Dental age in Central Poland

Individual dental and skeletal age assessment according to Demirjian and Baccetti: Updated norm values for Central-European patients

PURPOSE

Chronological age often differs from dental and skeletal age. With orthopantomograms and lateral cephalograms, dental and skeletal development can be determined according to the methods published by Demirjian et al. and Baccetti et al. However, gender and skeletal class as possible confounders were frequently not considered and available norm values are not up-to-date. This retrospective cross-sectional study thus aimed to evaluate effects of skeletal class and gender on dental and skeletal age of growing patients and to generate updated norm values for contemporary Central-European patients.

METHODS

A total of 551 patients were included in the dental and 733 in the skeletal age assessment, respectively. Dental analysis was based on tooth mineralisation stages in orthopantomograms (Demirjian) and skeletal age was defined by cervical vertebrae maturation stages (CVMS) in lateral cephalograms (Baccetti). Skeletal class was determined by the individualised ANB angle of Panagiotidis/Witt. With nonlinear regression analysis a formula for determining dental age was established. Effects of gender and skeletal class were evaluated and updated norm values generated.

RESULTS

Inter- and intrarater reliability tests revealed at least substantial measurement concordance for tooth mineralisation and CVMS. Demirjian stages and CVMS significantly depended on gender with girls developing earlier. Skeletal class significantly affected skeletal age only, but without clinical relevance. Updated norm values for dental age differed significantly from the original values of Demirjian and the values for skeletal age differed from those published by Baccetti.

CONCLUSION

Optimised norms, separated by gender, increase precision in determining individual dental and skeletal age during orthodontic treatment planning. Further studies analysing the effect of skeletal class on dental and skeletal development are needed.

Correlations between Dental Age, Skeletal Age, and Mandibular Morphologic Index Changes in Turkish Children in Eastern Anatolia and Their Chronological Age during the Pubertal Growth Spurt Period: A Cross-Sectional Study

In age determination, different methods aiming to obtain the closest result to chronological age have been investigated so far. The most commonly used one among these is the radiological method, which is usually used to evaluate the developmental stages of wrist bones or teeth. In our study, we assessed bone age estimations using the Gilsanz-Ratib atlas (GRA), which has recently become commonly used for children aged 9 to 15 years; evaluated the dental age, determined with Cameriere's European method; conducted morphometric measurements of the mandibular bone; and then examined their relationships with chronological age. The results of our study reveal that, in children during the puberty growth spurt, Cameriere's EU formula might have higher accuracy in estimating chronological age in younger age groups, while the GRA might be more accurate for older ages. Additionally, we conclude that of the mandibular morphometric measurements, condylar height and tangential ramus height show strong positive correlations with age. As a result, we conclude that the morphometric measurements evaluated in the present study can be used as auxiliary methods in forensic anthropology and forensic dentistry.

Dental Maturation in Two Groups of Children Born in 1969-1973 and 2005-2010

This study compared differences in dental maturation and dental age in Scandinavian children born in 1969-1973 and 2005-2010. The study was based on 130 ethnic Scandinavian children, who were divided in two groups corresponding to the time periods and matched on age and sex. Each group consisted of 65 children (30 girls, 35 boys, mean age 9.29 years and 9.30 years, respectively). Dental maturation was analysed by orthopantomographs, in accordance with Demirjian and Haavikko. Dental age was analysed by orthopantomographs in accordance with Demirjian. Boys and girls were analysed separately by linear regression analysis adjusted for age. For the children born in 2005-2010, teeth matured significantly earlier (Demirjian: 0.21 maturities, CI 95% 0.11-0.31, p < 0.000. Haavikko: maxilla: 0.39 maturities, CI 95% 0.21-0.56, p < 0.000. Mandible: 0.42 maturities, CI 95% 0.17-0.67, p = 0.001) and the dental age was significantly higher (Demirjian: 6.04 months, CI 95% 0.23-0.77, p < 0.000) in comparison with the children born in 1969-1973. In conclusion, the teeth of Scandinavian children born 2005-2010 matured significantly earlier than those of children born in 1969-1973. The results may prove valuable in forensic dentistry, pedodontics, and for the timing of pedodontic and orthodontic treatment.

