Accuracy of different dental age estimation methods on Turkish children

Tooth development is widely used to estimate age or maturation. Dental age estimation is so important for various research works. Numerous methods have been described to estimate dental age based on the dental maturation. The aims of this study were to decide the best method to estimate dental age on Turkish children by reviewing several methods and to illustrate the differences among the methods and to assist future studies. The records of Turkish children between the ages of 7 and 13 years who visited the Department of Pediatric Dentistry of the Faculty of Dentistry of the Süleyman Demirel University in Isparta, Turkey were reviewed and a total of 425 healthy children with complete records, satisfactory panoramic radiographs, similar socio-economic background and ethnic origin were included. Panoramic radiographs were examined with Nolla's, Haavikko's and Demirjian's methods. Dental age was calculated for each method, and the differences between the estimated dental age and the chronological age were compared with paired t-test and Wilcoxon signed rank test. The accuracy of three methods was obtained with ICC (intraclass correlation coefficient). An under-estimation of the dental age was observed by using Nolla's and Haavikko's methods (boys -0.53±0.95, girls -0.57±0.91, both -0.54±0.93; boys -0.60±0.80, girls -0.56±0.81, both -0.58±0.80, respectively) and an over-estimation of the dental age was observed by using Demirjian's method (boys 0.52±0.86, girls 0.75±0.90, both 0.64±0.89). Haavikko's method was more accurate in the dental age estimation compared to the other methods. All of the three methods are not completely suitable for Turkish children and establishment of the population-specific standards is essential and crucial.     

Dental age estimation in Belgian children: Demirjian's technique revisited.

Aim: The purpose of this study was to evaluate the accuracy of Demirjian's dental age estimation in children in a Belgian Caucasian population and to adapt the scoring system in case of a significant overestimation as frequently reported. We selected 2523 orthopantomograms of 1265 boys and 1258 girls, of which 2116 (1029 boys and 1087 girls) were used for estimating the dental age with the Demirjian's technique. The 407 other orthopantomograms were beyond the original age limit. A second sample of 355 orthopantomograms was used to evaluate the accuracy of the original method and the adapted method. A signed-rank test was performed to search for significant age differences between the obtained dental age and the chronological age. A weighted ANOVA was performed in order to adapt the scoring system for this Belgian population. The overestimation of the chronological age was confirmed. The adapted scoring system resulted in new age scores expressed in years and in a higher accuracy compared to the original method in Belgian Caucasians.     

Measurement of arch widths in a human population: relation of anticipated bite marks

The authors compared arch width measurements of diagnostic dental models obtained from dental school patients. Arch width measurements were taken in the canine area on each dental cast in an effort to assist forensic dental investigators in matching certain classes of subjects to the bites they might possibly inflict. If any canine teeth were absent, the measurements were taken using other specified adjacent teeth which the investigators felt would be interpreted as the arch width determiners in a bite mark injury. The ages of the subjects varied from 14 to 87 years. Statistical comparison of the maxillary arch width, mandibular arch width, and the mean difference between maxillary and mandibular arch width were performed. Significant differences between the arch width measurements were found to exist between several classes of subjects based on race and sex.     

Dental age in Central Poland

Precise evaluation of the developmental stage of a child is an integral part of both diagnosis and treatment of pediatric patients; it is also essential in forensic medicine and dentistry. Among radiological methods for dental age estimation in children the Demirjian's method is widely used, however original standards elaborated for the French-Canadian population are mostly not suitable for other populations. The aim of the study was to compare the dental age of children from the region of Mazovia (Central Poland) with the developmental standards presented by Demirjian, to analyse sexual dimorphism of dental age in the studied group and to estimate validity of the Demirjian's standards for the studied Polish population. The material consisted of clinical files and panoramic X-ray images of 994 children aged from 6 to 16 in good general health, without development impairments. Chronological ages of the patients were established. Next dental ages were estimated by means of the Demirjian method based on developmental maturity of seven left mandibular permanent teeth. It was found that the standards were significantly different from the chronological ages in the studied population, which means that dental development was considerably accelerated. The most significant acceleration was observed in girls aged 11 and 12, as well as in 13-year-old boys; in both groups a considerable acceleration of the dental age was seen in 6-year-olds. No statistically significant differences between dental ages of girls and boys were observed in particular age groups. There were devised gender-specific equations allowing for adaptation of original Demirjian's scores for estimation of dental age in the population of Mazovia (Central Poland). In conclusion, the developmental standards used by Demirjian are not suitable in the case of the population of children of Central Poland. Therefore, it is necessary to establish new tables for this population.     

