Age estimation of adults from dental radiographs

Previous studies have shown that with advancing age the size of the dental pulp cavity is reduced as a result of secondary dentine deposit, so that measurements of this reduction can be used as an indicator of age. The aim of the present study was to find a method which could be used to estimate the chronological age of an adult from measurements of the size of the pulp on full mouth dental radiographs. The material consisted of periapical radiographs from 100 dental patients who had attended the clinics of the Dental Faculty in Oslo. The radiographs of six types of teeth from each jaw were measured: maxillary central and lateral incisors and second premolars, and mandibular lateral incisors, canines and first premolars. To compensate for differences in magnification and angulation on the radiographs, the following ratios were calculated: pulp/root length, pulp/tooth length, tooth/root length and pulp/root width at three different levels. Statistical analyses showed that Pearson's correlation coefficient between age and the different ratios for each type of tooth was significant, except for the ratio between tooth and root length, which was, therefore, excluded from further analysis. Principal component analyses were performed on all ratios, followed by regression analyses with age as dependent variable and the principal components as independent variables. The principal component analyses showed that only the two first of them had significant influence on age, and a good and easily calculated approximation to the first component was found to be the mean of all the ratios. A good approximation to the second principal component was found to be the difference between the mean of two width ratios and the mean of two length ratios, and these approximations of the first and second principal components were chosen as predictors in regression analyses with age as the dependent variable. The coefficient of determination (r²) for the estimation was strongest when the ratios of the six teeth were included (r² = 0.76) and weakest when measurements from the mandibular canines alone were included (r² = 0.56). Measurement on dental radiographs may be a non-invasive technique for estimating the age of adults, both living and dead, in forensic work and in archaeological studies, but the method ought to be tested on an independent sample.     

Application of Kvaal et al.'s age estimation method to panoramic radiographs from Turkish individuals

Age estimation of living adult individuals can be accomplished with limited methods. Radiographic dental methods based on the pulpal narrowing with secondary dentin formation have been presented. In the present study, Kvaal et al.'s method, one of the radiographic dental age estimation methods, was applied to panoramic radiographs from Turkish individuals. The correlation between chronological and estimated ages was examined and the feasibility of length and width measurements of pulp cavity was evaluated for age estimation. The study population consisted of 123 patients with ages ranging from 14 to 57 years. The measurements of the length and width of six types of teeth on digitized panoramic radiographs were performed, and the ratios between tooth and pulp cavity measurements were calculated. Age was estimated using the linear regression models presented by Kvaal et al. and Paewinsky et al. High differences were observed between chronological and estimated ages. Measurement ratios showed no significant or weak correlation with age. The linear regression models were derived using variables that were significantly correlated with age. The determination coefficients of the models varied from 0.035 to 0.345. In conclusion, a difference of more than 12 years in the chronological and estimated ages derived using regression models in literature was found on panoramic radiographs in Turkish individuals. The length and width of the pulp cavity, measured according to the method of Kvaal et al. using panoramic radiographs, were insufficient to precisely estimate the age of Turkish individuals.     

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.     

Prosthetic restorations, dental root fillings and periodontal bone resorptions as a forensic-odontologic aid for determining the age above 18 years: A radiographic study of orthopantomograms from a group of teenagers and yount adults

The human teeth are a valuable source of information concerning identification and age calculation in forensic sciences. Dental treatment often causes permanent alteration of the teeth, which is visible on radiographs. The correlation of prosthetic restorations, root canal fillings and periodontal bone loss with chronological age has not yet been used for determining the completed 18th year of life in teenagers and young adults, e. g. for legal and anthropological purposes. The aim of this study was to determine whether the evaluation of such findings on radiographs correlates with the chronological age in teenagers and young adults. MATERIAL AND METHODS: The dental X-rays (orthopantomogram, OPG) of 1053 outpatients (age: 14 to 24 years) were avaluated. The values "prosthetically restored", "filled dental root", or "periodontal bone loss" were recorded for each tooth present. The data were then evaluated using statistical tools. RESULTS: The correlation between the number of prosthetically restored teeth and the chronological age is high. The positive predictive value of determining an age of at least 18 years proved to be very high. However, these findings are rarely present in this age group. The number of endodontically treated teeth correlated less exactly with age. On the other hand, the determination of periodontal bone loss gave reasonable positive predictive values for the threshold value "chronological age of 18 years or more". DISCUSSION: This study provides for the first time predictive values for the estimation whether a person is 18 years of age, based on the evaluation of teeth with prosthetic restorations, root canal fillings or periodontal bone loss on OPGs only. Whereas the number of patients with such findings is generally low in this age group, some of the positive findings can be used for age estimation as an adjunct to other sources of age calculation. The sole application of these criteria is not recommended, as sanitary conditions of the teeth depend on both social and individual circumstances. Therefore, the calculated values also reflect the culture of the sample studied. Finally, they are time-dependent and have to be compared to data from other populations. These results have some bearing on the field of forensic odontology.     

