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Akman H, Surme K, Cimen T, Ayyildiz H. Accuracy of different dental age estimation methods for determining the legal majority of 18 years in the Turkish population. Clin Oral Investig 2022; 26:4537-4547. [PMID: 35194681 DOI: 10.1007/s00784-022-04417-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Radiographic evaluation of the third molar maturation is used to estimate dental age, especially in adolescence. This study aimed to assess the application of three age estimation methods (Cameriere's third molar maturity index (I3M), Demirjian's maturation stages, and The London Atlas) to determine whether an individual is 18 years or older (adult) or younger than 18 years (minor). MATERIALS AND METHODS The dental age was estimated using the I3M, Demirjian's maturation stages, and The London Atlas methods on panoramic radiograms of a total of 500 Turkish individuals aged 14-22 years. A logistic model was derived with an individual's adult or minor status as the dependent variable, and each method and sex as predictive variables. The adult status was determined using dental age estimation methods and the performance of these methods in differentiating adults from minors was evaluated. The three methods were compared case-wise for their accuracy in predicting adult status. RESULTS Logistic regression analysis showed that sex and each estimation method were statistically significant in discriminating adults and minors (p < 0.05). In the case-wise comparison for estimate adulthood, both Demirjian's stages and I3M methods tended to perform better than the London Atlas method, with this trend reaching statistical significance (p < 0.05). CONCLUSIONS Cameriere's I3M and Demirjian's development stages are useful methods for adult age assessment in the tested population. CLINICAL RELEVANCE In forensic medicine and legal practices, Cameriere's I3M and Demirjian's maturation stage methods based on the development of the third molar teeth can be used to determine whether an individual is a minor or an adult.
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Affiliation(s)
- Hayri Akman
- Department of Pediatric Dentistry, Faculty of Dentistry, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Koray Surme
- Department of Pediatric Dentistry, Faculty of Dentistry, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Tansu Cimen
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Alanya Alaaddin Keykubat University, Antalya, Turkey.
| | - Halil Ayyildiz
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kütahya Health Sciences University, Kütahya, Turkey
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Magat G, Ozcan S. Assessment of maturation stages and the accuracy of age estimation methods in a Turkish population: A comparative study. Imaging Sci Dent 2022; 52:83-91. [PMID: 35387103 PMCID: PMC8967497 DOI: 10.5624/isd.20210231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study assessed the associations between chronological age, dental maturation (DM), cervical vertebrae maturation (CVM), and hand-wrist maturation (HWM) in individuals aged 9-19 years. In addition, this study aimed to derive practical methods to evaluate the skeletal age using DM, CVM, or HWM for orthodontic, medical, and forensic purposes and to compare which of these 3 developmental parameters is more accurate for estimating the age of individuals in a Turkish population. Materials and Methods Panoramic, lateral cephalometric, and hand-wrist radiographs of 284 patients aged 9-19 years were used in this study. The DM, CVM, and HWM stages were determined. The Kolmogorov-Smirnov, kappa, Wilcoxon, Kruskal-Wallis, chi-square, and Spearman correlation tests and simple linear regression analysis were used for statistical analysis. The significance level was 0.05. Results Statistically significant differences were found between chronological age and DM, chronological age and CVM, and chronological age and HWM in both sexes (P<0.05). DM did not show statistically significant differences according to sex (P>0.05), but CVM and HWM were statistically different between males and females (P<0.05). The DM-estimated age yielded more accurate values than the other methods. Conclusion All correlations between skeletal and dental stages were statistically significant. Our results showed that there was no statistically significant difference between chronological age and DM-estimated age. Therefore, it can be concluded that DM stages have the potential to be used for legal purposes.
