Ear identification: A multi-ethnic study sample

The external human ear is considered to be highly variable among individuals. Hence, forensic applications could be explored for human identification. This research compares the usefulness of Cameriere's ear identification method, in samples originating from six different countries (Brazil, India, Japan, Russia, South Africa and Turkey) in order to examine possible differences in their accuracy values. A sample of 2,225 photographs of the external human ear (1,134 left and 1,091 right ears) from 1,411 individuals (633 females and 778 males) was collected. The samples included healthy subjects with no systemic disorders and without any craniofacial trauma, maxillofacial abnormalities, auricular anomalies, ear diseases or previous auricular surgery. Cameriere's ear identification method was applied and measurements were performed on the images of each ear, considering four anatomic regions: helix, antihelix, concha, and lobe. The quantified measurement values were converted into a proposed coded number system. A search for identical codes was accomplished to find out the distinctiveness of the morphology of the human ear. The combined codes of left and right ears of each of the 814 subjects were not repeated in this multi-ethnic study sample. Dirichlet's distribution and the inherent study equation showed that the probability of two different individuals having the same code (false-positive identification) was found to be <0.0007. Because of the distinctive metrics of the ratios of external human ears, studies with Cameriere's ear identification method may be valuable for human identification. Studying the differences between the left and right ears of the same individual and across different ethnic groups could contribute to the development of supplementary tools for human identification.

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 Classification in Forensic Medicine Using Machine Learning Techniques

The aim of the study was to assess the capabilities of age determination (age group) at death using classification techniques by histomorphometric characteristics of osseous and cartilaginous tissue aging.

Comparison of the third molar maturity index (I3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample

The diagnostic accuracy of the I_3M to assess the legal age of 18 years has already been tested in several specific-population samples. The left lower third molar has been extensively used for discriminating between minors and adults. This research aimed to compare the usefulness of lower third molar maturity indexes, from both left and right side (I_3ML and I_3MR), in samples originating from four distinct continents in order to examine possible differences in their accuracy values. For this purpose, a sample of 10,181 orthopantomograms (OPGs), from Europe, Africa, Asia and America, was analysed and previously scored in other studies. The samples included healthy subjects with no systemic disorders with both third molars and clear depicted root apices. Wilcoxon Signed Rank test for left and right asymmetry did not show any significant differences. Data about sensitivity, specificity, predictive values, likelihood ratio and accuracy were pooled together and showed similar results for I_3ML and I_3MR, respectively. In addition, all these quantities were high when only the I_3MR was considered to discriminate between adults and minors. The present referable database was the first to pool third molar measurements using panoramic radiographs of subjects coming from different continents. The results highlighted that both I_3ML and I_3MR are reliable indicators for assessing the legal age of 18 years old in those jurisdictions where this legal threshold has been set as the age of majority.

Study of the ethnicity's influence on the third molar maturity index (I3M) for estimating age of majority in living juveniles and young adults

Estimation of age of majority has important applications in the forensic daily practice because of the increasing demand for age estimates of unaccompanied minors. Diagnostic accuracy of I_3M to assess legal adult age of 18 years has been already tested in several specific population samples. The aim of this work was to compare the available data about sensitivity and specificity of the third molar maturity index (I_3M) from five different regional groups' radiographic samples to study possible ethnical difference. For this purpose, a sample of 6157 orthopantomograms (OPGs), coming from 15 countries, was analysed. Data about sensitivity and specificity were pooled using a bivariate modelling approach. The one-way MANOVA analysis was applied to assess the likelihood that sensitivity and specificity of the five regional groups are sampled from the same population. The result of the one-way MANOVA showed that both sensitivity and specificity did not depend from the regional groups. The obtained sensitivity was 84% (95% CI: 82% and 85%), and its specificity was 94% (95% CI: 93% and 95%). Based on these results, the I_3M was a useful statistical tool to identify whether a subject has reached the legal age of 18 years old, regardless of his or her ethnicity.

Child brides: the age estimation problem in young girls

The aim of this work is to study a sample of girls from 15 different countries using Third Molar Maturity Index (I3M ), to assess the probability that a girl has reached the legal age of 18 years. The studied sample consisted of 3228 Orthopantomograms of healthy female subjects from 15 different countries. The cut-off value of I3M = 0.08 was tested to discriminate adults (≥18 years) and minors (<18 years). X-ray images were processed by computer-aided drafting program ImageJ. The information on sensitivity and specificity of I3M coming from the 15 countries was pooled together using a bivariate Bayesian modeling approach. Specificity of the I3M test did not change when the country was considered, and its value remains greater than 85% for each studied country. This method is useful to estimate the age of the girls involved in suspected early marriage because of the high probability of correctly identifying a minor with similar results observed among tested populations.

