Morphometric analysis of third molar root development by an experimental method using digital orthopantomographs

Abstract:  The aim of the study was to conduct a morphometric analysis of the root development of the third molar, with the purpose of overcoming the limits of an exclusively morphological analysis. The study was divided in two phases. The first one was the verification of the existence of a constant crown-root (C/R) ratio on a sample of 100 third molars, characterized by a complete root development. The value obtained was used in the second phase to predict the final root's length, knowing the crown height. So we have calculated, on a sample of 322 third molars with developing roots, the final ratios between incomplete roots and complete roots. Statistical analysis was then made with 90%, 95%, and 99% confidence intervals. The results showed a significant difference according to the age of the subject and the limit values, lower and upper, for subjects aged 16 and 17 years versus those aged 18 and 19. For each analysis, the width of the class of tolerance and other statistical indicators were calculated. The results we obtained support the advantage of a morphometric study as opposed to an exclusively morphological study, but all the techniques used to determine the age of a living subject can provide only indications of the biological age, but no certainties as regards chronological age.     

Age estimation of Korean adults by occlusal tooth wear

The aim of the present study was to evaluate the validity of the modified Kim's scoring system as a practical method of recording occlusal tooth wear and estimating age. For this purpose, 1092 pairs of maxillary and mandibular full-arch casts were randomly selected, scored, and analyzed. The results showed that the modified Kim's scoring system had excellent reliability, and that occlusal tooth wear had a positive correlation with age. Tooth wear scores of all teeth except the two lower central incisors were higher in males than in females. Calculating tables for age estimation were designed by multiple linear regression analysis. Estimated ages were within +/-5 years of actual ages in 63.5% of male subjects, and 64.0% of female subjects. The accuracy of age estimation was increased when the subjects were divided into two age groups and data were re-analyzed. Collectively, it was shown that the modified Kim's scoring system is a reliable and accurate method for age estimation, and that the data from these 1092 individuals can be used as a standard for age estimation of Korean adults.     

利用影像学技术进行第三磨牙与年龄关系研究的进展

目前无创便捷的影像学技术是进行青少年年龄研究的热点,但大多研究方法和观测指标在18岁左右的群体中应用受限。尽管第三磨牙变异性大,但是国外学者通过研究证实第三磨牙的钙化程度与年龄相关性较好,而且是该年龄段中少有的可参考的生物学指标,同时就种族间的差异进行了大量研究;而国内相关研究报道较少。本文通过归纳国内外利用第三磨牙生长发育进行年龄推断的方法及相关研究结论,从而为今后进行相关研究提供参考。     

Studies of the chronological course of wisdom tooth eruption in a Black African population

The importance of forensic age estimation in living subjects has grown over the last few years. In dental age estimation, tooth eruption is a parameter of developmental morphology that can be analyzed by either clinical examination or by evaluation of dental X-rays. In the present study, we determined the stage of wisdom tooth eruption in 410 male and 106 female Black South African subjects of known age (12-26 years) based on radiological evidence from 516 conventional orthopantomograms. Four eruption stages were determined (no emergence, alveolar emergence, gingival emergence, complete emergence). Statistical scores were determined for the individual stages separately for both sexes. The data presented here can be utilized for forensic estimation of the minimum and most probable ages of investigated persons.     

Age estimation by measurements of developing teeth: accuracy of Cameriere's method on a Brazilian sample

Developing teeth are commonly the criteria used for age estimation in children and young adults. The method developed by Cameriere et al. (Int J Legal Med 2006;120:49-52) is based on measures of teeth with open apex, and application of a formula, to estimate chronological age of children. The present study evaluated a sample of panoramic radiographs from Brazilian children from 5 to 15 years of age, to evaluate the accuracy of the method proposed by Cameriere et al. The results has proven the system reliable for age estimation, with a median residual error of -0.014 years between chronological and estimated ages (p = 0.603). There was a slight tendency to overestimate the ages of 5-10 years and underestimate the ages of 11-15 years.     

