Application of age assessment based on the radiographic visibility of the root pulp of lower third molars in a northern Chinese population

The relevance of taurodontism in forensic dental age estimation

Taurodontism is a dental morphological anomaly characterized by enlarged pulp cavities repositioned towards the apical region of the tooth, coupled with shortened root structures. Molars are commonly affected by this alteration. Certain populations exhibit up to 48% prevalences for this dental alteration, underscoring its significance in dental age estimation (DAE). In the field of DAE, an individual's chronological age is inferred from specific dental features, frequently employed within the forensic context. The effect of taurodontism on the features of DAE is an unanswered issue. The influence of taurodontism on eruption, mineralization, radiographic visibility of root canals, and radiographic visibility of the periodontal ligament space in mandibular third molars- some of the established criteria for DAE as examples-is currently not systematically examined. Some common staging scales for the dental features of DAE cannot technically be applied to taurodontic teeth. Additionally, given the association of taurodontism with syndromes affecting tooth development, caution is warranted in age assessment procedures. Notably, taurodontic teeth may serve as indicators of syndromes influencing skeletal development, further emphasizing the relevance of taurodontism in forensic age assessment. Presumably taurodontic teeth were included in reference data to some extent due to their partially high prevalence in the past, whereby the influence of taurodontism has been statistically absorbed within the overall spread of the features. Future studies should compare the temporal course of these tooth characteristics in affected and unaffected teeth. Subsequent initiatives should focus on raising awareness among forensic dentists regarding taurodontism, necessitating in-depth exploration of the subject.

Predicting chronological age of 14 or 18 in adolescents: integrating dental assessments with machine learning

AIM

Age estimation plays a critical role in personal identification, especially when determining compliance with the age of consent for adolescents. The age of consent refers to the minimum age at which an individual is legally considered capable of providing informed consent for sexual activities. The purpose of this study is to determine whether adolescents meet the age of 14 or 18 by using dental development combined with machine learning.

METHODS

This study combines dental assessment and machine learning techniques to predict whether adolescents have reached the consent age of 14 or 18. Factors such as the staging of the third molar, the third molar index, and the visibility of the periodontal ligament of the second molar are evaluated.

RESULTS

Differences in performance metrics indicate that the posterior probabilities achieved by machine learning exceed 93% for the age of 14 and slightly lower for the age of 18.

CONCLUSION

This study provides valuable insights for forensic identification for adolescents in personal identification, emphasizing the potential to improve the accuracy of age determination within this population by combining traditional methods with machine learning. It underscores the importance of protecting and respecting the dignity of all individuals involved.

Evaluation of radiographic visibility of root pulp in mandibular second molars using cone beam computed tomography images for age estimation

The purpose of this study is to estimate chronological age and determine whether individuals were aged under or over 18 years using root pulp visibility (RPV) in cone-beam computed tomography (CBCT) images. The study included CBCT images of 699 individuals aged between 15 and 75 years. One thousand twenty-three mandibular second molar (2M) teeth were evaluated using Olze's RPV method in four stages. Descriptive statistics of the stages and the relationship between the stages and the chronological age were assessed. The distribution of the stages was analyzed according to the 18-year age threshold. There was a positive correlation between RPV stages and chronological ages in both sexes. For females and males, the mean ages of stage 0, stage 1, and stage 2, for females and males, were found as 27.21, 28.93, and 33.68 years, and 37.69, 40.9, and 44.88 years, respectively. Stage 0 and stage 1 were found both in individuals aged under and over 18 years, and stage 2 and stage 3 were not observed in individuals aged under 18 years. The presence of stage 2 and stage 3 may be an indication that an individual is aged over 18 years according to Olze's RPV age estimation method. For more reliable results, 2M teeth should be examined bilaterally in forensic science.

