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Neves JA, Lopes LB, Machado V, Botelho J, Delgado AS, Mendes JJ. Evidence of Age Estimation Procedures in Forensic Dentistry: Results from an Umbrella Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:42. [PMID: 38256303 PMCID: PMC10818637 DOI: 10.3390/medicina60010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Background and objective: Age estimation is an important tool when dealing with human remains or undocumented minors. Although the skull, the skeleton or the hand-wrist are used in age estimation as maturity indicators, they often present a lack of good conditions for a correct identification or estimation. Few systematic reviews (SRs) have been recently published; therefore, this umbrella review critically assesses their level of evidence and provides a general, comprehensive view. Materials and methods: Considering the review question "What is the current evidence on age determination approaches in Forensic Dentistry?" an electronic database search was conducted in four databases (PubMed, Cochrane, WoS, LILACS) up to December 2022, focusing on SRs of age estimation through forensic dentistry procedures. The methodological quality was analyzed using the measurement tool to assess SRs criteria (AMSTAR2). Results: Eighteen SRs were included: five of critically low quality, six of low quality, three of moderate quality and four of high quality. The SRs posited that Willems' method is more accurate and less prone to overestimation; most methods seem to be geographically sensitive; and 3D-imaging and artificial intelligence tools demonstrate high potential. Conclusions: The quality of evidence on age estimation using dental approaches was rated as low to moderate. Well-designed clinical trials and high-standard systematic reviews are essential to corroborate the accuracy of the different procedures for age estimation in forensic dentistry.
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Affiliation(s)
- João Albernaz Neves
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
| | - Luísa Bandeira Lopes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
- Orthodontics Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
- Orthodontics Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
| | - Ana Sintra Delgado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
- Orthodontics Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, 2829-511 Monte de Caparica, Portugal
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Vila-Blanco N, Varas-Quintana P, Tomás I, Carreira MJ. A systematic overview of dental methods for age assessment in living individuals: from traditional to artificial intelligence-based approaches. Int J Legal Med 2023; 137:1117-1146. [PMID: 37055627 PMCID: PMC10247592 DOI: 10.1007/s00414-023-02960-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/31/2023] [Indexed: 04/15/2023]
Abstract
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.
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Affiliation(s)
- Nicolás Vila-Blanco
- Centro Singular de Investigación en Tecnoloxías Intelixentes (CiTIUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Departamento de Electrónica e Computación, Escola Técnica Superior de Enxeñaría, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Paulina Varas-Quintana
- Oral Sciences Research Group, Special Needs Unit, Department of Surgery and Medical Surgical Specialities, School of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Inmaculada Tomás
- Centro Singular de Investigación en Tecnoloxías Intelixentes (CiTIUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
- Oral Sciences Research Group, Special Needs Unit, Department of Surgery and Medical Surgical Specialities, School of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - María J Carreira
- Centro Singular de Investigación en Tecnoloxías Intelixentes (CiTIUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
- Departamento de Electrónica e Computación, Escola Técnica Superior de Enxeñaría, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
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3
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Yurdabakan ZZ, Karadayı B, Yetimoğlu N. Evaluation of Third Molar Maturity Index by Cone Beam Computed Tomography in Legal Age Estimation: A Preliminary Study. Am J Forensic Med Pathol 2023; 44:103-110. [PMID: 36607975 DOI: 10.1097/paf.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT This retrospective study aimed to evaluate the accuracy and applicability of the third molar maturity index (I 3M ) for discriminating Turkish minors from adults, and its relationship with chronological age using cone beam computed tomography (CBCT). A total of 122 CBCT scans of Turkish individuals (55 boys and 67 girls) aged 13 to 23 years were evaluated using the I 3M cutoff value. Chronological age gradually decreased as the I 3M value increased. The overall accuracy was 95.9%. The sensitivity and specificity of this test were 93.5% and 97.4%, respectively. Positive predictive value was 95.6%. The intraclass correlation coefficient values of the I 3M for the intraobserver and interobserver agreements were 0.998 and 0.996, respectively. This study showed relatively higher reproducibility of measurements on CBCT scans than on panoramic radiographs in the literature. Cone beam computed tomography may be advantageous and preferred over panoramic radiographs in distinguishing the legal age threshold of 18 years according to Cameriere's method when a more extensive investigation is needed to support the solution of challenging and uncertain cases in forensic medicine.
