Age estimation using carpals: study of a Slovenian sample to test Cameriere's method

Carpals are often used as age indicators. In a recent study, Cameriere et al. studied the use of the ratio between the total area of carpal bones and epiphyses of the ulna and radius (Bo) and carpals (Ca) as age indicators. The present study, of a sample of 158 Slovenian children and adolescents aged between 6 and 16 years, focused on analysing the best regression for age estimation. The regression model yielded the following equation: age=-3.411+0.942 g+20.927(Bo/Ca), and explained 91.6% of total variance (R(2)=0.916). The median of the absolute values of residuals (observed age minus predicted age) was 0.09 years, with a quartile deviation of 0.786 years, and a standard error of estimate of 0.658 years. Comparisons between the previous equation referring to Slovenian children and the equivalent linear equation proposed by Cameriere et al. did not reveal any significant differences between the intercepts and slopes of the two linear models. These results suggested a common regression model for both Italian and Slovenian samples. The common regression model, describing age as a linear function of gender and Bo/Ca ratio, yielded the following linear regression formula: age=-2.907+0.408 g+20.757(Bo/Ca). This model explained 86% of total variance (R(2)=0.86). The median of the absolute values of residuals (observed age minus predicted age) was 0.02 years, with a quartile deviation of 1.02 years and a standard error of estimate of 0.96 years.     

Accuracy of Three Age Estimation Methods in Children by Measurements of Developing Teeth and Carpals and Epiphyses of the Ulna and Radius

Abstract: The aim of this study was to compare the accuracy of three methods for age estimation in children: the measurements of open apices in tooth roots (T), the ratio between the total area of carpal bones and epiphyses of the ulna and radius (HW), and the combined method (THW). The sample consisted of 288 Caucasian Italian children (152 boys and 136 girls) aged between 5 and 15 years. Accuracy was determined as the difference between estimated age and chronological age, and accuracy was assessed by analyzing individuals’ orthopantomograms and hand‐wrist radiographs. Accuracies were 0.41 years for girls and 0.54 years for boys with the THW method; for the HW method, 1.00 years for girls and 0.92 years for boys; and for the T method, 0.62 years for girls and 0.71 years for boys. THW is the most accurate technique for age estimation in these children.     

Comparative study of Greulich and Pyle Atlas and Maturos 4.0 program for age estimation in a Portuguese sample

Age estimation of living individuals has become one of the big issues of forensic anthropology. The increase of children and adolescents with no valid proof of their chronological age is a legal concern to many countries, especially in situations of illegal immigration, sub adult delinquency and juvenile work. For this purpose, the use of radiological methods for evaluation of skeletal maturation is particularly useful. In this study we compare the two of the most common methods applied in age estimation by hand/wrist radiographs: the Radiographic Atlas of Skeletal Development of the Hand and Wrist made by Greulich and Pyle (GP), 1959,and the Sempé method developed for computer--Maturos 4.0 (MT) program. These methods were applied to a sample of 230 radiographs of the hand and wrist from Portuguese children and adolescents of known sex age and age, aged between 12 and 20 years, who performed medical examination at the University of Coimbra Hospitals during 2005. The methods achieved different performances, depending on the age group. Between 12 and 15 years the bone age with the MT program is closer to the chronological age, whereas in older ages the GP Atlas method is more trustworthy. At the ages with legal consequences in Portugal (16 and 18 years) the GP Atlas method is most accurate, namely to decide whether an individual is younger or older than 18 years. Around 16 years old, although there are doubts in relation to the accuracy of both methods, GP Atlas seems to perform better.     

