Dental age estimation using Demirjian and Willems methods: Cross sectional study on children from the Former Yugoslav Republic of Macedonia

Machine learning and regression analysis for age estimation from the iliac crest based on computed tomographic explorations in an Indian population

Age estimation constitutes an integral parameter of identification. In children, sub-adults, and young adults, accurate age estimation is vital on various aspects of civil, criminal, and immigration law. The iliac crest presents as a suitable age marker within these age cohorts, and the modified Risser method constitutes a relatively novel and unexplored method for iliac crest age estimation. The present study attempted to ascertain the applicability of this modified method for age estimation in the Indian population, an aspect previously unexplored, through computed tomographic examination of the iliac crest. Computed tomography scans of consenting individuals undergoing routine examinations of the pelvis/ abdomen for various clinically indicated reasons were collected and scored using the modified Risser stages. Computed tomographic examinations of the iliac crest indicate that the recalibrated method accurately depicts the temporal progression of ossification and fusion changes. Different regression and machine learning models were subsequently derived and/or trained to evaluate the accuracy and precision associated with the method. Amongst the ten regression models derived herein, compound regression exhibited the lowest inaccuracy (4.78 years) and root mean squared error values (5.46 years). Machine learning yielded further reduced error rates, with decision tree regression achieving inaccuracy and root mean squared error values of 1.88 years and 2.28 years, respectively. A comparative evaluation of error computations obtained from regression analysis and machine learning illustrates the statistical superiority of machine learning for forensic age estimation. Error computations obtained with machine learning suggest that the modified Risser method is capable of permitting reliable age estimation within criminal and civil proceedings.

Accuracy of Age Estimation Using Three Dental Age Estimation Methods in a Young, Large, and Multiethnic Patient Sample

European countries have become host countries for migrants and unaccompanied minors. However, many migrants arrive without identity documents. Many methods exist to estimate age; among them, several methods using dental age have been proposed. Our objective was to evaluate the accuracy of biological age determination in a multiethnic sample using dental age estimated using three methods: Nolla, Demirjian, and the London Atlas. Orthopantomograms collected for 324 patients of various ethnicities aged from 4 to 20 years old were included. Then, for each orthopantomogram, a blind trained examiner used the three methods of age estimation. For each method, the estimated mean age was greater than the real mean age (p < 0.0001). The accuracy after 18 years old with a 1-year margin was under 50%. Demirjian's method gave a less accurate estimated age than Nolla's method (p < 0.0001) or the London Atlas (p < 0.001). The most accurate methods were those of Nolla and the London Atlas, with average absolute deviations of 1.3 and 1.2 years, respectively. Demirjian's method was much less accurate, with a deviation of around 2 years. The evaluated methods are unable to provide reliable information to determine if an individual is a minor.

Radiographic dental age estimation applying and comparing Demirjian's seven (1973) and four (1976) teeth methods

To apply Demirjian's seven (1973, D7) and four (1976, D4) teeth methods in a sample of Brazilian children and compare their performances for age estimation. Panoramic radiographs of 1200 children (600 females and 600 males) were collected from Southeast Brazil. The children were equally distributed (n = 60 females and 60 males) between age intervals of 1 year between 6 and 15.9 (mean age = 10.9; standard deviation [SD]: 2.9) years. D7 and D4 dental age estimation methods were applied by two observers and were compared based on their error rates (error = estimated age-chronological age). Both methods overestimated the chronological age (p < 0.0001). D7 led to overestimations of 0.71 (p < 0.0001) in females and 0.83 (p < 0.0001) in males, while the overestimations with D4 were 0.14 (p = 0.0067) and 0.73 (p < 0.0001) for females and males, respectively. The mean age estimated by D7 was 11.7 (SD: 3.1) years, while for D4, it was 11.3 (SD: 3.3) years. Intra- and interobserver agreement was ≥ 0.98. D4 optimized the performance of radiographic dental age estimation compared to D7. Improvements were reflected in the total sample and separately for female and male children from Southeast Brazil.

The Cameriere, Haavikko, Demirjian, and Willems methods for the assessment of dental age in Croatian children

AIM

This study aimed to evaluate the accuracy and precision of the Cameriere European formula, Demirjian, Haavikko, and Willems methods for estimating dental age in a sample of children with permanent dentition in Croatia.

MATERIAL AND METHODS

The study consisted of a sample of 1576 panoramic radiographs; a sub-sample of 84 OPGs, in which all first seven mandibular teeth were maturated, was excluded from the study. A final sample of 1492 (704 males and 788 females) aged 6.0 to 13.9 years was evaluated. Seven mandibular teeth from the left side of the mandible were analyzed, and dental age (DA) was determined by the Cameriere European formula, Demirjian method from 1976, Haavikko, and Willems methods and compared to chronological age (CA). In addition, the mean age difference (DA-CA), the mean absolute error (MAE) between dental and chronological age, the percentage of the individuals of dental age within ± 0.25 to ± 2 years of chronological age, and intra-observer and inter-observer statistics were calculated.

RESULTS

The Cameriere European formula estimated the best dental age compared to the chronological age; the mean underestimation was - 0.4 years for both sexes, Haavikko underestimated by - 0.17 years, while Demirjian and Willems overestimated by 1.02 years and 0.48 years, respectively. The most significant difference showed the Demirjian method in 11-year-old and 12-year-old females. The MAE were 0.50 years, 1.01 years, 0.61 years, and 0.78 years in males and 0.51 years, 1.18 years, 0.61 years, and 0.70 years in females for the Cameriere European formula, Haavikko, Willems, and Demirjian methods, respectively. Furthermore, the Cameriere European formula showed the highest proportions of individuals with DA within ± 0.5 year difference of the CA, 61.5% in males and 59.6% in females. In addition, the Cameriere method showed the best intra-observer and inter-observer agreements.