The accuracy of Cameriere methods in Turkish children: chronological age estimation using developing teeth and carpals and epiphyses of the ulna and radius

The aim of the present study was to develop a specific formula by measuring the developing teeth, carpal bones, and epiphyses of the ulna and radius to determine the chronological age in Turkish children. The left developing permanent mandibular teeth were evaluated, and the number of teeth with closed apex was recorded. The distance between the inner sides of open apex/apices was measured by using the ImageJ program and divided by the tooth length. The sum of the normalized open apices was also calculated. The carpal area (Ca), covering the epiphyses of ulna and radius and the carpal bones, was measured on the X-rays of left hand. The areas of each carpal bone and epiphyses of the ulna and radius were measured, and these measurements were added together to obtain the bone area (Bo). The Bo/Ca ratio between the total area of carpal bones and the carpal area was calculated to normalize the measurements. The accuracy of the equations formulated by Cameriere was evaluated, and a new regression equation was developed accordingly. The new formula showed no statistically significant difference between the chronological and the estimated age for females, males, and total sample. The new formula, which hit the age with 72.80% accuracy, was more successful in predicting chronological age than other adjusted regression equations. The new regression model, created for the Turkish children by using both developing teeth and hand-wrist bones, was considerably successful in estimating the chronological age.

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

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

The Broad Variability in Dental Age Observed among Childhood Survivors Is Cancer Specific

PURPOSE

The study aimed to assess the differences in dental maturation between childhood cancer survivors and healthy children.

Materials and Methods

Fifty-nine cancer patients including 16 (27.1%) girls and 43 (72.8%) boys, aged between 4 and 16 years, underwent dental and radiographic examinations. The mean duration of anticancer therapy was 16.8 months (range, 1 to 47 months), and 4.6 years (range, 8 to 123 months) had passed since the termination of disease. The control group consisted of 177 panoramic radiographs of age- and sex-matched healthy individuals. Dental age (DA) was estimated with Demirjian's scale and delta age, i.e., DA-chronological age (CA), was used to compare groups.

RESULTS

The DA of cancer survivors was accelerated by almost 1 year compared to their CA (9.9±3.1 vs. 8.9±2.8, p=0.040). The greatest difference was observed among patients with brain tumor: delta (DA-CA) was 2.2±1.1 years. Among all cancer patients, only children with familial adenomatous polyposis (FAP)-associated hepatoblastoma (HP) demonstrated delayed DA, with regard to both other cancer survivors (p=0.011) and healthy patients (p=0.037). All four patients with HP suffered from FAP, and three of them had documented adenomatous polyposis coli (APC) genes mutation. The DA of cancer patients having teeth with short roots was significantly greater than that of the cancer survivors without this anomaly (12.8±3.2 vs. 9.0±2.4, p < 0.001).

CONCLUSION

DA in children may be altered by cancer disease.

Applicability of 2 Dental Age Estimation Methods to Taiwanese Population

The aim of this study is to assess the accuracy of Demirjian and Willems dental age estimation methods on a population of 8- to 15-year-old Taiwanese children. A total of 799 digital panoramic radiographs (404 boys, 395 girls) of children aged from 8.00 to 15.99 years are evaluated. All panoramic films are assessed by 2 examiners using Demirjian and Willems methods. We randomly select 48 panoramic films to evaluate the reproducibility of dental age measurements. The intraobserver and interobserver Cohen's kappa values are 0.733 and 0.762, respectively.The difference between chronological age and dental age is calculated for each individual using both methods. The result shows that Demirjian method slightly overestimates the chronological age of children. The mean age difference is 0.12 years for boys (standard deviation [SD], 0.80) and 0.21 years for girls (SD, 0.95). Willems method slightly underestimates the chronological age of children. The mean age difference is -0.22 years for boys (SD, 0.80) and -0.12 years for girls (SD, 0.92).In conclusion, Demirjian and Willems methods are both accurate for assessing dental age in the Taiwan region of China. The mean age differences of both methods are within ±1 year, which is acceptable at forensic odontology level. However, although the discrepancy between chronological age and dental age is frequently observed between -0.5 and 0.5 years in both methods, there is no guarantee it will be accurate for any particular individual, further modifications to both methods are suggested.