Intra- and interobserver error of the Greulich-Pyle method as used on a Danish forensic sample

The Section of Forensic Medicine at the University of Copenhagen performs age evaluations of the living at the request of the police. The established procedure in these cases involves: (1) a physical examination; (2) an odontological examination based on evaluation of an orthopantomogram and intraoral dental radiographs. Different methods are used depending on the maturity of the individual examined; and (3) a carpal X-ray examination, using the Greulich and Pyle Atlas (GPA) method. We present the results of intra- and interobserver tests of carpal X-rays in blind trials, and a comparison of the age estimations by carpal X-rays and odontological age estimation. We retrieved 159 cases from the years 2000-2002 (inclusive). The intra- and interobserver errors are overall small. We found full agreement in 126/159 cases, and this was between experienced users and novices. Overall, the mean difference was 0.053 years, with a standard deviation of +/-0.567 years. Our results show that the direct and na?ve use of the GPA is simple and reproducible, even when applied by non-experienced users. This is probably also why the method is still widely applied, even though other authors have stated that atlas-based techniques are obsolete and ought to be replaced by other methods. Specifically, the GPA test sample consisted of American "white" children "above average in economic and educational status", leading to the question as to how comparable subjects being scored by the GPA method today are to this original sample. Indeed, we found a minor difference in the age estimations for older juveniles between odontologists and radiologists, which may indicate that more studies on comparative dental and skeletal aging for geographically different populations would be beneficial. Finally, if using the GPA method in legal cases, we would advise that one should closely adhere to the standard deviations given, and intermediary scores should be noted and not just a resultant age. The final age statement should also address the problems of reference populations.     

7146名城市青少年肥胖、超重和体瘦者的年龄推测

目的观察城市青少年肥胖、超重和体瘦者的骨发育特征。方法以《中国人手腕骨发育标准-中华05》RUS-CHN法对5城市7146名(男3986,女3160)12～18岁汉族正常青少年手腕部X线片骨龄进行评价,计算各骨龄组的体重指数(BMI),BMI第85百分位数的受试者分类为肥胖和超重,BMI第15百分位数者分类为体瘦,观察骨龄减年龄差值。结果肥胖、超重青少年偏向发育提前,骨龄减年龄差值分布的下限在-1岁;体瘦青少年偏向于发育延迟,骨龄减年龄差值分布的上限在+1岁。结论应用BMI,肥胖、超重和体瘦青少年的年龄推测范围可能缩小。     

Morphologic analysis of third-molar mineralization for eastern Turkish children and youth

To date, there has been no chronological age estimation according to third-molar mineralization in eastern Turkish children and adolescents. The aim of this study was to analyze the development of the mandibular third molar and its relationship to chronological age in subjects aged 7-22 years according to Demirjian's stages. The final sample consisted of 1348 [622 males (mean age, 12.72 ± 3.14) and 726 females (mean age, 12.92 ± 2.89)] conventional orthopantomograms from eastern Turkish youths. An independent t-test was performed to evaluate the difference between sexes. Regression analysis was performed to obtain regression formulae for dental age calculation with chronological age. In males, there was a difference between males and females only at stage C (p = 0.03); females were advanced 0.37 years compared with males at the stage C. Third-molar development among eastern Turkish children and youths occurs at a more advanced age than other populations for almost all stages.     

Relationship Between Self‐Injurious Behaviors and Levels of Aggression in Children and Adolescents Who Were Subject to Medicolegal Examination,

Aggression, which is defined as a behavior causing harm or pain, is a behavioral pattern typically expected in children and adolescents who are involved in criminal activities. The aim of this study was to examine the relationship between aggression and self‐injurious behavior (SIB) in children and adolescents. The study was performed in 295 cases which were sent for medicolegal examination. The mean age of the subjects was 14.27 ± 1.05 years (age range 10–18 years). The aggression levels of the subjects were determined using the Aggression Questionnaire (AQ), which is an updated form of the Buss‐Durkee Hostility Inventory. The mean total AQ score of the subjects with and without SIB was 78.04 ± 21.0 and 62.75 ± 18.05, respectively (p < 0.01). There were significant statistical differences between the two groups with respect to their subscale scores (p < 0.01). It was concluded that the levels of aggression increased in children and adolescents who were involved in criminal activities when the SIBs increased.     