Evaluation of Cameriere and Willems age estimation methods in panoramic radiographs of Brazilian children

The importance of age estimation in the forensic field is inherent to the process of establishing the biological profile of children, sub-adults and adults. The established profile might be useful for the identification of deceased victims or living individuals when it comes to age of legal interest. In parallel, age estimation is also investigated for clinical purposes, especially for the diagnosis of dental and bone maturation. Several studies were developed to provide accurate age estimation methods based on skeletal and dental development. This study aimed to apply and compare Cameriere's and Willems' methods for dental age estimation in a Brazilian sample. Two examiners performed image analysis and method application in 180 panoramic radiographs of Brazilian children aged 6-14 years old. The ages estimated with both methods revealed a good correlation with the chronological ages of Brazilian boys and girls. Cameriere's method showed a slight underestimation of 0.05 years for girls and 0.03 for boys. Willems' method, on the other hand, showed an overestimation of -0.47 years for girls and -0.39 for boys. Better age estimates were obtained combining the outcomes of both methods. In practice, Cameriere's and Willems' methods reached reliable outcomes and could be applied for dental age estimation purposes.

A full Bayesian calibration model for assessing age in adults by means of pulp/tooth area ratio in periapical radiography

The Bayesian approach is being a fundamental tool in forensic and legal field where inferences and decisions are made. In this study, a full Bayesian calibration model was developed to make probabilistic inferences about age estimation in a reference sample of 891 periapical X-rays of upper and lower canines. These teeth belonged to both deceased and living adult subjects, aged between 20 and 86 years, coming from five different countries (Turkey, Italy, Portugal, Japan and Mexico). For this purpose, the narrowing of pulp chamber due to the apposition of secondary dentine was analysed by means of the pulp/tooth area ratio. To determine the agreement of the method, intra- and inter-observer differences for measuring process were calculated by means of the intraclass correlation coefficient (ICC) analysis. Observer error tests showed excellent agreement between observers and between repeated assessments. According to the results of the ANCOVA, neither nationality nor sex was associated to the secondary dentine apposition while it is associated with individual's age. The results of the present study indicated that the concept of probability is intrinsically linked to the assessment of age in a forensic context, and the Bayesian approach could be considered a robust tool to overtake the bias generated by traditional regression models, thus helping the decision-making process in a legal framework.

Age estimation in north east Brazilians by measurement of open apices

Dental age (DA) estimation is an extensively investigated resource used by forensic science. This study aimed to evaluate the applicability of the Measurement of Open Apices for DA estimation in north east Brazilians. A total of 429 orthopantomographs of individuals aged 5 to 14.99 years were used. The sample was distributed according to the age groups 5-6.99, 7-8.99, 9-10.99, 11-12.99 and 13-14.99 years, and the data were analyzed descriptively and by linear regression (α= 5%). The majority of the radiographs were from females (n = 241; 56.2%), with an overall mean age of 12 years (± 2.12). A significant difference was observed between DA and chronological age (CA) in the total sample and specifically in females and males. The method underestimated CA by 0.31 year (total sample) and by 0.3 and 0.32 year in females and males, respectively. In contrast, the method overestimated CA in the groups 5-6.99 and 7-8.99 years, with a mean difference (MD) of 0.48 year (p = 0.007) and 0.17 year (p = 0.182), respectively. In the other groups, DA was predicted to be below CA, with a significant difference in the group 13-14.99 (0.75 year). Based on the regression analysis, a correction factor was proposed from the original formula for this population, thereby reaching a predictive power of approximately 80%. To conclude, this method is applicable to the study population aged 5 to 13 years as the estimates obtained did not exceed the error limit of ±1 year.