CONCLUSIONS

Although the Demirjian method was used previously in Croatian children for legal, medical, and clinical purposes, the Cameriere European formula, Haavikko, and Willems were more accurate in the tested sample. According to our findings, the Cameriere European formula showed the best accuracy and precision in dental age assessment in Croatian children following Haavikko, and we recommend it as the method of the first choice in forensic and clinical analyses.

Validity of age estimation methods and reproducibility of bone/dental maturity indices for chronological age estimation: a systematic review and meta-analysis of validation studies

Several approaches have been developed to estimate age, an important aspect of forensics and orthodontics, using different measures and radiological examinations. Here, through meta-analysis, we determined the validity of age estimation methods and reproducibility of bone/dental maturity indices used for age estimation. The PubMed and Google Scholar databases were searched to December 31, 2021 for human cross-sectional studies meeting pre-defined PICOS criteria that simultaneously assessed the reproducibility and validity. Meta-estimates of validity (mean error: estimated age-chronological age) and intra- and inter-observer reproducibility (Cohen’s kappa, intraclass correlation coefficient) and their predictive intervals (PI) were calculated using mixed-effect models when heterogeneity was high (I² > 50%). The literature search identified 433 studies, and 23 met the inclusion criteria. The mean error meta-estimate (mixed effects model) was 0.08 years (95% CI − 0.12; 0.29) in males and 0.09 (95% CI − 0.12; 0.30) in females. The PI of each method spanned zero; of nine reported estimation methods, Cameriere’s had the smallest (− 0.82; 0.47) and Haavikko’s the largest (− 7.24; 4.57) PI. The reproducibility meta-estimate (fixed effects model) was 0.98 (95% CI 0.97; 1.00) for intra- and 0.99 (95% CI 0.98; 1.00) for inter-observer agreement. All methods were valid but with different levels of precision. The intra- and inter-observer reproducibility was high and homogeneous across studies.

Computed tomographic evaluation of the acetabulum for age estimation in an Indian population using principal component analysis and regression models

The acetabulum presents as a well-preserved evidence, resistant to taphonomic degradation changes and can thus aid in the age estimation process. A CT-based examination of the acetabulum can further help simplify the process of age estimation by overcoming the time-consuming process of maceration and by doing away with the interference resulting from tissue remnants. The aim of the present study was to evaluate the role of the acetabulum for age estimation in an Indian population through a CT-based examination, using principal component analysis and regression models. CT images of 400 individuals aged 10 years and above were evaluated according to the features defined in the San-Millán-Rissech method of age estimation. Five of the seven morphological features defined by San-Millán-Rissech were appreciable on CT scans, and, to enable further statistical analysis, a cumulative score was computed using these five features. A significant correlation of 0.835 and 0.830 for the right and left acetabulum, respectively, was obtained between computed cumulative scores and chronological age of individuals. No significant sex differences were observed in the scoring of different age-related morphological changes. Regression models were generated using individual features and cumulative scores. Regression models derived using the cumulative score yielded inaccuracy values of 9.67 years for the right acetabulum and 9.15 years for the left acetabulum. Inaccuracy and bias values were computed for each individual feature, as well as for each decade, using mean point ages established within the original study. Amongst the various features, acetabular rim porosity was seen to have the lowest values of inaccuracy (11.50 years) and bias (2.32 years) and activity on outer edge of acetabular fossa the highest (inaccuracy and bias values of 22.36 years and 21.50 years, respectively). Taking into consideration this differential contribution towards age estimation, weighted coefficients and mean point ages for different morphological features were determined using principal component analysis. Subsequently, summary age models were generated from the obtained weighted coefficients and mean age values. Summary age models derived in the present study yield lower estimates of inaccuracy of 7.60 years for the right acetabulum and 7.82 years for the left acetabulum. While regression models derived in the present study allow for age estimation using even a single appreciable feature, summary age models take into account the contribution of each feature and generate more accurate estimates of age. Both statistical computations yield reduced error rates and thus can render greater applicability to the acetabulum in forensic age estimation.

Validation of the Italian, European, North German, Malaysian, and South African black formulas on Cameriere method using panoramic radiographs in Kenyan children

This study aimed to validate the accuracy of five different formulas based on the Cameriere method for age estimation in Kenyan children. We analyzed panoramic radiographs of 350 Kenyan children (184 males and 166 females) aged between 6 and 13 years. The dental development of each child was estimated by the analysis of the first seven left permanent teeth in the left mandible. Dental age was calculated by the Italian, European, North German, Malaysian, and South African black formulas previously published in peer-review journals. The children's mean chronological age (CA) was 9.34 ± 2.02 years and 9.26 ± 2.01 years for males and females. In males, the South-African formula overestimated CA least, by 0.12 years, followed by the Italian formula by 0.22 years, the European formula by 0.37 years, the Malaysian formula by 0.48 years, and the North-German formula overestimated the most, by 0.57 years. In females, the South-African formula underestimated CA by - 0.12 years. The Italian overestimated by 0.12 years, followed by the North-German formula by 0.29 years, the European formula by 0.31 years, and the Malaysian formula by 0.40 years. The Italian formula provided the best accuracy in the absolute difference within ± 1 year, by 75.72% and 75%, following the North-German formula by 66.47% and 70.27% for males and females, respectively. Therefore, the findings suggest that the Italian formula best estimates dental age in Kenyan children.

Dental age estimation with fewer than mandibular seven teeth: An accuracy study of Bedek models in Turkish children

OBJECTIVES

One or more missing teeth, such as hypodontia, make it difficult to obtain accurate results in age estimation methods. This paper aims to test the accuracy of the models developed by Bedek et al. that can estimate age with fewer than seven teeth for Turkish children.