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Affiliation(s)
- Guldane Magat
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
| | - Sevgi Ozcan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Nigde Omer Halisdemir University, Nigde, Turkey
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Sgheiza V. Conditional independence assumption and appropriate number of stages in dental developmental age estimation. Forensic Sci Int 2021; 330:111135. [PMID: 34883298 DOI: 10.1016/j.forsciint.2021.111135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/14/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Abstract
When estimating the age of an individual it is critical that 1) age ranges are as narrow as possible while still capturing the true age of the individual with an acceptable frequency, and 2) this frequency is known. When multiple traits are used to produce a single age estimate, the simplest practice is to assume that the traits are conditionally independent from one another given age. Unfortunately, if the traits are correlated once the effect of age is accounted for, the resulting age intervals will be too narrow. The frequency at which the age interval captures the true age of the individual will be decreased below the expected value to some unknown degree. It is therefore critical that age estimation methods that include multiple traits incorporate the possible correlations between them. Moorrees et al. (1963) [1] scores of the permanent mandibular dentition from 2607 individuals between 2 and 23 years were used to produce and cross-validate a cumulative probit model for age estimation with an optimal number of stages for each tooth. Two correction methods for covariance of development between teeth were tested: the variance-covariance matrix for a multivariate normal, and the Boldsen et al. (2002) [2] ad-hoc method. Both correction methods successfully decreased age interval error rates from 21% to 23% in the uncorrected model to the expected value of 5%. These results demonstrate both the efficacy of these correction methods and the need to move away from assuming conditional independence in multi-trait age estimation.
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Affiliation(s)
- Valerie Sgheiza
- University of Illinois at Urbana-Champaign, Department of Anthropology, 109 Davenport Hall, 607 S. Matthews Avenue, Urbana, IL 61801, United States.
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Heldring N, Larsson A, Rezaie AR, Råsten-Almqvist P, Zilg B. A probability model for assessing age relative to the 18-year old threshold based on magnetic resonance imaging of the knee combined with radiography of third molars in the lower jaw. Forensic Sci Int 2021; 330:111108. [PMID: 34826761 DOI: 10.1016/j.forsciint.2021.111108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aims to generate a statistical model based on magnetic resonance imaging of the knee and radiography of third molars in the lower jaw, for assessing age relative to the 18-year old threshold. METHODS In total, 58 studies correlating knee or tooth development to age were assessed, 5 studies for knee and 7 studies for tooth were included in the statistical model. The relation between the development of the anatomical site, based on a binary system, and age were estimated using logistic regression. Separate meta-populations for knee and tooth were generated from the individual based data for men and women. A weighted estimate of probabilities was made by combining the probability densities for knee and tooth. Margin of errors for males and females in different age groups and knee and tooth maturity were calculated within the larger framework of transition analysis using a logit model as a base. Evidentiary values for combinations of knee and tooth maturity were evaluated with likelihood ratios. RESULTS For males, the sensitivity for the method was calculated to 0.78 (probability of correctly classifying adults), the specificity 0.90 (probability of correctly classifying minors), the negative predictive value 0.80 (proportion identified minors are minors) and the positive predictive value 0.89 (proportion identified adults are adults) indicating a model better at identifying minors than adults. The point at which half the female population has reached closed knee lies before the 18-year threshold, adding the knee as an indicator lowers specificity and increases sensitivity. The sensitivity when using tooth as an indicator for females is 0.24 and specificity 0.97, signifying few minors misclassified as adults but also a low probability of identifying adults. The negative predictive value for women when using tooth as the sole indicator is 0.56 and positive predictive value 0.88. Probabilities were calculated for males and females assuming a uniform age distribution between 15 and 21years. The calculated margin of error of minors classified as adults in a population between 15 and 21 years with the model was 11% for males and 12% for females. Further, the evidentiary value as well as margin of error vary for different combinations of knee and tooth maturity. CONCLUSION The statistical model based on the combination of MRI knee and radiography of mandibular third molars is a valid method to assess age relative to the 18-year old threshold when applied on males and of limited value in females.
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Affiliation(s)
- Nina Heldring
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden
| | - André Larsson
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden
| | - Ali-Reza Rezaie
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden
| | - Petra Råsten-Almqvist
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden
| | - Brita Zilg
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden
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Minor or adult? Introducing decision analysis in forensic age estimation. Sci Justice 2020; 61:47-60. [PMID: 33357827 DOI: 10.1016/j.scijus.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 11/20/2022]
Abstract
Nowadays, forensic age estimation takes an important role in worldwide forensic and medico-legal institutes that are solicited by judicial or administrative authorities for providing an expert report on the age of individuals. The authorities' ultimate issue of interest is often the probability that the person is younger or older than a given age threshold, which is usually the age of majority. Such information is fundamental for deciding whether a person being judged falls under the legal category of an adult. This is a decision that may have important consequences for the individual, depending on the legal framework in which the decision is made. The aim of this paper is to introduce a normative approach for assisting the authority in the decision-making process given knowledge from available findings reported by means of probabilities. The normative approach proposed here has been acknowledged in the forensic framework, and represents a promising structure for reasoning that can support the decision-making process in forensic age estimation. The paper introduces the fundamental elements of decision theory applied to the specific case of age estimation, and provides some examples to illustrate its practical application.
