Comparison of the accuracy of the London atlas and Smith method in dental age estimation in 5–15.99-year-old Iranians using the panoramic view

Comparison of Demirjian's comprehensive chart with the London atlas of tooth development in children and adolescents: a pilot study

Dental age estimation has its application in various subdisciplines of medicine and dentistry. New methods of dental age (DA) estimation are emerging and it is important that we compare different methods to determine which one is more closely related to the chronological age. Demirjian's method is one of the most widely used techniques and has been tested in various ethnic populations globally. In 2016, another approach to DA estimation is the London atlas of human tooth development and eruption. No study has compared Demirjian's comprehensive chart and London atlas method in the Indian population. Hence, in the current study, we estimated DA using Demirjian's comprehensive chart and London atlas method for association with the known chronologic age in children and adolescent population. The study also attempted to determine if sexual dimorphism existed in DA estimated by the two methods. Estimation was performed for both methods on 100 orthopantomogram records (50 males and 50 females, aged 6-16 years) of orthodontic patients. The data were compared and analysed using paired t-tests. There was an overestimation of DA by Demirjian's comprehensive chart on an average of +1.3 years in males and +0.5 years in females, whereas using London atlas, it was +1.4 years in males and +0.5 years in females. The mean of underestimation was -0.6 years in males and -0.8 years in females using Demirjian's comprehensive chart, whereas it was -0.8 years in males and -0.5 years in females. A statistically significant difference (P < 0.0001) was found when mean chronological age (11.6 ± 2.6) years of the participants was compared with DA estimated using either Demirjian's comprehensive chart (12.3 ± 2.8) years or London atlas (11.8 ± 2.9) years. The trends in this pilot study point towards more accuracy of London atlas over Demirjian's method when done using comprehensive chart for estimating DA. In summary, the results of the current pilot study indicates greater accuracy of London atlas method over Demirjian's comprehensive chart method for estimating DA in Indian population. This finding should be validated by conducting similar studies using larger sample, on diverse Indian ethnic populations, for applicability in pedodontic, orthodontic, and forensic domains.

Key points

No study has compared Demirjian's comprehensive chart and London atlas method in the Indian population.The dental age estimated by London method was closer to chronological age as compared to Demirjian's method in our study sample.Significant difference was found in chronological age and estimated age using London atlas method in both males and females.

Validation of London Atlas for forensic age estimation in Koreans by comparing with Lee's and Willems' methods

This cross-sectional study aimed to evaluate the applicability of the London Atlas for age estimation in the Korean population by comparing with Lee's and Willems' methods. Dental ages of 475 orthopantomographs from Korean individuals aged 4-15 years (mean 10.32 ± 3.31 years) were estimated using the London Atlas, Lee's and Willems' methods. Correlation between dental and chronological age was determined using Pearson's correlation coefficient, and the statistical difference between dental and chronological age was analyzed using a paired t-test. The bias (mean differences), mean absolute error, and root mean square error between dental and chronological age, stratified by age groups and estimation methods, were calculated. Differences in bias and absolute error between sexes were scrutinized using an independent-samples t-test. Age estimates of the three tested methods were combined and compared to those of each individual method. The London Atlas and Willems methods resulted in overestimations, whereas the Lee method led to an underestimation on the entire sample. The overall accuracy was observed in the order of Lee's method, the London Atlas, and Willems' method. The London Atlas demonstrated superior consistency of estimation performance across age groups and no significant differences in estimation performance between sexes. The combination of estimates from the London Atlas and Lee's method resulted in an enhancement in bias and accuracy. We conclude that the London Atlas, due to its bias and accuracy comparable to Lee's and Willems' methods, is applicable for forensic practice in the Korean population.

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

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

Applicability of the London Atlas method in the East China population

BACKGROUND

Dental age estimation is important for developmental assessment and individual identification. The London Atlas, a recently proposed method for dental age estimation, has been reported to perform satisfactorily in various populations.

OBJECTIVE

In this study, we assessed the reproducibility, repeatability and applicability of the London Atlas method in the East China population and compared it with the Demirjian method.

MATERIALS AND METHODS

We assessed panoramic radiographs of 835 pediatric patients ages 6.0-19.9 years using the London Atlas and the Demirjian method. We employed the intraclass correlation coefficient and Bland-Altman analysis to evaluate reproducibility and repeatability, respectively. We assessed the agreement between dental age and chronological age and calculated 95% and 80% prediction intervals for each dental age stage. Sensitivity, specificity and predictive values were calculated to assess the performance of both methods for identifying threshold ages.