14岁青少年手腕骨发育的研究I．男生骨龄标准的制定

目的研究我国当前青少年骨发育状况,制订专用于法医学推断男性刑事责任年龄14岁的骨龄标准。方法以湖南冷水江地区青少年为对象,按照纳入标准,选取14岁±3个月的健康男性中学生103名,拍摄其左手腕部后前位X线片。选择手腕骨15个部位,按照统一标准进行观察、测量,采用最大百分比法确定发育等级标准,建立骨龄评估方法,以单盲法进行验证。结果除第一掌骨、近节第四指骨骨骺发育等级为部分闭合外,其他均为未闭合;对于第四、五掌骨和近三指骨,不足14岁组以未闭合为主,已满14岁组以部分闭合为主。各个观察部位骨骺横径宽于干骺横径。30例的验证结果准确率为80.0%。结论根据发育等级特征及测量学方法建立骨龄评估标准可行,可望得到推广。本文以刑事责任年龄14周岁为对象,制订法医学专业骨龄推断标准,并引入测量学方法,辅助推断年龄。     

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).     

上、下尖牙髓腔/牙体表面积比值的年龄判定价值研究

目的 通过三维重建测量上、下颌尖牙髓腔/牙体表面积比值(Pulp/Tooth area Ratio,PTR)来推断个体年龄,为临床年龄推断的应用提供科学依据.方法 收集口腔门诊患者年龄在16～65岁200例锥形束CT(Cone beam computed tomography,CBCT)影像资料,以4个尖牙为测量对象并...     

Suicide in children and adolescents at a province in Turkey

Despite the well-documented increases in the rate of completed suicide among children, accurate knowledge of the characteristics of these suicides is limited. We examined all suicides by children and adolescents in Diyarbakir during 1999 and 2001. All of the cases were analyzed regarding the age, sex, method and location of suicide, time of year, and predictive factors. There were 56 children aged 11 through 19 years. Adolescents between 15 and 19 years of age constituted the overwhelming number (87%) of all the childhood suicides. Female children and adolescents predominated among the suicide victims (71%). The most frequent means of suicide were firearms (43%), hanging (28%), and jumping (16%), respectively. The majority of suicides occurred at the decedent's home (88%). Reasons identified were mainly psychiatric disorders, followed by troubles within the family. A prior suicide attempt or a note that was left by the decedent and elucidated the reason for the suicide was rare. There was no seasonal difference in rates of suicides.     

Development of hand-wrist bones of 14 year-old adolescents. II. Standard of bony age for girls

OBJECTIVE: To study the current development of hand-wrist bones of adolescents in China, and establish special forensic bony age standard for estimating 14 years of criminal responsible age in female adolescents. METHODS: One hundred and ten healthy girls aged from 13 years and 9 months to 14 years and 3 months in Lengshuijiang district of Hunan province were enrolled in this study. X-ray films of their left hand-wrists were taken dorsaventrally, and 15 sites on the wrist x-ray films were examined and measured under standard condition. The development grade was confirmed by maximal percentage to establish a method to estimate the bony age, which was then checked by single blind method. RESULTS: Development grade of the radius, the middle third phalanx and the fourth phalanx was partially closed (> 2/3), and the rest was wholly-closed with existence of the epiphyseal line. The development grade of the middle third phalanx and fourth phalanx was different between the younger group (< 14 years, partially closed, > 2/3) and the older group (> 14 years, mostly closed with existence of only epiphyseal line). The cross diameter of the osteoepiphysises were wider than that of all the diaphysises. The confirmed accuracy (in 30 girls) was 83.3%. CONCLUSION: Our study seemes to be feasible in establishing the estimation standard for bony age determination. The standard established by developmental metaphysis and authropometry may be particularly helpful in forensic practice for estimation of accurate criminal responsible age in adolescents.     