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da Luz LCP, Anzulović D, Benedicto EN, Galić I, Brkić H, Biazevic MGH. Accuracy of four dental age estimation methodologies in Brazilian and Croatian children. Sci Justice 2019; 59:442-447. [DOI: 10.1016/j.scijus.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 02/04/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
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Konigsberg LW, Frankenberg SR, Liversidge HM. Status of Mandibular Third Molar Development as Evidence in Legal Age Threshold Cases. J Forensic Sci 2018; 64:680-697. [DOI: 10.1111/1556-4029.13926] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Lyle W. Konigsberg
- Department of Anthropology University of Illinois at Urbana‐Champaign Urbana IL 61801
| | - Susan R. Frankenberg
- Department of Anthropology University of Illinois at Urbana‐Champaign Urbana IL 61801
| | - Helen M. Liversidge
- Institute of Dentistry, Barts and the London School of Medicine and Dentistry Queen Mary University of London London E1 2AD U.K
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Różyło-Kalinowska I, Kalinowski P, Kozek M, Galić I, Cameriere R. Validity of the third molar maturity index I3M for indicating the adult age in the Polish population. Forensic Sci Int 2018; 290:352.e1-352.e6. [DOI: 10.1016/j.forsciint.2018.06.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/14/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022]
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9
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Sironi E, Pinchi V, Pradella F, Focardi M, Bozza S, Taroni F. Bayesian networks of age estimation and classification based on dental evidence: A study on the third molar mineralization. J Forensic Leg Med 2018; 55:23-32. [DOI: 10.1016/j.jflm.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
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De Tobel J, Phlypo I, Fieuws S, Politis C, Verstraete KL, Thevissen PW. Forensic age estimation based on development of third molars: a staging technique for magnetic resonance imaging. THE JOURNAL OF FORENSIC ODONTO-STOMATOLOGY 2017; 35:117-140. [PMID: 29384743 PMCID: PMC6100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The development of third molars can be evaluated with medical imaging to estimate age in subadults. The appearance of third molars on magnetic resonance imaging (MRI) differs greatly from that on radiographs. Therefore a specific staging technique is necessary to classify third molar development on MRI and to apply it for age estimation. AIM To develop a specific staging technique to register third molar development on MRI and to evaluate its performance for age estimation in subadults. MATERIALS AND METHODS Using 3T MRI in three planes, all third molars were evaluated in 309 healthy Caucasian participants from 14 to 26 years old. According to the appearance of the developing third molars on MRI, descriptive criteria and schematic representations were established to define a specific staging technique. Two observers, with different levels of experience, staged all third molars independently with the developed technique. Intra- and inter-observer agreement were calculated. The data were imported in a Bayesian model for age estimation as described by Fieuws et al. (2016). This approach adequately handles correlation between age indicators and missing age indicators. It was used to calculate a point estimate and a prediction interval of the estimated age. Observed age minus predicted age was calculated, reflecting the error of the estimate. RESULTS One-hundred and sixty-six third molars were agenetic. Five percent (51/1096) of upper third molars and 7% (70/1044) of lower third molars were not assessable. Kappa for inter-observer agreement ranged from 0.76 to 0.80. For intra-observer agreement kappa ranged from 0.80 to 0.89. However, two stage differences between observers or between staging sessions occurred in up to 2.2% (20/899) of assessments, probably due to a learning effect. Using the Bayesian model for age estimation, a mean absolute error of 2.0 years in females and 1.7 years in males was obtained. Root mean squared error equalled 2.38 years and 2.06 years respectively. The performance to discern minors from adults was better for males than for females, with specificities of 96% and 73% respectively. CONCLUSION Age estimations based on the proposed staging method for third molars on MRI showed comparable reproducibility and performance as the established methods based on radiographs.