RESULTS

The London Atlas has better reproducibility and repeatability (intraclass correlation coefficients: 0.98 and 0.99; 95% limits of agreement: - 1.34 to 1.56 and - 1.22 to 0.88, respectively). Dental age estimated using the London Atlas was closer to chronological age in both genders (median absolute error = 0.58). The 95% prediction intervals for chronological age were wide (0.99 to 9.89 years).

CONCLUSION

The London Atlas has excellent reproducibility and repeatability. Thus, it might offer an alternative method for developmental assessment. We observed considerable variation in dental development in the East China population, which needs further research.

Age estimation using London Atlas methodology: A systematic review and meta-analysis

Age estimation is a fundamental competence of Forensic Anthropologists and Odontologists. The London Atlas is a dental development chart by AlQahtani et al. (2010) that gained recent notoriety due to its applicability in forensic scenarios. This study aimed to answer, by a systematic review of literature and meta-analysis, the following question: "on average, what is the deviation between real and estimated ages, when applying the London Atlas method in sub-adults?". This study was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO). Five electronic databases were screened (PubMed, SciELO, Scopus, Web of Science, and LILACS), and active search was carried out. The quality assessment was performed by means of Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews. The initial search resulted in 1021 studies, from which 24 filled the inclusion criteria. For the meta-analysis, 17 studies provided sufficient data. Out of these, eleven studies enabled meta-analysis of mean absolute difference values. Standardized mean differences were 0.02 years for MD and 0.78 for MAD. Analysis of subgroups was also accomplished by sex, and did not indicated heterogeneity between males and females. The London Atlas is an accurate age estimation method, presenting acceptable error and bias values worldwide. Despite the high heterogeneity of the studies, majority of studies presented a low risk of bias. Meta-analysis showed a non-significant and slight tendency of overestimating age, in total. Sub-group analysis showed modestly better results for boys than girls.

Assessing Children's Dental Age with Panoramic Radiographs

(1) Background: The aim of the study was to assess the dental age of the subjects and compare it to their chronological age; to assess the dominant tooth for evaluation of dental age; and to investigate possible individual differences between the left and right side of the dental arch. (2) Methods: This study involved evaluating panoramic radiographs of patients aged 7-13 years. A separate assessment was performed for each tooth according to the degree of germ development. Each subject's dental age was estimated. (3) Results: The study involved evaluating 349 panoramic radiographs. No difference was found between stages of tooth development on the right side and left side. Correlation between the stages of tooth development and the chronological age was found to be highest in the second permanent molar teeth. The age can be predicted with the estimated age of tooth #37 and the gender of the patient. (4) Conclusions: The chronological age of children aged 7-13 may be estimated based on a modified seven-stage London Atlas of tooth development, where the most accurate landmark(s) of use are second molars.

Employing the London Atlas in the Age Estimation of a Select South African Population

Dental age estimation in the living and deceased is a fundamental aspect of forensic sciences, civil cases, medico-legal proceedings and clinical dentistry. Accordingly, this study aimed to validate the accuracy and reproducibility of the London Atlas in a select South African sample of KwaZulu-Natal. In this cross-sectional study, 760 digital panoramic radiographs (n = 760) aged between 5.00 and 23.99 years were retrospectively reviewed through consecutive sampling. Each radiograph was assessed and assigned a dental age in accordance with the London Atlas of Human Tooth Development and Eruption by AlQahtani et al. (2010). The London Atlas overestimated age with a mean difference of −0.85 to −1.26 years in the selected South African sample of KwaZulu-Natal. A statistically significant difference between the chronological and estimated dental ages was recorded. Furthermore, the South African Black and Indian males had a higher overestimation of age than their female counterparts, with a mean difference of 0.13 and 0.07 years, respectively. This overestimation was less in the South African Indian population in comparison to the SA Black population. This outcome resulted in the creation of the KZN population- and sex-specific charts and atlases for the two selected cohorts of KwaZulu-Natal. The KZN Atlases were found to be more accurate in the selected sample, with a mean absolute error of 0.57 years and no statistically significant differences between the chronological and estimated dental ages.

Accuracy of different dental age estimation methods for determining the legal majority of 18 years in the Turkish population

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 (I_3M), 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 I_3M, 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 I_3M methods tended to perform better than the London Atlas method, with this trend reaching statistical significance (p < 0.05).

CONCLUSIONS

Cameriere's I_3M 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 I_3M 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.