Pulp volume quantification methods in cone-beam computed tomography for age estimation: A critical review and meta-analysis

The secondary dentin deposition that occurs after the tooth formation process results in a decrease in pulp cavity volume in adolescents and adults. The purpose of this critical review was to correlate pulpal and/or dental volume on cone-beam computed tomography (CBCT) with chronological age approximation. A subobjective was to investigate which methodology and CBCT technical parameters would be most appropriate to evaluate this correlation. This critical review followed the PRISMA guidelines, and it was conducted by a search through PubMed, Embase, SciELO, Scopus, Web of Science, Cochrane Library databases, as well as gray literature. Primary studies that used pulp volume, or pulp chamber to tooth volume ratio measured using CBCT were included. Seven hundred and eight indexed and 31 non-indexed records were identified. A qualitative analysis was performed including 25 selected studies with a total of 5100 individuals, age ranging from 8 to 87 years without sex predilection. The most used method was pulp volume/tooth volume. CBCT voxel size ranged between 0.09 and 0.5. Manual segmentation associated with threshold algorithms was used in most of the studies. Correlation between the pulp volume/tooth volume ratio was moderate: −0.66 for the upper central incisors, −0.59 for upper canines and −0.56 for lower canines. High heterogeneity was observed among the studies. It is concluded that pulp volume should be used with caution in age estimation. Evidence supports the preferable use of upper incisors with pulp volume/tooth volume ratio for age estimation. There is not enough evidence that voxel size interferes in age estimation by pulp volume.     

Age estimation by pulp/tooth ratio in lower premolars by orthopantomography

Accurate age estimation has always been a problem for forensic scientists, and apposition of secondary dentine is often used as an indicator of age. Since 2004, in order to examine patterns of secondary dentine apposition, Cameriere et al. have been extensively studying the pulp/tooth area ratio of the canines by panoramic and peri-apical X-ray images. The main aim of this paper is to examine the relationship between age and age-related changes in the pulp/tooth area ratio in monoradicular teeth, with the exception of canines, by orthopantomography. A total of 606 orthopantomograms of Spanish white Caucasian patients (289 women and 317 men), aged between 18 and 75 years and coming from Bilbao and Granada (Spain), was analysed. Regression analysis of age of monoradicular teeth indicated that the lower premolars were the most closely correlated with age. An ANCOVA did not show significant differences between men and women. Multiple regression analysis, with age as dependent variable and pulp/tooth area ratio as predictor, yielded several formulae. R(2) ranged from 0.69 to 0.75 for a single lower premolar tooth and from 0.79 to 0.86 for multiple lower premolar teeth. Depending on the available number of premolar teeth, the mean of the absolute values of residual standard error, at 95% confidence interval, ranged between 4.34 and 6.02 years, showing that the pulp/tooth area ratio is a useful variable for assessing age with reasonable accuracy.     

陕西省6～15岁汉族未成年人牙龄的研究

目的运用全口曲面断层影像技术,研究陕西省6-15岁汉族未成年人牙齿钙化规律,建立利用牙齿钙化程度推断陕西汉族6-15岁未成年人年龄的方法。方法按照中国汉族儿童及青少年牙齿钙化分级标准,对1997名（男934名,女1063名）陕西省6-15岁汉族未成年人的全口曲面断层影像中下颌恒牙钙化程度进行分级评分;将所得评分值及对应的年龄输入SPSS软件并进行统计分析,最终建立年龄推断的方程。结果下颌同名牙钙化评分值侧别间非参数检验结果 P〉0.05,而性别间非参数独立样本检验结果 P〈0.05;下颌左侧各颗恒牙钙化程度与年龄相关分析结果 r〉0.59;方程拟合优度检验所得校正决定系数均大于0.76,估计值标准误男性在0.85-1.05岁之间、女性在0.83-0.97岁之间。结论本研究建立的方法合理可靠,可用于陕西省汉族6-15岁未成年人年龄的推断。     

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 in children by measurement of open apices in tooth roots: Study of a Mexican sample