MATERIALS AND METHODS

Panoramic radiographs of 1118 children (540 girls and 578 boys) aged between 6 and 16 years were evaluated using the Willems method and Bedek models for the entire sample and for different ages and sexes. Differences between dental age (DA) and chronological age (CA) calculated for all methods for each sex and all age groups were analyzed the paired sample t-test and Wilcoxon signed rank test. The accuracy of the DA estimation methods was determined by the proximity of DA to CA by calculating mean absolute error (MAE).

RESULTS

While all Bedek models underestimated CA by 0.2 to 0.1 years, the Willems method overestimated CA by 0.3 years. DA-CA difference in the total sample and girls was statistically significant in all methods. In the total sample, the seven- and four-teeth models had the lowest MAE, while the one-tooth model had the highest MAE.

CONCLUSIONS

Seven- and four-teeth models were the most suitable for age estimation, and all models except the one-tooth model were found to be more accurate than the Willems method in northwestern Turkish children.

CLINICAL RELEVANCE

Especially in children with hypodontia, it may be possible to estimate DA with the use of Bedek models.

Validity of the Demirjian Method for Dental Age Estimation in Romanian Children

Dental age assessment is useful in various medical fields. The Demirjian method for dental age estimation is one of the most widely used in the field of pediatric dentistry. The aim of this study was to verify the accuracy of the Demirjian method in determining age in a sample of girls and boys from Oradea, Romania. This retrospective and radiographic study was based on the evaluation of 1006 panoramic radiographs, belonging to 1006 patients (431 boys and 575 girls) with ages between 3 and 13.9 years from the city of Oradea, Romania. They were collected from three private dental practices from Oradea and were analyzed between 1 September 2021, and 10 November 2021. The patients were distributed into 11 age groups, each group spanning over one year (e.g., 3−3.9, 4−4.9). For the assessment of dental age, the Demirjian method was used, which is based on the evaluation of the developmental stages of the lower left permanent teeth. The mean chronological age of the patients was 9.496 ± 2.218 years, and the mean dental age was 10.934 ± 2.585 years. The overestimation of dental age was obtained in all age groups for the entire sample. As such, dental age was higher than chronological age, with values varying from 0.34 years in the 3−3.9 years age group to 1.7 years in the 10−10.9 years age group. In girls, dental age was higher than chronological age, with values varying from 0.46 years in the 3−3.9 years age group to 1.73 years in the 11−11.9 years age group, while in boys, the values varied from 0.15 years in the first age group to 2.02 years in the 10−10.9 years age group. The comparison of the differences between chronological age and dental age according to the gender of the patients revealed that the distribution of the differences was nonparametric in both groups according to the Shapiro−Wilk test (p < 0.05). The differences between the groups were not significant according to the Mann−Whitney U test. However, larger differences were identified for boys (1.46 years) than girls (1.417 years), with an overestimation of the dental age. The Demirjian method overestimated the age of the children included in the investigated sample, with different values for the different age groups investigated, and requires adaptations.

The Applicable Dental Age Estimation Methods for Children and Adolescents in Indonesia

Indonesia is an archipelagic country bordered by tectonically active zones with intense seismicity and volcanism. This condition is often associated with a high-risk situation of disasters in Indonesia. Forensic identification is a necessary procedure to reveal an individual's identity. An identity, including sex and age, is needed to build a conclusion of human identification. Dental age estimation is a subfield of forensic odontology which focuses on establishing an individual's age. Tooth development, biochemical, and postformation changes are the parameters for estimating dental age. This review discusses the applicable dental age estimation method for children and adolescents in Indonesia. Several articles that have previously studied dental age estimation in Indonesia were reviewed for this manuscript. On reviewing these articles, it was found that the Demirjian method, the Willems method, and the Al Qahtani method are useful in this population with higher accuracy than other methods.

Age Estimation in Children by the Measurement of Open Apices in Teeth: A Study in the Western Indian Population

In forensic sphere and clinical dentistry, age estimation is a topic of utmost importance. Various techniques are employed in children to determine age; however, dental development has proven to be an appropriate method because of its low variability. Cameriere's method is a widely accepted method of age estimation in children, which is carried out by measuring the projections of open apices and also the heights of developing permanent teeth seen on panoramic radiographs. The aim of this study is to establish a new formula for age estimation in the Western Indian population by measuring the open apices of mandibular teeth using Cameriere's European formula. For this study, we included 311 panoramic radiographs of healthy children living in Western India (Maharashtra, Gujarat, and Goa) aged 4–15 years which were analysed by two independent researchers. Seven left permanent mandibular teeth were assessed for length and width of open apices. Dental maturity was evaluated using measurements of the left seven permanent mandibular teeth (x_i = A_i/L_i, i = 1,…, 7), the sum of the normalized open apices (s), and the number (N0) of teeth with complete root formation. A linear relationship between open apices, N0, age, and other factors was evaluated with the aid of a stepwise multiple regression model. A stepwise linear regression showed that all parameters, gender, s, N0, and x₅, were significantly associated with age (R = 85%). No statistically significant difference was found between the predicted and actual chronological age of children in the age group of 4–13 years using the regression equation for the Western Indian population. The present research suggests that the new regression formula developed will be more accurate for age assessment in the Western Indian population.

Dental age estimation of Tibetan children and adolescents: Comparison of Demirjian, Willems methods and a newly modified Demirjian method

Tibetan ethnic group is one of the oldest ethnic groups in China and South Asia. This study set out to analyze the dental development and validate Demirjian method and Willems method in estimating dental age of Tibetan children and adolescents, and to modify Demirjian method based on Tibetan population to provide ethnic-specific reference data and a more reliable method for forensic age assessment in Tibetan ethnic group. In this study, 1951 samples aged between 4 and 15 years were retrospectively collected and analyzed. Multiple linear regression was used to establish relationship between chronological age (CA) and developmental stages of left mandibular permanent teeth. The accuracy of the modified method was tested and compared with that of Demirjian and Willems method. Results showed that dental maturity score (DMS) was significantly greater in girls than in boys in all age groups except for the 4-year age group (p < 0.05). Mean absolute error (MAE) was 0.96 years for both boys and girls by Demirjian method, and 1.06 and 1.16 years for boys and girls respectively by Willems method. Adjusted scores table was established and tested. The age of boys was overestimated by 0.13 years and the age of girls was underestimated by 0.06 years by the adjusted scores table. MAE was lower than that of the other two methods. In conclusion, Demirjian method and Willems method was not sufficiently accurate in estimating dental age of Tibetan population. The modified method was more suitable for dental age estimation of Tibetan population than Demirjian and Willems method.

