Dental Age Assessment in Children: A Comparison of Four Methods in a Recent French Population

The aim of this study was to analyze the accuracy and the reliability of four methods of dental age estimation (Demirjian, Willems I, Willems II, and Chaillet standards) in a French population. Orthopantomograms of 743 children aged between 4 and 15 years were used. The Demirjian standards gave a consistent overestimation of dental age compared with chronological age (+0.45 and +0.46 years for girls and boys, respectively). We found that three modified methods were more accurate for both sexes than Demirjian's method: the Willems I method appeared to be more suitable when the sex and ethnicity are both known (?0.09 and +0.14 years for girls and boys, respectively); the Willems II method was more accurate for children of unknown sex (mean difference = 0.00 years), and the Chaillet method was found to be more accurate than the Demirjian method, but less accurate than the Willems I method (?0.59 and ?0.18 years for girls and boys, respectively).     

Age Estimation in Indians Using Demirjian’s 8‐teeth Method

Abstract: Demirjian’s grading of tooth calcification is widely used to assess age of individuals with developing dentitions. However, its application on numerous populations has resulted in wide variations in age estimates and consequent suggestions for the method’s adaptation to the local sample. Conventionally, Demirjian’s method utilized seven mandibular teeth on the left side. A recent modification incorporated the third molar with a view to apply the method on a wider age‐group. Moreover, the revised method developed regression formulas for assessing age. This paper tested the 8‐teeth method using 547 Indians (348 females, 199 males) aged 7–25 years. Demirjian’s formulas resulted in inferior age prediction in Indians (9.2% misclassification at 99% confidence interval vs. 0% misclassification in the original study); therefore, India‐specific regression formulas were developed, which gave better age estimates (mean absolute error, MAE = 0.87 years) than the original formulas (MAE = 1.29 years). This suggests that Demirjian’s 8‐teeth method also needs adaptation prior to use in diverse populations.     

Testing the Demirjian and the international Demirjian dental aging methods on a mixed ancestry urban American subadult sample from Detroit, MI

This paper tests the Demirjian and international Demirjian dental aging methods for forensic use when ancestry and ethnicity are unknown. A radiographic sample of 187 boys and girls was collected from the Department of Pediatric Dentistry at the University of Detroit Mercy and aged using both methods. The total sample and the sample by age categories (young, middle, and old) were analyzed using t-tests. The Demirjian method was found to better estimate age to a statistically significant degree for the total sample, as well as the middle and old age categories. The young category was aged better using the international Demirjian method. The results indicate that while the Demirjian method accurately estimates age, caution must be used with the method. Further research is needed to determine whether the international Demirjian method can be used for forensics in the U.S.     

Optimal Dental Age Estimation Practice in United Arab Emirates’ Children

The aim of the study was to detect whether the Willems model, developed on a Belgian reference sample, can be used for age estimations in United Arab Emirates (UAE) children. Furthermore, it was verified that if added third molars development information in children provided more accurate age predictions. On 1900 panoramic radiographs, the development of left mandibular permanent teeth (PT) and third molars (TM) was registered according the Demirjian and the Kohler technique, respectively. The PT data were used to verify the Willems model and to develop a UAE model and to verify it. Multiple regression models with PT, TM, and PT + TM scores as independent and age as dependent factor were developed. Comparing the verified Willems‐ and the UAE model revealed differences in mean error of ?0.01 year, mean absolute error of 0.01 year and root mean squared error of 0.90 year. Neglectable overall decrease in RMSE was detected combining PM and TM developmental information.     

Study of Chilean Children’s Dental Maturation*

Abstract: In forensic science, determining a person’s chronological age has become a challenge for researchers. Determining age using dental calcification is becoming increasingly important. The objective of this study is to estimate the dental age of the children’s population in Region VIII, Chile. The sample was randomly taken from children under the care of the Faculty of Dentistry at the Universidad de Concepción in Chile. The study encompasses 159 children between 3 and 14 years of age. The dental age was determined following the Demirjian method. The Bland–Altman method was applied to establish the correlation. It was determined that the range between chronological and dental age is similar, and the degree of correlation between both ages is nearly perfect. In conclusion, the degree of correlation between the chronological and dental ages for each gender is also very good although it is slightly higher for females.     