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.     

中国汉族6～18周岁人群牙齿生长发育的地区差异研究

目的探讨中国汉族儿童及青少年下颌恒牙钙化程度不同地区间的差异,为相关研究提供依据。方法根据牙齿钙化的分级标准,对来自广东、河南、陕西、黑龙江、重庆地区11275张(男5499张,女5776张)6～18周岁汉族儿童及青少年全口曲面断层影像片中下颌左侧恒牙钙化程度进行分级评分;评分数据使用SPSS 13.0软件进行统计处理,分性别及年龄段用非参数独立样本检验两两比较上述地区儿童及青少年牙齿生长发育的差异。结果下颌左侧各恒牙钙化分级值存在地区间差异(P0.05),差异最大的为尖牙。结论中国汉族儿童及青少年牙齿发育存在着地区差异;在建立相关利用牙齿钙化程度推断年龄的方程模型时,最好分地区建模。     

数字全口牙位曲面体层片的法医学同一认定指标

目的采用颌面全口牙位曲面体层片,针对牙齿无病变者筛选简洁实用的法医学同一认定识别指标并进行编码、统计分析及评估。方法随机选取170例牙齿无病变者的颌面数字全口牙位曲面体层片进行观测．根据牙齿的生理变异特征和牙齿的排列特征分别筛选全口牙型和牙列型识别指标。按设计的编码标准对全口牙型、牙列型逐一编码,统计分析编码的多样性,以评估两类识别指标的应用价值。结果170例中共有74种全口牙型编码,多样性为43．53％：170例中共有129种牙列型编码,多样性为75．88％;170例同时进行全口牙型和牙列型编码．则共有150种全口牙型／牙列型编码,多样性为88．24％。结论全口牙型编码多样性较低,单独使用尚不能满足法医学同一认定的要求。牙列型编码的多样性比较高,具有一定的法医学同一认定价值。如果同时进行全口牙型和牙列型编码,多样性明显提高,有较高的法医学同一认定价值。     

河南省安阳市6-15周岁汉族人牙龄的研究

目的建立利用牙齿钙化程度推断未成年人年龄的方法。方法选取河南省安阳市1575名（男性900名,女性675名）6～15周岁人群的全口曲面断层影像片,依照牙齿钙化分级标准对下颌恒牙钙化程度进行评分分级;所得数据经SPSS13．0软件统计分析,建立根据牙齿钙化程度推断年龄的方程;采用拟合优度检验、模型方差分析、回归系数检验和共线性诊断、残差分析对方程的合理性进行检验及盲测。结果下颌同名牙间钙化分级评分值无统计学差异（P〉0．05）,而下颌同名牙性别间钙化评分值在部分年龄组存在差异（P〈0．05）;下颌恒牙的钙化程度与年龄相关系数r均大于0．7;所建方程模型调整决定系数均大于0．8,估计值标准误男性为0．92岁至1．04岁、女性为0．92岁至1．00岁;推测年龄与真实年龄的平均误差男性为0．433±0．288岁、女性为0．502±0．297岁。结论本研究建立的方法在推断相关地区、相关年龄段人群的年龄推断中有较好的应用前景。     

The application of Kvaal's dental age calculation technique on panoramic dental radiographs

INTRODUCTION: Literature reports on a method for dental age calculation which is based only on radiological measurements on periapical dental radiographs: the relationship between chronological age and the two-dimensional dental pulpal size was analysed by means of multiple regression analyses. The purpose of the present study was to evaluate whether this approach could be feasible and could lead to statistically sound results with adequate repeatability when applied on panoramic radiographs. MATERIALS AND METHODS: One hundred and ninety seven panoramic radiographs were collected at random from patients of whom the age ranged from 19 to 75 years. According to the reported technique, six teeth were selected on the panoramic radiograph: in the maxilla the central and lateral incisor and second bicuspid, and in the mandibula the lateral incisor, cuspid and first bicuspid. The same exclusion criteria as in the original paper were respected. Statistical analysis was carried out in order to spot significant differences between the chronological age and the calculated age. RESULTS: When the age was calculated based on measurements of all six teeth or of all three mandibular teeth, no significant differences were found between the real age and the calculated one. In all other instances using the individual teeth separately or using all three maxillary teeth statistical analysis revealed significant differences. CONCLUSION: There appears to be no significant difference between applying the original technique on standard long-cone periapical radiographs or on orthopantomograms, especially when carrying out measurements on all six selected teeth.     

