Dental age estimation in Spanish and Venezuelan children. Comparison of Demirjian and Chaillet's scores

Age estimation by evaluation of obliteration of the palatine sutures: a scoping review

The age estimation (AE) of human remains is a challenging task since it is dependent on the state in which these remains are found. Since the macroscopic evaluation of palatal sutures has been proposed as a method for AE, the aim of this study was to review the literature on this method, considering that the cases of edentulous elderly are among the greatest challenges in anthropological and forensic contexts. A scoping review was performed using a specific search strategy in PubMed, Web of Science, SciELO, LILACS, and Google Scholar. The search identified 13 articles, among which the USA yielded the most information with 3 articles. Only 1 study was identified in Latin America (Peru). There was great diversity regarding the origin of samples, and the studies were carried out on both historical and modern populations. Only 6 articles exceeded the average sample size (168.08) and 4 articles studied samples of fewer than 100 individuals. Although 6 different methods were identified, Mann et al.'s revised method was the most used. The selection of appropriate methods for AE depends on what skeletal elements are present and the general age of the specimens. Although evaluation of the obliteration of the palatal sutures has been found to be simple and promising for AE in individuals over 60 years of age, this method has been reported to have less precision than other more complex methods, which makes the use of a combination of methods necessary to increase the level of confidence and the percentage of success. Further research could resolve this weakness, and methodological refinement (perhaps the digitization and automation of processes, or the application of Bayesian methodology) could provide the necessary solidity to comply with international standards in the forensic scenario.

Comparing the relative influence of obesity and ancestry on timing of dental development

INTRODUCTION

The dentition is one of the most accurate features for age estimation in children. However, there is some evidence that timing of dental development varies across populations. Recent research suggests that dental development may also be susceptible to influence by environmental factors, such as obesity. Given that there are also population differences in average body mass, it is possible that this may be a confounding variable that was not accounted for in prior work. We aim to compare the relative association between body mass index (BMI) and ancestry with timing of dental development.

METHODS

A retrospective cross-sectional chart review was undertaken using panoramic radiographs of 6- to 12-year-olds (n = 281). Age, ancestry, sex, height, and weight were obtained. Dental development was assessed using the Demirjian method, and chronological age was subtracted from estimated dental age to determine relative timing of dental development (ΔAge). BMI was calculated based upon recorded height/weight within 6 months of time of radiograph.

RESULTS

We found no difference in timing of dental development (accelerated/delayed) across ancestry groups (African-American, Euro-American, Hispanic, Asian; P = .15). Overweight/obese subjects had statistically significantly advanced (precocious) dental development (P < .001). Compared to normal-weight subjects, children who were overweight's age were overestimated by 5.76 months (0.48 years) and children with obesity by 5.97 months (0.49 years) on average.

CONCLUSIONS

BMI appears to have a greater impact on relative timing of dental development than ancestry in this population. Our results support other findings that obesity results in accelerated growth and development.

Age Estimation in 0-8-Year-Old Children in France: Comparison of One Skeletal and Five Dental Methods

Age estimation in juveniles is a critical procedure in judicial cases for verification of imputability or for civil reasons when adopting children. Several methods based both on skeletal and dental growth have been performed and applied on different populations; nevertheless, few articles have compared different methods in order to test their reliability in different conditions and age ranges, and this is a clear obstacle in the creation of common guidelines for age estimation in the living. A comparison of five dental methods (Anderson, Ubelaker, Schour and Massler, Gustafson and Koch, Demirjian) and one skeletal method (Greulich a Pyle atlas) was performed on a population of 94 children aged between 0 and 8 years. Results showed that, whereas under 2 years all the methods have the same inaccuracy, over 2 years the diagram methods, such as Schour and Massler and Ubelaker's revised one, have a lower error range than the most frequently used Greulich and Pyle atlas and Demirjian method. Schour and Massler, Gustafson and Koch, and Ubelaker methods showed, respectively, a mean error amounting to 0.40, 0.53, and 0.56 years versus the 0.74 and 0.88 years given by Demirjian and the Greulich and Pyle atlas. An in-depth analysis of the potential of several methods is necessary in order to reach a higher adherence of age estimation with the complexity of growth dynamics.

Age estimation of children based on open apex measurement in the developing permanent dentition: an Egyptian formula

Background

Cameriere’s original formula based on open apex measurements is a reliable, clinically applicable method for dental age estimation in different populations children. Dental development may differ between Egyptian children and other ethnic populations which may affect dental age accuracy using Cameriere’s formula.

Aim

Firstly, to verify Cameriere’s original formula on large Egyptian children sample, secondly, to develop an Egyptian-specific formula based on Cameriere’s method.

Material and methods

A prospective cross-sectional study of 762 good quality Orthopantomograms (OPGs) of 5–15 aged healthy Egyptian children selected from Nile Delta governorates between August 2020 and December 2021. Chronological age (CA) was calculated by subtracting birth date from radiograph date. OPGs were analyzed for N0, S, Xi morphologic variables using Sidexis program after that dental age was calculated using Cameriere’s formula then compared to CA. Multiple linear regression model was used to adapt Cameriere’s formula to construct an Egyptian formula. The same sample was used to verify the new formula accuracy.

Results

A total of 1093 OPGs were collected; 762 OPGs which met inclusion criteria were analyzed. Cameriere’s original formula revealed − 0.59- and − 0.53-year underestimation of females and males dental age (DA) respectively (p < 0.001). Regression analysis using the morphologic variables showed that X4, X7, N0 contributed significantly to CA yielding Egyptian-specific formula. New formula showed − 0.12-year male underestimation and 0.1-year female overestimation (p > 0.05).

Conclusion

Egyptian formula was more accurate than Cameriere’s formula in Egyptian children.

Clinical relevance

Egyptian-specific formula decreases the gap between CA and DA, so a relative approximate age is obtained that helps proper diagnosis and treatment planning for orthodontic and pediatric dentistry problems.

Association between dental agenesis and delay in dental development: a preliminary study in a Spanish paediatric population in relation with Dental Anomaly Pattern (DAP)

Background

The association between dental anomalies has been studied, giving rise to the concept of Dental Anomaly Pattern (DAP). Tooth agenesis has been associated with alterations such as molar infracclusion, taurodontism and delayed dental development. The aim of this study was to evaluate the dental development pattern in patients with non-syndromic dental agenesis, in comparison with a control group.

