Accuracy of Dental Age in Nonadults: A Comparison of Two Methods for Age Estimation Using Radiographs of Developing Teeth

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

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

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

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

Cameriere's open apices methodology for dental age estimation in children: a scoping review from a Latin American perspective

Dental age estimation (DAE) is key to establishing an individual's identity, and this is relevant in minors. A widely used method for DAE in children is Cameriere's open apices (CAM). Despite its wide dissemination, there are no clear reports of its use in Latin American populations. A scoping review was conducted using a search strategy in the PubMed/MEDLINE database, Web of Science, and a complementary manual search. Only papers using CAM or its regression equation models for evaluating Latin American populations were included. Ten studies published between 2007 and 2020 responded to the search objective. Brazil was the country with the most studies using CAM (7/10), and the University of Macerata (Italy) was the most declared affiliation (6/10). Seven studies used the original CAM formula in populations from Brazil and Peru, while the European formula (EuCAM) was applied in Mexico, Colombia, and Brazil. Although the method underestimated the age values with acceptable error margins, the correction factor substantially improved the predictive power of the method. Some limitations of the method are highlighted. CAM and its variants can be useful for validation in Latin American settings, but attention to population structures and terminologies is suggested for future research.

Applicability of the London Atlas method in the East China population

BACKGROUND

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Performance of the London Atlas, Willems, and a new quick method for dental age estimation in Chinese Uyghur children

BACKGROUND

Numerous dental age estimation methods have been devised and practised for decades. Among these, the London Atlas and Willems methods were two of the most frequently adopted, however dependent on atlantes or tables. A new estimation method less reliant on external measurement could be efficient and economical.

AIM

This study aimed to evaluate the utility and applicability of the dental age estimation methods of London Atlas, Willems, and a new quick method that subtracts the number of developing teeth from the universal root mature age of 16 years in one of the lower quadrants reported in this work among Chinese Uyghur children.

METHODS

A comparative cross-sectional study was conducted. Subjects enrolled in the study were screened according to preset inclusion and exclusion criteria. The observer then obtained the dental age from the subjects' panoramic radiographs based on the estimated rules of the London Atlas, Willems, and a new quick method. Paired t-test was used to compare the accuracy and precision of the above three estimation methods. Independent-sample t-test was used to find the difference between gender.

RESULTS

Totally, 831 radiographs entered the analyses of this study. Among the three methods evaluated, the Willems method, in particular, showed a distinct underestimated tendency. The mean error of the dental age predicted by the London Atlas, the Willems method, and the quick method was 0.06 ± 1.13 years, 0.44 ± 1.14 years, and 0.30 ± 0.63 years, respectively. The mean absolute error was 0.86 ± 0.75 years according to the London Atlas, 1.17 ± 0.89 years under the Willems method, and 0.70 ± 0.54 years under our quick method. No significant difference was found between the chronological age and dental age using the London Atlas, generally for the 10 to 15 years group (p > 0.05), but our quick method for the 15-16 years children (p < 0.05) and Willems method (p < 0.001).

CONCLUSION

The London Atlas outperformed the Willems method with better accuracy and precision among 10-15 years Chinese Uyghur children. Our new quick method may be comparable to the London Atlas for children aged 10-14 and potentially become a more straightforward dental age prediction instrument.

The Application of the Cameriere's Methodologies for Dental Age Estimation in a Select KwaZulu-Natal Population of South Africa

