUND

The age estimation of the individual by the forensic experts ascertains the chronological age of an individual. The possibility that the person being examined may be younger or older than a certain age threshold makes this process crucial, as it will establish whether or not the person is an adult under the law. The aim of this study was to test the applicability of the London Atlas of tooth development and eruption in Nepalese subset population.

METHODS

The London Atlas for age estimation was tested in 350 digital panoramic radiographs from the patients between four and twenty-four years visiting Tribhuvan University Teaching Hospital, Institute of Medicine, Nepal.

RESULTS

The mean values of the estimated age were higher in both the sexes, which was statistically not significant. Both the sexes showed an excellent positive correlation, and was significant with a p value of <0.001. The age estimation upto 10 years group classification was nearly accurate with less than 1 and 2.5 years variation in males and females respectively. The accuracy was good in 16-18 years group with maximum deviation of ±2.5 years. The accuracy was poor in more than 18 years group, as the variability was more than 5 years.

CONCLUSIONS

The London Atlas method was best suited for less than 18 years of age and was not very accurate in the age group of 13-14 and 14-15 years where most of the polymorphisms were noted.

Artificial Intelligence as a Decision-Making Tool in Forensic Dentistry: A Pilot Study with I3M

Expert determination of the third molar maturity index (I3M) constitutes one of the most common approaches for dental age estimation. This work aimed to investigate the technical feasibility of creating a decision-making tool based on I3M to support expert decision-making. Methods: The dataset consisted of 456 images from France and Uganda. Two deep learning approaches (Mask R-CNN, U-Net) were compared on mandibular radiographs, leading to a two-part instance segmentation (apical and coronal). Then, two topological data analysis approaches were compared on the inferred mask: one with a deep learning component (TDA-DL), one without (TDA). Regarding mask inference, U-Net had a better accuracy (mean intersection over union metric (mIoU)), 91.2% compared to 83.8% for Mask R-CNN. The combination of U-Net with TDA or TDA-DL to compute the I3M score revealed satisfying results in comparison with a dental forensic expert. The mean ± SD absolute error was 0.04 ± 0.03 for TDA, and 0.06 ± 0.04 for TDA-DL. The Pearson correlation coefficient of the I3M scores between the expert and a U-Net model was 0.93 when combined with TDA and 0.89 with TDA-DL. This pilot study illustrates the potential feasibility to automate an I3M solution combining a deep learning and a topological approach, with 95% accuracy in comparison with an expert.

Fetal Age Assessment From Primary Teeth and Long Bones

ABSTRACT

This study evaluated traditional and expedited methods for assessing the age of fetal remains. Because of their rare occurrence, the discovery of fresh, decomposing, disfigured, or skeletal fetuses engenders heightened awareness by forensic pathologists primarily tasked with age estimation in relation to viability. With decomposed complete or isolated fetal remains, dentists focus on primary molar mineralization, whereas anthropologists perform long bone measurements along with discernment of other indicators of skeletal maturity to obtain an age estimation.The results of this study are 4-fold: (1) The "best" technique for harvesting fetal tooth buds and long bones is the dissection of the developing tooth buds with maceration for the long bones. (2) Metric analysis was applied to the tooth buds and long bones for age estimation, and the findings were correlated. (3) There is a statistically significant difference between known age and dental age and between dental age and long bone age. The difference between known age and long bone age is not statistically significant, but a type II error exists because of the small sample size. (4) A central incisor staging technique for fetuses younger than 26 weeks was developed as a supplement to the molar staging system of Kraus and Jordan (1965).

Dental Age Assessment of United States Black and White Children: Performance Reliability of Harris and McKee (1990)

ABSTRACT

Medicolegal authorities use forensic dental age assessment of children to establish a biologic profile to assist in human identification, answer questions related to immigration, and answer questions used to substantiate eligibility for social benefits. The goal of this study was to assess the performance reliability of the child dental age assessment data previously published for White and Black children in the United States. A total of 432 dental panoramic radiographs were obtained from 3 geographic locations in the United States: Memphis, Tennessee, Knoxville, Tennessee, and Saint Louis, Missouri. Radiographs were staged, and the estimated age was calculated using the previously published data. Multiple age assessments were conducted to determine the effect of excluding certain teeth on estimated age. The results indicated estimated ages using the previously published reference data set were accurate and concordant with known chronologic age across the ancestral, sex, and geographic categories. The results also indicated that the known chronologic age fell within one standard deviation of the estimated age more than the statistical expectation for most categories. Excluding canines provided the most accurate estimation of known chronologic age.

[Chromatographic analysis of hard tooth tissue to determine the age of personality]

The biochemical approach for age assessment is most appropriate in forensic medicine, as racemization of aspartic acid in bones and teeth is closely related to human biological age. The aim of the study is to assess the biochemical parameters of aspartic acid in human teeth, which can be implemented into forensic practice in Russia. Samples of dentin in amount of 20, taken from the teeth of subjects aged between 16 and 76, were examined. Chromatographic analysis of the samples was performed on a gas chromatograph using chiral column. Statistical data processing showed that the relative squared peak of D-aspartic acid has a strong correlation with human biological age. Data, obtained from the Russian population study, demonstrate the applicability of chromatography for forensic purposes. It should be noted that the approach to the racemization rate estimation in the hard tooth tissue was performed using standard laboratory equipment, which allows to easily implement this method in forensic medical practice.

Age Estimation Using Maxillary Central Incisor Analysis on Cone Beam Computed Tomography Human Images

Forensic dentistry plays an important role in human identification, and dental age estimation is an important part of the process. Secondary dentin deposition throughout an individual's lifetime and consequent modification in teeth anatomy is an important parameter for age estimation procedures. The aim of the present study was to develop regression equations to determine age in adults by means of linear measurements and ratios on sagittal, coronal and axial slices of maxillary central incisors using cone bean computed tomography (CBCT). Multiplanar measurements of upper central incisors were taken for a sample of 373 CBCTs. Subsequently, one-way analysis of variance (ANOVA) and multivariate linear regressions were performed for age estimation. The equations obtained from axial linear measurements and ratios presented a standard error of the estimate (SEE) of ±10.9 years (R² = 0.49), and a SEE of ±10.8 years (R² = 0.50), respectively. The equation obtained for multiplanar linear measurements presented a SEE of ±10.9 years (R² = 0.52), while the equation for multiplanar ratios presented a SEE of ±10.7 years (R² = 0.51). Thus, CBCT measurements on upper central incisors were found to be an acceptable method for age estimation. Horizontal measurements, especially pulp measurements, improve the accuracy of age estimate equations.