Estimating Age of Majority on Third Molars Developmental Stages in Young Adults from Thailand Using a Modified Scoring Technique*

Abstract: The aim of this study was to achieve a referral database for dental age estimation of unaccompanied minors of Thai nationality. A total of 1199 orthopantomograms were collected from original Thai women and men equally divided in age categories between 15 and 24 years. On the radiographs, the developmental stage of the third molars was scored applying a modified scoring technique. Inter- and intra-observer reliabilities were tested using kappa statistics. Correlation between the scores of all four wisdom teeth and left–right symmetry were evaluated with Pearson’s correlation coefficient. Student’s t-test on asymmetry was performed and regression formulas were calculated. The present database was the first to assemble third molar developmental scores on radiographs of Thai individuals and provides more appropriate dental age estimation of unaccompanied Thai minors. Future research on similar databases of different nationalities worldwide may expose ethnical influences on dental development.     

Age estimation by pulp/tooth ratio in canines by peri-apical X-rays

Estimation of age in individuals has received considerable attention in forensic science, in which it is a widely used method for individual identification, together with paleo-demographic analyses to establish mortality patterns in past populations. The present investigation, which is a continuation of a previously published pilot study, was conducted to examine the possible application of the pulp/tooth area ratio by peri-apical images as an indicator of age at death. A total of 200 peri-apical X-rays of upper and lower canines were assembled from 57 male and 43 female skeletons of Caucasian origin, aged between 20 and 79 years. They belong to the Frassetto osteological collection of Sassari (Sardinia) and are housed in the Museum of Anthropology, Department of Experimental and Evolutionistic Biology, University of Bologna. For each skeleton, dental maturity was evaluated by measuring the pulp/tooth area ratio on upper (x(1)) and lower (x(2)) canines. Very good agreement was found between intraobserver measurements. Statistical analysis was performed in order to obtain multiple regression formulae for dental age calculation, with chronological age as dependent variable, and gender, and upper and lower canines as independent variables. Stepwise regression analysis showed that gender did not contribute significantly to the fit (p=0.881) whereas variables x(1) and x(2) and the first-order interaction between them did. These two variables explained 92.5% of variations in estimated chronological age and the residual standard error was 4.06 years. Lastly, two simple linear regression equations were obtained for age estimation using canines from the maxilla and mandible separately. Both models explained 86% of variations in estimated chronological age and allowed an age-at-death estimate with a residual standard error of about 5.4 years.     

Age estimation by pulp/tooth ratio in canines by mesial and vestibular peri-apical X-rays

Changes in the size of the pulp canal, caused by apposition of secondary dentine, are the best morphometric parameters for estimating age by X-rays. The apposition of secondary dentine is the most frequently used method for age estimation in adult subjects. In two previous papers, we studied the application of the pulp/tooth area ratio by peri-apical X-rays as an indicator of age at death. The aim of the present study was to test the accuracy of age evaluation by combined analysis of labio-lingual and mesial peri-apical X-rays of lower and upper canines. A total of 200 such X-rays were assembled from 57 male and 43 female skeletons of Caucasian origin, aged between 20 and 79 years. For each skeleton, dental maturity was evaluated by measuring the pulp/tooth area ratio according to labio-lingual and mesial X-rays on upper (x(1), x(2)) and lower (x(3), x(4)) canines. Very good agreement was found between intra-observer measurements. Statistical analysis showed that all variables x(1), x(2), x(3), and x(4) and the first-order interaction between x(1) and x(3) contributed significantly to the fit, so that they were included in the regression model, yielding the following regression formula: Age = 120.737 - 337.112x(1) - 79.709x(2) - 364.534x(3) - 65.655x(4) + 1531.918x(1)x(3) . The residual standard error of estimated ages was 3.62 years, with 94 degrees of freedom, and the median of the residuals was -0.155 years, with an interquartile range of 4.96 years. The accuracy of the method was ME = 2.8 years, where ME is the mean prediction error. The model also explained 94% of total variance (R(2) = 0.94).     

Accuracy of BR Regression Equation for Impacted Teeth in Age Estimation in Haryana Population of India

Abstract:  Dental cementum is a vital tissue that demonstrates continuous apposition throughout the life of a tooth. Positive correlation has been reported between the coronal displacement of cementum and age in impacted teeth and BR regression equation has been proposed. The present study is an attempt to calculate accuracy of BR regression equation in Haryana population of India. The study was conducted on 20 impacted mandibular third molars extracted from healthy patients, aged between 22 and 32 years. The bucco-lingual ground sections were prepared and the distance between the edges of enamel and cementum were measured with micrometer attached to a light microscope and BR regression equation was applied for age estimation. Although the estimated age with BR regression equation was less than chronological age it was not statistically significant. Hence, the BR regression equation can be used in medicolegal as well as in forensic odontology for age estimation.     