Validation of the third molar maturity index (I3M): study of a Dominican Republic sample

This retrospective study aims to test the third molar maturity index (I3M) cut-off value of 0.08 for 18 years old in Dominican Republic population. Orthopantomograms of 513 subjects (284 females and 229 males) were evaluated, intra- and inter-observer agreement, ICC (intra-class correlation coefficient) values were 0.88% (95 % CI 0.86% to 0.91%), and 0.93% (95% CI 0.90% to 0.96%), for the intra- and inter-observer reliability, respectively. Accuracy in females was 0.96 (95% CI: 0.93-0.97); the sensitivity was 0.99 (95% CI: 0.96-0.99) and specificity was 0.92 (95% CI: 0.86-0.95). In males, the accuracy was 0.96 (95% CI: 0.93-0.98); the sensitivity was 0.94 (95% CI: 0.88-0.97) and specificity was 0.99 (95% CI: 0.95-0.99). The PPV (Positive Predictive Value) was 0.93 for females and 0.99 for males. The results of this study show that I3M can be used for discriminating adults from minors in Dominican Republic subjects around the legal age of 18 years old.

Third molar maturity index (I3M) for assessing age of majority: study of a black South African sample

AIMS

The evaluation of the cutoff value of I_3M = 0.08 for discriminating black South African minors from adults, and its relationship with chronological age.

MATERIAL AND METHODS

A sample of 833 panoramic radiographs of healthy black South African subjects (500 females and 333 males), in the age range of 14 to 24 years (mean age 17.67 years in females and 17.42 years in males), was retrospectively evaluated.

RESULTS

ICC values were 99.10% (95% CI 97.70 to 99.70%) and 99.20% (95% CI 98.00 to 99.60%), for the intra- and inter-observer reliability, respectively. I_3M decreased as the real age gradually increased in both sexes. According to the logistic regression model, the variable sex was not significant when the probability that an individual is 18 years or older was calculated. The I_3M = 0.08 was valuable in discriminating between adults and minors. The overall accuracy (ACC = fraction of accurately classified subjects) is 0.90 (95% CI 0.87-0.91); the proportion of correctly classified subjects (Se = sensitivity) is 0.80 (95% CI 0.76-0.84), and specificity (Sp) is 0.95 (95% CI 0.93-0.97). The PPV (predictive positive value) is 0.96 (95% CI 0.95-0.97), and the negative predictive value is 0.76 (95% CI 0.72-0.80).

CONCLUSION

The results show that I_3M is a valuable method to distinguish subjects who are around legal adult age in South Africa.

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.

Adult or not? Accuracy of Cameriere's cut-off value for third molar in assessing 18 years of age for legal purposes

AIM

The discovery of reliable means to determine the age of an individual is a fundamental objective in forensic medicine, in consideration of the constant increase of illegal immigration into the European community. In 2008 Cameriere et al. developed a method based on the relationship between age and the third molar index (I3m), which assesses the degree of maturation of the third molar through measurements made on orthopantomography. The purpose of this work was to test the accuracy of Cameriere's cut-off for I3m as a tool to assess full age (18) on a new sample of living subjects.

METHODS

Orthopantomographs of 287 Italian living subjects aged between 13 and 22 years have been randomly selected and included in the study. Identification number, gender, date of birth and date of execution of the radiograph were recorded for each patient on a Microsoft Excel® spreadsheet. Radiographs were digitalized and analyzed using a computerized image-processing program (Adobe® Photoshop® CS4).

RESULTS

The results show that the sensitivity of the test was 84.1% and the specificity was 92.5%. The estimated post-test probability was 90.1%, with a confidence interval of 95% (83.6%, 95.2%). Thus, the probability that a person being positive to the test has 18 or more years of age was 90.1%.

CONCLUSION

The results highlight the contribution of Cameriere's cut-off value for the I3m in the assessment of full age, always remembering that the simultaneous employment of previously introduced complementary methods is essential for the purpose.

Twins and the paradox of dental-age estimations: a caution for researchers and clinicians

The biological age difference among twins is frequently an issue in studies of genetic influence on various dental features, particularly dental development. The timing of dental development is a crucial issue also for many clinicians and researchers. The aim of this study was therefore to verify within groups of twins how dental development differs, by applying Demirjian's method, Mincer's charts of development of third molars and two of Cameriere's methods for dental age estimation, which are among the most popular methods both in the clinical and the forensic scenario. The sample consisted of 64 twin pairs: 21 monozygotic, 30 dizygotic same-sex and 13 dizygotic opposite-sex with an age range between 5.8 and 22.6 years. Dental age was determined from radiographs using the mentioned methods. Results showed that dental age of monozygotic twins is not identical even if they share all their genes. The mean intra-pair difference of monozygotic pairs was low and similar to the difference in dizygotic same-sex twins; the maximum difference between monozygotic twins, however, was surprisingly large (nearly two years). This should lead to some circumspection in the interpretation of systematic estimations of dental age both in the clinical and forensic scenario.