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.     

Clinically Detectable Dental Identifiers Observed in Intra‐oral Photographs and Extra‐oral Radiographs,Validated for Human Identification Purposes

Screening the prevalence and pattern of dental identifiers contributes toward the process of human identification. This research investigated the uniqueness of clinical dental identifiers in photographs and radiographs. Panoramic and lateral cephalometric radiographs and five intra‐oral photographs of 1727 subjects were used. In a target set, two observers examined different subjects. In a subset, both observers examined the same subjects (source set). The distance between source and target subjects was quantified for each identifier. The percentage of subjects in the target set being at least as close as the correct subject was assessed. The number of molars (34.6%), missing teeth (42%), and displaced teeth (59.9%) were the most unique identifiers in photographs and panoramic and lateral cephalometric radiographs, respectively. The pattern of rotated teeth (14.9%) was the most unique in photographs, while displaced teeth was in panoramic (37.6%) and lateral cephalometric (54.8%) radiographs. Morphological identifiers were the most unique, highlighting their importance for human identifications.     

Approaches to chronological age assessment based on dental calcification

The aim of the present study was to find an accurate estimation of chronological age using a small number of selected teeth. For this purpose, the method devised by Nolla [C. Nolla, The development of the permanent teeth, J. Dent. Child. 27 (1960) 254-266.] was used: the development of each of the teeth was determined according to this method on 374 radiographs, 195 of boys (mean age 8.59) and 179 of girls (mean age 8.75). The 28 variables representing the calcification stages were analyzed using cluster analysis followed by multivariate analysis (multiple linear regression model). Patient age was considered to be a dependent variable. Our study showed that antimere teeth are the most homogeneous as regards stages of development. The prediction was more accurate for boys and girls below 10 years of age, using teeth 21, 43 and 46 from boys and teeth 21, 46 and 47 from girls. These teeth accounted for 80% total variance of chronological age for dental calcification. Standard error was +/-1.4 years for boys and +/-1.2 years for girls. When the age of the children remained completely unknown, the best estimates were provided by teeth 43, 47, 46 and 44 from boys and teeth 44, 47 and 43 from girls.     

Radiographic evaluation of teeth subjected to high temperatures: experimental study to aid identification processes

The radiographic evaluation of dental remains represents a significant aspect in the forensic identification process, particularly after an exposure to fire. The aim of this "in vitro" study was to evaluate the radiographic features of unrestored, endodontically treated and restored teeth after exposure to an experimental range of high temperatures. Ninety human teeth were divided into two groups: (1) unrestored teeth, as a control group and (2) teeth endodontically treated (condensation technique) and restored with amalgam or composite fillings. Before testing the high temperatures, periapical radiographs of all teeth were performed. The tests of exposure to heat were carried out in an oven for six different temperatures (200, 400, 600, 800, 1000 and 1100 degrees C (392, 752, 1112, 1472, 1832, 2012 degrees F)). After each exposure, periapical radiographs of all the teeth were taken. The radiographic appearance of all the teeth before and after the thermal stresses were evaluated and the differences were recorded. The results of the radiographic examination showed that a number of significant radiographic details were conserved: the composite fillings were in place maintaining the shape till 600 degrees C (1112 degrees F), the amalgam fillings were in place maintaining the shape till 1000 degrees C (1832 degrees F) and the endodontic treatments were recognisable till 1100 degrees C (2012 degrees F).     

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.     