Dental age assessment: the applicability of Demirjian method in eastern Turkish children

In the literature, little is known about the applicability of this method in Turkish children. The aim of this study was, therefore, to evaluate the reliability of Demirjian method of age estimation when used for eastern Turkish children. A retrospective study was performed on a sample of panoramic radiographs taken from 807 healthy eastern Turkish children. The stages of dental maturity of the mandibular left seven permanent teeth for each subject using the eight radiographic dental maturity stages demonstrated by Demirjian were evaluated. A paired t-test was used for statistical analysis. The mean difference between the chronological and dental ages ranged from 0.2 to 1.9 years in girls and from 0.4 to 1.3 years in boys. The differences between the chronological and dental ages were statistically significant in all age groups. The applicability of Demirjian method is not suitable for eastern Turkish population.     

Introducing Computed Tomography Standards for Age Estimation of Modern Australian Subadults Using Postnatal Ossification Timings of Select Cranial and Cervical Sites,

Contemporary, population‐specific ossification timings of the cranium are lacking in current literature due to challenges in obtaining large repositories of documented subadult material, forcing Australian practitioners to rely on North American, arguably antiquated reference standards for age estimation. This study assessed the temporal pattern of ossification of the cranium and provides recalibrated probabilistic information for age estimation of modern Australian children. Fusion status of the occipital and frontal bones, atlas, and axis was scored using a modified two‐ to four‐tier system from cranial/cervical DICOM datasets of 585 children aged birth to 10 years. Transition analysis was applied to elucidate maximum‐likelihood estimates between consecutive fusion stages, in conjunction with Bayesian statistics to calculate credible intervals for age estimation. Results demonstrate significant sex differences in skeletal maturation (p < 0.05) and earlier timings in comparison with major literary sources, underscoring the requisite of updated standards for age estimation of modern individuals.     

Forensic Dental Age Estimation by Measuring Root Dentin Translucency Area Using a New Digital Technique

Dentin translucency measurement is an easy yet relatively accurate approach to postmortem age estimation. Translucency area represents a two‐dimensional change and may reflect age variations better than length. Manually measuring area is challenging and this paper proposes a new digital method using commercially available computer hardware and software. Area and length were measured on 100 tooth sections (age range, 19–82 years) of 250 μm thickness. Regression analysis revealed lower standard error of estimate and higher correlation with age for length than for area (R = 0.62 vs. 0.60). However, test of regression formulae on a control sample (n = 33, 21–85 years) showed smaller mean absolute difference (8.3 vs. 8.8 years) and greater frequency of smaller errors (73% vs. 67% age estimates ≤ ±10 years) for area than for length. These suggest that digital area measurements of root translucency may be used as an alternative to length in forensic age estimation.     

Estimating age in Maori, Pacific Island, and European children from New Zealand

The islands of New Zealand are populated by persons of European, Maori, and Pacific Island extraction. The purpose of this research is to quantify the levels of dental maturation of each of these three populations, in order to obtain data that will be useful in forensic identification and age estimation. The sample consisted of 1383 orthopantomographs (660 males, 723 females) of 477 Maori, 762 European, and 144 Pacific Island children between the ages of 3 and 14 years. Each radiograph was digitized and the stages of mineralization of the seven left mandibular permanent teeth were assessed using the eight stages described by Demirjian. Values for 1, 3, 5, 50, 95, 97, and 99% confidence intervals are listed for each maturity score. Intra-observer reliability was evaluated using Bland-Altman's method on data from re-scoring one out of every 20 radiographs and standard dental maturation curves were constructed for the three populations by means of a quantile regression method. Despite the fact that quantile regression analysis showed that across the age group investigated there were differences between boys and girls, knowledge of the sex does not increase the accuracy of the age estimate, simply because the magnitude of the error of age estimation is greater than the difference between the sexes. Our analysis also shows that population divergence is most marked after the age of 9 years, with a peak difference seen at age 10.     

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

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

Excretion of Delta9-tetrahydrocannabinol in sweat

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).     