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Affiliation(s)
- Zeliha Zuhal Yurdabakan
- From the Department of Oral and Dentomaxillofacial Radiology, Altinbas University, Faculty of Dentistry
| | - Beytullah Karadayı
- Department of Forensic Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul
| | - Nihal Yetimoğlu
- Department of Oral and Dentomaxillofacial Radiology, Yozgat Bozok University, Faculty of Dentistry, Yozgat, Turkey
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4
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Angelakopoulos N, De Luca S, Oliveira-Santos I, Ribeiro ILA, Bianchi I, Balla SB, Kis HC, Jiménez LG, Zolotenkova G, Yusof MYP, Selmanagić AH, Pandey H, Pereira PC, da Nóbrega JBM, Kalani H, Mieke SM, Kumagai A, Gulsahi A, Zelić K, Marinković N, Kelmendi J, Galić I, Vázquez IS, Spinas E, Velezmoro-Montes YW, Moukarzel M, Toledo JP, El-Bakary AAES, Cameriere R. Third molar maturity index (I 3M) assessment according to different geographical zones: a large multi-ethnic study sample. Int J Legal Med 2023; 137:403-425. [PMID: 36520207 DOI: 10.1007/s00414-022-02930-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
Identification of living undocumented individuals highlights the need for accurate, precise, and reproducible age estimation methods, especially in those cases involving minors. However, when their country of origin is unknown, or it can be only roughly estimated, it is extremely difficult to apply assessment policies, procedures, and practices that are accurate and child-sensitive. The main aim of this research is to optimize the correct classification of adults and minors by establishing new cut-off values for four different continents (Africa, America, Asia, and Europe). For this purpose, a vast sample of 10,701 orthopantomographs (OPTs) from four continents was evaluated. For determination and subsequent validation of the new third molar maturity index (I3M) cut-off values by world regions, a cross-validation by holdout method was used and contingency tables (confusion matrices) were generated. The lower third molar maturity indexes, from both left and right side (I3ML and I3MR) and the combination of both sides (I3ML_I3MR) were calculated. The new cut-off values, that aim to differentiate between a minor and an adult, with more than 74.00% accuracy for all populations were as follows (I3ML; I3MR; I3ML_I3MR, respectively): Africa = (0.10; 0.10; 0.10), America = (0.10; 0.09; 0.09), Asia = (0.15; 0.17; 0.14), and Europe = (0.09; 0.09; 0.09). The higher sensitivity (Se) was detected for the I3ML for male African people (91%) and the higher specificity (Sp) of all the parameters (I3ML; I3MR; I3ML_I3MR) for Europeans both male and female (> 91%). The original cut-off value (0.08) is still useful, especially in discriminating individuals younger than 18 years old which is the goal of the forensic methods used for justice.
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Affiliation(s)
- Nikolaos Angelakopoulos
- Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland.,AgEstimation Project, Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Stefano De Luca
- AgEstimation Project, Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy. .,Panacea Cooperative Research S. Coop, Ponferrada, Spain.
| | - Inês Oliveira-Santos
- Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | | | - Ilenia Bianchi
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy
| | - Sudheer B Balla
- AgEstimation Project, Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy.,Department of Forensic Odontology, Panineeya Institute of Dental Sciences and Research Center, Hyderabad, Telangana, India
| | - Hatice Cansu Kis
- Department of Orthodontics, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Lourdes Gómez Jiménez
- Instituto Nacional de Patología "Dr. Sergio Sarita Valdez,", Santo Domingo, Dominican Republic
| | - Galina Zolotenkova
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Mohd Yusmiaidil Putera Yusof
- Centre for Oral & Maxillofacial Diagnostics and Medicine Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Aida Hadzić Selmanagić
- Department of Dental Morphology With Dental Anthropology and Forensics, Faculty of Dentistry, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Hemlata Pandey
- Department of Forensic Medicine and Toxicology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Palmela C Pereira
- Facultade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | | | - Hettiarachchi Kalani
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sylvia M Mieke
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Akiko Kumagai
- Division of Forensic Odontology and Disaster Oral Medicine, Department of Forensic Science, Iwate Medical University, Morioka, Iwate, Japan
| | - Ayse Gulsahi
- AgEstimation Project, Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy.,Dentomaxillofacial Radiology Department, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Ksenija Zelić
- Laboratory of Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nemanja Marinković
- Clinic for Orthodontics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Jeta Kelmendi
- Department of Orthodontics, Faculty of Medicine Alma Mater Europaea, University of Pristina, Campus Rezonanca, Pristina, Kosovo
| | - Ivan Galić
- AgEstimation Project, Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy.,Department of Oral Surgery, School of Medicine, University of Split, Split, Croatia
| | - Israel Soriano Vázquez
- Forensic Odontologist, Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Enrico Spinas
- Department of Surgical Sciences, Section of Dentistry, University of Cagliari, Cagliari, Italy
| | | | | | - Jorge Pinares Toledo
- Departamento de Patología Y Medicina Oral, Facultad de Odontología, Universidad de Chile, Santiago, Chile.,Escuela de Odontología, Facultad de Medicina, Universidad Católica de Chile, Santiago, Chile
| | | | - Roberto Cameriere
- AgEstimation Project, Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
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5
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Use of third molar eruption based on Gambier's criteria in assessing dental age. Int J Legal Med 2023; 137:691-699. [PMID: 36707450 DOI: 10.1007/s00414-023-02953-y] [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: 08/10/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