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Affiliation(s)
- Jannick De Tobel
- Department of Radiology and Nuclear Medicine, Ghent University, Belgium
- Department of Oral Health Sciences – Forensic Dentistry, KU Leuven and Department of Dentistry – University Hospitals Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, Leuven University Hospital, Belgium
- Department of Head, Neck and Maxillofacial Surgery, Ghent University Hospital, Belgium
| | - Inès Phlypo
- Department of Dentistry – Special Care in Dentistry, PaeCoMeDiS, Ghent University, Ghent, Belgium
| | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, Leuven University Hospital, Belgium
| | | | - Patrick W. Thevissen
- Department of Oral Health Sciences – Forensic Dentistry, KU Leuven and Department of Dentistry – University Hospitals Leuven, Belgium
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Sironi E, Vuille J, Morling N, Taroni F. On the Bayesian approach to forensic age estimation of living individuals. Forensic Sci Int 2017; 281:e24-e29. [DOI: 10.1016/j.forsciint.2017.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 10/04/2017] [Accepted: 11/05/2017] [Indexed: 11/30/2022]
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Balla SB, Galic I, P. K, Vanin S, De Luca S, Cameriere R. Validation of third molar maturity index (I 3M ) for discrimination of juvenile/adult status in South Indian population. J Forensic Leg Med 2017; 49:2-7. [DOI: 10.1016/j.jflm.2017.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/14/2017] [Accepted: 05/01/2017] [Indexed: 11/26/2022]
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Türkoz Ç, Kaygısız E, Ulusoy Ç, Ateş C. A practical formula for determining growth. Diagn Interv Radiol 2017; 23:194-198. [PMID: 28345523 DOI: 10.5152/dir.2016.16334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to establish a practical method to evaluate skeletal age using cervical vertebrae. METHODS The study consisted of hand-wrist and cephalometric radiographs of 324 subjects (167 girls, 157 boys; age range, 7.3-17.2 years). Skeletal ages of the subjects were calculated from hand-wrist radiographs, and cervical vertebral bodies were measured using cephalometric radiographs. A single formula based on C3 and C4 vertebral body heights with different coefficients for each gender was derived using ridge regression analysis. RESULTS The correlation coefficients for vertebral and hand-wrist bone age were 0.825 and 0.856 for girls and boys, respectively. The correlations among vertebral bone age and C3 and C4 vertebral body heights were also found to be significant. The intraclass correlation (ICC) score was found to be 0.914, which shows high consistency between the two measurements of the same investigator for each C3 and C4 vertebral body height result. CONCLUSION The formula derived for evaluating skeletal age in cephalometric radiographs is reliable and can be applied to both girl and boy subjects for legal requirements or therapeutic needs of age estimation.
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Affiliation(s)
- Çağrı Türkoz
- Department of Orthodontics, Gazi University School of Dentistry, Ankara, Turkey.
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Demirjian’s stages and Cameriere’s third molar maturity index to estimate legal adult age in Peruvian population. Leg Med (Tokyo) 2017; 25:59-65. [DOI: 10.1016/j.legalmed.2017.01.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/02/2017] [Accepted: 01/12/2017] [Indexed: 11/23/2022]
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Camacho-Basallo P, Yáñez-Vico RM, Solano-Reina E, Iglesias-Linares A. Five radiographic methods for assessing skeletal maturity in a Spanish population: is there a correlation? Acta Odontol Scand 2017; 75:106-112. [PMID: 27934543 DOI: 10.1080/00016357.2016.1265145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The need for accurate techniques of estimating age has sharply increased in line with the rise in illegal migration and the political, economic and socio-demographic problems that this poses in developed countries today. The methods routinely employed for determining chronological age are mainly based on determining skeletal maturation using radiological techniques. The objective of this study was to correlate five different methods for assessing skeletal maturation. MATERIALS AND METHODS 606 radiographs of growing patients were analyzed, and each patient was classified according to two cervical vertebral-based methods, two hand-wrist-based methods and one tooth-based method. Spearman's rank-order correlation coefficient was applied to assess the relationship between chronological age and the five methods of assessing maturation, as well as correlations between the five methods (p < 0.05). RESULTS Spearman's rank correlation coefficients for chronological age and cervical vertebral maturation stage using both methods were 0.656/0.693 (p < 0.001), respectively, for males. For females, the correlation was stronger for both methods. The correlation coefficients for chronological age against the two hand-wrist assessment methods were statistically significant only for Fishman's method, 0.722 (p < 0.001) and 0.839 (p < 0.001), respectively for males and females. CONCLUSIONS The cervical vertebral, hand-wrist and dental maturation methods of assessment were all found to correlate strongly with each other, irrespective of gender, except for Grave and Brown's method. The results found the strongest correlation between the second molars and females, and the second premolar and males. CLINICAL RELEVANCE This study sheds light on and correlates with the five radiographic methods most commonly used for assessing skeletal maturation in a Spanish population in southern Europe.
