Age Assessment In Children Research Articles

Age assessment in children with cleft lip and palate

Age assessment in children with cleft lip and palate

A Review on Dental Age Estimation in Children and Adolescents

Abstract Children are seen as beings who exist from birth through puberty, while teenagers are regarded as existing from puberty until around the age of 20 years. For a number of legal processes, including child labor, employment, the age of majority, rape, adoption, marriage eligibility, and situations where the birth certificate is unavailable, age estimation in children and adolescents is crucial. Despite the wide range of methods available, dental age estimation techniques that take into account tooth maturation are thought to be the most reliable predictors of chronological age in subadults. This is because genetic factors predominate and environmental factors, particularly between birth and age ten, tend to have little impact on tooth maturation. The eruption of teeth holds greater significance in the deciduous dentition, where genetic factors predominantly govern the process, compared to the permanent dentition. Conversely, tooth calcification serves as a viable indicator for estimating dental age in both primary and permanent dentitions. Current dental age estimation methods are based on age-related changes in teeth, such as tooth growth and development, changes that occur after teeth form, and biochemical changes. Therefore, in this review article, we will explore the several methodologies used for dental age assessment in children and adolescents.

Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review.

The aim was to identify, evaluate, and summarize the findings of relevant individual studies on the precision and accuracy of radiological BA assessment procedures among children from different ethnic groups. A qualitative systematic review was carried out following the MOOSE statement and previously registered in PROSPERO (CRD42023449512). A search was performed in MEDLINE (PubMed) (n = 561), the Cochrane Library (n = 261), CINAHL (n = 103), Web of Science (WOS) (n = 181), and institutional repositories (n = 37) using MeSH and free terms combined with the Booleans "AND" and "OR". NOS and ROBINS-E were used to assess the methodological quality and the risk of bias of the included studies, respectively. A total of 51 articles (n = 20,100) on radiological BA assessment procedures were precise in terms of intra-observer and inter-observer reliability for all ethnic groups. In Caucasian and Hispanic children, the Greulich-Pyle Atlas (GPA) was accurate at all ages, but in youths, Tanner-Whitehouse radius-ulna-short bones 3 (TW3-RUS) could be an alternative. In Asian and Arab subjects, GPA and Tanner-Whitehouse 3 (TW3) overestimated the BA in adolescents near adulthood. In African youths, GPA overestimated the BA while TW3 was more accurate. GPA and TW3 radiological BA assessment procedures are both precise but their accuracy in estimating CA among children of different ethnic groups can be altered by racial bias.

Correlation of skeletal age by Greulich-Pyle atlas, physiological age by body development index, and dental age by London Atlas and modified Demirjian’s technique in children and adolescents of an Eastern Indian population

BackgroundForensic age estimation using multiple maturity indicators necessitates investigation of correlation between various techniques. This study intended to compare and evaluate the correlation between skeletal age using Greulich-Pyle atlas, dental age by Acharya’s modification of Demirjian’s technique and London Atlas method of Tooth Development, and age estimated by body developmental index with chronological age. Orthopantomograms and left hand-wrist radiographs of one hundred seventy-four subjects (64 males and 70 females) in the age group of 8–20 years were evaluated by age estimation methods. Physical parameters including height, weight, biacromial breadth, and biliospinale breadth were measured. The data were entered in the SPSS software (Version 27.0). Comparison between age estimation methods was done using Student’s t-test for paired samples. Unpaired t-test was utilized for gender-wise comparison of age. Pearson’s correlation coefficient was calculated to assess correlation between the various methods.ResultsSignificant mean differences were noted between the chronological age and all the age estimation methods when Greulich-Pyle atlas method (− 0.43), modified Demirjian’s method (− 0.31), London Atlas Method (− 0.62), and body developmental index (− 0.51) were employed respectively. Inter-group comparison between all methods yielded no significant differences except for modified Demirjian’s method and London Atlas method (mean difference = 0.31). All the age estimation techniques showed strong correlation with chronological age; the best was provided by the Greulich-Pyle method (r = 0.92).ConclusionAll the assessed age estimation techniques show strong correlation with chronological age. Acharya’s modified Demirjian’s method (dental age) and Greulich-Pyle atlas method (skeletal age) showed good accuracy and strong correlation with chronological age, suggesting that these methods can be used simultaneously and/or interchangeably for age assessment in children and adolescents of Eastern Indian population.