The biological aspects of determining the dental age of subadults represent an important interdisciplinary scientific link with applications in criminal law and in forensic anthropology and dentistry. In criminal procedural law, it is necessary to determine the exact age of an undocumented person in view of the application of the provisions on juvenile offenders and minor victims. Chronological age can be estimated from the development of the third molars, as these are the only teeth that develop at the age of 18. The aim of this study was to verify the applicability of the Gambier method based on the eruption of the third permanent molars in the mandible and maxilla, to contribute to forensic age assessment. The analyzed group that met the criteria consisted of 811 orthopantomograms (OPGs) (339 females and 472 males) between the ages of 13 and 25 years. The OPGs were retrospectively analyzed according to the method of Gambier et al. (Int J Legal Med 133:625-632, 29), which refers to the eruption stages of the third molar. Differences between eruption stages of maxillary and mandibular third molars were statistically significant in both biological sexes. Intersexual differences in mean age were significant only at stage 3 for any M3 tooth and at stage 1 for mandibular M3. There were no statistically significant differences between the left and right mandibular and maxillary third molars, respectively. Differences between mandibular and maxillary M3 were significant only for stage 1 in males on the left side and for stage 2 in both sexes and sides. The method used allowed the best classification of individuals into minor and adult groups (based on phase D-90.41% of individuals, based on the third stage of the mandibular left third molar-86.29%). Based on the results obtained, we can assume that the method cannot be used alone in the initial examination of living individuals, since all four third molars must be assessed and there are no additional findings from practice.
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6
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Correlation of chronological age with dental age estimated using modified Cameriere’s method and UT-age estimation software — a cross-sectional study. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2023. [DOI: 10.1186/s41935-023-00324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
Estimating age is essential in both the analysis of human skeletal remains and assessing live persons. The third molar develops over a longer period and is hence used in age estimation for subadults. Since dental age correlates with chronological age better than other growth markers, this study aims to assess the reliability of dental age assessed using the University of Texas (UT) age estimation method and modified Cameriere’s method.
Methods
It is a retrospective cross-sectional study in which the development and maturation of mandibular third molars were examined in 600 orthopantomograms (264 males and 336 females) of South Indian individuals (16–23 years). Dental age was estimated by using an Indian-specific formula based on maturity index value and the UT-age estimation software program. The results were evaluated using the Student’s t-test for both methods and Pearson’s correlation test to compare chronological age with estimated dental age.
Results
Positive correlation was noted between chronological age and estimated dental age for males, females, and the total sample with highly statistically significant differences (p = 0.000). Modified Cameriere’s method underestimated dental age in samples ranging from less than 1 year to more than 2 years. UT-age estimation method underestimated age in samples above 20 years and overestimated age in samples below 20 years. The predictive classification of utilizing the maturity index was 79.17% accurate.
Conclusions
Dental age was negligibly over and underestimated in UT software method whereas it was overestimated in the modified Cameriere's method. To evaluate the reliability of these two methods, studies with larger sample sizes and population-specific data sets should be performed.
Graphical Abstract
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7
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Legal age determined by a new threshold value of third molar maturity index in subjects with impacted mandibular third molars: An orthopantomographic study in south Indian adolescents. Int J Legal Med 2021; 136:251-259. [PMID: 34633500 DOI: 10.1007/s00414-021-02715-8] [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: 03/01/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
Third molars are one of the few biological markers available for age estimation in juveniles, especially for the estimation of the 18-year-age threshold. Literature has indicated that impaction has an influence on the development of third molars, which could possibly result in age misclassifications. The present study is intended to identify an alternative cut-off value of the third molar maturity index (I3M) in impacted mandibular third molars and also to evaluate its applicability in estimating the major (≥ 18 years)/minor (< 18 years) status. A total of 1330 digital orthopantomograms (OPGs) of 665 male and 665 female south Indian adolescents aged from 15 to 22 years were collected and assessed. Eight hundred forty OPGs (63.1%) represented test sample, and 490 OPGs (36.9%) represented validation sample. I3M was measured for the total sample. Logistic regression, receiver operating characteristic (ROC) curve analysis, and Youden's index were used to test the performance of the method in the test sample. An alternative cut-off value of I3M < 0.17 was established for the highest value of the Youden's index of 0.598 for both sexes. When tested in validation sample, it has resulted in sensitivity and specificity values of 0.91 (95% CI; 0.86-0.95) and 0.90 (95% CI; 0.78-0.91) in males and 0.86 (95% CI; 0.80-0.92) and 0.90 (95% CI; 0.83-0.95) in females. In conclusion, cut-off value of I3M < 0.17 could accurately discriminate adults from minors with impacted mandibular third molars. However, more work is needed to be done among a more diverse sample to confirm these findings.