Methods

Dental and chronological age was analysed in a sample size of 204 orthopantomographs divided into a study group (n = 104) and a control group (n = 100) with the Demirjian Method. Intra and intergroup differences in chronological and dental age, and the correlation between them were calculated by statistical analysis with a 95% confidence level (p < 0.05).

Results

Dental age exceeded chronological age both in the control group and in the study group. Statistically significant differences (p = 0.004) were found when comparing the difference between chronological and dental age in the study (-0.16 ± 1.12) and control group (-0.58 ± 0.90). Regarding sex and age intergroup differences, the results were only statistically significant in the girls’ group (p = 0.017), and the age over 8 years old (p < 0.05). There were no significant differences in tooth development depending on the number of missing teeth or the affected tooth group, but there was a delay in the development of the homologous tooth contralateral to the absent one in 14.9% of patients.

Conclusions

The difference between chronological and dental age in permanent dentition is significantly lower in Spanish children with non-syndromic agenesis compared to a control group, presenting a lower dental age than chronological age than children without non-syndromic agenesis.

Adapting Demirjian Standards for Portuguese and Spanish Children and Adolescents

Estimation of children's chronological age is highly important in human and forensic sciences. The Demirjian method has been reported as accurate for this purpose. The literature review shows some evidence that the accuracy of estimating chronological age via the Demirjian standards is not a straightforward process. The objective of this research is to analyze the reliability of the Demirjian standards in Portuguese and Spanish children and adolescents and adapt it to include sex and group age as contingent factors.

METHODS

Orthopantomographs of 574 Portuguese and Spanish male and female children and adolescents were employed to test the reliability of the Demirjian method. After testing for inter-rater consistency and age estimation using the Demirjian standards, multiple regression analysis was performed controlling for sex and age group.

RESULTS

The Demirjian standards overestimated chronological age for both sexes, mainly for females. Through the development of regression functions, more detailed dental age estimation was performed. The predictive capacities of the Demirjian method and the significant teeth varied as a function of children's age. The Demirjian global standard predicted over 65% of the variance of the chronological age. Taking a tooth-by-tooth approach, the predictive ability increased by over 70%.

CONCLUSIONS

The accuracy of estimating chronological age via the Demirjian method is not as reliable as it might appear, judging from the results found according to age group and according to sex crossed with age group.

A Novel Mathematical Method to Diagnose the Transverse Growth Deficit of the Nasomaxillary Complex

The diagnosis of transverse growth deficit of the maxilla in daily clinical practice is carried out mainly through the experience of a well-trained clinician, which implies a lack of objective criteria applicable in a protocolized manner. The objective of this study was to establish a mathematical method to diagnose maxillary compression in relation to the dimensions of the skull and mandible. Methods: Records of 97 cases with an overall mean age of 9.8 ± 2.6 years were analyzed by three experienced orthodontists. The group of transverse compression was comprised of 62 cases and the control group of 35 cases. The main measurements of the widths were made on a frontal teleradiography of the skull (cranial, zygomatic, orbital, maxillary, bigonial and biantegonial width) and a lateral teleradiography of the skull (facial axis, mandibular plane, SNA, SNB, ANB and Wits). It was established that from the cranial width it is possible to predict the group to which each subject studied belongs—the compression group or the control group. A mathematical formula was obtained in the form of logistic regression that allows for the diagnosis of the presence of maxillary compression based on the cranial, maxillary and orbital widths with a sensitivity of 88.7% and a specificity of 77.1%.

Use of the Demirjian method to estimate dental age in panoramic radiographs of patients treated at the Buenos Aires University School of Dentistry

The aim of this study was to determine the difference between real age (RA) and dental age (DA) in boys and girls from the Autonomous City of Buenos Aires (C.A.B.A.) by analyzing digital panoramic radiographs from the database of the Imaging Department at the Buenos Aires University School of Dentistry, using the Demirjian Method (DM). The sample consisted of 508 panoramic radiographs of 6- to 14-year old Argentines (268 female and 240 male). The Demirjian method was used to estimate dental age from each panoramic radiograph, and the Wilcoxon test was applied to perform a comparative analysis with the real age recorded in the image database. Average RA was 9.36 years (SD 2.11), and average DA according to the Demirjian method was 10.45 years (SD 2.31). For females, RA was 9.25 (SD 2.12), and DA according to the DM was 10.40 years (SD 2.41). For males, RA was 9.46 (SD 2.10), and DA according to the DM was 10.50 years (SD 2.22). An inter-classcorrelationcoefficient(ICC) calculated as a correlation measure between dental age and real age was ICC = 1.09%. The ICC was 1.04% for the males and 1.15% for females. Significant differences were found between DA and RA (p<0.01) in general and according to sex. Real age was found to be lower than dental age in the study population from Buenos Aires City.

Dental age estimation of Tibetan children and adolescents: Comparison of Demirjian, Willems methods and a newly modified Demirjian method

Tibetan ethnic group is one of the oldest ethnic groups in China and South Asia. This study set out to analyze the dental development and validate Demirjian method and Willems method in estimating dental age of Tibetan children and adolescents, and to modify Demirjian method based on Tibetan population to provide ethnic-specific reference data and a more reliable method for forensic age assessment in Tibetan ethnic group. In this study, 1951 samples aged between 4 and 15 years were retrospectively collected and analyzed. Multiple linear regression was used to establish relationship between chronological age (CA) and developmental stages of left mandibular permanent teeth. The accuracy of the modified method was tested and compared with that of Demirjian and Willems method. Results showed that dental maturity score (DMS) was significantly greater in girls than in boys in all age groups except for the 4-year age group (p < 0.05). Mean absolute error (MAE) was 0.96 years for both boys and girls by Demirjian method, and 1.06 and 1.16 years for boys and girls respectively by Willems method. Adjusted scores table was established and tested. The age of boys was overestimated by 0.13 years and the age of girls was underestimated by 0.06 years by the adjusted scores table. MAE was lower than that of the other two methods. In conclusion, Demirjian method and Willems method was not sufficiently accurate in estimating dental age of Tibetan population. The modified method was more suitable for dental age estimation of Tibetan population than Demirjian and Willems method.