Background: The estimation of an individual’s age is a fundamental component of forensic odontology. Literary reports found that the efficiency of Cameriere methodology for age estimation varied among many population groups. Therefore, this study aimed to determine the applicability of the Cameriere methods to a select South African population of the KwaZulu-Natal (KZN) province. Materials and Methods: This cross-sectional retrospective study was conducted on 840 digital panoramic radiographs that met the inclusion criteria. Dental maturity was determined through the morphometric analysis of the seven left permanent mandibular and maxillary teeth in accordance with Cameriere et al. (2006). Moreover, the dental age was also calculated using the South African Black Bayesian formulae of the Cameriere method by Angelakopoulos et al. (2019). The paired sample t-test or Wilcoxon’s signed rank test assessed the significant difference between the chronological age and estimated dental age for the various formulae. A p-value < 0.05 was considered to be statistically significant. Results: The Cameriere et al. (2006) Italian formula and the South African Black Bayesian formulae of the Cameriere method by Angelakopoulos et al. (2019) underestimated and overestimated age in the South African Black and Indian population groups of the KZN province, respectively. Therefore, the authors generated a novel population-specific regression formulae (including and excluding third molars) using “step-wise regression analysis” and a “best-fit model” for the South African Black and Indian population groups of KZN. Conclusion: This study recommends that the population-specific formulae generated in this study be utilized in the KZN population to improve the accuracy of dental age estimation within this region.

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.

Application of Willems Method as an Age Estimator in Early Adolescents of Bangalore Population

INTRODUCTION

Dental age (DA) assessment is a reliable method for chronological age (CA) estimation used for criminal, forensic, and anthropologic purposes. Age estimation also provides valuable information when the birth date is unavailable, as in case of migrants. Furthermore, the CA of living people is important for employment and marriage purpose.

OBJECTIVES

The aim of the present study is to check the reliability of the Willems method in the population of Bangalore.

MATERIALS AND METHODS

The study was conducted on 205 (109 boys and 96 girls) participants by their radiographic records in the department of forensic odontology using modified Demirjian's method by Willem et al.

RESULTS

A total of 205 subjects were selected for the study, among which 109 (53.2%) were boys and 96 (46.8%) were girls. The mean CA was 12.23 ± 1.75 and the mean DA was 12.20 ± 1.99. Willems method seems to be reliable in estimating DA in Bangalore populations.

CONCLUSION

This study showed that the Willems method gave near precise estimation of the CA.

Dental age and skeletal maturity assessment in patients with cerebral palsy

The aims of this study were to calculate the estimated dental age and the degree of skeletal maturity in patients with cerebral palsy and control patients (i.e., without a diagnosis of cerebral palsy) and to compare the findings with the chronological age of patients in both study groups. In this cross-sectional study, the European formula and the Willems method were used to estimate the dental age of 52 patients with cerebral palsy and 104 control patients, all aged between 7 and 15 years. For all patients, their estimated dental age was compared with their chronological age. The degree of skeletal maturity of 35 patients with cerebral palsy and 104 control patients was estimated according to Baccetti's method. There was no statistically significant difference in the deviation of the estimated dental age from the chronological age between patients with cerebral palsy and control patients when the European formula or the Willems method was applied. No difference was found in the frequency of Baccetti's stages between patients with cerebral palsy and control patients in the same age category, for both sexes. To estimate dental age in patients with cerebral palsy, the European formula is preferable for orthodontic purposes and the Willems method is preferable for forensic purposes. Using Baccetti's method it was not possible to detect potential differences in skeletal maturity between patients with cerebral palsy and controls.

Age Estimation Using the Cameriere Methods of Open Apices: A Meta-Analysis

Purpose: To evaluate the actual variability of the mean difference between chronological and dental age using the Cameriere method of open apices and to test its accuracy in variable age groups. Method: We selected studies that contained data about the mean, standard deviation, and number of cases for chronological age, dental age and gender. We used a random-effects model. Statistical significance was estimated, at a p < 0.05, using prediction intervals. For the analysis of publication bias we used the funnel plot and Egger’s regression test for plot asymmetry. I² was used to test the presence of heterogeneity between studies. The Z test was used to test for statistical differences between subgroups, with p < 0.05 being considered statistically significant. We also used 95% for confidence intervals and prediction intervals. Results: In boys, the average difference between chronological and dental age was 0.44 (0.26–0.63) years, while in girls the average difference between chronological and dental age was 0.34 (0.19–0.49) years. In the 6–7 years age group and in the 14–15 years age group, there was a statistically significant difference between dental and chronological age. Our study shows that the Cameriere method is useful for estimating the chronological age, with errors of less than one year. Conclusions: The Cameriere method of evaluating dental age using open apices is sufficiently accurate for forensic practice, at least in the 7–14 age-interval.