Contributions of the pars lateralis, pars basilaris and femur to age estimations of the immature skeleton within a South African forensic setting

Dental development and eruption sequences have prevailed as the gold standard in age estimations of previously unidentified immature individuals within a legal context. However, in the absence of the dentition, skeletal assessments have served as a frequently applied alternative. While various cranial and postcranial skeletal elements have been used in estimating age of the immature skeleton, little is known about the anthropometric value of the pars basilaris, pars lateralis and femur as skeletal age estimation tools. Thus, this study aimed to assess if these bones of the immature human skeleton were useful elements in estimating the age of prenatal and postnatal individuals. These bones were excised from the remains of 74 unclaimed human immature individuals and evaluated using traditional anthropometric methods. The study sample was sourced from the Johannesburg Forensic Pathology Services (JFPS) and the Johannesburg Forensic Paediatric Collection (JFPC), University of the Witwatersrand and subdivided into an early prenatal (younger than 30 gestational weeks); late prenatal (30 to 40 gestational weeks) and postnatal (birth to 7.5 months) age ranges. Statistically significant differences (p ≤ 0.05) were found when assessing the maximum length, sagittal length, maximum width and distal width of the bones across each of the age ranges (30 gestational weeks to 7 postnatal months). The cranial and postcranial skeletal elements investigated in this study provide a valuable contribution to skeletal ageing in African individuals.

Dental age assessment of 3-15-year-old Saudi children and adolescents using Demirjian's method-A radiographic study

Dental age assessment plays a pivotal role in clinical practice, demographic studies, forensics, and courts of law but is affected by ethnic and geographic variations. The aim was to determine the population-specific weighted scores needed when dental age is estimated using Demirjian's method for Saudi children and adolescents between the ages of 3 and 15 years. Design: A total of 298 panoramic radiographs were collected from Saudi Arabia. Dental age was assessed using Demirjian's method (1973). Chronological age was determined from the date of birth and the date on which the panoramic radiograph was taken for each individual. Between 3- and 15-years age group, the Saudi boys had an estimated age of 9.07 ± 1.96 years and chronological age of 8.49 ± 2.30 years. The Saudi girls had an estimated age of 9.22 ± 1.93 years and chronological age of 8.78 ± 2.32 years. With Demirjian's method, the Saudi boys were 0.57 ± 1.48 years, and girls were 0.44 ± 1.66 years ahead of their chronological ages (p < .05). New population-specific weighted scores were developed to convert dental age according to Demirjian's method into estimated ages in the contemporary Saudi Arabian population. This study can be used for further research and comparisons with other population groups, regions or communities.

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

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

Dental development in a sample of South African HIV-positive children

AIMS

While oral soft tissue manifestations associated with HIV-infection in children are well documented, few studies have investigated the dental development of this group. The aim of this study was to assess dental development in a sample of HIV-positive children in comparison with an age-matched HIV-negative control group.

METHODS AND RESULTS

The sample comprised 44 HIV-positive children and 44 HIV-negative children matched for age, gender, and ethnicity. An orthopantomograph (OPG) of each patient was assessed in order to calculate the dental age. The mineralization stages of teeth were used to calculate the dental age using tables formulated by Phillips and van Wyk-Kotze for this grouping. Results showed that dental development for both groups were similar to the dental age-related tables. HIV-positive children between 8 and 10 years of age showed significantly advanced dental development (p = 0.04). HIV-positive females showed significant advancement in dental age as compared to their chronological ages. Thirty-six (81.8%) HIV-positive children were on antiretroviral (ARV) drugs.

CONCLUSION

HIV-positive children presented stages of dental development in accordance with their chronological ages and in tandem with that of the HIV-negative controls.