Age-at-death estimation by pulp/tooth area ratio in canines: study of a 20th-century Mexican sample of prisoners to test Cameriere's method

Accurate age estimation has always been a problem for forensic scientists, and apposition of secondary dentine is often used as an indicator of age. Cameriere et al. studied the pulp/tooth area ratio by peri-apical X-ray images of the canines, to observe the apposition of secondary dentine. The present study examines the application of this technique in a Mexican identified sample coming from the Department of Physical Anthropology of the INAH, at Mexico City. The main aim of this work is to test the reliability of this method in a skeletal sample of a specific population, different from the samples used for its development. The obtained regression model explained 96.2% of total variance (R(2) = 0.962) with a standard error of estimate of 1.909 and a standard deviation of 1.947. These results demonstrate great reliability and that the age/secondary dentine relationship is not variable in this specific population.     

Reliability of Third Molar Development for Age Estimation in a Texas Hispanic Population: A Comparison Study*

Abstract: Evaluating third molars from 950 Hispanic individuals aged 12–22 years using Demirjian’s schematic for crown and root formation found that Hispanic third molar development was 8–18 months faster than American Caucasians as reported by Mincer, Harris and Berryman in 1993. This represents a statistically significant increase. Earlier development was more apparent in the later stages F through H. Hispanic males reach developmental stages faster than Hispanic females and maxillary third molars reach developmental stages faster than mandibular third molars in both sexes. The earliest age observed for stages B–H (e.g., Stage H first observed at age 13.92 years in females) and the oldest age observed for Stages B–G were developed to facilitate age prediction of unknown individuals. Prediction tables for minimum and maximum age for an observed stage (e.g., if a female maxillary third molar is stage F it means she is older than 13 years) for each sex‐jaw group were calculated.     

The Reliability of Chronological Age Determination by Means of Mandibular Third Molar Development in Subjects in Croatia*

Abstract: The aim of this study was to determine the development of the mandibular third molar and its relation to chronological age. The evaluated material consisted of 979 orthopantomograms of patients of Croatian Caucasian origin aged between 5.7 and 14.6 years. Third molar developmental stages were evaluated according to the stages proposed by Nolla. The frequencies of different stages of mineralization and the mean value of the mineralization of the mandibular third molars with regard to age, gender, and size of the mandible were determined and the coefficient of correlation determined between the age of the subject and the stage of development of the mandibular molars. Statistically significant correlation was determined between mineralization of the mandibular third molar and chronological age of the subjects (boys, mandibular left third molar r = 0.779, right third molar r = 0.793; girls, mandibular left third molar r = 0.746, right third molar r = 0.725). It can be concluded that the accuracy of age estimation based on Nolla’s method is applicable for Croatian children.     

Radiographic evaluation of third molar development in relation to chronological age among Turkish children and youth

A sharp increase in forensic age estimation of living persons has been observed in recent years. However, ethnic populations residing in different countries have been insufficiently analyzed. According to 2004 data compiled by the Essen-based Turkey Research Center, there are 3.8 million Turkish people living abroad, and 3.2 million of them reside in European Union countries. Despite the high number of Turks living abroad, little is known about third-molar development for forensic application in this population. Hence, it was considered worthwhile to determine the developmental stages of the third molar in a group of Turkish population, to assess chronological age estimation based on the developmental stages, and to compare third molar development according to sex, age and location. Orthopantomograms of 1134 Turkish patients, ages 4-20 years were examined and third-molar developmental stages were evaluated based on Demirjian's classifications. Orthopantomograms were scored by two different observers, and Wilcoxon matched-pairs signed-ranks test used to test intra- and inter-observer reliability revealed a strong agreement between both intra- and inter-observer measurements. Linear regression analysis was performed to correlate third-molar development and chronological age, and further statistical analysis was performed to determine the relation between sex, age and location. Results showed a strong linear correlation between age and molar development (males: r(2)=0.57; females: r(2)=0.56). Mineralizations of left and right third molars were compared using Wilcoxon tests, and no statistical differences were found. No significant differences were found in third-molar development between males and females. Mandibular third molar crypt formation was observed in 2.4% of patients at age seven and maxillary third molar crypt formation was observed in 1.3% of patients at age seven. A strong correlation was found between third-molar development and chronological age. Among the Turkish population, third molar crypt formation is observable at as early as 7 years in both the mandible and maxilla. Agenesis can be determined conclusively if no radiolucent bud is present by age 14.     