Relationship Between Pulp Tooth Area Ratio and Chronological Age Using Cone‐beam Computed Tomography Images

This study investigated the relationship between chronological age and pulp tooth area ratio (PTR) in maxillary central teeth using cone‐beam computed tomography (CBCT) images in the Turkish population. The sample consisted of CBCT images of 120 male and female subjects between 14 and 75 years old. The PTR of the maxillary central teeth was calculated using inVivo 5 software (Anatomage, San Jose, CA). Data were analyzed with independent t‐test and Pearson's rank correlation test. There was a significant negative correlation between chronological age and PTR (r = ?0.615). The results showed that the PTR of maxillary central teeth is a reliable method for age estimation in the Turkish population.     

Dental and Chronological Age in Children Under Oncological Treatment

The current oncology treatment has improved the survival of children with several types of cancer, and the effect of radiotherapy and/or chemotherapy treatment on dental maturation in comparison with chronological age is not widely known. The aim of this work was to evaluate and compare the impact of radiotherapy and/or chemotherapy treatment during dental maturation with chronological age in Chilean children diagnosed with cancer. Study Design was cross‐sectional study on children diagnosed with different types of cancer and treated with radiotherapy and/or chemotherapy when they were ages of 0.1 to 13 years. Demirjian tables for both girls and boys are used to determine the dental age. The association between chronological and dental age was highly significant. Nevertheless, a linear relation between chronological and dental age was not observed when the data were stratified by BMI and type of treatment. This study confirmed that dental age is an indicator of chronological age but that other variables, such as body mass index, in children with cancer could be confounder variables. Thus, further studies are necessary to investigate the influence of BMI on tooth eruption/maturation in children under oncological treatment.     

应用放射影像技术进行牙龄推断

牙龄是年龄推断的重要方法之一，国外学者常将其与骨龄联合应用以提高年龄推断的准确性，但国内尚未普遍开展。大量研究表明，应用放射影像学这一无创的检查手段，可以准确观察牙齿的增龄性变化，如牙冠与牙根的发育程度、牙髓腔的变化等。目前应用放射影像学进行牙龄推断的主要方法有Gleiser和Hunt法、Demirjian法及牙髓腔测量法等。其中Demirjian法的准确性最高，但在推断法定敏感年龄时尚存在局限性。随着放射影像学的发展，尤其是CT的出现，依赖其高分辨率以及相匹配的测量软件，可提高牙龄推断的准确性与可靠性，有望成为今后推断活体年龄的重要手段。     

A Comparative Assessment of the Chen et al. and Suchey‐Brooks Pubic Aging Methods on a North American Sample, ,

Accurately estimating the age‐at‐death of adult human skeletons is fundamental in forensic anthropology. This study evaluates the accuracy of two pubic bone age estimation methods—Chen et al. and Suchey‐Brooks. Specimens were obtained from a known collection of modern pubic bones curated at the Maricopa County Forensic Science Center in Phoenix, Arizona. A sample of 296 left male pubic bones of European ancestry was statistically evaluated via bias, absolute mean error, and intra‐ and inter‐observer error. Results indicate that the two methods are similar; the Suchey‐Brooks method is the most accurate for aging young adults (error c. 7 years), while the Revised Chen et al. method is most accurate for aging middle‐age adults (error c. 6 years). Thus, the Chen et al. method is an important contribution to forensic anthropology for aging older adult skeletal remains. There are, however, some limitations such as subjectivity and the intricate scoring system of Chen et al. method.     