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

Background

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

Material/Methods

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

Results

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

Conclusions

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

Accuracy of the Demirjian and Willems methods of dental age estimation for children from central southern China

The aim of this study was to compare the accuracy of the Demirjian method and the Demirjian method as revised by Willems for age estimation based on orthopantomograms from central southern Chinese Han population aged 8-16 years. Discrepancies between chronological and estimated ages were statistically evaluated by analyzing 1249 orthopantomograms from 603 girls and 646 boys. Using the Demirjian method, the mean age estimates underestimated chronological age by 0.03 years (p = 0.48) for girls and overestimated it by 0.03 years (p = 0.59) for boys; these differences with respect to chronological age were not statistically significant. In contrast, the Willems method underestimated chronological age by 0.54 years (p < 0.01) for girls and 0.44 years (p < 0.01) for boys; these differences with respect to chronological age were statistically significant. Compared to the Demirjian method, the overall mean absolute error generated using the Willems method was slightly higher (0.85 and 0.86 years, respectively). Since the Demirjian method was more accurate, we highly recommend that it should be applied when estimating dental age in the Chinese Han population. Further modifications of these two methods for populations from other regions and additional studies of other age groups are warranted.

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

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

Some inconsistencies in Demirjian's method

Nowadays, given the massive migration movements toward and across EU countries, age assessment can be highly useful for estimating the real age of asylum seekers or in medico-legal assessments of age-disputed children charged with criminal acts. Demirjian et al.'s dental maturity score is currently a dental scoring system universally adopted for age assessment of unidentified children. Here we explore the biological compatibility of Demirjian's scores with respect to the estimation of certain chronological ages of forensic interest through an algorithm based on the theory of constrained graphs integrated with combinatory analysis. Rather than simply respect Demirjian's indications (direct method) on a sample of children, we followed a reverse procedure (indirect method) as follows: i. chronological age selection and identification of the corresponding maturity score (MS); ii. determination of all the possible combinations of dental maturity stages whose sum of the scores is equal to the MS under consideration; iii. checking for all such possible combinations the biological congruity of the state of maturity of each tooth compared to the chronological age initially chosen. By evidencing dental development inconsistencies, our mathematical approach explains why Demirjian's method typically overestimates age. Therefore, even if the method in question remains the recommended way to assess individual dental maturity, it should definitely be considered unsuitable for application in certain forensic scenarios, particularly as regards the most disputed age range 14-16 years.

Analysis of Dental Maturation in Relation to Sagittal Jaw Relationships

Background

The degree of mineralization of permanent tooth germs in dental age assessment has been an area of interest among many authors for years. However, only recently have researchers attempted to determine the potential interdependencies between dental age and jaw relationships. The aim of this work was to compare dental maturation in patients with skeletal Class II to patients with skeletal Classes I and III.

Material/Methods

The study involved 150 patients who sought orthodontic treatment. Dental age was assessed from panoramic radiographs using the Demirjian’s method. Skeletal class was evaluated according to the value of the ANPg angle from the Björk’s analysis. We used the analysis of variance (ANOVA) and the Student’s t-test.

Results

The mean dental age in patients with skeletal Class III was significantly higher than the mean dental age in patients with skeletal Class II (p<0.0005). A correlation between the dental age and chronological age was established. The weakest correlation was seen between the dental age and skeletal Class II. Among patients with skeletal Class II, the strongest correlation was found between chronological age and the formation of the germ of the second lower premolar (r=0.67; p<0.001).

Conclusions

Dental age among patients with skeletal Class II was the lowest.

Radiographic evaluation of dental age maturity in 3-17-years-old saudi children as an indicator of chronological age

OBJECTIVE:

This study was aimed to evaluate the dental age in Saudi children from panoramic radiographs using the Demirjian method to estimate their chronological age.

MATERIALS AND METHODS:

This retrospective cross-sectional study consisted of 1902 panoramic radiographs of 955 boys and 947 girls between the ages of 3–17 years. All children were placed in the age group closest to their chronological age. The dental age was scored on all seven left mandibular teeth by calibrated examiners. Bivariate analyses using the t-test and Pearson correlation were performed.