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Affiliation(s)
- Paula Camacho-Basallo
- Department of Stomatology, Craniofacial Research Group CTS353, University of Seville, Seville, Spain
- Department of Stomatology IV, School of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Rosa-María Yáñez-Vico
- Department of Stomatology, Craniofacial Research Group CTS353, University of Seville, Seville, Spain
- Department of Stomatology IV, School of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Enrique Solano-Reina
- Department of Stomatology, Craniofacial Research Group CTS353, University of Seville, Seville, Spain
- Department of Stomatology IV, School of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Alejandro Iglesias-Linares
- Department of Stomatology, Craniofacial Research Group CTS353, University of Seville, Seville, Spain
- Department of Stomatology IV, School of Dentistry, Complutense University of Madrid, Madrid, Spain
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Diskussion ethischer Aspekte zahnärztlicher Altersschätzung bei jungen Flüchtlingen durch Röntgendiagnostik. Ethik Med 2016. [DOI: 10.1007/s00481-016-0429-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lefèvre T, Chariot P, Chauvin P. Multivariate methods for the analysis of complex and big data in forensic sciences. Application to age estimation in living persons. Forensic Sci Int 2016; 266:581.e1-581.e9. [DOI: 10.1016/j.forsciint.2016.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/14/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
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Accuracy of the third molar index for assessing the legal majority of 18 years in Turkish population. Forensic Sci Int 2016; 266:584.e1-584.e6. [DOI: 10.1016/j.forsciint.2016.04.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/21/2016] [Accepted: 04/26/2016] [Indexed: 11/18/2022]
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Pinchi V, De Luca F, Focardi M, Pradella F, Vitale G, Ricciardi F, Norelli GA. Combining dental and skeletal evidence in age classification: Pilot study in a sample of Italian sub-adults. Leg Med (Tokyo) 2016; 20:75-9. [PMID: 27161928 DOI: 10.1016/j.legalmed.2016.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 04/24/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dental and skeletal maturation have proved to be reliable evidence for estimating age of children and prior studies and internationally accredited guidelines recommend to evaluate both evidence in the same subject to reduce error in age prediction. Nevertheless the ethical and legal justification of procedures that imply a double exposition of children stands as a relevant issue. This study aims to evaluate the accuracy of age estimation provided by a combination of skeletal and dental methods applied in the same sample of children. MATERIALS AND METHODS The sample consisted of 274 orthopantomographies and left hand-wrist X-rays of Italian children, (aged between 6 and 17years) taken on the same day. Greulich and Pyle's (GP), Tanner-Whitehouse's version 3 (TW3) and Willems' (W) and the Demirjian's (D) methods were respectively applied for estimating skeletal and dental age. A combination of skeletal and dental age estimates through Linear Discriminant Analysis (LDA) is proposed to obtain a classifier respect to an age threshold. RESULTS The combination of D and TW3 obtained an improvement of accuracy in classifying female subjects respect to the 12years threshold respect to the original methods (from about 77% using either original methods to 83.3% combining TW3+D) as well as a consistent reduction of false positives rate (from 17% to 21% for original methods to 5.6% with TW3+D). For males the LDA classifier (based on TW3 and W) enable a small improvement in accuracy, whilst the decreasing of false positives was as noticeable as for females (from 17.6 to 14.1% for original methods to 6.2% combining TW3+W). CONCLUSIONS Although the study is influenced by the limited size and the uneven age distribution of the sample, the present findings support the conclusion that age assessment procedures based on both dental and skeletal age estimation can improve the accuracy and reduce the occurrence of false positives.