Dental CT imaging as a screening tool for dental profiling: advantages and limitations

The use of dental processing software for computed tomography (CT) data (Dentascan) is described on postmortem (pm) CT data for the purpose of pm identification. The software allows reconstructing reformatted images comparable to conventional panoramic dental radiographs by defining a curved reconstruction line along the teeth on oblique images. Three corpses that have been scanned within the virtopsy project were used to test the software for the purpose of dental identification. In every case, dental panoramic images could be reconstructed and compared to antemortem radiographs. The images showed the basic component of teeth (enamel, dentin, and pulp), the anatomic structure of the alveolar bone, missing or unerupted teeth as well as restorations of the teeth that could be used for identification. When streak artifacts due to metal-containing dental work reduced image quality, it was still necessary to perform pm conventional radiographs for comparison of the detailed shape of the restoration. Dental identification or a dental profiling seems to become possible in a noninvasive manner using the Dentascan software.     

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.     

Decayed, filled and missing teeth as a forensic-odontologic aid for determining the age above 18 years: A radiographic study of orthopantomograms from a group of teenagers and young adults

The human teeth are a valuable source of information concerning identification and age calculation in forensic sciences. Dental treatment often causes permanent alteration of the teeth, which is visible on radiographs. The correlation of decayed, missing or filled teeth and chronological age has not yet been used for determining the accomplished 18th year of life in teenagers and young adults, e. g. for legal and anthropological purposes. The aim of this study was to determine whether the evaluation of these findings on radiographs correlates with the chronological age in teenagers and young adults. MATERIAL AND METHODS: The dental X-rays (orthopantomograms, OPG) of 1053 outpatients (age: 14 to 24 years) were evaluated. The values "decayed", "missing", or "filled" were recorded for each tooth present. The data were then calculated using statistical tools. RESULTS: The correlation between the number of missing teeth and the chronological age is low. However, the positive predictive value of determining the age of 18 years for certain types of teeth proved to be very high, even up to 100 %. Further, high numbers of filled teeth gave reasonable positive predictive values for an age of 18 years. The number of decayed teeth did not correlate with age. DISCUSSION: This study provides for the first time predictive values for the estimation whether a person is 18 years of age, based on the evaluation of decayed, missing or filled teeth on OPGs only. Whereas the number of patients with such findings is generally low in this age group, some of the positive findings can be used for age estimation as an adjunct to other sources of age calculation. The sole application of these items is not recommended, as sanitary conditions of the teeth depend on both social and individual circumstances. Therefore, the calculated values also reflect the culture of the sample studied. Finally, they are time-dependent and have to be compared to data from other populations. These results have some bearing on the field of forensic odontology.     

Third molar root development in relation to chronological age: a large sample sized retrospective study

The aim of the present investigation, which is a continuation and extension of a previous published pilot study [Forensic Sci. Int. 129 (2002) 110], was to calculate the chronological age of an individual based on the dental developmental stages of third molars (so-called wisdom teeth). The evaluated material consisted of 2513 orthopantomograms (OPG's) of patients all of Belgian Caucasian origin between 15.7 and 23.3 years. The sample of OPG's was scored by two observers who were calibrated for intra- and interobserver reliability by means of kappa statistics. The kappa statistics revealed a strong agreement between the intra- and interobserver measurements. Further statistical analysis was performed in order to obtain multiple regression formulae for dental age calculation with the chronological age as the independent variable and the third molar developmental stages as dependent variables. Both for males and females a significant Pearson correlation coefficient was noticed for contralateral third molars, a smaller less significant one for the antimeres. For the application of the regression formulae one has to take into consideration the gender, the location and number of wisdom teeth. Probabilities for an individual to be older than 18 years were also calculated in case of fully developed wisdom teeth.     

Age estimation of Korean children based on dental maturity

The aim of this study was to evaluate the relationship between age and dental maturity and to establish the standard database of dental maturity based on the Demirjian's stages, which can be used for the age estimation of Korean children. For this purpose, dental maturity was measured by the Demirjian's stages on a randomly selected sample of panoramic radiographs taken from 2706 patients between 1 and 20 years of age and analyzed by multiple linear regression analysis based on the method of least squares. The results showed that, except for the third molars, the development of permanent teeth in Korean children was more advanced in females. The Demirjian's stage G of the second molar appeared last in both male and female subjects by age 18, showing 95th percentile at age in the male and female subjects between 16.7-17.4 years and 17.1-17.3 years, respectively. Coefficients of determination (r(2)) of the Demirjian's stages relative to age in regression analysis were 0.9721 in male and 0.9740 in female subjects. The standard error was 0.63 years in male and 0.62 years in female subjects. The estimated age according to regression analysis was within +/-1.0 year of the actual age in 92.0% of male and 92.5% of female subjects. Collectively, the data of the present study can be used as a reference for dental maturity and a standard for age estimation of Korean children.     