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Angelakopoulos N, Galić I, Balla SB, Kiş HC, Gómez Jiménez L, Zolotenkova G, Mohd Yusof MYP, Hadzić Selmanagić A, Pandey H, Palmela Pereira C, Nóbrega JBM, Hettiarachchi K, Mieke SM, Kumagai A, Gulsahi A, Zelić K, Marinković N, Kelmendi J, Bianchi I, Soriano Vázquez I, Spinas E, Velezmoro-Montes YW, Oliveira-Santos I, De Luca S, Arrais Ribeiro IL, Moukarzel M, Cameriere R. Comparison of the third molar maturity index (I 3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample. Int J Legal Med 2021; 135:2423-2436. [PMID: 34228192 DOI: 10.1007/s00414-021-02656-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/27/2021] [Indexed: 11/26/2022]
Abstract
The diagnostic accuracy of the I3M to assess the legal age of 18 years has already been tested in several specific-population samples. The left lower third molar has been extensively used for discriminating between minors and adults. This research aimed to compare the usefulness of lower third molar maturity indexes, from both left and right side (I3ML and I3MR), in samples originating from four distinct continents in order to examine possible differences in their accuracy values. For this purpose, a sample of 10,181 orthopantomograms (OPGs), from Europe, Africa, Asia and America, was analysed and previously scored in other studies. The samples included healthy subjects with no systemic disorders with both third molars and clear depicted root apices. Wilcoxon Signed Rank test for left and right asymmetry did not show any significant differences. Data about sensitivity, specificity, predictive values, likelihood ratio and accuracy were pooled together and showed similar results for I3ML and I3MR, respectively. In addition, all these quantities were high when only the I3MR was considered to discriminate between adults and minors. The present referable database was the first to pool third molar measurements using panoramic radiographs of subjects coming from different continents. The results highlighted that both I3ML and I3MR are reliable indicators for assessing the legal age of 18 years old in those jurisdictions where this legal threshold has been set as the age of majority.
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Affiliation(s)
- N Angelakopoulos
- Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland
- AgEstimation Project, Macerata, Italy
| | - I Galić
- AgEstimation Project, Macerata, Italy
- Department of Oral Surgery, School of Medicine, University of Split, Split, Croatia
| | - S B Balla
- AgEstimation Project, Macerata, Italy
- Department of Forensic Odontology, Panineeya Institute of Dental Sciences and Research Center, Hyderabad, Telangana, India
| | - H C Kiş
- Faculty of Dentistry, Oral and Maxillofacial Radiology, Nuh Naci Yazgan University, Kocasinan, Kayseri, Turkey
| | - L Gómez Jiménez
- Instituto Nacional de Patología Dr. Sergio Sarita Valdez, Santo Domingo, República Dominicana
| | - G Zolotenkova
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Design Information Technologies Centre, Russian Academy of Sciences (DITC RAS), Moscow, Russia
| | - M Y P Mohd Yusof
- Centre for Oral & Maxillofacial Diagnostics and Medicine Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - A Hadzić Selmanagić
- Department of Dental Morphology With Dental Anthropology and Forensics Faculty of Dentistry, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - H Pandey
- Department of Forensic Medicine and Toxicology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - C Palmela Pereira
- Facultade de Medicina Dentária da Universidade de Lisboa, Lisboa, Portugal
| | - J B M Nóbrega
- Postgraduate Program in Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brasil
| | - K Hettiarachchi
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Kandy, Central Province, Sri Lanka
| | - S M Mieke
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - A Kumagai
- Division of Forensic Odontology and Disaster Oral Medicine, Department of Forensic Science, Iwate Medical University, Iwate, Japan
| | - A Gulsahi
- AgEstimation Project, Macerata, Italy
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Baskent University, Ankara, Turkey
| | - K Zelić
- Laboratory of Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia
- School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - N Marinković
- Clinic for Orthodontics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - J Kelmendi
- Department of Orthodontics, Faculty of Medicine Alma Mater Europaea, University of Prishtina, Campus Rezonanca, Prishtina, Kosovo
| | - I Bianchi
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy
| | | | - E Spinas
- Department of Surgical Sciences, Section of Dentistry, University of Cagliari , Cagliari, Italy
| | | | - I Oliveira-Santos
- Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Stefano De Luca
- AgEstimation Project, Macerata, Italy.