Dental maturation in a Chinese sample using Demirjian method

BACKGROUND

Dental calcification information is relevant for clinical, archaeological, and forensic applications. However, dental maturity measurements in current cohorts of Chinese children are insufficient.

AIM

This study aimed to establish the mandibular dental maturity table and determine the accuracy of dental age estimation using the Demirjian method in a Chinese sample.

SUBJECTS AND METHODS

Permanent mandibular teeth, excluding the third molar, in 2091 panoramic radiographs of 1008 males and 1083 females aged 3-15 were graded, and dental age was estimated according to Demirjian's criteria. Age-of-attainment was calculated with probit regression for each stage by sex, and sex differences were analysed using the Mann-Whitney U test. Dental age was compared with chronological age using paired t-tests.

RESULTS

Although females showed earlier age-of-attainment than males, significant sex differences were only found in stages D-G (p < 0.05). The Demirjian method overestimated the dental age in both males (0.68 ± 1.05 years) and females (0.59 ± 0.97 years).

CONCLUSIONS

The relationship between mineralisation stage and chronological age in this study can be applied as a reference for mandibular dental maturity of Chinese children and adolescents. The Demirjian method overestimated the chronological ages of this sample.

A critical test of twelve methods for estimating age using radiographic staging of developing teeth on a sample of 6- to 15-year-old children from Mérida, Yucatán (México)

Cross-population applicability of osteological and dental methods is a known issue in forensic anthropology, but very little is known about whether differences between populations are due to ancestry, environment effects, or even the statistical approach utilized for developing the methods. This study wishes to add to the discussion of population-specificity of dental age estimation methods and examine the impact of their statistical basis on their accuracy and precision. These parameters were estimated by testing 12 different dental age estimation techniques on a sample of 182 panoramic radiographs of children between the ages of 6 and 15 years (110 girls and 72 boys) from the city of Mérida in Yucatán, México. None of the 12 methods selected is based on Mexican samples. Dental maturation was scored following and methods tested employed two dental scoring schemes: Moorrees, Fanning, and Hunt's (MFH) 13-/14-stage system and Demirjian's 8-stage system. Results show that methods derived from more geographically specific groups do not fare better or worse than methods developed on more diverse and inclusive international samples, even if no methods specific to Mexicans were tested. While some of the methods performed very well, and they were not based on a Mexican sample, this suggests that population-specific dental age estimation methods may be relatively unimportant or that population differences in dental maturation are very small. Other issues seemed to have a greater impact on accuracy and precision, such as age dependency, inclusion of the third molar in age assessments, age truncation and age heaping in reference samples, the dental scoring scheme used, and how predicted age is calculated mathematically. As such, findings in this study suggest that validation tests of age estimation methods may not be a useful or reliable means to assess population differences and that these differences need to be more systematically assessed if an argument is to be made for the increased accuracy and precision of population-specific methods. The statistical basis of dental prediction methods seems to have a more significant role in their accuracy and precision outside of their reference sample.

Age estimation in the living: A scoping review of population data for skeletal and dental methods

Age estimation of living individuals has become a crucial part of the forensic practice, especially due to the global increase in cross-border migration. The low rate of birth registration in many countries, hence of identification documents of migrants, especially in Africa and Asia, highlights the importance of reliable methods for age estimation of living individuals. Despite the fact that a number of skeletal and dental methods for age estimation have been developed, their main limitation is that they are based on specific reference samples and there is still no consensus among researchers on whether these methods can be applied to all populations. Though this issue remains still unsolved, population information at a glance could be useful for forensic practitioners dealing with such issues. This study aims at presenting a scoping review and mapping of the current situation concerning population data for skeletal (hand-wrist and clavicle) and dental methods (teeth eruption and third molar formation) for age estimation in the living. Two hundred studies on the rate of skeletal maturation and four hundred thirty-nine on the rate of dental maturation were found, covering the period from 1952 and 2020 for a total of ninety-eight countries. For most of the western and central African countries there are currently no data on the rate of skeletal and dental maturation. The same applies to the countries of the Middle East, as well as the eastern European countries, especially as regard the skeletal development.

Accuracy assessment of dental age estimation with the Willems, Demirjian and Nolla methods in Spanish children: Comparative cross-sectional study

Background

The objective of this study was to evaluate and compare the validity and accuracy of the Willems, Demirjian and Nolla methods in predicting chronological age in a Spanish ethnicity population.

Methods

A sample of 604 orthopantomographs of Spanish children aged 4 to 13 years was evaluated by two independent evaluators. Descriptive statistics were applied to calculate the chronological age and dental age, presenting the mean and standard deviation. The difference between dental age and chronological age was calculated for each method. A positive result indicated an overestimation and a negative figure indicated an underestimation. The Wilcoxon test for paired data and Spearman’s correlation coefficient were applied by age groups and sex to compare the chronological age and dental age of each method (that of Willems, Demirjian and Nolla). Statistical tests were performed at a 95% confidence level.

Results

The interexaminer agreement was 0.98 (p = 0.00), and the intraexaminer agreement was 0.99 (p = 0.00). The Willems method significantly overestimated the age of boys (0.35 years (0.93)) and girls (0.17 years (0.88)). The Demirjian method significantly overestimated the age of boys (0.68 years (0.95)) and girls (0.73 years (0.94)). The Nolla method significantly underestimated age in boys (0.44 years (0.93)) and girls (0.82 years (0.98)).

Conclusions

In the Spanish population, the use of the Demirjian method for legal and medical purposes is frequent. This study reveals that the Willems method is more appropriate due to its greater precision in estimating dental age.