RESULTS:

There was significant difference in both boys and girls in all the age groups between their chronological age and dental age. Even though there was a slight overestimation in boys in some age groups and slight underestimation in girls in some groups, correlation analysis showed that there was a highly significant correlation between the chronological age and dental age for both boys (r² = 0.96, P < 0.001) and girls (r² = 0.98, P < 0.001). Moreover, correlation analyses for each age group showed a significant correlation between the chronological age and the dental age, using the Demirjian method, in most age groups (P < 0.01). When comparing the maturation score between boys and girls, the Student's t-test showed that there were no statistical differences between boys and girls in most age groups.

CONCLUSION:

Saudi boys and girls living in the western region of Saudi Arabia exhibited similar pattern of dental development when compared to the Demirjian method. Hence, the Demirjian method could be used as reference in children from the western region of Saudi Arabia.

Dental age assessment among Tunisian children using the Demirjian method

Context:

Since Demirjian system of estimating dental maturity was first described, many researchers from different countries have tested its accuracy among diverse populations. Some of these studies have pointed out a need to determine population-specific standards.

Aim:

The aim of this study is to evaluate the suitability of the Demirjian's method for dental age assessment in Tunisian children.

Materials and Methods:

This is a prospective study previously approved by the Research Ethics Local Committee of the University Hospital Fattouma Bourguiba of Monastir (Tunisia). Panoramic radiographs of 280 healthy Tunisian children of age 2.8–16.5 years were examined with Demirjian method and scored by three trained observers.

Statistical Analysis Used:

Dental age was compared to chronological age by using the analysis of variance (ANOVA) test. Cohen's Kappa test was performed to calculate the intra- and inter-examiner agreements.

Results:

Underestimation was seen in children aged between 9 and 16 years and the range of accuracy varied from −0.02 to 3 years. The advancement in dental age as determined by Demirjian system when compared to chronological age ranged from 0.3 to 1.32 year for young males and from 0.26 to 1.37 year for young females (age ranged from 3 to 8 years).

Conclusions:

The standards provided by Demirjian for French-Canadian children may not be suitable for Tunisian children. Each population of children may need their own specific standard for an accurate estimation of chronological age.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A Comparison of the Accuracy of Four Age Estimation Methods Based on Panoramic Radiography of Developing Teeth

Background and aims. Tooth development is widely used in determining age and state of maturity. Dental age is of high importance in forensic and pediatric dentistry and also orthodontic treatment planning .The aim of this study was to compare the accuracy of four radiographic age estimation methods. Materials and methods. Orthopantomographic images of 537 healthy children (age: 3.9-14.5 years old) were evaluated. Dental age of the subjects was determined through Demirjian's, Willem's, Cameriere's, and Smith's methods. Differences and correlations between chronological and dental ages were assessed by paired t-tests and Pearson's correlation analysis, respectively. Results. The mean chronological age of the subjects was 8.93 ± 2.04 years. Overestimations of age were observed following the use of Demirjian's method (0.87 ± 1.00 years), Willem's method (0.36 ± 0.87 years), and Smith's method (0.06 ± 0.63 years). However, Cameriere's method underestimated age by 0.19 ± 0.86 years. While paired t-tests revealed significant differences between the mean chronological age and ages determined by Demirjian's, Willem's, and Cameriere's methods (P < 0.001), such a significant difference was absent between chronological age and dental age based on Smith's method (P = 0.079). Pearson's correlation analysis suggested linear correlations between chronological age and dental age determined by all four methods. Conclusion. Our findings indicated Smith's method to have the highest accuracy among the four assessed methods. How-ever, all four methods can be used with acceptable accuracy.

Radiographic evaluation of dental age using Demirjian's eight-teeth method and its comparison with Indian formulas in South Indian population

Aim:

The study was conducted to evaluate the applicability of Demirjian method and its comparison with Indian formulas for estimation of dental age in subjects attending a dental school in South India.

Materials and Methods:

A total of 250 individuals (130 males and 120 females) between 7 and 18 years, with orthopantamographs were included in the study. Chronological age was recorded based on subject's date of birth. Dental age was estimated using Demirjian's and Indian formulas. All the data obtained was entered into spreadsheet and subjected to statistical analysis.