- Área de Identificación Forense, Unidad de Derechos Humanos, Servicio Médico Legal, Santiago de Chile, Chile.
| | - I L Arrais Ribeiro
- Postgraduate Program in Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brasil
| | | | - R Cameriere
- AgEstimation Project, Macerata, Italy
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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9
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Cameriere R, De Luca S, Ferrante L. Study of the ethnicity's influence on the third molar maturity index (I 3M) for estimating age of majority in living juveniles and young adults. Int J Legal Med 2021; 135:1945-1952. [PMID: 34023943 DOI: 10.1007/s00414-021-02622-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/17/2021] [Indexed: 12/18/2022]
Abstract
Estimation of age of majority has important applications in the forensic daily practice because of the increasing demand for age estimates of unaccompanied minors. Diagnostic accuracy of I3M to assess legal adult age of 18 years has been already tested in several specific population samples. The aim of this work was to compare the available data about sensitivity and specificity of the third molar maturity index (I3M) from five different regional groups' radiographic samples to study possible ethnical difference. For this purpose, a sample of 6157 orthopantomograms (OPGs), coming from 15 countries, was analysed. Data about sensitivity and specificity were pooled using a bivariate modelling approach. The one-way MANOVA analysis was applied to assess the likelihood that sensitivity and specificity of the five regional groups are sampled from the same population. The result of the one-way MANOVA showed that both sensitivity and specificity did not depend from the regional groups. The obtained sensitivity was 84% (95% CI: 82% and 85%), and its specificity was 94% (95% CI: 93% and 95%). Based on these results, the I3M was a useful statistical tool to identify whether a subject has reached the legal age of 18 years old, regardless of his or her ethnicity.
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Affiliation(s)
- R Cameriere
- AgEstimation Project, Macerata, Italy.,Department of Forensic Medicine, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Stefano De Luca
- AgEstimation Project, Macerata, Italy. .,Área de Identificación Forense, Unidad de Derechos Humanos, Servicio Médico Legal, Santiago, Chile.
| | - L Ferrante
- Centre of Epidemiology, Biostatistics and Information Technology, Polytechnic University of Marche, Ancona, Italy
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10
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Minor migrants' age estimation: Comparison of two dental methods. Forensic Sci Int Synerg 2021; 3:100134. [PMID: 33532722 PMCID: PMC7829137 DOI: 10.1016/j.fsisyn.2021.100134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/27/2022]
Abstract
In case of minor migrants, absence of valid identification documents that clearly define age is a critical issue, because without these data the child cannot enjoy the rights provided by the Convention on the Rights of the Child. Differentiation between minors and adults is fundamental when age is disputed in human identification, asylum seeking, criminal liability, and child abuse fields. Few indications are available about qualitative/statistical agreement of different age estimation methods. Ages of 301 individuals were estimated through two dental methods in order to: determine quantitative and statistical agreements in legal age definition; identify practical recommendations. The study pointed out discrepancy between the two methods in 7/301 cases. From a statistical point of view, this finding corresponded to an almost perfect agreement. Thus, authors suggested that the two methods can be alternately used for legal age assessment, but operators should use both methods when the estimated age is 18.5 years.
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11
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Age estimation in the living: A scoping review of population data for skeletal and dental methods. Forensic Sci Int 2021; 320:110689. [PMID: 33561788 DOI: 10.1016/j.forsciint.2021.110689] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/22/2022]
Abstract
Age estimation of living individuals has become a crucial part of the forensic practice, especially due to the global increase in cross-border migration. The low rate of birth registration in many countries, hence of identification documents of migrants, especially in Africa and Asia, highlights the importance of reliable methods for age estimation of living individuals. Despite the fact that a number of skeletal and dental methods for age estimation have been developed, their main limitation is that they are based on specific reference samples and there is still no consensus among researchers on whether these methods can be applied to all populations. Though this issue remains still unsolved, population information at a glance could be useful for forensic practitioners dealing with such issues. This study aims at presenting a scoping review and mapping of the current situation concerning population data for skeletal (hand-wrist and clavicle) and dental methods (teeth eruption and third molar formation) for age estimation in the living. Two hundred studies on the rate of skeletal maturation and four hundred thirty-nine on the rate of dental maturation were found, covering the period from 1952 and 2020 for a total of ninety-eight countries. For most of the western and central African countries there are currently no data on the rate of skeletal and dental maturation. The same applies to the countries of the Middle East, as well as the eastern European countries, especially as regard the skeletal development.