Dental Age Estimation: A Test of the Reliability of Correctly Identifying a Subject Over 18 Years of Age Using the Gold Standard of Chronological Age as the Comparator

This study was designed to test the reliability of using the third molars to demarcate between child and adult status. A total of 2000 dental panoramic tomographs were used for assessment of the calculated age using the 8‐stage system of tooth development and applied to all four third molars. The LL8 was also assessed using this 8‐stage system. For each tooth development stage, the Normal distribution and percentile summary data were estimated. The calculated dental age compared with the chronological age was statistically significantly different (p < 0.001) for both females and males giving underestimates of the true age. Comparison of single tooth dental age and chronological age was only slightly different. The most important finding is that the assignment to above or below the 18‐year threshold, in the age range 17 years to 19 years, could be wrong on up to 50% of occasions.     

Orthodontic Treatment: Real Risk for Dental Age Estimation in Adults?

Dental age estimation becomes a challenge once the root formation is concluded. In living adults, one dental age indicator is the formation of secondary dentine, also associated with orthodontic treatment as well as root shortening. The aim of this study was to establish whether these secondary effects of orthodontic treatment could generate a statistically significant difference in dental age estimations when using Kvaal's method. The study sample included 34 pairs of pre‐ and postorthodontic panoramic radiographs, from different individuals with exactly the same age and sex distribution. Females 65%, median age 17.5 years, and males 35%, median age 22.5 years, were included. After data collection, dental age was estimated per tooth using formulae previously published. The risk of obtaining over‐estimation of age was calculated. (RR = 1.007). The changes caused by orthodontic treatment do not have any significant effect on age estimation when Kvaal et al.'s method is applied on panoramic radiographs.     

Secular Trend in the Development of Permanent Teeth in a Population of Istria and the Littoral Region of Croatia

The study evaluated secular trends in dental development during a period of 30 years, correlation between dental and chronological age in Istria and the littoral region of Croatia. The sample consisted of 1000 panoramic radiographs of children, aged 6–16 years (mean 10.0 ± 1.8), taken in the period 1977–1979 (N = 500; 243 females) and 2007–2009 (N = 500; 299 females). Dental age was assessed according to Demirjian's method. Correlation between chronological and dental age was linear, positive, high, and statistically significant in both periods and genders, ranging from 0.73 to 0.86. Dental age was underestimated when compared to chronological age by 1 year on average, more 30 years ago (?1.35 ± 1.17) than today (?0.63 ± 1.09), less for girls (?0.80 ± 1.22) than boys (?1.21 ± 1.10). A statistically significant positive secular trend in acceleration of dental development was present of 0.72 years during the 30‐year period and was more significant in girls than boys (0.83‐ and 0.51‐year acceleration).     

Validity of Demirjian's and modified Demirjian's methods in age estimation for Korean juveniles and adolescents

In estimating age of juveniles and adolescents, the teeth are employed primarily because of its low variability and less affection by endocrine and nutritional status in development. Demirjian established criteria for evaluating maturity of teeth and his method has been used throughout the world. However, several studies showed the inappropriateness of Demirjian's method on populations other than the one it is based on. Consequently some researchers modified Demirjian's method using data of several different populations. Demirjian himself also published a revised method to overcome other shortcomings of his original method. The aim of this study was to test the validity of Demirjian's and the modified methods (Demirjian's revised, Willems', Chaillet's and new Korean methods) for Korean juveniles and adolescents. 1483 digital orthopantomograms which consist of 754 males and 729 females in the age range of 3-16 years were collected. New age estimation method based on Korean population data was calculated. Dental age was estimated according to each method and the validity was evaluated using the differences between chronological and dental age. The inter- and intra-observer reliability was evaluated to be excellent. Statistically significant difference was observed between chronological and dental age in all the methods for both sexes except new Korean method for both sexes and Demirjian's revised method for males. However, when analyzing absolute and squared value of difference, Willems' method was found to be most accurate followed by new Korean method with slight difference for Korean population for both sexes. In conclusion, both Willems' method and new Korean method conducted by present study were proven to be suitable for Korean population.     

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.