Age estimation by pulp/tooth ratio in lateral and central incisors by peri-apical X-ray

Since 2004, several papers on the analysis of the apposition of secondary dentine have been published. The aim of this paper was to study a sample of peri-apical X-ray images of upper and lower incisors, both lateral and medial, to examine the application of pulp/tooth area ratio as an indicator of age. A sample of 116 individuals, 62 men and 54 women, aged between 18 and 74 years, was studied. Data were fitted with age as a linear function of the pulp/tooth ratio of incisors. The total variance explained by the regression equation ranged from 51.3% of age, when lower lateral incisors were used as explanatory variable, to 81.6% when upper lateral incisors were used. The accuracy of the corresponding regression model yielded ME = 8.44 and 5.34 years, respectively. These results show that, although incisors are less reliable than canines or lower premolars, they can be used to estimate age-at-death when the latter are absent.

Age estimation in archaeological skeletal remains: evaluation of four non-destructive age calculation methods

Estimation of age at death is an essential part of reconstructing information from skeletal material. The aim of the investigation was to reconstruct the chronological age of an archaeological sample from Croatia using cranial skeletal remains as well as to make an evaluation of the methods used for age estimation. For this purpose, four age calculation methods were used: palatal suture closure, occlusal tooth wear, tooth root translucency and pulp/tooth area ratio. Cramer's V test was used to test the association between the age calculation methods. Cramer's V test showed high association (0.677) between age determination results using palatal suture closure and occlusal tooth wear, and low association (0.177) between age determination results using palatal suture closure and pulp/tooth area ratio. Simple methods like palatal suture closure can provide data about age at death for large number of individuals, but with less accuracy. More complex methods which require qualified and trained personnel can provide data about age for a smaller number of individuals, but with more accuracy. Using different (both simple and complex) age calculation methods in archaeological samples can raise the level of confidence and percentage of success in determining age.

Age estimation by pulp/tooth area ratio in canines: study of a Portuguese sample to test Cameriere's method

Age estimation in adults is an important problem in both anthropological and forensic fields, and apposition of secondary dentine is often used as an indicator of age. In recent papers, Cameriere et al. studied the pulp/tooth area ratio of canines for this purpose. The present study examines the application of the pulp/tooth area ratio by peri-apical X-ray images as an age indicator in a Portuguese identified sample. The statistical model was then compared with results from an Italian identified sample, to establish whether a common regression model for both samples could be developed. The Portuguese sample consisted of 126 canines of male and 132 of female from subjects 20 to 84 years old, from the osteological collection of the Museum of Anthropology at Coimbra University. The Italian sample consisted of 114 canines of male and 86 of female from subjects 20 to 79 years old, analyzed in Cameriere et al. (2007), and came from the Frassetto osteological collection of Sassari (Sardinia), now housed in the Museum of Anthropology, Department of Experimental and Evolutionistic Biology, University of Bologna. Statistical analysis was performed in order to obtain multiple regression formulas for dental age calculation, with chronological age as dependent variable, and gender and pulp/tooth area ratio on upper (RA(u)) and lower canines (RA(l)) as independent variables. ANCOVA analysis showed that gender was not significant but that variables RA(u) and RA(l) were. The regression model for the Portuguese sample yielded the following equations: Age=101.3-556.68 RA(u) (upper canines) and Age=92.37-492.05 RA(l) (lower canines). Both models explained about 97% of total variance, and mean prediction errors were ME=2.37 years and 2.55 years, respectively. Comparisons between the equation referring to the Portuguese sample and the equivalent linear equations proposed by Cameriere et al. for the Italian sample did not reveal significant differences between the linear models, suggesting that a common regression model could be applied for both samples. The common regression model, describing age as a linear function of RA(u) and RA(l), yielded the following linear regression formulas: Age=100.598-544.433 RA(u); Age=91.362-480.901 RA(l), and explained 86% and 93% of total variance, respectively. Mean prediction errors were ME=2.68 years and 2.73 years, respectively.