Accuracy of the London Atlas, Haavikko's Method and Cameriere's European Formula of dental age estimation in Turkish children

Age estimation is a mandatory procedure when the chronological age is unknown or uncertain. Dental development is the preferred characteristic for estimating a child's age. There are many methods for dental age estimation, but their reliability can differ between populations. This study compared the accuracy of three of these methods-the London Atlas (LA), Haavikko's method (HM), and Cameriere's European formula (CF)-in Turkish children living in northwestern Turkey. Panoramic radiographs of 980 children from northwestern Turkey aged between 6.00 and 14.99 years were examined for the whole study group and separately for different ages and sexes by all three methods. Statistical differences between chronological age and dental age were tested using the paired sample t-test and the Wilcoxon signed-rank test. The LA, HM, and CF accuracies were determined based on the mean absolute error. Spearman's rank correlation coefficient showed that the correlation between chronological age and dental age for both sexes was linear for all methods. The LA overestimated the chronological age by 0.09 years, while HM and CF underestimated it by 0.49 and 0.11 years, respectively. The difference between dental age and chronological age was significant in all samples, for all methods, except for the LA in boys. When boys, girls, and the total sample were evaluated, values with the lowest mean absolute error were obtained by HM and were statistically significant in all three groups. Therefore, HM is more accurate than the LA and CF for dental age estimation in Turkish children living in northwestern Turkey.

Dental age estimation in children that have undergone antineoplastic treatment

OBJECTIVE

Even though many studies have been performed to estimate DA in general population, limited research has been performed concerning medical compromised populations such as childhood cancer survivors. The aims of this case-control study were (a) to estimate dental age in a population of children that have undergone antineoplastic treatment with three different methods and (b) to compare it with the estimates from healthy subjects (control group).

MATERIALS AND METHODS

Seventy-three oncology patients and equal number of healthy control subjects from the Pediatric dentistry Department had their dental age estimated through recent orthopantograms using Dermijian's, Willems' and London Atlas methods. All OPGs randomly assessed by two calibrated observers. Mean age difference was calculated. Intraclass Correlation Coefficient was used to assess intra-observer reliability and the Concordance Correlation Coefficient used to assess inter-observer reliability.

RESULTS

Concerning the CCS group 35 subjects (48%) were males and 38 (52%) were females, with an overall mean chronological age 10.95 years, ranging between 5.37 and 15.83 years. Intra- and inter-examiner reliability was exceptional for all methods. Mean DA differences in both groups and were not statistically sinificant regardless of the method used. The marginally lower values when males and females were investigated separately is basically due to the corresponding reduction of the sample size.

CONCLUSION

An overestimation of DA observed in both groups by all methods was not significant. All three methods produced highly accurate comparable results when it comes to estimate the actual chronological age in both groups (CCS and control subjects) regardless of gender.

Dental Subphenotypes in Infants With Orofacial Clefts-A Longitudinal Population-Based Retrospective Radiographic Study of the Primary and Secondary Dentitions

OBJECTIVES

To determine the developmental patterns of primary and secondary dentitions in infants with orofacial clefts.

DESIGN

Retrospective, longitudinal, population-based cohort study.

MATERIALS

Longitudinal records and radiographs of 192 nonsyndromic Northern European infants with isolated unilateral cleft lip (UCL, n = 111) and isolated cleft palate (CP, n = 81).

METHODS

Radiographic assessments of primary and secondary dentition anomalies and dental maturation, by gender and cleft severity for comparisons between the groups and with historical controls.

RESULTS

In infants with UCL, the frequencies of dental anomalies were high in both primary (38.7%) and secondary (18.0%) dentitions. Primary and secondary dentition anomalies were not observed in infants with CP and different in the UCL group (P = .003). Risk differences involved primary supernumerary teeth (P = .0001) and talon cusp formation (P = .0001), and secondary tooth agenesis (P = .001) of the maxillary lateral incisor on the side of the cleft lip. Delayed primary and secondary dental maturation occurred in the UCL and CP groups, greater in infants with UCL (P < .0001). Primary and secondary dental maturation featured sexual dimorphism with greater delay in males (UCL, P < .0001; CP, .0001 > P = .001). The effect of cleft severity on dental maturation was significant in infants with UCL (P = .0361) and CP (P = .0175) in the primary but not in the secondary dentition.

CONCLUSIONS

There were different dental anomalies in the primary and secondary dentitions in operated infants with UCL and no dental anomalies in unoperated infants with CP. Dental maturation was delayed in infants with UCL and CP with greater delay in males compared to females.