Deep Neural Networks for Chronological Age Estimation From OPG Images

Chronological age estimation is crucial labour in many clinical procedures, where the teeth have proven to be one of the best estimators. Although some methods to estimate the age from tooth measurements in orthopantomogram (OPG) images have been developed, they rely on time-consuming manual processes whose results are affected by the observer subjectivity. Furthermore, all those approaches have been tested only on OPG image sets of good radiological quality without any conditioning dental characteristic. In this work, two fully automatic methods to estimate the chronological age of a subject from the OPG image are proposed. The first (DANet) consists of a sequential Convolutional Neural Network (CNN) path to predict the age, while the second (DASNet) adds a second CNN path to predict the sex and uses sex-specific features with the aim of improving the age prediction performance. Both methods were tested on a set of 2289 OPG images of subjects from 4.5 to 89.2 years old, where both bad radiological quality images and images showing conditioning dental characteristics were not discarded. The results showed that the DASNet outperforms the DANet in every aspect, reducing the median Error (E) and the median Absolute Error (AE) by about 4 months in the entire database. When evaluating the DASNet in the reduced datasets, the AE values decrease as the real age of the subjects decreases, until reaching a median of about 8 months in the subjects younger than 15. The DASNet method was also compared to the state-of-the-art manual age estimation methods, showing significantly less over- or under-estimation problems. Consequently, we conclude that the DASNet can be used to automatically predict the chronological age of a subject accurately, especially in young subjects with developing dentitions.

Reconstructing breastfeeding and weaning practices in the Bronze Age Near East using stable nitrogen isotopes

Objectives

Breastfeeding and childhood diet have significant impact on morbidity and mortality within a population, and in the ancient Near East, it is possible to compare bioarchaeological reconstruction of breastfeeding and weaning practices with the scant textual evidence.

Materials and Methods

Nitrogen stable isotopes (δ¹⁵N) are analyzed here for dietary reconstruction in skeletal collections from five Bronze Age (ca. 2,800–1,200 BCE) sites in modern Lebanon and Syria. We employed Bayesian computational modeling on cross‐sectional stable isotope data of collagen samples (n = 176) mainly from previous studies to test whether the bioarchaeological evidence aligns with the textual evidence of breastfeeding and weaning practices in the region, as well as compare the estimated weaning times to the global findings using the WARN (weaning age reconstruction with nitrogen isotope analysis) Bayesian model.

Results

Though the Near East sites in this study had different ecological settings and economic strategies, we found that weaning was introduced to the five sites at 0.5 ± 0.2 years of age and complete weaning occurred around 2.6 ± 0.3 years of age on using the WARN computational model. These weaning processes are within the time suggested by historical texts, though average estimated weaning age on the Mediterranean coast is later than inland sites.

Discussion

Compared globally, these Near Eastern populations initiated the weaning process earlier but completed weaning within the global average. Early initial weaning may have created short spacing between pregnancies and a high impact on demographic growth within these agricultural populations, with some variation in subsistence practices accounting for the inland/coastal discrepancies.

Validity of the Demirjian and Fishman Methods for Predicting Chronological Age Amongst Yemeni Children

Objectives

There has been an increasing need for reliable chronological age (CA) estimation in several aspects, including orthodontic treatment needs and legal, civil and forensic purposes. This study aimed to assess the validity of the Demirjian and Fishman methods in predicting the CA of Yemeni children.

Methods

This descriptive cross-sectional study was conducted at seven schools in Sana’a, Yemen, between December 2016 and December 2017. One orthopantomograph and one left hand-wrist X-ray were obtained for each child to calculate the dental age (DA) and skeletal age (SA) which were correlated and compared with the CA.

Results

A total of 358 Yemeni children aged 8–16 years were included in this study. The mean CA, DA and SA were 12.00 ± 2.25, 11.34 ± 2.42 and 12.39 ± 1.65 years, respectively. The Demirjian method significantly underestimated the CA by 0.58 ± 1.25 years in the total sample and 0.73 ± 1.30 and 0.40 ± 1.17 years in males and females, respectively (P <0.001). The Fishman method significantly underestimated the CA by 0.23 ± 1.19 and 0.44 ± 1.26 years in the total sample and in males, respectively (P ≤0.02). The Fishman method insignificantly underestimated the females CA by 0.02 ± 1.08 years (P = 0.898).

Conclusions

Yemeni CA is highly correlated to DA and SA estimated by the Demirjian and Fishman methods, respectively. The Fishman method was more accurate amongst Yemeni females. Results showed that Yemeni children are delayed in dental development and skeletal maturity.

The applicability of the Demirjian, Willems and Chaillet standards to age estimation of 5-15 year old Indian children

BACKGROUND

Demirjian's method of age estimation has been reported to overestimate age and Willems' method to give consistently more accurate results. Not enough, however, is known about the applicability of Chaillet's standards.

AIM

The present study aimed to compare the accuracy of Demirjian's, Willems' and Chaillet's standards in age estimation of 5 to 15 year-old Indian children.

DESIGN

In this cross-sectional observational study, three methods were compared for accuracy in estimating the age of 1200 Indian children aged 5-15 years.

RESULTS

Demirjian's method overestimated age by +0.24 ± 0.80 years, +0.11 ± 0.81years and +0.19 ± 0.80 years in boys, girls and the total sample, respectively. With Willems' method, overestimations of +0.09 ± 0.80 years, +0.08 ± 0.80 years and +0.09 ± 0.80 years were obtained in boys, girls and the total sample, respectively. Chaillet's method underestimated age by -0.12 ± 0.69 years, -0.45 ± 0.88 years and -0.25 ± 0.83 years in boys, girls and the total sample, respectively. Statistically significant differences were observed between dental and chronological ages with all methods (p < 0.001). Significant sex-based differences were observed only with Demirjian's and Chaillet's methods (p < 0.05).

CONCLUSION

Willems' method was the most accurate in age estimation, followed by Demirjian's and Chaillet's methods. While Demirjian's method was more accurate than Chaillet's in females, Chaillet's method better predicted the age of males.

New model for dental age estimation: Willems method applied on fewer than seven mandibular teeth

Willems method measures the developmental stages of the seven left permanent mandibular teeth and is frequently used for dental age estimation. The aim of this study was to test its accuracy on a large sample of the Croatian population and to develop new models for estimation based on one to seven mandibular teeth. The developmental stages were evaluated on the digital, standardized orthopantomograms of 1868 Croatian children aged 5 to 16. Univariate regression was used for age estimation based on one tooth and regression with forward and backward elimination for selection of the best combination on two to six teeth. Tested in parallel with Willems method, the accuracy of the new models was assessed within intervals of ± 0.5, ± 1, ± 1.5 and ± 2 years and shows the percentage of correct estimations. Using Willems method, the average overestimation was 0.41 years for boys and 0.22 years for girls. Newly developed models that use two to seven teeth proved to be significantly more accurate (p < 0.001). The accuracy of age estimation increases significantly with the number of teeth in a model. Predictably, within the interval ± 0.5 years, a model with three teeth has 3% fewer accurate age estimations than a model including seven teeth. In both theory and practice, Willems method has been considered suitable for age estimation among Croatian children. However, these newly developed models significantly surpass its accuracy. Models using two to seven teeth represent a simple, reliable, and accurate method for age estimation, even in cases with missing mandibular teeth.