Artificial Intelligence in Pediatric Dentistry – A Systematic Review

Abstract Background: Artificial intelligence (AI) refers to the development of computer systems capable of performing tasks that normally require human intelligence. AI and its subsets, machine learning and deep learning, have been incorporated into several aspects of dentistry including pediatric dentistry. However, there is a lack of documentation and analysis of the current applications of AI in pediatric dentistry. Aim: The aim of this systematic review was to evaluate the effectiveness of AI as a diagnostic tool in pediatric dentistry. Materials and Methods: The literature for this paper was identified by performing a thorough search in electronic databases such as PubMed, Google Scholar, and Cochrane Library from the years 2011 to 2021. The following keywords and Boolean operators were used: AI AND pediatric dentistry, artificial neural networks AND pediatric dentistry, convolutional neural networks AND pediatric dentistry, and machine learning AND pediatric dentistry. After applying appropriate inclusion and exclusion criteria, 13 articles were selected, fully read, and systematically analyzed as per a specific research question. Results: Among the 13 selected articles, it was found that AI is a useful tool for dental diagnosis/classification, cephalometric landmark identification, identification of early childhood caries patterns, chronological age assessment in children, assessment of facial attractiveness in cleft patients, dental plaque detection, and oral health education. Conclusion: The selected articles indicate that AI is an effective diagnostic tool and has the potential for assisting several aspects of pediatric dentistry. However, further studies are required to assess the clinical effectiveness of these AI models.

The Application of Artificial-Intelligence-Assisted Dental Age Assessment in Children with Growth Delay.

Background: This study aimed to reveal the efficacy of the artificial intelligence (AI)-assisted dental age (DA) assessment in identifying the characteristics of growth delay (GD) in children. Methods: The panoramic films matching the inclusion criteria were collected for the AI model training to establish the population-based DA standard. Subsequently, the DA of the validation dataset of the healthy children and the images of the GD children were assessed by both the conventional methods and the AI-assisted standards. The efficacy of all the studied modalities was compared by the paired sample t-test. Results: The AI-assisted standards can provide much more accurate chronological age (CA) predictions with mean errors of less than 0.05 years, while the traditional methods presented overestimated results in both genders. For the GD children, the convolutional neural network (CNN) revealed the delayed DA in GD children of both genders, while the machine learning models presented so only in the GD boys. Conclusion: The AI-assisted DA assessments help overcome the long-standing populational limitation observed in traditional methods. The image feature extraction of the CNN models provided the best efficacy to reveal the nature of delayed DA in GD children of both genders.

Age Assessment in Children and Adolescents by Measuring the Open Apices in Teeth: A New Sardinian Formula.

Age estimation in children is fundamental in both clinical and forensic fields. The aim of this study was to evaluate the accuracy of the Cameriere’s European and Italian formulae for age estimation in Sardinian children and adolescents, a genetically isolated population. A sample of 202 orthopantomograms of healthy Sardinian children and adolescents (100 females and 102 males) aged between 6 and 17 years was retrospectively evaluated. The seven left mandibular teeth were assessed with the Cameriere’s European and Italian formulae. The teeth with closed apex (N0) were counted and, in the teeth with open apex, the distance between the inner sides was calculated. All variables showed a significant and negative correlation with age except N0 and g. Sex (g), the variables s, N0, and the first-order interaction between them, contributed substantially to the age measurement (p < 0.001). Although the value of x5 had a low prediction level, it generated the following multiple linear regression formula, specific for the Sardinian sample: Age = 10.372 + 0.469 g + 0.810 N0 − 1.079 s − 0.398 s ∙ N0 − 0.326 × 5. Only the Sardinian and European formulae allowed to obtain an acceptable interclass agreement (both the lower and upper >0.7). The results showed that the European formula could be accurate for assessing age in this sample of children and adolescents.