Dental maturation in a Chinese sample using Demirjian method

BACKGROUND

Dental calcification information is relevant for clinical, archaeological, and forensic applications. However, dental maturity measurements in current cohorts of Chinese children are insufficient.

AIM

This study aimed to establish the mandibular dental maturity table and determine the accuracy of dental age estimation using the Demirjian method in a Chinese sample.

SUBJECTS AND METHODS

Permanent mandibular teeth, excluding the third molar, in 2091 panoramic radiographs of 1008 males and 1083 females aged 3-15 were graded, and dental age was estimated according to Demirjian's criteria. Age-of-attainment was calculated with probit regression for each stage by sex, and sex differences were analysed using the Mann-Whitney U test. Dental age was compared with chronological age using paired t-tests.

RESULTS

Although females showed earlier age-of-attainment than males, significant sex differences were only found in stages D-G (p < 0.05). The Demirjian method overestimated the dental age in both males (0.68 ± 1.05 years) and females (0.59 ± 0.97 years).

CONCLUSIONS

The relationship between mineralisation stage and chronological age in this study can be applied as a reference for mandibular dental maturity of Chinese children and adolescents. The Demirjian method overestimated the chronological ages of this sample.

Dental age, agenesis, and morphological anomalies in individuals with Van der Woude syndrome and isolated cleft palate

OBJECTIVES

To analyse the differences between dental age and chronological age and dental anomalies in individuals with Van der Woude syndrome (VWS) and compare with non-syndromic cleft palate (NSCP) and non-cleft controls.

MATERIALS AND METHODS

In total, 204 oral panoramic radiographs (118 girls and 86 boys) consisting of 51 VWS patients (age x̅ = 8.17 ± 1.34 years), 51 NSCP patients (age x̅ = 8.09 ± 1.41 years), and 102 normative non-cleft children (age x̅ = 8.62 ± 1.24 years) were collected. Dental stages were assessed by the Demirjian method, with the local dental maturity index as reference. Dental anomalies including agenesis were investigated. Statistical differences were determined by One-way ANOVA and regression. Repeatability was calculated by an intra-class correlation test and 95% confidence interval.

RESULTS

The difference between dental age and chronological age of the VWS group (0.12 years) and the NSCP group (0.09 years) was significantly lower than the non-cleft group (0.40 years) (P = 0.002). There was no significant difference between the VWS and NSCP groups (P = 0.885). Hypodontia was more prevalent in both the VWS group (37.25%, P = 0.0001) and the NSCP group (19.60%, P = 0.035) compared with the non-cleft group (5.88%). The odds for hypodontia in the VWS group were approximately double compared with the NSCP group. In VWS patients, the most commonly missing teeth were the permanent second premolars and the maxillary permanent laterals incisors. Peg-shaped teeth had a prevalence of 13.70% in VWS patients.

CONCLUSIONS

In VWS and NSCP patients compared with non-cleft children, the difference in dental age compared with chronological age decreased. Hypodontia occurs at a high prevalence in VWS and NSCP patients compared with non-cleft children.

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.

Dental age estimation: Demirjian's versus the other methods in different populations. A literature review

Age estimation is an important issue in forensic anthropology and odontology, since it is applied to both the living and the dead. Studies have shown that assessing tooth development using radiological methods is a reliable way to estimate age, especially in children. Demirjian's method is the most widely used estimation method for dental age evaluation. Over the years, many methods have been developed in order to asses which one predicts more accurately the age. In the literature, many populations were examined with these different methods and discordant results are described. This review aims to evaluate the studies in which Demirjian's method was compared with Willems', Cameriere's, Nolla's, Smith's, Haavikko's and Chaillet's methods in order to estimate the most accurate dental age estimation method in different populations. Using the methodology described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement, the authors conducted a review of existing literature using three databases: PubMed, Google Scholar and Google Scopus.

Analysis of 100 most cited articles on forensic odontology

OBJECTIVES

Bibliometric analysis of best-cited papers brings awareness about the influential publications and trends in the literature on a particular topic. This will help not only the researchers and academicians but also the students for selecting quality landmark articles. With this view in mind a bibliometric analysis was performed to identify the 100 top-cited papers on Forensic Odontology (FO) in the literature.

MATERIALS AND METHODS

A search was performed using Scopus database in August 2019. The articles were further reviewed and basic standard information related to bibliometric analysis was recorded.

RESULTS

The 100 most cited articles were published from 1985 to 2014 (77% published after 2001). The most frequently cited article received 259 citations, whereas the least received 31 (mean citations 58.78 ± 33.14). There were 16 different journals with Forensic Science International having the most number of articles (n = 36). One author had 16 articles while 8 authors had 4 or more articles published in the top 100 list. Belgium was the country with most number of articles (n = 17) followed by United States (n = 16). In terms of document type, 87 were original research, 7 conference papers and 6 reviews. Five organizations funded 5 of the top 100 articles. Katholieke Universiteit Leuven, Belgium affiliated the most documents (n = 16). Majority of the papers were related to age estimation (46) followed by victim identification (30), mass disaster (9), bite mark analysis (8), sex determination (5), race determination (4), dental DNA analysis (3), palatal rugae pattern (2) and lip prints (1).