Maximum length of deciduous dentition as an indicator of age during the first year of life: Methodological validation in a contemporary osteological collection

Out of all the available methods for estimating age at death from immature human skeletal remains, those based on odontometric variables of deciduous dentition have proved to be one of the most accurate. The development of odontometric methods has been improved through the creation of documented human osteological collections, allowing their validation in different populations. The present study aims to test the regression equations for age estimation proposed by Liversidge et al. 1993, Irurita Olivares et al. 2014, and Cardoso et al. 2019, on the basis of the maximum length of deciduous teeth in an Argentinian sample of 35 infants of known age at death. The results showed that the absolute mean difference between estimated and chronological age was 5.76±6.33 weeks for Liversidge's method, 5.71±6.41 weeks for Irurita Olivares's method, and 6.79±5.80 for Cardoso's method. It was also found that, for Liversidge's method, the canines provided the most accurate and the least biased estimations. For Irurita Olivares's method, mandibular anterior teeth were the most accurate, while the first mandibular molars offered the least biased estimations. For Cardoso's method, the canines presented the most accurate estimations, while the lateral incisors the least biased ones. Finally, 95% confidence intervals of estimated ages were calculated for each method, finding that Irurita Olivares's method provided the most reliable age estimations when using mandibular central incisors and mandibular first molars.

Impact of population-specific dental development on age estimation using dental atlases

OBJECTIVES

The steady development and subsequent eruption of the dentition is particularly useful for the estimation of age in juveniles. There are few studies that examine and test methods on a population-diverse sample. Our goal is to test the Ubelaker () and London Atlas (2010) dental charts on a sample representing several different population backgrounds to infer if refinement for population-specific standards should be developed.

MATERIALS AND METHODS

The first and second authors examined panoramic radiographs of 335 individuals from the James K. Economides Orthodontic Collection blind to chronological age, sex, and ancestry and scored using both dental atlases.

RESULTS

The age of Native Americans and African Americans was generally overestimated, suggesting faster rates of development. European Americans and New Mexico Hispanics, while not always showing the highest success rates, generally were closer to the correct age than other ancestry groups. The overall success rate for Ubelaker () was 80.00% for both observers, while the London Atlas was significantly lower at approximately 21.79-23.28%. Accuracy rates did not differ significantly between ancestry groups, though patterns were evident regarding under- or over-estimation of age.

DISCUSSION

The present study demonstrates that incorrect age estimations were typically still within 1.5 years of the actual age. Ubelaker () had higher rates of success due to broader age ranges. The results suggest that though accuracy rates did not significantly differ, different developmental rates may affect age estimates and population-specific standards should be considered for known-ancestry individuals, while aging standards constructed from a diverse sample should be utilized for unknown-ancestry cases.

Testing and comparing the accuracy of two dental age estimation methods on saudi children: Measurements of open apices in teeth and the London Atlas of Tooth Development

Evaluation of dental development is frequently performed to assess maturity and estimate age. The aim of this study was to test and compare the accuracy of two dental age estimation methods in a sample of Saudi children by using Cameriere's formula (measurements of mandibular teeth open apices) and The London Atlas of Tooth Development. Four hundred archived digital panoramic radiographs of healthy children (200 males and 200 females) between the ages of 6 to 15.99years attending the Pediatric Dental clinics of King Saud University, College of Dentistry, Riyadh, Saudi Arabia were used. The mean difference between the Estimated Age (EA) and Real Age (RA) was (-0.89years) for Cameriere's formula with a standard deviation of (±1.14years), and it was (-0.59years) with a standard deviation of (±1.45years) for The London Atlas. Both methods consistently underestimated the age. No statistically significant difference between the sexes was found in both methods In conclusion, the London Atlas was found to be slightly more accurate and easier to use than was Cameriere's formula.