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De Micco F, Martino F, Velandia Palacio LA, Cingolani M, Campobasso CP. Third molar maturity index and legal age in different ethnic populations: Accuracy of Cameriere's method. MEDICINE, SCIENCE, AND THE LAW 2021; 61:105-112. [PMID: 33591873 DOI: 10.1177/0025802419900686] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Molar development is widely accepted as a reliable indicator of chronological age in a forensic context. A quantitative method for age estimation has been proposed by Cameriere et al. based on the relationship between chronological age and the third molar maturity index (I3M), which is the ratio between the two apical pulp widths and the total tooth length. Cameriere's cut off value of 0.08 was found to be a reliable tool in assessing the threshold of 18 years of age. The aim of this study was to evaluate the accuracy of the I3M in different ethnic populations focusing on its specificity (subjects correctly classified as <18 years based on I3M >0.08) and sensitivity (subjects correctly classified as ≥18 years based on I3M <0.08). A review of 22 scientific articles was performed, representing data from panoramic radiographs of 12,286 individuals (5723 males and 6563 females) from all over the world, including some ethnical subgroups. The I3M showed an overall sensitivity for both sexes ranging from 51.8% to 93.4% and a specificity ranging from 86.2% to 100%. The proportion of correctly classified individuals ranged from 74% to 95%. These results can be useful to refer the age estimation with the margin of error of subjects correctly classified as minors (specificity) or adults (sensitivity), according to sex, ethnicity and geographical distribution. The I3M can be considered a suitable method for estimating adulthood in forensic settings, regardless of sex. However, ethnic group can affect the accuracy.
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Affiliation(s)
- Francesco De Micco
- Dipartimento di Medicina e Scienze della Salute 'Vincenzo Tiberio', Università del Molise, Italy
| | - Federica Martino
- Dipartimento di Medicina Sperimentale, Università della Campania 'Luigi Vanvitelli', Italy
| | | | | | - Carlo Pietro Campobasso
- Dipartimento di Medicina e Scienze della Salute 'Vincenzo Tiberio', Università del Molise, Italy
- Dipartimento di Medicina Sperimentale, Università della Campania 'Luigi Vanvitelli', Italy
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13
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Albernaz Neves J, Antunes-Ferreira N, Machado V, Botelho J, Proença L, Quintas A, Delgado AS, Mendes JJ, Cameriere R. Validation of the Third Molar Maturation Index (I 3M) to assess the legal adult age in the Portuguese population. Sci Rep 2020; 10:18466. [PMID: 33116188 PMCID: PMC7595217 DOI: 10.1038/s41598-020-75324-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
Age estimation is a major step in forensic and legal procedures. Its relevance has been increasing due to growing society issues, such as identification of missing people, crimes against minors or lack of valid identification papers from locals or foreigners. Evaluation of the cut-off value of the Third Molar Maturation Index (I3M) = 0.08 for discriminating minors from adults in the Portuguese population. The left lower third molars were analysed by applying a specific cut-off value of 0.08 determined by Cameriere et al. in 2008. A sample of 778 digital panoramic radiographs of a representative Portuguese sample (442 females and 336 males), in the age range of 12–24 years (mean age 17.7 ± 2.98 years in females and 18.1 ± 3.0 years in males), was retrospectively evaluated. I3M decreased as the real age gradually increased in both sexes. The 0.08 cut-off score was valuable in discriminating adults from minors. According to the pooled results, the accuracy, by means of area under the curve, was 92.8% (95% confidence interval (CI) 91.0–94.6%). The proportion of correctly classified subjects (sensitivity) was 90.7% (95% CI 88.7–92.8%) and the specificity was 94.9% (95% CI 93.3–96.4%). The results show that I3M is a valuable method to differentiate minors from adults in the Portuguese population.