Dental age assessment in the living: a comparison of two common stage classifications for assessing radiographic visibility of the root canals in mandibular third molars

After dentition is complete, degenerative tooth characteristics can be used for dental age assessment. Radiological assessment of the visibility of the root canals of the mandibular third molars in dental panoramic radiographs (DPRs) is known to be one such suitable feature. Essentially, two different stage classifications are available for evaluating the visibility of the root canals of mandibular third molars in the DPR. The aim of this study was to determine if one method outperforms the other. Therefore, the 2010 method of Olze et al. was directly compared to the 2017 method of Lucas et al. in the 2020 modification of Al Qattan et al. To this end, 233 DPRs from 116 females and 117 males aged 20.0 to 40.9 years were evaluated by three independent experienced examiners. In addition, one examiner ran two independent evaluations. Correlation between age and stage was investigated, and the inter- and intra-rater reliability was estimated for both methods. Correlation between age and stage was higher with the Olze method (Spearman rho 0.388 [95% CI 0.309, 0.462], males and 0.283 [95% CI 0.216, 0.357], females) than the Lucas method (0.212 [95% CI 0.141, 0.284], males and 0.265 [95% CI 0.193, 0.340], females). The intra-rater repeatability of the Olze method (Krippendorff's α = 0.576 [95% CI 0.508, 0.644], males and α = 0.592 [95% CI 0.523, 0.661], females) was greater than that for the Lucas method (intra-rater α = 0.422 [95% CI 0.382, 0.502], males and α = 0.516 [95% CI 0.523, 0.661], females). Inter-rater reproducibility was also greater for the Olze method (α = 0.542 [95% CI 0.463, 0.620], males and α = 0.533 [95% CI 0.451, 0.615], females) compared to the Lucas method (α = 0.374 [95% CI 0.304, 0.443], males and α = 0.432 [95% CI 0.359, 0.505], females). The method of Olze et al. was found to present marginal advantages to the Lucas et al. method across all examinations and may be a more appropriate method for application in future studies.

Three-dimensional verification of the radiographic visibility of the root pulp used for forensic age estimation in mandibular third molars

OBJECTIVES

The aim of this study was to assess the reliability of panoramic radiography (OPG) using age estimation method using cone beam computed tomography (CBCT) verification in the evaluation of radiographic visibility of root pulp (RPV) of mandibular third molars for age estimation.

METHODS

CBCT and OPG images of 429 mandibular third molars from 290 patients were evaluated. RPV of fully mineralized mandibular third molars was evaluated as stages 0, 1, 2, and 3 for both imaging methods. Descriptive statistics were performed separately for stages by age for both genders. The consistency of these scores with chronological age was evaluated for both imaging methods. The reliability of OPG evaluation was also analyzed with CBCT scores.Results Spearman's rho correlation demonstrated a positive correlation between RPV and chronological age for both genders and for OPG and CBCT evaluation. Considering the minimum ages of both imaging methods, all stages were above the age of 18 except for the female group of Stage 2 and all Stage 0. For the comparison of OPG and CBCT RPV Staging scores, the κ score was found to be 0.312 (p < 0.001), indicating a fair agreement.

CONCLUSION

In conclusion, the absence of Stage 3 at age of 18 and under might have a forensic value for RPV age estimation method. Considering the fair agreement in the verification of OPG scores, it is not possible to determine the exact age with the RPV detected in OPG images, the use of CBCT for the RPV evaluation is recommended to available cases.

Chronological Age Assessment Based on the Root Pulp Visibility in Lower Third Molars in a Group of Thai Population: Panoramic Radiographic Study

Background:

Radiographic visibility of the root pulp in lower third molars is one of the reliable methodologies for chronological age estimation.

Objective:

To evaluate the radiographic visibility of the lower third molar root pulp using digital panoramic radiographs of the Thai population, and determine the appropriation of this technique in age assessment, especially at the age of 18 years.

Methods:

A total of 746 digital panoramic radiographs of the Thai population aged from 16 to 26 years were recruited for the present study. The visibility of root pulp of lower third molars with completed root formation was recorded in the four stages. Descriptive statistics were performed for each stage in both males and females.

Results:

The first appearance of stage 0 is 16.71 years in males and 17.00 years in females. The minimum age of stage 1 was found at 17.08 years in males and 17.18 years in females. The beginning of stage 2 was 18.33 years in males and 18.17 years in females. For stage 3, the earliest presence was started at 18.58 years in males and 18.83 years in females.

