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.     

利用牙齿推断年龄的研究进展

牙齿是人体最坚硬的器官之一,其抗腐蚀能力强,多项形态特征具有增龄性变化,因此利用牙齿推断年龄在法医学中得到广泛应用。由于牙齿的生理性变化的复杂性及环境因素的影响,不同牙齿推断年龄的方法各具其应用价值,同时也存在一定的局限性,法医工作者需要依据具体情况选择适合的方法并加以综合运用,以提高年龄推断的准确性。本文对国内外利用牙齿推断年龄的研究现状进行综述,并对各种推断方法进行比较评价,希望能为相关研究和实践提供参考。     

To evaluate the utility of smaller sample sizes when assessing dental maturity curves for forensic age estimation

Dental maturation and chronological age estimation were determined from 144 healthy Western Australian individuals aged 3.6-14.5 years. The results were compared with Farah et al.'s previous study which comprised a larger heterogeneous sample of Western Australian individuals (n = 1450). Orthopantomograms were analyzed with the application of Demirjian and Goldstein's 4-tooth method based on eight stages of dental mineralization. Analysis of variance revealed no significant differences in dental maturity scores in each age group among the males in both studies; similar results were seen in the females. Paired t-tests showed no statistical significance overall between chronological and estimated ages for the males in our sample (p = 0.181), whereas the females showed significant differences (p < 0.001). Our results show that smaller samples may be used when assessing dental maturity curves for forensic age estimation.     

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.     

Age Estimation from the Teeth Using a Modified Demirjian System*

Abstract: The estimation of age at time of death is often an important step in the identification of human remains. The purpose of this study was to test the applicability of the Demirjian system on a sample of the Sydney child population and to develop and test age‐prediction models using a large sample of Sydney children (1624 girls, 1637 boys). The use of the Demirjian standards resulted in consistent overestimates of chronological age in children under the age of 14 by as much as a mean of 0.99 years. Of the alternative predictive models derived from the Sydney sample, those that provided the most accurate age estimates are applicable for the age ranges 2–14 years, with R‐square = 0.94 and a 95% confidence interval of ±1.8 years. The Sydney‐based standards provided significantly different and more accurate estimates of age for that sample when compared to the published standards of Demirjian.     

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.     

Antemortem dental records: attitudes and practices of forensic dentists

This study was designed to provide insight concerning the attitudes and practices of forensic dentists regarding antemortem dental records reviewed for purposes of dental identification. Forensic dentists were invited to participate in a 10 item survey. The majority of the respondents reported a considerable amount of experience in dental identifications of the deceased. Sixty-six percent reported having suspected dental negligence or fraud in their antemortem record reviews. Only 17% believe that a forensic dentist should report suspected dental negligence, while 31% agree that dental fraud should be reported. Their response to additional issues addressed in the study suggests diversity in the practices and attitudes of forensic dentists in the use of antemortem dental records. In conclusion, opening a dialogue among practicing forensic dentists may lead to a standardized set of recommendations by the appropriate societies in the forensic dental community.     

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.     

Age estimation and the developing third molar tooth: an analysis of an Australian population using computed tomography

The third molar tooth is one of the few anatomical sites available for age estimation of unknown age individuals in the late adolescent years. Computed tomography (CT) images were assessed in an Australian population aged from 15 to 25 years for development trends, particularly concerning age estimation at the child/adult transition point of 18 years. The CT images were also compared to conventional radiographs to assess the developmental scoring agreement between the two and it was found that agreement of Demirjian scores between the two imaging modalities was excellent. The relatively wide age ranges (mean ± 2SD) indicate that the third molar is not a precise tool for age estimation (age ranges of 3-8 years) but is, however, a useful tool for discriminating the adult/child transition age of 18 years. In the current study 100% of females and 96% of males with completed roots were over 18 years of age.     