Comparison of dental maturity in children of different ethnic origins: international maturity curves for clinicians

Dental maturity was studied with 9577 dental panoramic tomograms of healthy subjects from 8 countries, aged between 2 and 25 years of age. Demirjian's method based on 7 teeth was used for determining dental maturity scores, establishing gender-specific tables of maturity scores and development graphs. The aim of this study was to give dental maturity standards when the ethnic origin is unknown and to compare the efficiency and applicability of this method to forensic sciences and dental clinicians. The second aim was to compare the dental maturity of these different populations. We noted an high efficiency for International Demirjian's method at 99% CI (0.85% of misclassified and a mean accuracy between 2 to 18 years +/- 2.15 years), which makes it useful for forensic purposes. Nevertheless, this international method is less accurate than Demirjian's method developed for a specific country, because of the inter-ethnic variability obtained by the addition of 8 countries in the dental database. There are inter-ethnic differences classified in three major groups. Australians have the fastest dental maturation and Koreans have the slowest.     

Radiographic Recognition of Dental Implants as an Aid to Identifying the Deceased

Abstract:  This study was undertaken to determine if dental implants can be radiographically differentiated by company type to aid forensic identification of the deceased. Recognition of dental implants on intraoral radiographic images was assessed in a blind study using a radiographic examination guide to highlight differences between dental implants. Inter- and intra-examiner comparisons were conducted and a computer program (Implant Recognition System^®) was evaluated to see whether it improved the accuracy of implant recognition. The study found that dental implants could be radiographically differentiated by company type. The Implant Recognition System^® in its current form was of little benefit for radiographic assessment of dental implants for forensic odontologists. Prior knowledge of implant types, with a McNemar's statistical value of 92.9, proved to be most significant in identification.     

Objective measurement of dental color for age estimation by spectroradiometry

Age-related changes in tooth color have been described previously, however, the use of dental color for age estimation in forensic odontology has been limited due to the difficulty of measuring color objectively. This study presents an objective method for determining dental color to estimate the age of an individual. Dentine color in 250 teeth from patients ranging in age from 10 to 89 years was determined by spectroradiometry. Color measurements were performed as suggested in the CIE 1931 (International Commission on Illumination). Chromaticity coordinates (x, y, z), luminance (Y), whiteness index (WIC, Z%, WIC) and yellowness index (YI) were obtained. Correlations between these colorimetric variables and aging were established by linear regression analyses. All the variables fit the mathematical model with correlation coefficients ranging from 0.53 to 0.75. This method of color measurement produced an expected associated error of calibration averaging 13.7 years about the mean estimated values, at a 70% level of confidence. Two different multiple regression models for dental age estimation were tested, and variables that made the greatest contributions to age calculation were identified. To determine the effect of postmortem interval on tooth color and its influence in age estimation, 37 teeth obtained from human skeletal remains buried during an interval ranging from 21 to 37 years were also studied. In this material, the correlation between age and dental color measured by spectroradiometry was weaker than in fresh extracted teeth.It is concluded that determination of dentine color by spectroradiometry is a potentially useful objective method to estimate age in forensic studies in combination with other methods.     

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.     

中国汉族6-18周岁男性牙齿生长发育的年龄研究

目的研究牙齿钙化程度与年龄的关系,建立利用牙齿钙化程度推断中国汉族6～18周岁男性年龄的办程。方法通过对6568名6～18周岁汉族男性全口曲面断层影像上牙齿的钙化程度进行评分;将分级值及其对应年龄输入SPSS软件进行分析,建立推断年龄的方程模型;从研究样本外随机抽取已知年龄的样本160例进行卣测,,结果同名牙齿钙化评分值侧别间秩合检验结果P〉0．05;下颌左侧恒牙钙化评分值与年龄相关分析结果r值均存0．7以上,下颌同名牙间相关系数r均在0．9以上;所建回归模型拟合优度R^2=0．828,估计值标准误为1．23岁;阿测平均洪差为0．423±0．269岁。结论本研究所建立的方法准确可靠,可用于中国汉族6～18周岁男性人群的年龄推断。     