Results:

The mean chronological age of the study sample was 12.39 ± 3.32 years; while the mean age obtained from Demirjian's method and Indian-specific regression formula were 11.56 ± 3.17 years and 14.20 ± 3.24 years, respectively. In the present study, the Demirjian's method under estimated dental age by 0.84 years in males and 0.83 years in females (P < 0.05). Indian-specific regression formulas overestimated dental age by 1.72 years in males and 1.91 years in females (P < 0.05).

Conclusion:

The published Demirjian's and Indian-specific regression formulas are not applicable to the present study group. Hence population-specific cubic regression formulas were developed for males and females in Bhimavaram town (South India).

The reliability of Cameriere's method in Turkish children: a preliminary report

Dental age estimation in children is an important issue both legally and medically. Currently, however, there is a lack of contemporary dental age estimation standards for a Turkish population. This study assessed the accuracy of Cameriere's method by examining the panoramic radiographs of 573 healthy Turkish children between the ages of 8 and 15 years. Radiographs of the left permanent developing mandibular teeth, except wisdom teeth, were evaluated. All subjects were divided into 7 groups according to their chronological age. The Intra-class Correlation Coefficient was used to determine the intra- and inter-observer agreement error. A comparison of the distributions of estimation errors among age groups was performed using the Nemenyi test. There were no significant differences between inter-observer (p=0.352), and intra-observer readings after 2 weeks (p=0.275 and p=0.273, respectively). The dental age was underestimated when using Cameriere's method with a mean difference of -0.35 years (-0.24 years for girls and -0.47 years for boys). The median values of the differences between dental and chronological age were -0.44 years in boys (range: -3.70, 4.06) and -0.21 years in girls (range: -2.74, 3.29). In addition, the differences between dental and chronological ages in the different age groups decreased with increasing chronological age. Results from the Nemenyi test implied that Cameriere's method is more accurate for girls than for boys in this cohort of a Turkish population.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Testing international dental maturation scoring system and population-specific Demirjian versions on Saudi sub-population

Objectives: The purpose of this study was to test the applicability of the Demirjian method and revised versions for estimating chronological age (CA) from dental age (DA) in a sample of children. Study Design: A sample of 252 individuals of known age (4 to 14 yrs), sex (males: 125, females: 127), and ethnicity (Saudi) was collected. Each individual was aged using the original Demirjian method and revised versions, including Saudi, Kuwaiti, Belgian, and revised international curves. The differences between dental age and chronological age were analyzed using paired sample t-tests with Bonferroni corrections and multinomial regression tests at the 0.05 level of significance. Results: The results indicated an over-aging of the sample as a whole by about 10 months using Demirjian tables, 5.5 months using Kuwaiti tables, 24.7 months using Belgian tables, and 5 months using revised international tables. The sample was under-aged by 0.6 month using Saudi tables. The overall discrepancies between CA and DA were statistically significant (P < 0.0001) for all methods with the exception of Saudi curves. Conclusions: The findings suggest that the Saudi population method is most accurate on a Saudi population.

Key words:Age estimation, juvenile, forensic dentistry, Saudi Arabia.

Dental maturity of Saudi children: Role of ethnicity in age determination

Purpose

Demirjian's dental maturity scores and curves have been widely used for human age determination. Several authors have reported considerable differences between the true and estimated age based on the Demirjian curves, which have been accounted for by ethnicity. The purpose of the current study was to assess the role of ethnicity-specific dental maturation curves in age estimation of Saudi children.

Materials and Methods

A sample of 452 healthy Saudi children aged 4 to 14 years were aged based on the original French-Canadian Demirjian curves and several modified Demirjian curves specified for certain ethnic groups: Saudi, Kuwaiti, Polish, Dutch, Pakistani, and Belgian. One-way ANOVA and a post hoc Scheffé's test were used to assess the differences between chronological age and dental age estimated by the different curves (P<0.05).

Results

The curves designed for Dutch, Polish, Saudi, and Belgian (5th percentile) populations had a significantly lower error in estimating age than the original French-Canadian and Belgian (50th percentile) curves. The optimal curve for males was the Saudi one, with a mean absolute difference between estimated age and chronological age of 8.6 months. For females, the optimal curve was the Polish one, with a mean absolute difference of 7.4 months. It was revealed that accurate age determination was not related to certain ethnicity-specific curves.