Brief Report: Estimating the Dental Age of Children with Autism Spectrum Disorders

Determining a patient's dental age is essential from the dental standpoint but can also have connotations of a forensic, anthropological and medicolegal nature. In this study, we assessed the correspondence between dental age and chronological age in a group of 50 children with autism spectrum disorders, with a chronological age range of 3-17 years. The dental age was calculated using panoramic radiography images, applying linear regression models derived from the classical indices by Nolla and Demirjian. In 2 of every 3 boys, the dental age was ahead of the chronological age, and in almost 1 of every 3 cases, the difference was ≥ 12 months. In the girls, conversely, we found no significant differences between dental age and chronological age.

Evaluation of the relationship between the Demirjian and Nolla methods and the pubertal growth spurt stage predicted by skeletal maturation indicators in Turkish children aged 10-15: investigation study

OBJECTIVE

The aim of this study was to investigate the possibility of evaluating the relationship between dental maturation and skeletal maturation without taking a hand-wrist radiogram outside of panoramic radiogram.

MATERIALS AND METHODS

Panoramic and hand-wrist radiographs of 717 patients (383 girls and 334 boys), with ages ranging from 10 to 15 years, were evaluated. Dental maturity stages of the mandibular canine, first premolar, second premolar and second molar teeth were determined by Demirjian's and Nolla's methods. The skeletal maturation was determined by Fishman method and bone age was determined through the Greulich and Pyle method.

RESULTS

All teeth showed positive and statistically significant correlations, the highest correlation was between the mandibular second premolar calcification stages and hand-wrist maturation stages. According to both dental age determination methods, mandibular second premolar was prominent in determining to the pubertal growth stages.

CONCLUSIONS

There was a positive relationship between dental calcification stages and skeletal maturation stages, in the study population. Dental calcification stages of the second mandibular premolar showed the highest positive correlation with the skeletal maturation stages.

Assessment of the Dental Age of Children in the Polish Population with Comparison of the Demirjian and the Willems Methods

Background

Dental age is less affected than the bone age by nutritional and hormonal factors. The assessment of dental age in children is of value in clinical and forensic practice. The aims of this study were to compare the Demirjian method and the Willems method in the assessment of dental age in children in Poland and to consider the need to standardize dental age assessment.

Material/Methods

Polish children of Caucasian ethnicity (n=1,002) who were treated at a single orthodontic center between 1994–2016 included girls (n-540) and boys (n=462) aged between 4–17 years, and 1,002 panoramic radiographs were reviewed. Dental age was assessed using the Demirjian method and the Willems method, the findings of the two methods were compared with the chronological age of the study participants.

Results

Following statistical analysis, both the Demirjian method and the Willems method overestimated the dental age of the younger study participants, and underestimated the dental age of the older study participants. Both the Demirjian method and the Willems method had similar accuracy in estimating the chronological and dental age in the Polish population.

Conclusions

In the assessment of dental age in Polish children from panoramic radiographs, both the Demirjian method and the Willems method were accurate and should still be used as a method of choice. However, it seems reasonable to create international standards for the assessment of dentition maturity for this population to obtain a more acceptable range of error values between the dental age and chronological age.

Dental age assessment on panoramic radiographs: Comparison between two generations of young Finnish subjects

Objective

To analyse the accuracy of a meta-analysis-based dental age assessment (DAA) method in Finnish paediatric patients and to compare the dental development between two generations of Finnish children.

Methods

Panoramic radiographs of Finnish Caucasian healthy children from two generations (early: born 1981–1984; subsequent: born 1996–2008) were analysed. All developing teeth on the left maxilla and mandible as well as the third permanent molars were analysed following Demirjian’s classification. For each patient, dental age was calculated and compared with chronological age. Dental maturation patterns between the two groups were compared.

Results

The study included 200 Finnish Caucasian healthy children from two generations (early: aged 7–13 years; subsequent: aged 6–15 years). In the early generation, DAA underestimated the chronological age by a mean of 3.15 years. The underestimation was only 0.11 years in patients < 10 years, but 3.86 years in patients ≥ 10 years. In the subsequent generation, the dental age was overestimated by a mean of 0.34 years; by 0.40 years in patients < 10 years and by 0.08 years in patients ≥ 10 years.

Conclusions

The present DAA method is applicable to current Finnish children. Differences in dental development between two generations of Finnish children were detected.

Aspartic acid racemization of root dentin used for dental age estimation in a Polish population sample

Precise age determination of unidentified bodies and human remains is one of the essential tasks of forensic science. The aim of this study was to assess the applicability of using the enantiomeric composition of aspartic acid racemization in root and crown dentin for dental age estimation using a Polish population sample. Coronal and root dentin from four teeth groups from the mandible were studied using gas chromatography with mass spectrometry. The results demonstrated a very high correlation between the chronological age and enantiomeric composition in both of the dentin samples. Individual linear equations of root dentin with correlation coefficients between 0.96 and 0.98 and a standard estimation error of ±2.95–4.84 years validated the application of aspartic acid racemization as a significant practical contribution to everyday forensic medical practice. Discrepancies in methodological aspects and modifications that simplify the protocol are presented.

Dental age estimation in southern Chinese population using panoramic radiographs: validation of three population specific reference datasets

BACKGROUND

The accuracy of estimated age should depend on the reference data sets (RDS) from which the maturity scores or Ages of Attainment (AoA) were obtained. This study aimed to test the accuracy of age estimation from three different population specific dental reference datasets (RDS).