Digitalised exercise material in forensic odontology

IntroductionThis paper presents digital educational material in forensic odontology, including dental identification after multiple fatalities and dental age estimation from different age groups.Material and methodElectronic patient records consisting of intraoral scans of the dentition, digital radiographs, photographs and written dental records were collected. Exercises in age estimations contained digital radiographs and photographs of ground tooth sections, with digital measuring tools and tables according to age groups. The teaching material was organised as a module in an electronic Learning Management System with external links to all relevant teaching material.ResultsFor the identification exercises, intraoral scans and the latest digital radiographs simulated the postmortem examination of the deceased. For comparison, all other radiographs, photographs and dental records were available as antemortem material. The exercise was to match postmortem findings with the antemortem records using the Interpol standard and reconciliation. Age assessment of children used designated tables to grade tooth development on digital radiographs. For adults, non-destructive methods, digital radiographs, photographs and measuring tools were used.DiscussionThe teaching concept was hybrid, but it can easily be adapted as a fully digital exercise. The instructions and written material can be translated into different languages. The level of difficulty in the exercises can be adjusted according to the participant’s level of knowledge.ConclusionThe educational material embraces the new possibilities for digitalisation and intraoral scanning. This might be a valuable tool for motivating and engaging the students in their participation and understanding of the subject.

Coronal pulp: An age biomarker - A cross-sectional radiographic study in children.

Background:Age plays an important role in personal identification, treatment planning, forensic dentistry, and legal issues. It is one of the key identification tools for distinguishing one person from another and one population from another. An intraoral radiographic technique for age estimation is an easier approach. The widely accepted age estimation method in children is the Demirjian system. Tooth coronal index is another method that gained popularity for adult age estimation.Aim:This study aims to estimate the tooth coronal index (TCI) of mandibular right and left second deciduous molar and its correlation with chronological age to derive a regression equation.Settings and Design:The present study is a cross-sectional radiographical study which is conducted in AME's Dental College and Hospital, Raichur, Karnataka, India.Materials and Methods:A total of 100 children aged 5–10 years were selected. Digital intraoral periapical radiographs were taken for right and left deciduous mandibular second molar. The length of the tooth crown and the coronal pulp cavity were measured. Statistical Analysis: Further, the data are subjected to student's unpaired t-test and ANOVA test for the statistical analysis and simple linear regression to derive the regression equation.Results:TCI showed a statistically significant reduction with increasing age in both right and left mandibular deciduous second molar (P ≤ 0.05), and the strength of the correlation is moderate (r = −0.59) if age is correlated with TCI using simple linear regression.Conclusion:The tooth coronal index method is found as a simple, noninvasive, nondestructive and cost-effective method for age assessment in children.

Clinical significance of skeletal age assessment in children

Bone development is influenced by a number of factors, including nutrition, hormonal secretions, and genetics.Skeletal age assessment(SAA)is a clinical procedure, which is used in determining the skeletal age(SA)of children and adolescents.The selection of evaluation methods, the difference of evaluation techniques, and the influence of disease can affect the accuracy of SAA.Currently, the main clinical methods for SAA are the Greulich-Pyle(GP)and Tanner -Whitehouse(TW)methods.The GP method has the advantage of being quick and easy to use.The method of TW, however, seems to be more reliable than the GP method.In China, the CHN method is also used.With the development of technology, the computer automatic SAA and ultrasonic SAA are gradually applied in clinical practice.The SAA plays an important role in the diagnosis and treatment of endocrine diseases, such as short stature and precocious puberty, and also in the children′s growth and development.In order to improve the accuracy of SAA, this article reviews the related methods, techniques and clinical applications. Key words: Skeletal age; Endocrine disease; Final adult height