Accuracy of the London atlas, Willems, and Nolla methods for dental age estimation: a cross-sectional study on Eastern Turkish children

OBJECTIVES

This study aimed to estimate the dental age (DA) using the London Atlas, Willems, and Nolla methods and to compare their accuracies.

METHODS

The DA was estimated using the aforementioned methods on panoramic radiograms of a total of 919 Eastern Turkish patients aged 6-14 years, of whom 459 were female and 460 were male. The overestimation and underestimation values were determined in relation to the chronological age (CA) values. The paired t test was used to compare the mean DA and CA values. Multiple regression analysis was used to derive gender-specific formulations for the three methods.

RESULTS

The most accurate method for estimating the DA was the Willems method (mean prediction error 0.80), followed by the London Atlas (mean prediction error 0.83) and Nolla (mean prediction error 0.89) methods. Statistically significant differences were found only between the Willems and Nolla methods.

CONCLUSION

All three methods can be used for DA estimations of Eastern Turkish children.

CLINICAL RELEVANCE

Willems was the most suitable method for this patient sample. However, the London Atlas method may be preferred due to its practicability and comparable accuracy.

Deep orofacial phenotyping of population-based infants with isolated cleft lip and isolated cleft palate

Isolated orofacial clefts (OFC) are common with poorly understood aetiology. Heterogeneous phenotypes and subphenotypes confound aetiological variant findings. To improve OFC phenome understanding, population-based, consecutive, pre-treatment infants with isolated unilateral cleft lip (UCL, n = 183) and isolated cleft palate (CP, n = 83) of similar ancestry were grouped for deep phenotyping. Subphenotypes stratified by gender and cleft severity were evaluated for primary dental malformations and maturation using radiographs. We found that cleft severity and tooth agenesis were inadequate to distinguish heterogeneity in infants with UCL and CP. Both groups featured slow dental maturity, significantly slower in males and the UCL phenotype. In 32.8% of infants with UCL, supernumerary maxillary lateral incisors were present on the cleft lip side, but not in infants with CP, suggesting a cleft dental epithelium and forme fruste cleft dentoalveolus of the UCL subphenotype. The findings underscored the importance of deep phenotyping to disclose occult OFC subphenotypes.

Age estimation of Brazilian individuals using the London Atlas

OBJECTIVE

The objective of the present study was to evaluate, for the first time, the applicability of the London Atlas method for age estimation on a sample of Brazilian population.

DESIGN

The study consisted of archived dental panoramic radiographs (n = 288) of individuals aged between 5 and 23 years. Radiographs were assessed using the London Atlas method to determine the developmental and eruption stages of all teeth on each sides of each jaw separately, and also to make an age estimation.

RESULTS

There was no significant differences between the right and left sides of the jaws (p = 0.31 for males and p = 0.65 for females). An overestimation of age occurred more likely in the female sample when compared to the male sample. Three age groups, 20.5, 18.5 and 19.5 years, presented the highest values ​​of mean absolute difference found in the whole sample.

CONCLUSION

The London Atlas of age estimation performed well in general and good viability in an expert context, with most age groups showing age differences lower than two years of age, however it is necessary that it be applied with caution in certain age groups, especially when the third molar is used as a decision tooth for age estimation. Therefore, it is recommended to use more than one method for assessing the age in those age groups.

Comparison of three methods to estimate dental age in children

OBJECTIVES

In 1973, Demirjian and colleagues introduced a staging for tooth mineralization. Staging of the teeth of the left mandible generates a dental maturity score and an estimate of dental age. An update of this method was published in 2001 by Willems and colleagues. The London Atlas (2008) is another method used to assess dental age. This study compared the precision of these three methods for forensic age estimation.

MATERIALS AND METHODS

A total of 500 panoramic images of 251 boys and 249 girls aged 6-16 years had dental maturity evaluated by the same observer using the London Atlas and the methods of Demirjian and Willems. Individuals with syndromes potentially affecting dental maturation were excluded. The three methods were compared with respect to their precision in estimating chronological age.

RESULTS

Age estimates using Willems' method were significantly more precise than those obtained using Demirjian's method, while estimates obtained using the London Atlas method were comparable with both the others. The highest precision was obtained using the average of age estimates from Willems' method and the London Atlas.

CONCLUSIONS

To estimate age in individuals suspected of being below 16 years of age, we suggest first applying the London Atlas then computing age from the Demirjian stages of particular teeth using Willems' method, and finally using the average age estimate of both methods.

CLINICAL RELEVANCE

Combining the London Atlas and Willems' scoring method provides more precise estimates of dental age than the current practice of applying a single preferred method.