METHODS

Two hundred and sixty six dental panoramic radiographs of subjects belonging to southern Chinese ethnicity were scored and dental age (DA) was estimated from three reference datasets: French-Canadian, United Kingdom (UK) Caucasian and southern Chinese. Statistical significance was set at p < 0.05 and for each method, the difference between the chronological age (CA) and dental age (CA-DA) was calculated using paired t-tests. In addition, Chi-square tests were performed to evaluate the accuracy of the age estimates within specific time interval from CA.

RESULTS

The estimated age difference (CA-DA) using the French Canadian RDS was - 0.62 years for males and - 0.36 years for females. For the UK Caucasian RDS, the age difference was 0.25 years for males and 0.23 years for females. The difference observed using the southern Chinese RDS was - 0.02 years for both genders and the difference was not statistically significant (p > 0.05). The southern Chinese RDS estimated the age of 80% of subjects within ±12 months range, and 90% of subjects within ±18 months range (p < 0.05) showing it to be more accurate than other datasets.

CONCLUSION

It is concluded that population specific Reference Data Sets improve the accuracy of dental age estimation.

Dental age estimation using four Demirjian's, Chaillet's and Willems' methods in Kosovar children

BACKGROUND

Tooth formation was recognized as useful body system to assess maturity and predict age. Tooth mineralization is much less affected by the endocrine and different nutritional status than bone mineralization, and teeth formation provides a more reliable indication of chronological age. Demirjian et al. in 1973 presented a scoring system and method for dental age estimation on a sample of French-Canadian children. Chaillet et al. and Willems et al. modified original Demirjian method. This study aimed to evaluate the accuracy of four Demirjian's, Chaillet and Willems methods for age estimation in the children of Kosovo.

MATERIALS AND METHODS

The cross-sectional study was based on the evaluation of the sample of 1022 orthopantomograms (OPTs) of healthy Kosovar children, aged between 5 and 14 years. OPTs were taken from the Radiology unit of University Dentistry Clinical Center of Kosova, as part of random clinical treatment. We tested the accuracy of four methods based on seven mandibular teeth, Demirjian from 1973 (Dem73) and 1976 (Dem76), Chaillet from 2005 (Chaillet) and Willems from 2001 (Willems) and two Demirjian's methods based on different sets of four teeth (Dem76PM1 and Dem76IN2).

RESULTS

For most tested methods, we found statistically significant differences between the chronological age (CA) and dental age (DA) (p < 0.05). In males, the most accurate method were those using four teeth, Dem76IN2 (0.03 years) following by Dem76PM1 (-0.05 years), following those using seven teeth, Willems (-0.14 years), Chaillet (-0.24 years) and Dem73 (0.43 years). In females, dental age was the most accurate for the Willems method (-0.24 years) following Chaillet (-0.35 years), Dem76 (0.43 years) and Dem73 (0.55 years), while Dem76PM1 and Dem76IN2 overestimated by 0.45 years and 0.46 years, respectively. The mean absolute difference between DA and CA were between 0.61 years for the Willems, to 0.78 years for the Dem73 in males, and 0.64 years for the Willems to 0.75 years for the Dem76IN2 in females.

CONCLUSION

The Willems method was the most accurate for estimating a dental age if all seven mandibular teeth are available for analysis, and we found the similar accuracy of Dem76PM1 and Dem76IN2 methods. Therefore, we may encourage their use for age estimation on the Kosovar children.

The WITS Atlas: A Black Southern African dental atlas for permanent tooth formation and emergence

Current dental maturity charts, such as the widely applied London atlas, do not take into consideration advanced tooth emergence and formation patterns observed in children of African ancestry. The result is inaccurate age estimation in Southern Africa, a region where there is great forensic and anthropological need for reliable age estimation.

OBJECTIVES

To develop a population-specific atlas of permanent tooth emergence and formation for age estimation of Black Southern Africans.

MATERIALS AND METHODS

Using data from a cross-sectional study of 642 school children aged 5-20 years, panoramic radiographs taken during routine dental examination in a mobile treatment van were analyzed using the Demirjian method of eight (A-H) tooth formation stages. Tables of the stages of tooth development for each tooth, including the third molars, were generated separately for age cohorts and by sex. The most frequently occurring (modal) stage of tooth formation was considered the signature developmental stage for the age. The relationship of the third molar occlusal surfaces with occlusal tables on the radiographs were checked and compared with the findings recorded during intra oral examination.

RESULTS

Comparison with the London atlas shows that at age 9.5 years, the canine and premolar emergence are at least one year ahead and the third molar formation completes four years earlier in the WITS Atlas.

DISCUSSION

Similarities in advancement in tooth formation and emergence across sub-Saharan Africa suggest that the WITS Atlas can be used for those populations as well.

Dental age assessment in 6- to 14-year old German children: comparison of Cameriere and Demirjian methods

BACKGROUND

The aim of the study was to compare two frequently used dental age estimation methods for accuracy.

METHODS

A total of 479 panoramic radiographs in age groups 6-14 years from a German population were evaluated. The dental age of 268 boys and 211 girls was assessed by means of the method of Demirjian (1973) and Cameriere (2006) and compared with their actual chronological age.

RESULTS

Demirjan's method showed an overestimation of dental age compared to chronological age in all age groups for boys (mean difference -0.16, p = 0.010, range -0.35 to 0.09), age group 9 showed an underestimation. Using the same method for girls (mean difference -0.18, p = 0.008, range -0.45 to 0.13), an overestimation could also be shown in all age groups except for age groups 8 and 13. Results for Cameriere's method showed for boys (mean difference 0.07, p = 0.314, range -1.38 to 3.83) in age groups 6 to 11 an overestimation, but in age groups 12 to14 an underestimation. The results for girls (mean difference 0.08, p = 0.480, range -1.55 to 4.51) showed an overestimation for age groups from 6 to 10, and an underestimation in age groups 11 to 14.

CONCLUSIONS

The comparison shows an advantage of Demirjian's method for both genders. While Cameriere's method showed a higher inaccuracy in all age groups, Demirjian's method showed more appropriate results for dental age estimation of the investigated German population. To avoid errors in forensic age estimation and to prevent misidentifications for defendants in criminal processes, further studies of more precise methods for age estimation for the German population are required.