Conclusion:

The occurrence of stages 2 or 3 in both males and females indicated that the subject is over 18 years of age. Further study on the Thai population should be conducted to confirm the results of the present study.

Zur Anwendbarkeit der dentalen Methode von Roberts et al. aus dem Jahr 2016 zum Nachweis der Vollendung des 18. Lebensjahres lebender Personen

Es sollte die Methode von Roberts et al. aus dem Jahr 2016 zum Nachweis der Vollendung des 18. Lebensjahres überprüft werden.

Dazu wurden 603 Orthopantomogramme (OPG) von 300 Frauen und 303 Männern im Alter von 16,01 bis 25,99 Jahren von 3 Untersuchern ausgewertet, wobei ein Hauptuntersucher alle OPGs zweimal begutachtet hat. Durch die 3 Untersucher wurde eine konsensuale Bestimmung für die Fälle vorgenommen, bei denen mindestens ein Untersucher ein Stadium zugeordnet hatte.

In 31 Fällen (11 Frauen, 20 Männer) konnte konsensuell ein Stadium bestimmt werden. Hauptursache für die Nichtauswertbarkeit war die nicht abgeschlossene Entwicklung des Zahnes 38 [FDI] (30,18 %), gefolgt von Karies, Restaurationen oder anderen Pathologien (20,56 %) und dem Fehlen des Zahnes 38 (19,57 %). Das Stadium „RCW‑C“ konnte bei den Frauen konsensual nicht, die Stadien „RCW‑B“ und „RCW‑C“ konnten bei den Männern nur 4‑mal (3x „RCW-C“, 1x „RCW-B“) bestimmt werden. Der Cohen’s-Kappa-Wert für die Binnenbeobachterübereinstimmung für die 47 Fälle, in denen der Hauptuntersucher in mindestens einem Durchgang ein Stadium zugeordnet hatte, lag im moderaten bzw. guten Bereich (Frauen: 0,44; Männer: 0,62). Der Fleiss’-Kappa-Wert für die Zwischenbeobachterübereinstimmung der 3 Untersucher für die 69 Fälle, bei denen mindestens ein Untersucher ein Stadium zugeordnet hatte, lag im mangelhaften Bereich (Frauen: 0,07; Männer: 0,11), wobei die 95%-Konfidenzintervalle für den Kappa-Wert auch die „0“ einschlossen.

Alle Personen, bei denen ein Stadium zugeordnet wurde, waren über 18 Jahre alt. Aktuell kann eine Anwendung der Methode nicht empfohlen werden. Es wird die Frage aufgeworfen, ob den Stadien eine allgemeingültige Entwicklungsabfolge zu Grunde zu liegt, da bei 30 Fällen der Befund nicht mit den Stadien in Deckung zu bringen war.

Evaluation of secondary dentin deposition in lower first molars to indicate a legal age threshold of 14 years using receiver operating characteristic curves

The age threshold of 14 years has become vital in proving legal violations involving children, particularly in cases of suspected child labour, child pornography and the minimum age of criminal responsibility. In recent years, there has been great interest in the evaluation of age in children and sub-adults using analysis of regressive changes in teeth, with a particular focus on age thresholds that are of medico-legal importance. This research aimed to compare the sensitivity and specificity of stages of root pulp visibility by Olze et al. in a sample of South Indian children aged between 12 and 16 years, with an age threshold of 14 years, using receiver operating characteristic curves and the area under the curve (AUC). Among the four stages of root pulp visibility, stage 2 showed the highest AUC in both female and male cohorts. For stage 2, lower sensitivity and higher specificity values were recorded, indicating the possibility of type II errors (i.e. false negatives). In both sexes, stage 2 had a higher AUC (i.e. 0.696 in females and 0.706 in males, respectively). Based on our findings, it can be concluded that this staging method in lower first molars is of limited value in indicating the legal age threshold of 14 years. Future research should validate the proposed approach in a larger sample and consider how to improve predictions in this area.