CONCLUSION

This is first of its kind citation analysis of the 100 most cited articles in the field of FO. The results of this paper will help the researchers, academicians and students for appropriate article referrals.

Dental age estimation using Willems method: A cross-sectional study on children in a North Indian city

Background:

Numerous methods of age estimation have been proposed. The Demirjian method which was first applied in a French-Canadian population in 1972 is the most frequently used dental age estimation method. However, a constant over estimation using this method has been reported by numerous researchers. The Willems method is a modification of the above and was first applied in a Belgian Caucasian population in 2002. Several studies in the recent years found Willems method to be more accurate than the original Demirjians method.

Objectives:

The objective of this study was to evaluate the applicability of Willems method for dental age estimation in 6 -15-year-old North Indian children.

Methods:

The sample for this cross sectional study consisted of 390 OPGs of (215 boys and 175 girls) randomly selected from the patient records of a post graduate training dental college in North India. Exact chronological age of the subjects (in years and months) was calculated. The OPGs were used to score the seven mandibular teeth and dental age was estimated using the tables proposed in Willems method.

Results:

Significant correlation between the chronological age and dental age estimated using Willems method was observed in both males (r = 0.90) and females (r = 0.87). The mean difference between estimated DA and CA for males was 0.004 ± 1.08 years (P = 0.94). While for females, it was 0.031 ± 1.18 years (P = 0.72). The results showed no statistically significant difference between chronological age and dental age estimated using Willems method in the study population.

Conclusion:

Willems dental age estimation method without any modification can predict the chronological age of 6-15 year old North Indian children with good accuracy.

Forensic odontology: The prosthetic ID

The term “forensic science” involves forensic (or forensis, in Latin), which means a public discussion or debate. In a more modern context, however, forensic applies to courts or the judicial system. Combine that with science, and forensic science means applying scientific methods and processes to solving crimes. People can be identified by their fingerprints, foot creases, and from traces of their DNA from blood, skin, hair, saliva, and semen by DNA analysis. However, in situations where these records are unavailable or unusable due to the nature of the disaster, the dental records and aids prove to be useful for victim identification. This article aims at highlighting the importance of the dental records and the forensic odontology in the accurate and efficient identification of the conflict victims or deceased to serve as an important adjunct to the forensic medicine in a simplified manner.

The applicability of Willems dental age estimation method for Indonesian children population in Surabaya

Background

The applicability of dental age estimation has been expanded to meet a variety of medico-legal needs, law enforcement, and disaster victim identification. The objective of this study is to examine the applicability of the Willems method for Indonesian children.

Material and method

A total of 110 panoramic radiographs of the patients (6–14 years old) who met the inclusion criteria were obtained from the Department of Forensic Odontology and Department of Radiology, Universitas Airlangga, Indonesia. Estimated dental age (EDA) was assessed using the Willems method by two blinded examiners. The statistical analysis was carried out using IBM® SPSS® Statistics version 23.0 (IBM, Armonk, NY, USA).

Results and discussion

The mean of the chronological age (CA) in this study is 11.30 ± 1.43 years (boys) and 11.65 ± 1.55 years (girls). The overall mean difference between CA and EDA for boys and girls is − 0.08 ± 0.76 and − 0.31 ± 0.97, respectively. This study showed that the mean age difference in girls was more significant than in boys. The growth spurt timing between boys and girls might cause a difference in dental maturation, whereas the onset of the pubertal growth spurt in girls is about 2 years earlier than in boys. In general, girls start and finish their dental development earlier than boys end.

Conclusion

The present study suggests that the dental age estimation methods proposed by Willems can be considered as an applicable method for the children population in Surabaya, both boys and girls. However, a detailed study may be required while applying this approach to the 11–14-year-old girl population in Surabaya, as a substantial underestimation was observed in this community.

Age determination in children by orthopantomograph and lateral cephalogram: A comparative digital study

BACKGROUND AND AIMS

The assessment of age is useful in forensic medicine and forensic odontology and in treatment planning in various branch of dentistry. The aim of study is comparative evaluation and assessment of applicability of Demirjian's method, Willem's method of dental age (DA) estimation, and Maria de Paula Caldas's method of skeletal age estimation for children aged 9-16 years.

MATERIALS AND METHODS

A total of 140 individuals (70 females and 70 males) between the age group of 9-16 years were enrolled. These individuals were grouped by a difference of 1 year into 7 groups (each group comprising of 20 individuals: 10 males and 10 females). Dental age estimation was performed from orthopantomograph images of mandibular teeth of left quadrant by both Demirjian's and Willem's methods. Skeletal age estimation was done from Lateral Cephalogram by Caldas Digital Method. The differences between the chronological age and the estimated dental and skeletal ages were statistically tested using paired t-test.

RESULTS

Demirjian's DA estimation overestimated males (0.4040 years) and females (0.1316 years). Willem's DA estimation method underestimated males (0.1386 years) and females (0.4210 years) and Caldas skeletal age estimation overestimated males (0.2982 years) and females (0.4259 years).

CONCLUSION

The study concluded Willem's DA estimation method was the most accurate for male and Demirjian's method for female for Gujarati Population. Caldas's new computer-assisted method for skeletal age estimation used in the present study is easy to perform and less time-consuming and objective method and can be applied for Gujarati population.

The applicability of the Demirjian, Willems and Chaillet standards to age estimation of 5-15 year old Indian children

BACKGROUND

Demirjian's method of age estimation has been reported to overestimate age and Willems' method to give consistently more accurate results. Not enough, however, is known about the applicability of Chaillet's standards.

AIM

The present study aimed to compare the accuracy of Demirjian's, Willems' and Chaillet's standards in age estimation of 5 to 15 year-old Indian children.

DESIGN

In this cross-sectional observational study, three methods were compared for accuracy in estimating the age of 1200 Indian children aged 5-15 years.