Accuracy of the estimation of dental age in comparison with chronological age in a Spanish sample of 2641 living subjects using the Demirjian and Nolla methods

Age estimation is an important procedure in forensic medicine and is carried out for a number of reasons. For living persons, age estimation is performed in order to assess whether a child has attained the age of criminal responsibility, in scenarios involving rape, kidnapping or marriage, in premature births, adoption procedures, illegal immigration, pediatric endocrine diseases and orthodontic malocclusion, as well as in circumstances in which the birth certificate is not available or the records are suspect. According to data from the UNHCR (United Nations High Commissioner for Refugees), the number of people seeking refugee status continued to increase in the last years, driven by the wars in Syria and Iraq, as well as by conflict and instability in Afghanistan, Eritrea and elsewhere. The objective of this study is to compare the accuracy of estimating dental age versus chronological age using the Nolla and Demirjian methods in a Spanish population. A final sample of 2641 panoramic X-rays corresponding to Spanish patients (1322 males and 1319 females) between 7-21 years of age was analyzed. Dental age was assessed using the Nolla and Demirjian methods, establishing comparisons with mean chronological age based on the Student t-test for paired samples, followed by the generation of a linear regression model. Both methods showed slight discrepancy between dental and chronological age. On examining the reproducibility of the Nolla and Demirjian methods, technical errors of 0.84% and 0.62%, respectively, were observed. On average, the Nolla method was found to estimate an age 0.213years younger than the chronological age, while the Demirjian method estimated an age 0.853years older than the chronological age. Linear combination of the mean Nolla and Demirjian estimates increased the predictive capacity to 99.2%. In conclusion the Nolla and Demirjian methods were found to be accurate in estimating chronological age from dental age in a Spanish population. The error was found to be greater in males than in females, and involved an over-estimation of age with the Demirjian method and under-estimation of age with the Nolla method. Combination of the Nolla and Demirjian methods for estimating chronological age from dental age affords a predictive capacity of over 99%, and is fast and easy to perform, and inexpensive.

Dental age assessment on panoramic radiographs in a Swiss population: a validation study of two prediction models

OBJECTIVES

Dental age assessment methods are widely used for age estimation. This study aimed to analyse the accuracy of a meta-analysis method to estimate dental age in Swiss individuals and to detect potential limitations of the method. Precision of repeated tooth staging using Demirjian's classification on maxillary and mandibular teeth was also assessed.

METHODS

Panoramic radiographs of 50 Swiss white healthy children were analysed. Developing teeth on the left maxilla and mandible and all third permanent molars were staged following Demirjian's classification. Dental age was calculated for each subject, using a random effects model and a fixed effect model, and compared with chronological age.

RESULTS

The mean error of the dental age ranged between -3 and +1 months for both the calculation models. Dental age calculated with the fixed effect model overestimated the age of the subjects (average + 0.10 y, ranging from -1.95 y to +2.16 y) compared with their chronological age, whereas the random effects model underestimated the age (average -0.32 y, ranging from -2.24 y to +1.61 y).

CONCLUSIONS

Demirjian's method allowed a precise repeated staging of maxillary and mandibular developing teeth. For both calculation models, dental age correlated well, on average, with chronological age of Swiss subjects younger than 12 years. The random effects model showed a better accuracy for these subjects than the fixed effect model. However, both models underestimated the chronological age in subjects older than 12 years.

Dental age assessment of Western Saudi children and adolescents

Aim

The aim of this study was to evaluate the use of the London Atlas of Human Tooth Development and Eruption for age estimation in Saudi Arabian children and adolescents (aged 2–20 years), for forensic odontology application.

Materials and methods

This cross-sectional survey analyzed orthopantomograms (OPGs) of the complete dentition (including root development) to estimate the deviation from chronological age. Each OPG was de-identified and analyzed individually and classified into age-groups by the lead author, using the methods of the Atlas of Tooth Development.

Results

OPGs from a total of 252 patients [110 (44%) males, 142 (56%) females] aged 2–20 years (24–240 months) were examined in this study. The average estimated and chronological ages of subjects differed significantly p < 0.001 (143 ± 55.4 vs. 145 ± 57.9 months). Most (65.5%) estimates were within 12 months of subjects’ chronological ages; 19% overestimated and 15.5% underestimated age by >12 months.

Conclusion

This study, conducted in a sub-population of different origin than the UK sample used for the development of the London Atlas, identified variation in age estimates that may have significant impacts on results. The establishment of a composite international repository of atlas-based data for diverse ethnic sub-populations would be of great value to clinicians across the globe.

The accuracy of estimating chronological age from Demirjian and Nolla methods in a Portuguese and Spanish sample

BACKGROUND

Age determination has great importance in many clinical decisions, being commonly used in odontopediatrics, orthodontics, pediatrics, and forensic medicine. The Nolla and Demirjian et al. methods have been used for these purposes. However, estimating chronological age by means of the dental mineralization stage is not a straightforward analysis, and it is fundamental to test the validity of these methods and their applicability to populations. In this article we intend to compare the accuracy of estimating chronological age from dental age measured with the Nolla and Demirjian methods in a Portuguese and Spanish sample, considering the variables of sex and age-group.

METHODS

The sample was composed of 821 orthopantomographs of healthy Portuguese (n = 270) and Spanish (n = 551) subjects from 4 to 34 years old. For the Nolla and Demirjian methods, seven mandibular left teeth were examined, staged according to the dental maturity scale of each method. We obtained a good index of inter-rater agreement, a good internal consistency for the teeth assessment, and a good temporal consistency.

RESULTS

Dental age was calculated for each method. The Demirjian et al. method tends to overestimate the real age of participants and the Nolla method tends to underestimate it. The accuracy of both methods varied between the sexes and age groups. Both methods were found to be more precise with males. As the age-group increases, the predictive capacities of both methods diminish. The Nolla method was more accurate than the Demirjian method in early and late childhood for both sexes. Neither method could predict chronological age in adults.

CONCLUSIONS

We can estimate chronological age for early and late childhood, through the Nolla and Demirjian methods, with the former showing greater predictive capacities than the latter. The Demirjian method tends to overestimate age and the Nolla method tends to underestimate it, leading to the importance of forming regression equations adapted to the population studied. Nolla and Demirjian formulas adapted to our sample were created as a function of sex and age-group.