Accuracy of age estimation of radiographic methods using developing teeth

Developing teeth are used to assess maturity and estimate age in a number of disciplines, however the accuracy of different methods has not been systematically investigated. The aim of this study was to determine the accuracy of several methods. Tooth formation was assessed from radiographs of healthy children attending a dental teaching hospital. The sample was 946 children (491 boys, 455 girls, aged 3-16.99 years) with similar number of children from Bangladeshi and British Caucasian ethnic origin. Panoramic radiographs were examined and seven mandibular teeth staged according to Demirjian's dental maturity scale [A. Demirjian, Dental development, CD-ROM, Silver Platter Education, University of Montreal, Montreal, 1993-1994; A. Demirjian, H. Goldstein, J.M. Tanner, A new system of dental age assessment, Hum. Biol. 45 (1973) 211-227; A. Demirjian, H. Goldstein, New systems for dental maturity based on seven and four teeth, Ann. Hum. Biol. 3 (1976) 411-421], Nolla [C.M. Nolla, The development of the permanent teeth, J. Dent. Child. 27 (1960) 254-266] and Haavikko [K. Haavikko, The formation and the alveolar and clinical eruption of the permanent teeth. An orthopantomographic study. Proc. Finn. Dent. Soc. 66 (1970) 103-170]. Dental age was calculated for each method, including an adaptation of Demirjian's method with updated scoring [G. Willems, A. Van Olmen, B. Spiessens, C. Carels, Dental age estimation in Belgian children: Demirjian's technique revisited, J. Forensic Sci. 46 (2001) 893-895]. The mean difference (+/-S.D. in years) between dental and real age was calculated for each method and in the case of Haavikko, each tooth type; and tested using t-test. Mean difference was also calculated for the age group 3-13.99 years for Haavikko (mean and individual teeth). Results show that the most accurate method was by Willems [G. Willems, A. Van Olmen, B. Spiessens, C. Carels, Dental age estimation in Belgian children: Demirjian's technique revisited, J. Forensic Sci. 46 (2001) 893-895] (boys -0.05+/-0.81, girls -0.20+/-0.89, both -0.12 y+/-0.85), Demirjian [A. Demirjian, Dental development, CD-ROM, Silver Platter Education, University of Montreal, Montreal, 1993-1994] overestimated age (boys 0.25+/-0.84, girls 0.23+/-0.84, both 0.24 y+/-0.86), while Nolla [C.M. Nolla, The development of the permanent teeth, J. Dent. Child. 27 (1960) 254-266] and Haavikko's [K. Haavikko, The formation and the alveolar and clinical eruption of the permanent teeth. An orthopantomographic study, Proc. Finn. Dent. Soc. 66 (1970) 103-170] methods under-estimated age (boys -0.87+/-0.87, girls -1.18+/-0.96, both -1.02 y+/-0.93; boys -0.56+/-0.91, girls -0.79+/-1.11, both -0.67 y+/-1.01, respectively). For individual teeth using Haavikko's method, first premolar and second molar were most accurate; and more accurate than the mean value of all developing teeth. The 95% confidence interval of the mean was least for mean of all developing teeth using Haavikko (age 3-13.99 years), followed by identical values for Demirjian and Willems (sexes combined).     

Quantification of Pubic Symphysis Metamorphosis Based on the Analysis of Clinical MDCT Scans in a Contemporary Malaysian Population

Forensic age estimation methods are biased to sex and population; in general, accuracy is reduced when applied to foreign populations. This study assessed the accuracy of the Suchey–Brooks method in contemporary Malaysian individuals and aimed to formulate population‐specific standards. Multi‐detector computed tomography scans of 355 individuals (165 male; 190 female) of 15–83 years of age were reconstructed using 3D‐volumetric rendering in RadiAnt. Pubic symphyseal phase, bias, inaccuracy, and percentage correct age classifications are examined. Transition analysis was used to develop age estimation standards. High observer agreement (κ = 0.763–0.832) and a positive relationship between age and pubic symphyseal phase (r = 0.884–0.90) were demonstrated. Mean inaccuracies were 8.62 and 8.95 years for males and females, respectively; overall correct classification was 97.8%. Transition ages between phases in males were 18.79, 23.29, 28.85, 43.64, and 61.15 years; in females, the corresponding data were 19.77, 22.53, 32.62, 41.85, and 57.39 years.     

Effects of Parturition on Pelvic Age Indicators

This research assessed whether parity has a differential effect on age indicators of the pelvis. The data were collected from the William M. Bass Donated Skeletal Collection. Age indicators of the pubic symphysis and auricular surface were assessed using the Todd, Suchey–Brooks, Lovejoy et al., and Buckberry and Chamberlain scoring systems. A transition analysis was conducted, and scoring systems of the pubic symphysis showed the parous female group transitioning between eight and 14 years earlier than the nulliparous female and male groups, and 1 and 7 years earlier using the auricular surface methods. A likelihood ratio test produced significantly different results between parous and nulliparous females using the pubic symphysis (p < 0.01) but not the auricular surface (p > 0.05). Although parous females were inaccurately assessed more often than nulliparous females, no correction of methods is necessary at this time as current standards take parity into account by utilizing a lumped female sample.