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Affiliation(s)
- João Albernaz Neves
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal.
| | - Nathalie Antunes-Ferreira
- Laboratório de Ciências Forenses E Psicológicas Egas Moniz (LCFPEM), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz CRL, Monte de Caparica, Portugal.,Laboratory of Biological Anthropology and Human Osteology (LABOH), CRIA/FCSH, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal.,Evidence-Based Hub, CiiEM, Egas Moniz, CRL, Monte de Caparica, Portugal
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal.,Evidence-Based Hub, CiiEM, Egas Moniz, CRL, Monte de Caparica, Portugal
| | - Luís Proença
- Quantitative Methods for Health Research (MQIS), CiiEM, Egas Moniz, CRL, Monte de Caparica, Portugal
| | - Alexandre Quintas
- Laboratório de Ciências Forenses E Psicológicas Egas Moniz (LCFPEM), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz CRL, Monte de Caparica, Portugal.,Laboratory of Biological Anthropology and Human Osteology (LABOH), CRIA/FCSH, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana Sintra Delgado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal.,Evidence-Based Hub, CiiEM, Egas Moniz, CRL, Monte de Caparica, Portugal
| | - Roberto Cameriere
- Department of Forensic Medicine, University of Sechenov, Moscow, Russia.,AgEstimation Project, FOR.MED.LAB, University of Macerata, Macerata, Italy
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14
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Akkaya N, Yilanci HÖ. Assessment of third molar maturity index for legal age threshold of 18 in a sample of Turkish individuals. AUST J FORENSIC SCI 2020. [DOI: 10.1080/00450618.2020.1729412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Nursel Akkaya
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - H. Özge Yilanci
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, İzmir Democracy University, İzmir, Turkey
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15
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Kumar GK, Kumar DRS, Kulkarni G, Balla SB, Shyam NDVN, Naishadham Y. 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. J Forensic Dent Sci 2020; 11:84-89. [PMID: 32082043 PMCID: PMC7006308 DOI: 10.4103/jfo.jfds_40_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/17/2019] [Accepted: 11/21/2019] [Indexed: 11/06/2022] Open
Abstract
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 (I3M < 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 I3M < 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 I3M< 0.08 in discriminating adults and minors of Hyderabad sample when a test of high sensitivity and specificity is required.
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Affiliation(s)
- G Kiran Kumar
- Department of Oral Pathology, GDC, Hyderabad, Telangana, India
| | - D R Shravan Kumar
- Department of Oral Pathology, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Ganesh Kulkarni
- Department of Oral Pathology, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Sudheer B Balla
- Department of Forensic Odontology, Panineeya Institute of Dental Sciences and Research Center, Hyderabad, Telangana, India
| | - N D V N Shyam
- Department of Oral Pathology, GDC, Hyderabad, Telangana, India
| | - Yashovardhan Naishadham
- Department of Oral Pathology Panineeya Institute of Dental Sciences and Research Center, Hyderabad, Telangana, India
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16
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Wang M, Fan L, Shen S, Bai X, Wang J, Ji F, Tao J. Applicability of the third molar maturity index for assessment of age of majority in Eastern China. Leg Med (Tokyo) 2019; 41:101639. [DOI: 10.1016/j.legalmed.2019.101639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 01/26/2023]
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17
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Ribier L, Saint-Martin P, Seignier M, Paré A, Brunereau L, Rérolle C. Cameriere's third molar maturity index in assessing age of majority: a study of a French sample. Int J Legal Med 2019; 134:783-792. [PMID: 31401681 DOI: 10.1007/s00414-019-02123-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 07/05/2019] [Indexed: 01/18/2023]
Abstract
Forensic age estimation is a challenging field in forensic sciences because of the increase of migratory flows. Medicolegal age assessment is a key point because it has many implications for authorities. Dental age estimation is an essential part of the global age assessment. The aim of this study was to evaluate and test the accuracy of Cameriere's cutoff values of the third molar maturity index (I3M) in assessing legal adult age of 18 years in a French population. The sample was constituted of 431 orthopantomograms performed between January 2014 and August 2017 on patients aged between 14 and 22 years. The reproducibility and repeatability of the method were high. Age distribution gradually decreases as I3M increases in both sexes. 0.08 seemed to be the best I3M cutoff. For females, the sensitivity and specificity of the test were 74.51% and 88.23%, respectively. The sensitivity and specificity for males were 92.19% and 88.35%, respectively. The accuracies were 80.74% for female, 90.57% for male. Estimated post-test probabilities were 0.879 for female and 0.899 for male. To conclude, the specific cutoff value of I3M ˂ 0.08 may be a useful additional tool in discriminating adults and minors in French population.