RESULTS

Demirjian's method overestimated age by +0.24 ± 0.80 years, +0.11 ± 0.81years and +0.19 ± 0.80 years in boys, girls and the total sample, respectively. With Willems' method, overestimations of +0.09 ± 0.80 years, +0.08 ± 0.80 years and +0.09 ± 0.80 years were obtained in boys, girls and the total sample, respectively. Chaillet's method underestimated age by -0.12 ± 0.69 years, -0.45 ± 0.88 years and -0.25 ± 0.83 years in boys, girls and the total sample, respectively. Statistically significant differences were observed between dental and chronological ages with all methods (p < 0.001). Significant sex-based differences were observed only with Demirjian's and Chaillet's methods (p < 0.05).

CONCLUSION

Willems' method was the most accurate in age estimation, followed by Demirjian's and Chaillet's methods. While Demirjian's method was more accurate than Chaillet's in females, Chaillet's method better predicted the age of males.

New model for dental age estimation: Willems method applied on fewer than seven mandibular teeth

Willems method measures the developmental stages of the seven left permanent mandibular teeth and is frequently used for dental age estimation. The aim of this study was to test its accuracy on a large sample of the Croatian population and to develop new models for estimation based on one to seven mandibular teeth. The developmental stages were evaluated on the digital, standardized orthopantomograms of 1868 Croatian children aged 5 to 16. Univariate regression was used for age estimation based on one tooth and regression with forward and backward elimination for selection of the best combination on two to six teeth. Tested in parallel with Willems method, the accuracy of the new models was assessed within intervals of ± 0.5, ± 1, ± 1.5 and ± 2 years and shows the percentage of correct estimations. Using Willems method, the average overestimation was 0.41 years for boys and 0.22 years for girls. Newly developed models that use two to seven teeth proved to be significantly more accurate (p < 0.001). The accuracy of age estimation increases significantly with the number of teeth in a model. Predictably, within the interval ± 0.5 years, a model with three teeth has 3% fewer accurate age estimations than a model including seven teeth. In both theory and practice, Willems method has been considered suitable for age estimation among Croatian children. However, these newly developed models significantly surpass its accuracy. Models using two to seven teeth represent a simple, reliable, and accurate method for age estimation, even in cases with missing mandibular teeth.

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.

Dental age estimation in Somali children using the Willems et al. model

AIM

The aim of the current study was to retrospectively collect dental panoramic radiographs from Somali children living in Finland, to use the radiographic data to develop a new age estimation model based on the model established by Willems et al. (J Forensic Sci 46(4):893-895, 2001), and to compare the age prediction performances of the Willems et al. model (WM) and the newly developed model.

MATERIAL AND METHODS

Dental panoramic radiographs from 808 healthy Somalis born in Finland were selected. The development of the seven left mandibular permanent teeth, from the central incisor to the second molar, was staged according to Demirjian et al. (Hum Biol 45(2):211-227, 1973). Radiographs with all listed permanent teeth completely developed were excluded. The studied sample consisted of 635 subjects (311 females, 324 males) ranging in age from 4 to 18 years. Kappa and weighted Kappa statistics were used to quantify intra- and inter-observer agreement in stage allocation. The collected dataset was used to validate the WM, constructed on a Belgian Caucasian reference sample, and to establish a Somali-specific age estimation model (SM) based on the WM. Both models were validated and their age prediction performances quantified using mean error (ME), mean absolute error (MAE) and root mean squared error (RMSE).

RESULTS

The SM resulted in a slight underestimation of age when the sex groups were analysed separately or combined, with ME varying between 0.04 (standard deviation (SD) 1.01) and 0.05 (SD 1.04) years, MAE between 0.77 and 0.80 years and RMSE between 1.01 and 1.04 years. The WM statistically significantly underestimated the age of females, with an ME of 0.20 (SD 1.01) years (p = 0.0006). For males, and for females and males combined, no statistically significant ME was observed.

CONCLUSION

The WM and SM were similar in their age prediction performances, and the use of the WM in dental age assessment in the Somali population is justified.

New equations for age estimation using four permanent mandibular teeth in Thai children and adolescents

The purposes of this study were to generate new age estimation equations using two four-teeth methods and to test the accuracy of the resulting equations in comparison with Demirjian and Goldstein four-teeth methods in a Thai population. A sample of 720 digital panoramic radiographs of Thai individuals (360 males and 360 females), aged between 7 and 15 years was randomly selected and assessed for age estimation. The new equations were developed using quadratic regression analysis. The results showed the Thai population-specific equations had a strong relationship between the dental maturity score and the chronological age in both sexes (r = 0.946-0.956). The new equations revealed no statistically significant differences between the estimated and the chronological ages in either sex. On the other hand, Demirjian and Goldstein four-teeth methods showed statistically significant differences between the estimated and the chronological ages in both sexes. Moreover, we found slight differences in the mean absolute error between Demirjian and Goldstein methods and our new equations (0.01 years for males and 0.03 years for females in method I and 0.04 years for males and 0.02 years for females in method II) and the root mean square error between Demirjian and Goldstein methods and our new equations (0.02 years for males and 0.04 years for females in method I and 0.00 years for males and 0.04 years for females in method II). In summary, although Thai population-specific equations provide a slightly increased accuracy in age estimation in Thai children and adolescents, Demirjian and Goldstein methods are still relevant.