Estimation of legal age using calcification stages of third molars in living individuals

The increased number of adolescents and young adults with unknown or inaccurately given date of birth is a current issue in justice and legal medicine. The objective of this study was to determine the extent to which third molar calcification stages assessed on panoramic X-rays could be useful as additional criteria for forensic age estimation in living individuals, focusing on the legally important ages 17 and 18. In a retrospective multi-center study, the developmental stage of each individual's third molar was analyzed using Demirjian's scale in 2360 cases. Additionally, sex, age and ancestry were assessed. Individuals with the lowest calcification stage of all present molars in stage H were ≥18 years with a likelihood of ≥99.05% in the female (n=388), and ≥99.24% in the male (n=482) population. The lowest calcification stage of all present third molars proved to be useful as an additional reliable criterion for the determination of an age ≥18 years.

Bone age assessment methods: a critical review

The bone age of a child indicates his/her level of biological and structural maturity better than the chronological age calculated from the date of birth. Radiography of the hand & wrist is the commonest modality used to calculate bone age. Automated methods for evaluation of hand and wrist radiographs are also being developed which reduce inter rater variability compared to manual methods. Non radiation based techniques of visualizing hand & wrist bones such as ultrasonography for bone age calculation have been theorized but are not as accurate as radiographic methods. By the age of 18 years, bone age cannot be computed from hand & wrist radiographs, therefore the medial end of the clavicle is used for bone age calculation in individuals aged 18—22 years. CT visualization of the clavicle has been extensively studied but requires a high dose of radiation. MRI based methods are being developed but require more research. Dental age is an alternate form of bone age determination, which also gives an estimate of skeletal maturity. The iliac bone and femoral head have also been studied for computation of bone age but no standardized methods have yet been generated.

As different modalities of bone age estimation provide different results and their applicability differs in different ethnicities, we need to design studies in order to compare them and select the method best suited to Pakistani children.

Sources of Data/Study Selection: Recent articles published between years 2004-2013 obtained from online search engines Pubmed and Google Scholar were used in preparation of this review.

Dental age assessment in children: a comparison of four methods in a recent French population

The aim of this study was to analyze the accuracy and the reliability of four methods of dental age estimation (Demirjian, Willems I, Willems II, and Chaillet standards) in a French population. Orthopantomograms of 743 children aged between 4 and 15 years were used. The Demirjian standards gave a consistent overestimation of dental age compared with chronological age (+0.45 and +0.46 years for girls and boys, respectively). We found that three modified methods were more accurate for both sexes than Demirjian's method: the Willems I method appeared to be more suitable when the sex and ethnicity are both known (-0.09 and +0.14 years for girls and boys, respectively); the Willems II method was more accurate for children of unknown sex (mean difference = 0.00 years), and the Chaillet method was found to be more accurate than the Demirjian method, but less accurate than the Willems I method (-0.59 and -0.18 years for girls and boys, respectively).

A new method to estimate dental age

OBJECTIVE

The aim of this study was to evaluate the accuracy of Demirjian's method in estimating the dental age in Turkish children and to estimate the validity of Demirjian's standards for the studied population.

MATERIALS AND METHODS

Panoramic radiographs of 756 northwestern Turkish children aged 5-13 years were examined. The new method for dental age estimation for both genders was studied to determine the relationship between dental age, chronological age and Demirjian's scores. Descriptive statistics were used and analysis of correlation was carried out between chronological age, dental age and Demirjian's scores. The difference between dental age and the chronological age was determined with the paired t-test.

RESULTS

The results showed that northwestern Turkish children had delays in dental maturity. The new method was applied to Demirjian's scores and dental age scales for both genders were obtained. The tables were used to adapt Demirjian's scores to dental age determination in Turkish children using the new formula.

CONCLUSIONS

The developmental standards used by Demirjian are not suitable for northwestern Turkish children. The methods for determining dental development must have population-specific standards. The established gender-specific equations and the new tables are more appropriate for dental age assessment in northwestern Turkish children.

The French-Canadian data set of Demirjian for dental age estimation: a systematic review and meta-analysis

BACKGROUND

Estimation of age of an individual can be performed by evaluating the pattern of dental development. A dataset for age estimation based on the dental maturity of a French-Canadian population was published over 35 years ago and has become the most widely accepted dataset. The applicability of this dataset has been tested on different population groups.

AIM

To estimate the observed differences between Chronological age (CA) and Dental age (DA) when the French Canadian dataset was used to estimate the age of different population groups.

MATERIALS AND METHODS

A systematic search of literature for papers utilizing the French Canadian dataset for age estimation was performed. All language articles from PubMed, Embase and Cochrane databases were electronically searched for terms 'Demirjian' and 'Dental age' published between January 1973 and December 2011. A hand search of articles was also conducted.

RESULTS

A total of 274 studies were identified from which 34 studies were included for qualitative analysis and 12 studies were included for quantitative assessment and meta-analysis. When synthesizing the estimation results from different population groups, on average, the Demirjian dataset overestimated the age of females by 0.65 years (-0.10 years to +2.82 years) and males by 0.60 years (-0.23 years to +3.04 years).

CONCLUSION

The French Canadian dataset overestimates the age of the subjects by more than six months and hence this dataset should be used only with considerable caution when estimating age of group of subjects of any global population.

Dental maturity in saudi children using the demirjian method: a comparative study and new prediction models

A sample of 422 dental panoramic radiographs from individuals of known age (from 4 to 14 yrs), sex (males: 217, females: 205), and ethnicity (Saudi) was collected. A dental maturation score for each individual was calculated using the Demirjian method. Age was then estimated using the original Demirjian curves and tables based on French-Canadian population and population-specific curves and tables for Arab (Saudi and Kuwaiti) and European (Belgian) populations. The differences between dental age and chronological age were analyzed and compared using paired t-tests, one-way ANOVA test, and a post hoc Scheffé's test. The Demirjian method utilizing French-Canadian standards presented significant difference between dental age and chronological age for the total sample and in the vast majority of age groups in both sexes. The mean overestimation of age was about 10 months (P < 0.05). The tables designed specifically for Arab populations had a significantly lower error than the tables designed for French-Canadian and Belgian populations. The latter had the largest error in age predication. New age prediction models and maturation scores for Saudi population were developed based on the Demirjian method using multinomial functions.