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Affiliation(s)
- Léo Ribier
- Institut Médico-Légal, Hôpital Trousseau, CHRU Tours, 37044, Tours cedex 9, France
- Service de Radiologie Adulte, CHRU Tours, 37044, Tours cedex 9, France
| | - Pauline Saint-Martin
- Institut Médico-Légal, Hôpital Trousseau, CHRU Tours, 37044, Tours cedex 9, France
| | - Mélanie Seignier
- Institut Médico-Légal, Hôpital Trousseau, CHRU Tours, 37044, Tours cedex 9, France
| | - Arnaud Paré
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHRU Tours, 37044, Tours cedex 9, France
| | - Laurent Brunereau
- Service de Radiologie Adulte, CHRU Tours, 37044, Tours cedex 9, France
| | - Camille Rérolle
- Institut Médico-Légal, Hôpital Trousseau, CHRU Tours, 37044, Tours cedex 9, France.
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18
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Age estimation by measuring open apices in teeth: a new formula for two samples of South African black and white children. Int J Legal Med 2019; 133:1529-1536. [DOI: 10.1007/s00414-019-02096-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
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19
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Kumagai A, Takahashi N, Palacio LAV, Giampieri A, Ferrante L, Cameriere R. Accuracy of the third molar index cut-off value for estimating 18 years of age: Validation in a Japanese samples. Leg Med (Tokyo) 2019; 38:5-9. [DOI: 10.1016/j.legalmed.2019.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 02/04/2019] [Accepted: 03/03/2019] [Indexed: 11/29/2022]
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20
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Dental age estimation in Somali children and sub-adults combining permanent teeth and third molar development. Int J Legal Med 2019; 133:1207-1215. [PMID: 30993445 PMCID: PMC6570682 DOI: 10.1007/s00414-019-02053-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/22/2019] [Indexed: 11/16/2022]
Abstract
Estimation of an individual’s age has important applications in forensics. In young individuals, it often relies on separate evaluations of permanent teeth (PT) and third molars (TM) development. Here, we analysed the age prediction performance of combined information from PT and TM in an unusual sample of healthy Somalis, born and living in Finland. PT development was staged according to Demirjian et al. (Hum Biol, 1973) and TM development according to Köhler et al. (Ann Anat, 1994), using panoramic radiographs from 803 subjects (397 males, 406 females) aged 3–23 years. A sex-specific Bayesian age-estimation model for the multivariate distribution of the stages conditional on age was fitted on PT, TM and PT and TM combined. The age-estimation performances were validated and quantified. The approach combining PT and TM only overestimated age with an ME of − 0.031 years in males and − 0.011 years in females, indicating the best age prediction performance.
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21
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Is the third molar maturity index (I 3M) useful for a genetic isolate population? Study of a Sardinian sample of children and young adults. Int J Legal Med 2018; 132:1787-1794. [PMID: 30232544 DOI: 10.1007/s00414-018-1933-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/05/2018] [Indexed: 02/04/2023]
Abstract
This work aims to assess the validity of the cut-off value (0.08) of the third molar maturity index (I3M) for discriminating minors from adults in Sardinian population. A sample of 336 digital panoramic radiographs of healthy Sardinian children and young minors (165 females and 171 males), aged between 15 and 23 years (mean age, 19.35 years in females and 18.80 years in males), was retrospectively evaluated. The left lower third molars were analysed by applying a specific cut-off value of 0.08 determined by Cameriere et al. in 2008. The reliability and reproducibility of the test was also studied: the intra-class correlation coefficients (ICC) were 0.91 (95% CI, 0.89-0.93) and 0.88 (95% CI, 0.86-0.90), for the intra- and inter-observer reliability, respectively. The I3M gradually decreased as the real age gradually increased in both sexes. According to the pooled results of the diagnostic test, the accuracy (ACC) was 0.86 (95% CI, 0.82-0.89); the proportion of correctly classified subjects (Se = sensitivity) was 0.82 (95% CI: 0.76-0.86); and specificity (Sp = specificity) was 0.95 (95% CI, 0.89-0.97). The positive predictive values (PPV) and the negative predictive values (NPVs) were 0.97 (95% CI, 0.94-0.99) and 0.70 (95% CI, 0.62-0.77). The LR+ and the LR- were 17.12 (95% CI, 7.27 to 40.36) and 0.19 (95% CI, 0.14 to 0.25). In spite of this, significant differences in the early mineralisation of the third molar were found between sexes as well as in the results of the diagnostic test, showing a better sensitivity in males than in females. The results showed that, although the third molar teeth are highly variable in development, and with differences between females and males as compare to other teeth, the I3M is a reliable method to distinguish between minors and adults even in such a genetic isolate population.
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