Die Aussagekraft sozialpädagogischer Altersschätzungen im Vergleich zur forensischen Altersdiagnostik

In der vorliegenden Studie sollte die Aussagekraft sozialpädagogischer Altersschätzungen im Vergleich zu forensischen Altersbegutachtungen, die entsprechend den Empfehlungen der Arbeitsgemeinschaft für Forensische Altersdiagnostik durchgeführt worden waren, analysiert werden. Hierfür wurden 47 Fälle ausgewertet, bei denen sowohl sozialpädagogische Altersschätzungen von in Jugendhilfeeinrichtungen betreuten unbegleiteten minderjährigen Flüchtlingen als auch forensische Altersgutachten zur Verfügung standen. In 44 Fällen, in denen die Einrichtungen von Minderjährigkeit ausgingen, bescheinigten die forensischen Altersgutachten in 12 Fällen zweifelsfreie Volljährigkeit und in 24 weiteren Fällen wahrscheinliche Volljährigkeit. In 2 Fällen, in denen die Einrichtungen die Minderjährigkeit anzweifelten, wurden im Ergebnis der forensischen Altersbegutachtung in dem einen Fall zweifelsfreie Volljährigkeit und in dem anderen Fall wahrscheinliche Volljährigkeit festgestellt. In einem Fall, in dem die Einrichtung von Volljährigkeit ausging, wurde auf der Grundlage der forensischen Altersbegutachtung wahrscheinliche Volljährigkeit mit noch möglicher Minderjährigkeit attestiert. Objektivierbare psychosoziale Kriterien, mit denen Volljährigkeit zweifelsfrei festgestellt werden kann, ließen sich nicht erkennen. Es ist davon auszugehen, dass der Anteil falsch-positiver Minderjährigkeitsfeststellungen bei sozialpädagogischen Altersschätzungen deutlich höher als bei forensischen Altersbegutachtungen ist. Ebenso scheint ein relevantes Risiko falsch-positiver Volljährigkeitsfeststellungen bei sozialpädagogischen Altersschätzungen zu bestehen. Es wurde geschlussfolgert, dass sozialpädagogische Altersschätzungen keine überzeugende Alternative zu forensischen Altersbegutachtungen darstellen.

Examination of the radiographic visibility of the root pulp of the mandibular second molars as an age marker

Forensic odontologists often confront with conceptually simple medicolegal question of whether an individual is a juvenile or an adult. The demand for additional research into extending dental age estimation methods in late adolescence is never the less, especially in those who have passed 15 years and are suspected older than 18 years. The present research investigated the regressive dental characteristic, i.e. radiographic visibility of the root pulp in mandibular second molars for the purpose of age assessment, especially for determining the age over 18 years. Nine hundred thirty-six orthopantomograms comprised of 436 males and 500 females aged from 14 to 22 years were examined. Descriptive statistics were performed for each stage in both sexes. The correlation statistics revealed that there is a strong, positive correlation between the chronological age and root pulp visibility stages. The analysis revealed that stage 0 occurred first at the age of 14 years in both sexes. Stage 1 first occurred at the age of 14.26 years in females and 14.74 years in males. Stage 2 was first achieved at the age of 18.6 and 15.2 years in males and females, respectively. The suitability of the studied characteristics in mandibular second molars for age estimation could be confirmed but of limited value. The presence of this stage 2 root pulp visibility in male subjects represents a potential criterion for indicating the age over 18 years. In future studies, the pattern of secondary dentin formation in other tooth types should be investigated.

Juristische Aspekte der forensischen Altersdiagnostik auf der Grundlage des § 42f SGB VIII