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Affiliation(s)
- Vilma Pinchi
- Department of Health Sciences, Section of Medical Forensic Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
| | - Federica De Luca
- Department of Health Sciences, Section of Medical Forensic Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Martina Focardi
- Department of Health Sciences, Section of Medical Forensic Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Francesco Pradella
- Department of Health Sciences, Section of Medical Forensic Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Giulia Vitale
- Department of Health Sciences, Section of Medical Forensic Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Federico Ricciardi
- Department of Statistical Science, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Gian-Aristide Norelli
- Department of Health Sciences, Section of Medical Forensic Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Galić I, Mihanović F, Giuliodori A, Conforti F, Cingolani M, Cameriere R. Accuracy of scoring of the epiphyses at the knee joint (SKJ) for assessing legal adult age of 18 years. Int J Legal Med 2016; 130:1129-1142. [DOI: 10.1007/s00414-016-1348-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 02/22/2016] [Indexed: 11/29/2022]
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Third molar maturity index (I3M) for assessing age of majority in a black African population in Botswana. Int J Legal Med 2016; 130:1109-1120. [PMID: 26972694 DOI: 10.1007/s00414-016-1344-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
Abstract
Assessment of legal age, also known as age of majority, is a controversial issue as there are few body biomarkers or evidence during late adolescence differentiating a subject from being a minor or adult. The third molar was recognized as a suitable site for age examination in late adolescence. We analyzed the development of the left mandibular third molar by the third molar maturity index (I3M) and a specific cut-off value of I3M = 0.08, established by Cameriere et al. in 2008 and used it for discriminating between minors and adult black Africans from Gaborone, Botswana. A final sample of panoramic radiographs (OPTs) of 1294 people (582 males and 712 females) aged between 13 and 23 years was evaluated. The real age decreased as I3M gradually increased. There was no statistically significant difference in the third molar development evaluated using I3M between males and females (p > 0.05) across different I3M classes. Results of 2 × 2 contingency tables for different cut-off values indicated that I3M = 0.08 was useful in discriminating between adults and minors. Precisely, for I3M = 0.08, the values of accuracy or overall fraction of correctly classified were 0.91 in males with a 95 % confidence interval (95 % CI) of 0.88 to 0.93 and 0.92 (95 % CI, 0.90 to 0.93) in females. Values of sensitivity of the test or the proportion of participants being 18 years and older were 0.88 (95 % CI, 0.87 to 0.90) in males and 0.88 (95 % CI, 0.90 to 0.93) in females, while values of specificity or proportion of individuals younger than 18 who have I3M <0.08 were 0.94 (95 % CI, 0.91 to 0.96) in males and 0.96 (95 % CI, 0.94 to 0.98) in females. Positive predictive values of the test, where the participants whose I3M <0.08 were adults, were 0.94 (95 % CI 0.91 to 0.96) in males and 0.97 (95 % CI, 0.94 to 0.98) in females, while negative predictive values of the test, where the participants whose I3M was ≥0.08 were minors, were 0.88 (95 % CI 0.85 to 0.90) in males and 0.97 (95 % CI, 0.94 to 0.98) in females. The likelihood ratios of the positive test (LR+) were 13.67 (95 % CI, 9.21 to 21.02) in males and 23.73 (95 % CI, 14.20 to 42.28) in females, while likelihood ratios of the negative test (LR-) were 0.12 (95 % CI 0.10 to 0.16) in males and 0.12 (95 % CI, 0.11 to 0.15) in females. Bayes post-test probabilities, p, were 0.94 (95 % CI 0.90 to 0.98) in males and 0.97 (95 %CI, 0.93 to 1.00) in females. These results indicate with high accuracy that I3M may be a useful alternative method in legal and forensic practice to discriminate individuals of black African origin who are around the legal adult age of 18 years in Botswana. Further studies should address the usefulness of this method and specific cut-off for different adolescent populations.