A Retrospective Review of Forensic Odontology Reports Written by the Joint POW/MIA Accounting Command Central Identification Laboratory for Remains Identified from the Korean War

As of August 2014, the Joint POW/MIA Accounting Command has identified the remains of 1980 previously unknown U.S. service members; 280 were from the Korean War. To determine the accuracy and completeness of the available antemortem (AM) dental records, a review of the AM/postmortem (AM/PM) dental record comparisons from 233 Forensic Odontology Reports written in support of remains identified from the Korean War was performed. Seventy‐two AM/PM comparisons resulted in exact dental chartings while 161 contained discrepancies which were explainable. Explainable discrepancies include undocumented treatment (103), incorrectly charted third molars as missing (82), differing opinions of specific molars present/missing (20), and erroneous treatment documentation and/or misidentification of teeth present/missing (22, other than molars). Reassessment has revealed varying levels of completeness for our available AM dental records, the need to thoroughly review our computerized comparisons, adjust our comparisons to include molar pattern variations/third molars, and updating our database comparison program.     

Third molar development in a London population of White British and Black British or other Black ethnicity

Population differences in dental development between Black and White ethnic groups have been debated but not previously studied in the UK. Using inappropriate data for dental age estimation (DAE) could lead to erroneous results and injustice. Data were collected from dental panoramic radiographs of 5590 subjects aged 6–24 years in a teaching hospital archive. Demirjian stages were determined for left-sided teeth and third molars and data collected regarding hypodontia and third molar agenesis. Third molar development in self-assigned Black British, including other self-assigned Black ethnicity, was compared with that of self-assigned White British subjects. Data were compared for males and females in the two ethnic groups using T-tests for Demirjian Stages A–G of third molar development and Mann-Whitney tests for Stage H once a cut-off age at the maximum age for Stage G had been imposed. Third molar development occurred earlier in subjects of Black ancestry compared to those of White ancestry. While both ethnic groups showed large age ranges for every third molar stage, in female subjects these generally occurred at least 1.5 years earlier, and in males at least one year earlier. Hypodontia and third molar agenesis were more prevalent in White British, but the ethnic difference in third molar development persisted in subjects with complete dentitions. This is a large study that confirms ethnic differences in a London population, emphasises the difficulties of establishing the 18-year-old threshold using DAE, and confirms the risk of overestimating the age of individuals of Black ethnicity using White ethnic reference data.     

Digitalization of dental recording

A short survey is given of the present status in the digitalization of dental recording, the initiative to which was taken by the Fédération Dentaire Internationale (FDI) in 1970. Apart from being an international ‘language’ for the dental profession which — among other things — will greatly facilitate epidemiological research, such digitalization is of particular interest to forensic dental experts in that it may simplify their comparisons of ante- and postmortem dental data for identification purposes.     

Probabilistic Classification of Age by Third Molar Development: The Use of Soft Evidence

Abstract: This study introduces a method to classify individuals according to an age threshold, given sex and third molars’ dental maturity measured on the Demirjian scale by expressing uncertainty on dental evidence (soft evidence). We introduced a procedure to learn the parameters of the Naïve Bayes model, and we discussed two classification rules. The model was estimated and tested on 559 Italians aged 16–22. Two experts provided the dental evaluations, and the model was estimated for each of them. We evaluated the coherence of the evidence provided by the experts. Some indexes have been proposed to evaluate the effectiveness of the models, emphasizing how the experts’ ability and the technology affect the results. We introduced two benchmarks, one based on the sample distribution per sex and age: in this case, probability of correct classification increases 22% and the proportion of false adults impressively decreases 80.2%; the other benchmark, obtained by simulating hard evidence, shows how the use of soft evidence increases the proportion of correct classification 3.1% and decreases the crucial proportion of false adults about 20%. Similarly, the proportion of false minors decreases about 5.3%.     

Identification via dental remains: Pan American Flight 759

Pan American Flight 759 crashed on takeoff from New Orleans International Airport on 9 July 1982. One-hundred-and-fifty-four persons lost their lives making this the second worst air crash in the United States. A dental identification team was assembled and began working the next morning. Ninety-three victims were positively identified by dental means and twenty-three other victims had strong supporting dental evidence as to their identities. The organization, method used, planning, and problem resolution concerning the dental team for this crash are presented.