On the applicability of secondary dentin formation to radiological age estimation in young adults

The literature provides linear regression formulas for dental age estimation that is based on radiological two-dimensional measurements of the pulp size. The aim of the present study was to explore whether the previously presented regression formulas could lead to statistically sound results and to appropriate repeatability when applied to young individuals. Orthopantomograms (OPGs) of 44 Austrian individuals, aged between 13 and 24 years, were selected at random. In accordance with the reported method, six teeth on each OPG were chosen to carry out the measurements. Statistical analysis was performed in order to assess the difference between the estimated and the true chronological age. The regression formulas reported by Kvaal et al. (1995) led to a consistent underestimation; the regression formulas reported by Paewinsky et al. (2005) resulted in a constant overestimation of age. The statistical analysis of intraobserver and interobserver variation revealed a variation width below 2%, respectively.     

A test of the differential accuracy of the maxillary versus the mandibular dentition in age estimations of immature skeletal remains based on developing tooth length

Liversidge and colleagues developed a method for predicting the age of immature skeletal remains based on the length of developing teeth. This quantitative method combines dental data from both jaws, except for the permanent lateral incisor, and because there are reasons to suspect that these two types of data are not identical and should not be combined, it raises concerns regarding the accuracy of the technique when applied differently to each jaw. In this study, the differential accuracy of the method was test when applied to the maxillary and mandibular dentition. The test sample is comprised of 57 Portuguese subadult skeletons of known age at death. Results suggest an overall high consistency between estimates obtained from both jaws, but for the permanent dentition only. In the deciduous dentition the age estimates obtained from the maxillary teeth tend to be greater than the age estimates obtained from the mandibular pair, and the differences are significant for the incisors and canine. Additionally, ages obtained from the maxillary deciduous canine also differ significantly from true chronological age. In the permanent dentition there were no differences between the ages provided by both jaws but both the maxillary and mandibular second molars show a significant tendency to underestimate true chronological age. Although this study cannot validate completely the method presented by Liversidge and colleagues, it does provide an important test to its accuracy and calls for further research into its overall performance, particularly with respect to the results obtained from both jaws.     

Age Estimation by Racemization Method in Teeth: Application of Aspartic Acid,Glutamate, and Alanine

Abstract: Here, we report on an experimental approach of simultaneous determination of various amino acids racemization (AAR) rates in teeth. We evaluated the measurements of aspartic acid (Asp), glutamate (Glu), and alanine (Ala) isolated from dentin. Asx D/L rates from total amino acid fraction, generally used for age estimation, showed high correlation (r = 0.98) with age. As Glx and Ala showed very slow racemization kinetics in TA, we performed further analysis of the acid‐soluble protein (SP) fraction. The results supported improved correlation between age and D/L rates for Glu (r = 0.84) and Ala (r = 0.85), as well as for Asp (r = 0.98). By providing further elucidation on dentin protein racemization, the technique offers a considerable opportunity to involve other amino acids in age estimation studies. As the process does not require additional separation steps, the method can be easily adapted to existing protocols.     

Dental Cementum in Age Estimation: A Polarized Light and Stereomicroscopic Study

Abstract: Dental hard tissues are good candidates for age estimation as they are less destructive and procedures to determine age can be easily performed. Although cementum annulations and cementum thickness are important parameters in this regard, they are seldom used. This study was undertaken to review the methods, difficulties in execution of techniques, and accuracy of cementum thickness and annulations in estimating the age. Unstained and stained ground sections of tooth were used to measure cemental thickness and count cemental annulations based on which age was estimated and was compared with known age. Although there was positive relation between cemental thickness and annulations with age, only in 1–1.5% of cases, age could be predicted with accuracy.