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Pinchi V, Pradella F, Vitale G, Rugo D, Nieri M, Norelli GA. Comparison of the diagnostic accuracy, sensitivity and specificity of four odontological methods for age evaluation in Italian children at the age threshold of 14 years using ROC curves. MEDICINE, SCIENCE, AND THE LAW 2016; 56:13-18. [PMID: 25748440 DOI: 10.1177/0025802415575416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The age threshold of 14 years is relevant in Italy as the minimum age for criminal responsibility. It is of utmost importance to evaluate the diagnostic accuracy of every odontological method for age evaluation considering the sensitivity, or the ability to estimate the true positive cases, and the specificity, or the ability to estimate the true negative cases. The research aims to compare the specificity and sensitivity of four commonly adopted methods of dental age estimation - Demirjian, Haavikko, Willems and Cameriere - in a sample of Italian children aged between 11 and 16 years, with an age threshold of 14 years, using receiver operating characteristic curves and the area under the curve (AUC). In addition, new decision criteria are developed to increase the accuracy of the methods. Among the four odontological methods for age estimation adopted in the research, the Cameriere method showed the highest AUC in both female and male cohorts. The Cameriere method shows a high degree of accuracy at the age threshold of 14 years. To adopt the Cameriere method to estimate the 14-year age threshold more accurately, however, it is suggested - according to the Youden index - that the decision criterion be set at the lower value of 12.928 for females and 13.258 years for males, obtaining a sensitivity of 85% and specificity of 88% in females, and a sensitivity of 77% and specificity of 92% in males. If a specificity level >90% is needed, the cut-off point should be set at 12.959 years (82% sensitivity) for females.
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Affiliation(s)
- Vilma Pinchi
- Section of Forensic Medical Sciences, Department of Health Sciences, University of Firenze, Italy
| | - Francesco Pradella
- Section of Forensic Medical Sciences, Department of Health Sciences, University of Firenze, Italy
| | - Giulia Vitale
- Section of Forensic Medical Sciences, Department of Health Sciences, University of Firenze, Italy
| | - Dario Rugo
- Section of Forensic Medical Sciences, Department of Health Sciences, University of Firenze, Italy
| | | | - Gian-Aristide Norelli
- Section of Forensic Medical Sciences, Department of Health Sciences, University of Firenze, Italy
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Sironi E, Pinchi V, Taroni F. Probabilistic age classification with Bayesian networks: A study on the ossification status of the medial clavicular epiphysis. Forensic Sci Int 2016; 258:81-7. [DOI: 10.1016/j.forsciint.2015.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/01/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
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Pinchi V, Pradella F, Buti J, Baldinotti C, Focardi M, Norelli GA. A new age estimation procedure based on the 3D CBCT study of the pulp cavity and hard tissues of the teeth for forensic purposes: A pilot study. J Forensic Leg Med 2015; 36:150-7. [PMID: 26458182 DOI: 10.1016/j.jflm.2015.09.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/02/2015] [Accepted: 09/14/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dental age of adults can be estimated by the analysis of the progressive physiological and degenerative phenomena which affect dental tissues. The pulp-dentinal complex is one of the dental structures that show modifications related to age, mainly resulting in the reduction of the pulp chamber volume due to the continual deposition of secondary dentin. The study aims to evaluate the accuracy of a simple and conservative method for estimating the age of adults based on CBCT (Cone Beam Computed Tomography) analysis of the narrowing of the pulp chamber caused by secondary dentin deposition. MATERIALS AND METHODS Two operators have randomly analyzed 148 CBCT (Scanora 3D - Soredex) and considered the upper left central incisor. The sample consists of 57 male individuals and 91 females aged between 10 and 80 years. This research was designed to simplify dental volume measurement through geometric approximation of the different parts of the tooth. The root and the pulp were assimilated to elliptical based cones and the crown to an elliptical based truncated cone and these volumes were calculated through measurements using Osirix(®) software (OnDemand 3D software CyberMed Inc.). The ratio between the pulp volume and the hard tissues volume (PHr) was assumed as a variable according to the following formula: PHr = V pulp/V ht. The proposed method based on geometric approximation of dental volumes was validated comparing volumes calculated using CBCT with physical measurements of real volumes of 3 teeth. RESULTS The physical measurements revealed that the measurement procedures using CBCT produce a regular underestimation of real volumes, that ranges from 53% to 70%. Since the error occurs quite regularly both for pulp and for hard tissue volume, it tends to be eliminated when their ratio is considered. The PHr was statistically significant (p-value < 0.001) as a predictor for age estimation. The gender variable was not significantly correlated with age (p = 0.7694) and it was, therefore, excluded from the linear regression formula for age estimation: Age = -64.14 - 32.00*Ln PHr. The age cohorts between 30 to 59 years showed the highest accuracy in age prediction (residual errors 0.71, 2.88, and -5.86 years), whilst for other age cohorts the estimation error is similarly reported by applying other dental methods. CONCLUSION The outcomes of this pilot study show that the narrowing of the pulp chamber is a reliable parameter for estimating the age of adults, and that CBCT is an easy and conservative approach that allows accurate calculation of tooth volumes. The proposed approach based on geometric approximation of upper central incisor volumes measured by CBCT remarkably reduced the operating time in comparison to other more complex and expensive techniques. The validation procedure in which real volumes are compared with those calculated using CBCT supports the accuracy of the experimented approach and the good inter-examiner agreement (ICC 0.99) demonstrates that the method is highly reproducible.