Seit Inkrafttreten des § 42f SGB VIII am 01.11.2015 ist das Verfahren zur Altersfeststellung von unbegleiteten und fraglich minderjährigen Ausländern durch Jugendämter in Deutschland gesetzlich geregelt. Hiernach hat das Jugendamt die Minderjährigkeit zunächst durch Einsichtnahme in die Ausweispapiere des jungen Menschen zu prüfen. Fehlen gültige Ausweispapiere, oder sind die in ihnen enthaltenen Geburtsdaten zweifelhaft, haben Jugendamtsmitarbeiter die Minderjährigkeit mittels einer qualifizierten Inaugenscheinnahme zu beurteilen. Lässt sich auch dadurch eine Minderjährigkeit nicht zweifelsfrei ausschließen, hat das Jugendamt eine ärztliche Untersuchung zur Altersfeststellung zu veranlassen. Eine Analyse der einschlägigen Rechtsprechung sowie der juristischen Fachliteratur ergab, dass Röntgenuntersuchungen zur forensischen Altersdiagnostik auf der Grundlage des § 42f SGB VIII nicht nur zulässig sind, sondern diese auch ausdrücklich eingefordert werden. Die Rechtsprechung erkennt zudem die medizinischen Untersuchungen nach den Empfehlungen der Arbeitsgemeinschaft für Forensische Altersdiagnostik (AGFAD) zur Altersdiagnostik unbegleiteter minderjähriger Ausländer als rechtlich zulässige, valide und zumutbare Methode an. Der von der Zentralen Ethikkommission (ZEKO) bei der Bundesärztekammer vertretenen Auffassung, dass die von der AGFAD empfohlenen Methoden nicht geeignet seien, Volljährigkeit hinreichend zuverlässig nachzuweisen, wird von der Rechtsprechung nicht gefolgt. Vielmehr wird darauf verwiesen, dass durch die Anwendung des Mindestalterkonzepts die von der ZEKO geäußerten Bedenken hinsichtlich der Schwankungsbreiten medizinischer Untersuchungen ausgeräumt werden.

Olze et al. stages of radiographic visibility of root pulp and cameriere's third molar maturity index to estimate legal adult age in Hyderabad population

Context:

Predicting one's attainment of age of majority is a controversial issue and considered as important aspect in medicolegal cases. In India, individuals older than 18 years of age have full capacity regarding civil conduct and are tried as adults for criminal charges.

Aims and Objective:

To compare the accuracy of Olze et al., stages of radiographic visibility of root pulp, and Cameriere's third molar maturity index (I_3M < 0.08) to estimate the age of majority.

Materials and Methods:

A total of 615 digital orthopantomographs of children aged between 15 and 22 years. The lower left third molars were evaluated using ImageJ computer software. The effectiveness of both methods was evaluated using sensitivity, specificity, positive likelihood ratios (LR+), and LR negative (LR−).

Results:

For I_3M < 0.08, the sensitivity, specificity, LR+, LR− were 0.76, 0.72, 2.79, 0.32 and 0.67, 0.76, 2.83, 0.43 in males and females respectively. For Stage 0, the sensitivity, specificity, LR+, LR− were 0.68, 0.86, 5.18, 0.36 and 0.72, 0.91, 8.63, 0.31, respectively.

Conclusion:

Stage 0 of Olze's radiographic root pulp visibility showed to be more accurate than cutoff value of I_3M< 0.08 in discriminating adults and minors of Hyderabad sample when a test of high sensitivity and specificity is required.

Forensic age assessment of living adolescents and young adults at the Institute of Legal Medicine, Münster, from 2009 to 2018

Due to high migration inflows to Europe, forensic age assessment of living persons has clearly gained importance. If there is a legal justification for X-ray examinations without a medical indication, the Study Group on Forensic Age Diagnostics (AGFAD) recommends the combination of a physical examination with anamnesis, an X-ray examination of the hand and a dental examination with evaluation of an orthopantomogram for age assessments of adolescents and young adults. If the development of the hand skeleton has been completed, an additional CT examination of the clavicles is to be performed. To demonstrate the outcome of forensic age assessments according to AGFAD recommendations with regard to migrants of doubtful minority declaration, this study analyzes the expert reports carried out at the Institute of Legal Medicine, Münster, from 2009 to 2018. A total of 597 age assessments were performed during the study period. A total of 227 age assessments were issued on behalf of youth welfare offices in the legal area of social law, 282 in family law proceedings, 76 in criminal proceedings, and 12 age assessments in immigration law proceedings. In 211 out of 597 cases, the stated age was compatible with the findings of the age assessment. In the remaining 386 cases, the average difference between the stated age and the minimum age was 1.9 years. The average difference between stated age and most probable age was 5.1 years. Of the 521 age assessments carried out outside criminal proceedings, 197 unaccompanied minors with questionable age minority (37.8%) have reached the age of majority beyond doubt. A total of 388 unaccompanied minors (74.5%) have most probably reached the age of majority. Forensic age assessments with the AGFAD methodology make an important contribution to legal certainty, the welfare of the child, and the fair distribution of resources.