The third molar maturity index in indicating the legal adult age in Kosovar population

The third molar tooth, known as the "wisdom tooth," is the only tooth that can be used to determine legal adult age. This study aimed to test the accuracy of Cameriere's third molar maturity index (I_3M) in assessing the legal adult age of 18 years in the Kosovar population. Orthopantomographs (OPTs) of 1221 healthy living Kosovar individuals, aged between 12 and 23 years and with no congenital or developmental anomalies, were analyzed. Intra-class correlation coefficients were 0.858 (95% CI, 0.786 to 0.906) and 0.852 (95% CI, 0.779 to 0.903) for intra-rater and for inter-rater agreement, respectively. The sample was divided into training dataset (800 OPTs) and test dataset (421 OPTs). The training dataset was used to generate the logistic regression model, while the test dataset was used to study the performance of the model. I_3M and gender as independent variables and adult age (≥ 18 years) or minor age (< 18 years) as the dependent variable were used for logistic regression analysis. The receiver operating curve (ROC) analysis was used to determine the specific cut-off value of I_3M for predicting adult age. The results showed that only I_3M statistically significantly contributed to discriminating adults and minors. ROC analysis showed that the cut-off value of I_3M < 0.08 was the best in discriminating adults and minors. An analysis of the test dataset (421 OPTs) showed that as I_3M decreased the age gradually increased. The performance of the cut-off value of I_3M < 0.08, to discriminate between adults and minors, was analyzed by contingency tables for both sexes. In males, the accurate classification (Acc) was 0.968 (95% CI, 0.926 to 0.985), the sensitivity (Se) was 0.962 (95% CI, 0.925 to 0.978), and the specificity (Sp) was 0.976 (95% CI, 0.929 to 0.995). The Bayes post-test probability (Bayes PTP) was 0.975 (95% CI, 0.905 to 1.00). In females, Acc was 0.909 (95% CI, 0.870 to 0.917), Se and Sp were 0.826 (95% CI, 0.787 to 0.834) and 0.991 (95% CI, 0.953 to 1.00) respectively, while Bayes PTP was 0.989 (95% CI, 0.926 to 1.00). Our data support the usefulness of I_3M < 0.08 to indicate legal adult age in a Kosovar population.

The Demirjian versus the Willems method for dental age estimation in different populations: A meta-analysis of published studies

BACKGROUND

The accuracy of radiographic methods for dental age estimation is important for biological growth research and forensic applications. Accuracy of the two most commonly used systems (Demirjian and Willems) has been evaluated with conflicting results. This study investigates the accuracies of these methods for dental age estimation in different populations.

METHODS

A search of PubMed, Scopus, Ovid, Database of Open Access Journals and Google Scholar was undertaken. Eligible studies published before December 28, 2016 were reviewed and analyzed. Meta-analysis was performed on 28 published articles using the Demirjian and/or Willems methods to estimate chronological age in 14,109 children (6,581 males, 7,528 females) age 3-18 years in studies using Demirjian's method and 10,832 children (5,176 males, 5,656 females) age 4-18 years in studies using Willems' method. The weighted mean difference at 95% confidence interval was used to assess accuracies of the two methods in predicting the chronological age.

RESULTS

The Demirjian method significantly overestimated chronological age (p<0.05) in males age 3-15 and females age 4-16 when studies were pooled by age cohorts and sex. The majority of studies using Willems' method did not report significant overestimation of ages in either sex. Overall, Demirjian's method significantly overestimated chronological age compared to the Willems method (p<0.05). The weighted mean difference for the Demirjian method was 0.62 for males and 0.72 for females, while that of the Willems method was 0.26 for males and 0.29 for females.

CONCLUSION

The Willems method provides more accurate estimation of chronological age in different populations, while Demirjian's method has a broad application in terms of determining maturity scores. However, accuracy of Demirjian age estimations is confounded by population variation when converting maturity scores to dental ages. For highest accuracy of age estimation, population-specific standards, rather than a universal standard or methods developed on other populations, need to be employed.

Age estimation based on Willems method versus new country-specific method in South African black children

AIM

The aims of our study were to develop new maturity scores for dental age estimation in South African black children according to the Willems method, which was developed based on Belgian Caucasian (BC) reference data (Willems et al. J Forensic Sci 46(4):893-895, 2001), and to compare age prediction performance of both methods.

SUBJECTS AND METHODS

A total of 986 panoramic radiographs of healthy South African black (SAB) children (493 males and 493 females) in the age range of 4.14 to 14.99 years (mean age 10.06 years) were selected for obtaining developmental staging scores (according to Demirjian et al. Hum Biol 45(2):211-227, 1973). Willems BC methodology was applied to develop new country-specific maturity scores (Willems SAB). Age prediction performance of Willems BC and Willems SAB was compared.

RESULTS

On average, Willems BC renders acceptable results with an overestimation of chronological age of 0.06 years (SD 0.88 years) in SAB children. Compared to Willems SAB, the overall mean absolute error was slightly higher with Willems BC (0.62 and 0.68 years, respectively), but this was not significant in males. Also, the root mean squared error was marginally higher in Willems BC.

CONCLUSION

The new age prediction method developed in South African black children was found to be better compared to Willems BC, although the difference seems to be small and clinically not relevant, especially in males.

Performance of Willem's dental age estimation method in children: A systematic review and meta-analysis

Through numerous validation and method comparison studies on different populations, the Willems method exhibited a superior accuracy. This article aims to systematically examine how accurate the application of Willems dental age method on children of different age groups and its performance based on various populations and regions. A strategic literature search of PubMed, MEDLINE, Web of Science, EMBASE and hand searching were used to identify the studies published up to September 2014 that estimated the dental age using the Willems method (modified Demirjian), with a populations, intervention, comparisons and outcomes (PICO) search strategy using MeSH keywords, focusing on the question: How much Willems method deviates from the chronological age in estimating age in children? Standardized mean differences were calculated for difference of dental age to chronological age by using random effects model. Subgroup analyses were performed to evaluate potential heterogeneity. Of 116 titles retrieved based on the standardized search strategy, only 19 articles fulfilled the inclusion criteria for quantitative analysis. The pooled estimates were separately kept as underestimation (n=7) and overestimation (n=12) of chronological age groups for both genders according to primary studies. On absolute values, females (underestimated by 0.13; 95% CI: 0.09-0.18 and overestimated by 0.27; 95% CI: 0.17-0.36) exhibited better accuracy than males (underestimated by 0.28; 95% CI: 0.14-0.42 and overestimated by 0.33; 95% CI: 0.22-0.44). For comparison purposes, the overall pooled estimate overestimated the age by 0.10 (95% CI: -0.06 to 0.26) and 0.09 (95% CI: -0.09 to 0.19) for males and females, respectively. There was no significant difference between the young and older child in subgroup analysis using omnibus test. The mean age between different regions exhibited no statistically significant. The use of Willems method is appropriate to estimate age in children considering its accuracy among different populations, investigators and age groups.