Conclusion

We conclude that ethnicity might play a role in age determination, but not a principal one.

Dental age assessment validity of radiographic methods on Serbian children population

In order to establish reliable age estimation method based on dental development, various correlations between chronological age and real growth were tested. Demirjian's scheme was mostly used, but lately the Willems' method has been found to be more reliable. The aim of this study was to evaluate the accuracy of Demirjian's and Willems' methods for dental age estimation in Serbian children population. The study sample encompassed panoramic radiographs of 686 children (322 boys and 364 girls) with age range from 4 to 15 years. The dental age was assed using Demirjian's and Willems' maturity scores. Statistical analysis was performed to test the accuracy of investigated methods by comparing the mean chronological and mean estimated age in total sample, as well as in each group comprising individuals within one-year-age-interval. Both methods showed discrepancy between obtained and chronological age. The Demirjian's method overestimated age with a mean accuracy of 0.45 in boys and 0.42 in girls, while Willems' method showed lower discrepancy (0.12 and 0.16 in boys and girls, respectively). Overall, both methods were unsatisfactory in some age groups, however, Willems' method provided more accurate age estimation in majority of categories. In summary, our results suggest that Willem's method was more accurate for estimating dental age in contemporary Serbian children population.

A new method to estimate dental age

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Applicability of Greulich and Pyle and Demirijan aging methods to a sample of Italian population

Age estimation in forensics is essential in cases involving both living and dead subjects. For living subjects, age estimation may be used to establish an individual's status as a minor in cases involving adoption, criminal responsibility, child pornography, and those seeking asylum. Criteria for age estimation in the living have recently been put forth by The Study Group on Forensic Age Diagnostics. The group has proposed guidelines with a three-step procedure: a physical examination and anthropometrical analysis; dental analysis by orthopantomogram (OPG); and X-ray study of the left hand and wrist. The board of FASE highlighted advantages and limits of each method, and suggested practical solutions concerning the age estimation process for adults and subadults. The aim of this study was to verify the applicability of the Greulich and Pyle, and Demirjian techniques on a sample group of Italians, whose ages were known, in determining the skeletal and dental age, in addition to evaluating the reliability of these techniques. 535 subjects between the ages of 7 and 15years were examined, each one undergoing both an orthopantomography (OPG) and radiography of the left wrist and hand. The data obtained underwent statistical analysis. The analyses have shown that a correlation exists between skeletal and dental age, and real age. Age estimation carried out using the Greulich and Pyle method has shown itself to be especially accurate on the Italian sample, particularly in the age ranges of 7-9years and 10.4-11.5years. The Greulich and Pyle method has shown itself to be reliable for the sample analyzed notwithstanding the ethnic differences between the original sample of reference and those analyzed in this study. Application of the Demirjian technique resulted in an overestimation of dental age. This difference is shown to be more highly significant in the higher age ranges. The combination of the Greulich and Pyle, and Demirjian methods have revealed a difference regarding real age, which turns out to be more modest in the younger age ranges and more significant in older subjects.

Orthopantomographic evaluation of canine and first premolar using Demirjian's stages in central India: new approach to forensic age estimation

Teeth development is widely used for age estimation in forensic science. The aims of this study were as follows: first, to establish Indian data on canine and first premolar development for age estimation and second, to investigate population differences in teeth development. Orthopantomograms of 340 Indian children aged between 5 and 14 years were analyzed. Demirjian's stages were recorded for the developmental evaluation of canine and first premolar and for further descriptive statistical analysis. A two-way ANOVA was performed to test the significance of difference in teeth development by sex and stage. A one-way ANOVA was performed to investigate population differences in teeth development. Results showed statistically significant differences in teeth development by sex and stage. Accordingly, teeth development was earlier in girls. No statistically significant differences were observed in timings of Demirjian's stages among different populations. In conclusion, the findings of this study could be used for age estimation of Indian children.