A comparison of Demirjian's four dental development methods for forensic age assessment

The aim of this study was to determine the comparative accuracy of Demirjian's four dental development methods for forensic age estimation in the Western Australian population. A sample comprising 143 individuals aged 4.6 to 14.5 years were assessed using Demirjian's four methods for dental development (original 7-tooth: M(2), M(1), PM(2), PM(1), C, I(2), and I(1); revised 7-tooth: M(2), M(1), PM(2), PM(1), C, I(2), and I(1); 4-tooth: M(2), M(1), PM(2), and PM(1); and an alternate 4-tooth: M(2), PM(2), PM(1), and I(1)). When comparing all four methods, the 4-tooth method overestimated age in both males and females by 0.04 and 0.25 years, respectively. The original 7-tooth was least accurate for males, while the original 7-tooth, the revised 7-tooth, and the alternate 4-tooth were unsuitable for females. Therefore, we recommend the 4-tooth method to be used for forensic age estimation in Western Australian males and females, as it has the lowest overall mean deviation and the highest accuracy.     

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).     

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.     

Assessment of histomorphological features of the sternal end of the fourth rib for age estimation in Koreans

The aim of this study was to assess the histomorphological features of the fourth rib and to develop age-predicting equations for Koreans. Sixty-four rib samples (36 males and 28 females) obtained from forensic cases were used for developing equations. Two thin sections (<100-microm thick) per sample were prepared by manual grinding. Multivariate analysis of covariance revealed statistically significant differences in age-adjusted histomorphological variables between sexes. Using stepwise regression analysis, osteon population density and average osteon area were correlated with unknown sex (r2 = 0.826), and sex plus two histomorphological variables provided the best results for an age-predicting equation given the assumption of knowing the sex of a specimen (r2 = 0.839). Average Haversian canal area had little influence on age estimation for male or female samples, and relative cortical area was not significantly related to age for any specimen.     

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.     

Evaluation of age estimation technique: testing traits of the acetabulum to estimate age at death in adult males

This study evaluates the accuracy and precision of a skeletal age estimation method, using the acetabulum of 100 male ossa coxae from the Grant Collection (GRO) at the University of Toronto, Canada. Age at death was obtained using Bayesian inference and a computational application (IDADE2) that requires a reference population, close in geographic and temporal distribution to the target case, to calibrate age ranges from scores generated by the technique. The inaccuracy of this method is 8 years. The direction of bias indicates the acetabulum technique tends to underestimate age. The categories 46-65 and 76-90 years exhibit the smallest inaccuracy (0.2), suggesting that this method may be appropriate for individuals over 40 years. Eighty-three percent of age estimates were ±12 years of known age; 79% were ±10 years of known age; and 62% were ±5 years of known age. Identifying a suitable reference population is the most significant limitation of this technique for forensic applications.     

Forensic age estimation on digital X-ray images: Medial epiphyses of the clavicle and first rib ossification in relation to chronological age

In recent years, there has been a renewed interest in forensic sciences about forensic age estimation in living subjects by means of radiological methods. This research was conducted on digital thorax X-rays to test the usefulness of some radiological changes in the clavicle and first rib. The sample consisted in a total of 123 subjects of Spanish origin (61 men and 62 women; age range: 5-75 years). From all subjects, a thorax posterior-anterior radiograph was obtained in digital format. Scoring for fusion of medial epiphyses of the clavicle was carried out by Schmeling's system and ossification of the costal cartilage of the first rib by Michelson's system. Degree of ossification and epiphyseal fusion were analyzed in relation with known age and sex of these subjects. The results give a minimum age of >20 years for full fusion of the medial epiphysis of the clavicle (Stages 4 and 5). Concerning the first rib, all subjects with the final Stage 3 of ossification were above 25 years of age. These results suggest that the first rib ossification might become an additional method to the ones so far recommended for forensic age estimation in subjects around 21. New research would be desirable to confirm this suggestion.     

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.     

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.