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Affiliation(s)
- Vilma Pinchi
- Department of Health Sciences, Departmental Section of Forensic Medical Sciences, University of Firenze, Italy
| | - Francesco Pradella
- Department of Health Sciences, Departmental Section of Forensic Medical Sciences, University of Firenze, Italy.
| | - Jacopo Buti
- School of Dentistry, Department of Periodontology, University of Manchester, United Kingdom
| | | | - Martina Focardi
- Department of Health Sciences, Departmental Section of Forensic Medical Sciences, University of Firenze, Italy
| | - Gian-Aristide Norelli
- Department of Health Sciences, Departmental Section of Forensic Medical Sciences, University of Firenze, Italy
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Trevino-Tijerina MC, Valenzuela-Garach DA, Elizondo-Pereo RA, Cerda-Flores RM, Vargas-Villarreal J, González-Salazar F. Age estimation of teenagers from Monterrey (Mexico) by the evaluation of dental mineralization after multi-slice helical computed tomography. AUST J FORENSIC SCI 2015. [DOI: 10.1080/00450618.2015.1034777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Probabilistic graphical models to deal with age estimation of living persons. Int J Legal Med 2015; 130:475-88. [DOI: 10.1007/s00414-015-1173-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
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Reply to the letter to the editor. Int J Legal Med 2014; 129:1275-6. [DOI: 10.1007/s00414-014-1044-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
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Pinchi V, De Luca F, Ricciardi F, Focardi M, Piredda V, Mazzeo E, Norelli GA. Skeletal age estimation for forensic purposes: A comparison of GP, TW2 and TW3 methods on an Italian sample. Forensic Sci Int 2014; 238:83-90. [DOI: 10.1016/j.forsciint.2014.02.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 02/13/2014] [Accepted: 02/25/2014] [Indexed: 11/29/2022]
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Focardi M, Pinchi V, De Luca F, Norelli GA. Age estimation for forensic purposes in Italy: ethical issues. Int J Legal Med 2014; 128:515-22. [PMID: 24633466 DOI: 10.1007/s00414-014-0986-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 03/06/2014] [Indexed: 11/27/2022]
Abstract
Age assessment in children and young adults is a relevant medicolegal issue due to the gradual increase of persons devoid of proper identification documents in European countries. Because of the illegal immigration and growing crime rates among children and adolescents, age estimation for forensic purposes is often required. The scientific research and the extensive experience of forensic experts in the last decades focused on the use of radiographic methods addressed to evaluate the degree of skeletal or dental development as the most accurate parameters to estimate the chronological age of children and adolescents. This paper analyzes the ethical issues related to age estimation procedures based on radiographic methods, showing how the ethical principles of beneficence, nonmalevolence, justice, and autonomy may be guaranteed during the execution of the age assessment in forensic practice. The procedure might be conducted in accordance with international guidelines and protocols, though they need a higher homogenization and standardization. A strong collaboration between various scientific societies of professionals (forensic odontologists, forensic pathologists, forensic anthropologist, radiologists, pediatricians, and psychologists), who have been involved in age estimation for years, is needed to reach this goal.
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Affiliation(s)
- Martina Focardi
- Section of Forensic Medical Sciences, Department of Health Sciences, University of Florence, Florence, Italy,
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