Estimation of dental age and its comparison with chronological age: accuracy of two radiographic methods

INTRODUCTION

Accurate age data are always necessary in medicine and dentistry, and are also important to assess maturity and estimate age in a number of disciplines, such as forensic odontology, paediatric and preventive dentistry, orthodontics, etc.

AIM

This investigation determines the accuracy of dental age estimation and its comparison with chronological age by two methods: Demirjian's and Willems'.

MATERIALS AND METHODS

Tooth development was assessed in seven left mandibular teeth from 215 orthopantomograms (OPGs) belonging to healthy children aged 6-15 years selected by convenience sampling, from patients of the Sudha Rustagi College of Dental Sciences & Research, Faridabad, and were staged according to Demirjian's and Willems' scales. The statistical analysis was performed using the unpaired 't'-test and the correlation was analysed using Karl Pearson's correlation coefficients test.

RESULTS

Overall, Willems' method was found to be more accurate with a mean age overestimation of 0.36 years (SD = 0.38) in boys and 0.24 years (SD = 0.36) in girls, and Demirjian's method produced a mean overestimation of 0.66 years (SD = 0.41) in boys and 0.56 years (SD = 0.43) in girls, respectively. Also, correlation between the two methods revealed a high coefficient value, 0.9947 for boys and 0.9944 for girls (P < 0.05).

CONCLUSION

Despite the favourable result of Willems' method in comparison with Demirjian's method, this study demonstrated a high correlation coefficient between both chronological and obtained dental age, thus confirming their potential applicability in clinical practice and forensic dentistry.

Permanent teeth development in a Spanish sample. Application to dental age estimation

The purpose of this study is to clarify the chronology of different stages of dental development, according to Demirjian, in a sample of Spanish children, which will enable us to build a database that will be used as a reference in regard to the dental development of individuals of our socio-geographic environment. In the same studied sample, a calculation of the dental age according to Demirjian was carried out. This study was conducted in a final sample consisting of 1010 orthopantograms, corresponding to Spanish children (485 boys and 525 girls) ages 2-16. Comparing the age of onset of the different stages among the children, evidence was found that girls had an earlier general development than boys. These differences were only statistically significant in teeth and concrete stages. The canine teeth revealed greater gender dimorphism, with significant differences in all stages compared with the upper canines. The method proposed by Demirjian for dental age calculation resulted in a significant overestimation of dental age in relation to the chronological age in boys (average of 0.87 years) and girls (average of 0.55 years). Data from this study may be used as reference for dental maturity, as well as a standard for estimating age in Spanish children.

The "blind age assessment": applicability of Greulich and Pyle, Demirjian and Mincer aging methods to a population of unknown ethnic origin

PURPOSE

Age estimation is one of the most crucial issues in case of unknown deceased as well as in the living and is very frequently of radiological interest. Three methods for age estimation have been designated as the most reliable among the others: Greulich and Pyle, Demirjian and Mincer. The literature provides several studies concerning their applicability in different geographic contexts. However, not always can ancestry be ascertained, for example, in the case of badly preserved corpses. In these cases, age assessment must be performed without the corrections suggested by the literature for different ethnic groups. One may therefore wonder how reliable the result of age assessment performed without knowing the racial group to which the subject belongs may be. This study aimed at testing the applicability of the Greulich and Pyle Atlas, the Demirjian and the Mincer methods on a mixed population to compare skeletal and dental methods of age estimation.

MATERIALS AND METHODS

X-ray films of 167 subjects aged between 4 and 31 years from more than 18 countries were recruited. One hundred and nine orthopantomographs (OPG) of children aged between 4 and 15.5 years were evaluated by Demirjian's method; whenever the highest Demirjian score was reached (31 cases), the Mincer method was applied. The skeletal maturation of 54 subjects aged between 7 and 19 years was determined by the Greulich and Pyle method.

RESULTS

The lowest average variance from chronological age was shown by the Greulich and Pyle method, followed by Demirjian. The Mincer method showed very high mean variances.

CONCLUSIONS

Mean variances from the different methods do not significantly differ from data reported in the literature and demonstrate that the reliability of Demirjian, and Greulich and Pyle as they stand may be applied satisfactorily to remains or individuals of unknown ethnic origin.