Age determination and the importance of teeth in forensic odontology: A retrospective review

Because of illegal immigrations, particularly after the so called Arab spring and the growing incidence of natural and man-made disasters which regrettably was very common in the last three to four decades, age determination has gained increasing importance in legal medicine. Forensic odontology is a branch of dentistry which deals with the proper handling and examination of dental evidence and the proper evaluation and presentation of dental findings in the interest of justice. There are various methods are used in Dentistry as an Evidence in Forensic Identification. Dental maturity, have a very imperative position in the assessment of age in children and adolescents forensic examinations. As time passes, with the increase in human greed and aspirations to conquer more and more nations in the false name of ‘removal of the dictators’ and the ‘forceful imposition of imported western democracy’ that has produced devastating results in the middle east and ultimately resulting in illegal mass immigration occurring towards Europe, eventually resulting in increase of crime and other legal and illegal activities, Forensic odontology as a branch in dentistry will continue to play its important role in legal medicine.

The iliac crest in forensic age estimation: evaluation of three methods in pelvis X-rays.

Age assessment in children and young adults is a relevant forensic issue. It is requested not only in evaluating criminal responsibility in youths without proper identification documents, often in relation to age thresholds, but also for release of a residency permit, and asylum seekers of minors. The analysis of the Risser sign and the iliac crest ossification process has been proposed as a useful tool for forensic age estimation. We evaluated the applicability of three different age estimation methods on a sample of 497 pelvic radiographs of Italian individuals between 10 and 25years of age. Each method showed high reliability for both reproducibility and repeatability. The staging technique inspired by Kreitner and Kellinghaus methods (KK-MS) is easier than the Risser method in applicability, as it is not affected by the variations of ossification. We observed that all subjects who attained stage 3c of KK-MS and 5 of Risser Fr were >14years, suggesting the benefits of these methods for that age threshold. The applicability of the area measurement method, inspired by Cameriere's approach, ranged between 12 and 20years, but the statistical analysis showed only a moderate correlation with age. In order to evaluate the possible use of this approach it is therefore necessary to clarify and exclude external factors influencing the parameter. In conclusion, the iliac crest ossification is of interest in age estimation for forensic purposes. The evaluation of the pelvis X-ray, in addition to the other common dental and skeletal methods, could become a useful supplementary tool in age estimation for the 14 year threshold in order to fulfill forensic-level requirements.

Applicability of Demirjian’s Method and Modified Cameriere’s Methods for Dental Age Assessment in Children

Tooth development is extensively used for age estimation as a part of forensic science. The purpose of this study was to evaluate the reliability of Demirjian's, Cameriere's and modified Cameriere's population-specific regression equation methods in the dental age estimation of West Godavari children. The study included orthopantomograms (OPG) of 60 children of West Godavari district with age group between 9 to 14 years on whom all the three methods were used for age estimation. The OPG were traced with the help of a tracing paper and lead pencil and the appropriate dimensions were measured. Age estimation was done based on canine calcification stage as per Demirjian's method and measurements of the seven permanent left mandibular teeth using Cameriere's formula and modified population-specific regression equation obtained for the South Indian population from Cameriere's formula. The resultant data were subjected to statistical analysis by student's paired t-test. The estimated age was closer to the chronological age when the modified Cameriere's population-specific regression equation was used (p=0.68); whereas, the difference was more in Demirjian's method (p=0.008) followed by Cameriere's method (p<0.001). The method using modified Cameriere's population-specific regression equation exhibited a least significant difference in chronological and dental age assessment in children of West Godavari district as compared to the other two methods.

Metric approach for age assessment of children: an alternative to radiographs?