The aim of this cross-sectional study was to test the accuracy of Cameriere's European formula for age assessment in a large sample of Mexican children. The accuracy of dental age estimation was defined as how closely real age, measured as the difference between chronological age (CA) and dental age (DA), could be predicted. Digitalized orthopantomographs of 502 Mexican children (254 girls and 248 boys), aged between 5 and 15 years, were analyzed. The seven left permanent mandibular teeth were evaluated using Cameriere's method. Intra- and inter-observer variability for this technique was tested on a small random sample. Dental age was estimated for each individual and compared with known chronological age. Accuracy was measured as the difference between known chronological age and dental age and tested for significance with the mean prediction error (ME). The standard deviation and 95% confidence interval of the mean difference were also calculated. ME was 0.63 years for girls and 0.52 years for boys. ME was found to be slightly overestimated by 0.10 years for girls, but was correctly estimated for boys with an accuracy of 0.00. In conclusion, this method is very useful and may be recommended for practical application both in clinical dentistry and forensic procedures on the Mexican population.     

TW2、TW3法腕骨骨龄评价方法的诊断性试验

目的比较TW2法英国人标准、TW2法中国人南方标准和TW3法测定腕骨骨龄对特发性性早熟(IPP)女孩的诊断价值。方法女性IPP患儿55例;对照组83例。回顾性分析初诊左腕X线片,用TW2法、TW2CHC中国人南方标准和TW3法盲法分期,分别测得其腕骨骨龄及其百分位,并分为5个连续性的工作点,即:>P97、>P90、>P75、>P50和、≤P50。结果敏感度(Sen)和特异度(Spe)都比较高的有以下3个工作点:TW2CH“>P90”点,TW3“>P90”点,TW2“>P90”点。结论TW系统3种腕骨骨龄对于IPP女孩都有诊断价值,TW3法和TW2法中国人南方标准诊断价值比较高,TW2法英国人标准的诊断价值为中等。     

中国汉族6～18周岁人群下颌恒牙钙化的性别差异研究

目的通过对中国汉族男女6～18周岁人群全口曲面断层影像上所显示的下颌左侧牙齿钙化程度进行比较研究,探究牙齿生长发育的性别差异,为建立用牙齿推断中国汉族儿童及青少年年龄的线性回归模型提供理论依据。方法通过对13491张(男6568张,女6923张)中国汉族6～18周岁儿童及青少年全口曲面断层影像的牙齿钙化规律进行研究,建立牙齿钙化的分级标准,并对下颌恒牙进行分级评分;数据用SPSS 13.0软件处理。结果非参数检验结果显示大部分年龄组下颌左侧8颗恒牙钙化分级值性别间的差异有统计学意义(P0.05);在8颗恒牙发育程度同等条件下,女性年龄比男性小0.303岁。结论中国汉族6～18周岁人群牙齿发育存在着性别差异;在利用牙齿钙化程度建立推断中国汉族儿童及青少年年龄的方程模型时,应分性别建模。     

Sex assessment from the carpals bones: discriminant function analysis in a 20th century Spanish sample

Sex assessment is one of the first essential steps in human identification, in both medico-legal cases and bio-archaeological contexts. Fragmentary human remains compromised by different types of inhumation or physical insults may frustrate the use of the traditional sex estimation methods, such as the analysis of the skull and pelvis. Currently, the application of discriminant functions to sex unidentified skeletal remains is steadily increasing. However, several studies have demonstrated that, due to variation in size and patterns of sexual dimorphism, discriminant function equations are population-specific [1,2,5,12,61]. In this study, in order to improve sex assessment from skeletal remains and to establish population-specific discriminant functions, the diagnostic values of the carpal bones were considered. A sample of 100 individuals (50 males and 50 females) of known sex and age was analyzed. They belong to a 20th century identified collection from the Municipal Cemetery of "San José", Granada (Spain) and housed in the Laboratory of Anthropology, Faculty of Medicine, University of Granada (Spain). The age of the individuals ranged between 22 and 85 years. Between four and nine measurements of each carpal bone were performed [41,59]. Discriminant function statistics showed a sex assessment accuracy as high as 97.8%. The results suggest that carpal bones can be used for assessing sex in both forensic and bio-archaeological identification procedures.