Dental and Skeletal Age Estimations in Lebanese Children: A Retrospective Cross-sectional Study

Aims and Objectives:

Assessing dental and bone ages is frequently required in a wide range of fields such as odontology, forensic science, as well as orthopedics. The aim of this study was to evaluate applicability of two methods of bone age assessment and two methods of dental age (DA) assessment for Lebanese children.

Materials and Methods:

Skeletal age (SA) of 260 orthodontic patients (124 males, 136 females divided into four groups each) was consecutively assessed using Greulich and Pyle and Fishman's SMI methods. DA was evaluated using both Demirjian's and Willem's methods. Mean age was 11.89 ± 1.38 years for males and 11.75 ± 1.58 years for females. Data were collected and statistically analyzed using the SPSS software (IBM SPSS Statistics, version 21, USA). The differences between estimated DA, estimated SA, and chronological age (CA) were compared by gender and age group.

Results:

Greulich and Pyle method showed nonsignificant difference with CA in male sample, while in both assessment methods, the difference between skeletal and CAs is significant in female sample. Results of Willem's method in the whole sample suggested a statistically nonsignificant difference, when compared to CA. Demirjian's method delivered higher mean value than Willem's assessment in both genders.

Conclusions:

Greulich and Pyle method is accurate for SA assessment in males and only in one group of females, while it significantly overestimates age in all other female groups. Willem's method is more suitable to assess DA in both genders. A strong correlation exists between both dental and skeletal assessment methods and CA.

Dental Age in Orthodontic Patients with Different Skeletal Patterns

Objective. To evaluate the difference between chronological and dental age, calculated by Willems and Cameriere methods, in various skeletal patterns according to Steiner's ANB Classification. Methods. This retrospective cross-sectional study comprised the sample of 776 participants aged between 7 and 15 years (368 males and 408 females). For each participant, panoramic images (OPT) and laterolateral cephalograms (LC) were collected from the medical database. On LC ANB angle was measured; on OPT dental age (DA) was calculated while chronological age (CA) and sex were recorded. The sample was divided into three subgroups (Class I, Class II, and Class III) with similar distribution based on the chronological age and ANB angle. CA was calculated as the difference between the date of OPT imaging and the date of birth, while DA was evaluated using Willems and Cameriere methods. ANB angle was measured on LC by two independent investigators using the cephalometric software. Differences between sexes and the difference between dental and chronological age were tested by independent and paired samples t-test, respectively; one-way ANOVA was used to test differences among ANB classes with Tukey post hoc test to compare specific pairs of ANB classes. Results. The significant difference was found between Class III and other two skeletal classes in males using both dental age estimation methods. In Class III males dental age was ahead averagely by 0.41 years when using Willems method, while Cameriere method overestimated CA for 0.22 years. Conclusion. In males with Class III skeletal pattern, dental development is faster than in Classes I and II skeletal pattern. This faster development is not present in females.

Age estimation in Portuguese population: The application of the London atlas of tooth development and eruption

Chronological age estimation from the dental parameters is becoming increasingly important. The London atlas of tooth development is the most recent developed method and represents a modification of the previous older methods. The aim of this study was to evaluate the accuracy of the London atlas for the dental age estimation in the Portuguese population. The study sample included 736 radiographic images (498 females and 238 males) of Portuguese origin, patients of Dental Clinic of Superior Institute of Health Sciences Egas Moniz and Dental Medicine Faculty, University of Lisbon. The age range of the individuals was between 3 and 24 years. Estimated age was compared with the chronological age using the paired t-test. The results showed that there was no statistically significant difference between left and right side of the jaw (p>0.05). Both sides showed an average overestimation of age by one month approximately. Moreover, the significant difference between chronological and estimated age was not observed in the females. However, the significant difference was observed in a sample coming from males (right: p=0.008; left: p=0.003). Our results showed that the London atlas can be potentially used as a tool for age estimation. However, the difference between sexes clearly suggests that separate charts should be made for each sex. Further studies, which will have as a final goal the development of a new method for age estimation using dental parameters, are needed.

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.

Morphologic Patterns of Lip Prints in a Sample of Croatian Population

PURPOSE

Cheiloscopy deals with the study of elevations and depressions which form a characteristic pattern on the external surface of the lips. Lip grooves are considered to be unique and analogous to the fingerprint. The aim of the research was to determine the type of grooves on healthy lips of men and women using lip prints in a sample of Croatian population, to determine whether there is a statistically significant difference between men and women in the types of grooves and to determine whether there are any differences between male and female lip prints.

MATERIAL AND METHODS

A randomly selected sample of Croatian population consisted of 40 male and 50 female subjects. The samples of lip grooves were classified according to Tsuchihashi classification.

RESULTS

The research has shown that most women in Croatia belong to Type 2 (40.0%), followed by Type 1 (34.0%), Type 3 (12.0%), Type 4 (8.0%), and Type 5 (6.0%) which is of less importance. Most Croatian men belong to Type 3 (35.0%) and Type 2 (25.0%). A small number of men belong to Type 4 (15.0%), Type 5 (12.5%) and Type1 (12.5%).

CONCLUSION

There was a statistically significant difference between men and women regarding the types of lip grooves.