The objective of this study was to examine the use of metric assessment of the face and body height for age estimation of young children for legal proceedings. The sample consisted of 591 healthy children (317 boys and 274 girls) aged between 3 and 6 years from Germany, Italy and Lithuania. Multiple regression models for age estimation were developed using body height and selected craniofacial measurements and proportions. The accuracy of the models was assessed by the mean absolute error on a sample of 60 children. Sex-specific regression equations were established using five craniofacial indices (sestozyzy, zyzyeueu, tsetgn, seprnsegn, seprnsesto), associated absolute measurements, and body height. The standard deviations for a mean age estimate in a child of a given sex, body height and face dimensions ranged from 6 to 10 months. Mean absolute errors between real and estimated ages ranged from 4 to 9 months. It is concluded that facial measurements and body height may be used for age estimation in young children either as a complementary method to dental and skeletal assessment or as an alternative method for radiological evaluation when this cannot be applied due to lack of access or legislative restrictions for unaccompanied minors or adopted children

Age Assessment in Children: A Novel Cameriere's Stratagem.

AimAge is one of the essential factors in establishing the identity of a person, especially in children. Age estimation plays an important part in treatment planning, forensic dentistry, legal issues, and paleodemographic research. The present study was an attempt to estimate the chronological age in children of Davangere population by using Cameriere’s India specific formula.Materials and methodsThis was a retrospective observational study to estimate the chronological age in children of Davangere population. A total of 150 panoramic radiographs of patients aged between 6 and 15 years, including both sexes, were selected. Age was calculated by measuring open apices of seven right or left mandibular teeth using Adobe Photoshop software.ResultsStatistical analysis was performed to derive a regression equation for estimation of age, which showed that, of the variables X1, X2, X3, X4, X5, X6, X7, s, N0, the variables N0 and X4 were statistically noteworthy. Hence, these two variables were used to derive the linear regression formula:Age = 10.522 + 0.712(N0) - 5.040(X4). The model was found to be statistically significant, F(2, 147) = 207.96, p < 0.001, and accounted for approximately 74% of the variance of age (R2 = 0.739, adjusted R2 = 0.735).ConclusionCameriere’s method can be used for age assessment in children for forensic as well as legal contexts and based on these variables a reliable age estimation equation could be proposed specifically for Davangere population.How to cite this articleAttiguppe PR, Yavagal C, Maganti R, Mythri P. Age Assessment in Children: A Novel Cameriere’s Stratagem. Int J Clin Pediatr Dent 2016;9(4):330-334.

Age estimation by dental developmental stages in children and adolescents in Iceland

Studies have shown that it is necessary to create a database for dental maturity for every population and compare it to others. The present study is the first one for dental development in the Icelandic population the age range being 4–24 years. It will help in forensic dental age estimation and will also help dentists, physicians, anthropologists, archaeologists and other professionals who rely on developmental age assessment in children and adolescents. In this present retrospective cross-sectional study, dental maturity was determined in 1100 Icelandic children and adolescents from orthopantomograms (OPGs). The first 100 were used for a pilot study and the remaining 1000 for the main study. A total of 23 subjects were excluded. The sample consisted of 508 girls and 469 boys from the age of 4–24 years and a dental developmental scoring system was used as a standard for determination of dental maturity stages. A total of 200 OPGs were studied both on the left and right side and the remaining on the right side. Dental maturity was established for all teeth and both genders, when the sample permitted, from the beginning of crown formation to the root apex closure. The Cronbach's Alpha reliability test showed high reliability, R=0.982. Girls in Iceland reach dental maturity root completed (stage 10, Rc) at 17.81 years of age for the maxillary and at 18.47 years for the mandibular teeth. Boys reach dental maturity root completed (stage 10, Rc) at 18.00 years of age in the maxilla and 17.63 in the mandible. There was no significant difference between left and right side (r=0.95–1.00) and there was no gender difference, except in root formation in maxillary and mandibular canines where girls reached root completed earlier than boys. A reliable database has been established in Iceland for tooth development in the age range of 4–24 years, which is compatible with international studies. These results will help forensic odontologists and other professionals to estimate with high accuracy both age and dental maturity in Icelandic children and adolescents.