Usability of dental pulp visibility and tooth coronal index in digital panoramic radiography in age estimation in the forensic medicine

Age estimation has a great importance due to legal requirements. The aim of our study was to determine the applicability of two different methods in age estimation; one of them based on the calculation of the visibility of the root pulp of mandibular third molar teeth and the other based on the calculation of the tooth coronal index (TCI) in the mandibular first and second molar teeth in the 9059 digital orthopantomogram of people aged between 15 and 40 in Bursa. In the first method in which the visibility of the fully mineralized root pulp of the mandibular third molar teeth was evaluated in 4 stages; the stages 0, 1, 2, and 3 were observed regardless of sex at the earliest 17.2; 19.1; 20.1, and 25.1 years, respectively. In the second method in which TCI was regressed on chronological age using measuring crown and coronal pulp cavity heights, the most accurate age estimation model based on simple linear regression for all cases without any sex difference was found to be with right first molar tooth (SEE ±7304 years) and the most accurate age model based on multiple regression model was found to be with bilateral first molar teeth (SEE ±7413 years). In conclusion, we believe that the root pulp visibility of the third molar teeth can be applied safely for stages 1, 2, and 3 at 16, 17, and 21 years of ages, respectively. A correlation was also found between TCI and age, and our findings have shown that both methods are available for forensic purposes.

Dental age estimation based on the radiographic visibility of the periodontal ligament in the lower third molars: application of a new stage classification

The purpose of the present study was to test whether a new stage classification based on radiographic visibility of the periodontal ligament in lower third molars in a Chinese population can be used for the 18- and 21-year thresholds. A total of 1300 orthopantomograms, including equal numbers of northern Chinese males and females evenly distributed between the ages of 15 and 40 years, were analyzed. The stages were defined according to the visibility of periodontal ligament for the outer parts of lower third molar roots because the visibility status of the periodontal ligament between the roots of lower third molars is none valuable in many Chinese individuals. Stage 0 was first achieved at the age of 17.05 years in males and 17.46 years in females. The earliest appearance of stage 1 was 17.47 years in males and 17.86 years in females. Stage 2 was first observed in males at the age of 21.43 years and in females at the age of 21.96 years. The onset of stage 3 was first observed at the age of 25.83 years in males and 23.14 years in females. Compared with the stage classification of Olze et al., which also considers the mesial parts of the roots, the number of assessable cases could be significantly increased. Therefore, our novel approach is effective for age estimation in the Chinese population.

Age assessment in the living using modified Gustafson's criteria in a northern Chinese population

Regressive dental changes appear to be suitable for age assessment in living adults. In 2012, Olze et al. showed that several criteria presented by Gustafson for extracted teeth can also be applied to orthopantomograms. The objective of this study was to test the applicability and reliability of this method in a Chinese population. For this purpose, 1300 orthopantomograms of 650 female and 650 male Chinese aged between 15 and 40 years were evaluated. The characteristics of secondary dentin formation, periodontal recession, attrition, and cementum apposition were reviewed in all the mandibular premolars. The sample was split into a training and test dataset. Based on the training set, the correlation of the individual characteristics with chronological age was studied with a stepwise multiple regression analysis, in which individual characteristics formed the independent variable. According to the results, the R values amounted to 0.80 to 0.83; the standard error of estimate was 4.29 to 4.75 years. By analyzing the test dataset, the accuracy of the present study, Olze's and Timme's formulas were determined by the difference between the estimated dental age (DA) and chronological age (CA). Taking both mean differences and mean absolute differences into account, the Chinese age estimation formula did not always perform better compared with Olze's and Timme's formulas for both males and females. It was concluded that this method can be used in Chinese individuals for age assessment. However, the applicability of the method is limited by the quality of the X-ray images, and the method should only be applied by experienced forensic odontologists.