Statistical methods to assess the reliability of measurements in the procedures for forensic age estimation

In forensic science, anthropology, and archaeology, several techniques have been developed to estimate chronological age in both children and adults, using the relationship between age and morphological changes in the structure of teeth. Before implementing a statistical model to describe age as a function of the measured morphological variables, the reliability of the measurements of these variables must be evaluated using suitable statistical methods. This paper introduces some commonly used statistical methods for assessing the reliability of procedures for age estimation in the forensic field. The use of the concordance correlation coefficient and the intraclass correlation coefficient are explained. Finally, some pitfalls in the choice of the statistical methods to assess reliability of the measurements in age estimation are discussed.

How old am I? Age estimation in living adults: a case report

Age estimation is a common task in forensic medicine. Odontologists are frequently involved in the age assessment of human remains or living juveniles. The need to estimate the age of living individuals is becoming more frequent, because of the increasing number of immigrants (illegal or otherwise) without acceptable identification documents and with missing or uncertain birth dates. Whereas age estimation in subadults is usually performed by methods based on the physiological growth of bones and teeth, in the case of living adults age determination is more difficult, because body maturation has come to an end and the most commonly used procedures in forensics on human remains are too invasive for the living individual. The following case report aims at highlighting the difficulties of performing age estimation in the living adult and the importance of a multidisciplinary approach including forensic odontology: a middle-aged woman from Ethiopia who was supposed to be 62 years old (according to one set of documents), was removed from employment lists as she had reached the retirement age for Italy. However another set of documents indicated a younger age (46 years). Hormonal dosage of E2 (17-β estradiol) and FSH (Follicle Stimulating Hormone) showed an age close to the begininng of menopause. An experimental dental method, based on the decrease of canine pulp chamber with age, was performed in order to obtain more information: the result was an estimation of a 47-57 age range. Combined results suggested that it was more likely that the actual age of the woman was closer to 46 than to 62.

The comparison between measurement of open apices of third molars and Demirjian stages to test chronological age of over 18 year olds in living subjects

This paper concerns a method for assessing adult age based on the relationship between age and the third molar maturity index (I(3M)), which is related to the measurement of the open apices of the third molar. Furthermore, this method was compared to those based on Demirjian's stages G and H. The sample consisted of 906 Caucasian individuals aged between 14 and 23 years (53.6% females and 46.4% males). Orthopantomographs were analyzed by two observers and calibrated by means of the concordance correlation coefficient for the reproducibility of the third molar maturity index (I(3M)) and kappa statistics for reproducibility of the Demirjian stages. Probabilities for an individual to be older than 18 years of age (adult age) were derived using the measurements of the third molar maturity index (I(3M)). These results were exploited to set out a threshold value to assign an individual to juvenile or adult age. A cutoff value of I(3M) = 0.08 was taken. The sensitivity of this test was 70% and specificity was 98%. Furthermore, the proportion of individuals with a correct classification was 83%. The results of the test showed a better specificity when compared to the choice of stage G and a better sensitivity when compared to the choice of stage H for adult age.

Accuracy of age estimation in children using radiograph of developing teeth

The aims of this study were: first, to determine the accuracy of the Cameriere method for assessing chronological age in children based on the relationship between age and measurement of open apices in teeth and, second, to compare the accuracy of this method with the widely used Demirjian et al. method and with the method proposed by Willems et al. Orthopantomographs taken from white Italian, Spain and Croatian children (401 girls, 355 boys) aged between 5 and 15 years were analysed following the Cameriere, Demirjian and Willems methods. The difference between chronological and dental age was calculated for each individual and each method (residual). The accuracy of each method was assessed using the mean of the absolute values of the residuals (mean prediction error). Results showed that the Cameriere method slightly underestimated the real age of children. The median of the residuals was 0.081 years (interquartile range, IQR=0.668 years) for girls and 0.036 years for boys (interquartile range, IQR=0.732 years). The Willems method showed an overestimation of the real age of boys, with a median residual error of -0.247 years and an underestimation of the real age of girls (median residual error=0.073 years). Lastly, the Demirjian method overestimated the real age of both boys and girls, with a median residual error of -0.750 years for girls and -0.611 years for boys. The Cameriere method yielded a mean prediction error of 0.407 years for girls and 0.380 years for boys. Although the accuracy of this method was better for boys than for girls, the difference between the two mean prediction errors was not statistically significant (p=0.19). The Demirjian method was found to overestimate age for both boys and girls but the mean prediction error for girls was significantly greater than that for boys (p=0.024), and was significantly less accurate than the Cameriere method (p<0.001). The Willems method was better than that of Demirjian (p=0.0032), but was significantly less accurate than that of Cameriere (p<0.001).