Automated Greulich-Pyle bone age determination in children with chronic kidney disease.

Growth restriction and retarded bone age are common findings in children with chronic kidney disease (CKD). We compared the automated BoneXpert™ method with the manual assessment of an X-ray of the non-dominant hand. In this retrospective multicenter study, 359 patients with CKD stages 2-5, aged 2-14.5 (girls) or 2.5-17 years (boys) were included. Bone age was determined manually by three experts (according to Greulich and Pyle). Automated determination of bone age was performed using the image analysis software BoneXpert™. There was a strong correlation between the automatic and the manual method (r = 0.983, p < 0.001). The automatic method tended to generate higher bone age values (0.64 ± 0.73 years) in the younger patients (4-5 years) and to underestimate retardation or acceleration of bone age. The so-called "bone health index" (BHI) was reduced in comparison to the reference population. Bone health index standard deviation score (BHI-SDS) was not related to the stage of CKD, but weakly negatively correlated with plasma PTH concentrations (r = 0.12, p = 0.019). BoneXpert™ allows an objective, time-saving, and in general valid bone age assessment in children with CKD. Possible underestimation of retarded or accelerated bone age should be taken into account. Validation of the BHI needs further study.

Age estimation for forensic purposes in Italy: ethical issues

Age assessment in children and young adults is a relevant medicolegal issue due to the gradual increase of persons devoid of proper identification documents in European countries. Because of the illegal immigration and growing crime rates among children and adolescents, age estimation for forensic purposes is often required. The scientific research and the extensive experience of forensic experts in the last decades focused on the use of radiographic methods addressed to evaluate the degree of skeletal or dental development as the most accurate parameters to estimate the chronological age of children and adolescents. This paper analyzes the ethical issues related to age estimation procedures based on radiographic methods, showing how the ethical principles of beneficence, nonmalevolence, justice, and autonomy may be guaranteed during the execution of the age assessment in forensic practice. The procedure might be conducted in accordance with international guidelines and protocols, though they need a higher homogenization and standardization. A strong collaboration between various scientific societies of professionals (forensic odontologists, forensic pathologists, forensic anthropologist, radiologists, pediatricians, and psychologists), who have been involved in age estimation for years, is needed to reach this goal.

Skeletal age assessment in children using an open compact MRI system

MRI may be a noninvasive and alternative tool for skeletal age assessment in children, although few studies have reported on this topic. In this article, skeletal age was assessed over a wide range of ages using an open, compact MRI optimized for the imaging of a child's hand and wrist, and its validity was evaluated. MR images and their three-dimensional segmentation visualized detailed skeletal features of each bone in the hand and wrist. Skeletal age was then independently scored from the MR images by two raters, according to the Tanner-Whitehouse Japan system. The skeletal age assessed by MR rating demonstrated a strong positive correlation with chronological age. The intrarater and inter-rater reproducibilities were significantly high. These results demonstrate the validity and reliability of skeletal age assessment using MRI.

Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control

Unprecedented changes in both the scale and the complexity of international migration have led to international concern and controversy over the assessment of age in children and young people subject to immigration control or seeking asylum who say they are children yet have no documents to prove their stated age. The article reviews the existing evidence on the reliability of medical and non-medical techniques for the assessment of chronological age. There is evidence that radiography (X-rays) of bones and teeth, which is increasingly relied upon by immigration authorities, is imprecise, unethical and potentially unlawful, and should not be used for age assessment. Medical techniques including X-rays continue to be relied upon in the absence of an alternative approach resulting in legal challenges and uncertainty for children and young people. Further work is needed to establish a process for age assessment based on a 'holistic' multi-disciplinary approach which focuses not on chronological age exclusively but rather on the needs of children and young people subject to immigration control.