Dental Age Estimation Methods Research Articles

Comparative evaluation of two different dental age estimation methods using tooth pulp: A CBCT study.

To estimate the age of an individual based on 3D radiographic evaluation of pulp width of maxillary central incisor. This study included 185 CBCT images of individuals within age range of 14-64 years. Images were evaluated for maxillary central incisors and pulp width measurements were taken from cementoenamel junction and middle third of root. Obtained data was subjected to correlation and regression analysis from which the age of an individual was predicted. Results of the present study were compared with another study by the same authors. A negative linear relationship was obtained between age and pulp width. The standard error of estimate (SEE) in sagittal section was 11.36 years and that in coronal section was 11.23 years. The coefficient of determination for sagittal section was 0.107 and for coronal section was 0.127. An obtained regression formula was highly significant. Division of samples into various age groups reduced SEE drastically. It can be concluded that pulp width of maxillary central incisor is a reliable indicator of age estimation.

Machine learning assisted 5-part tooth segmentation method for CBCT-based dental age estimation in adults.

The utilization of segmentation method using volumetric data in adults dental age estimation (DAE) from cone-beam computed tomography (CBCT) was further expanded by using current 5-Part Tooth Segmentation (SG) method. Additionally, supervised machine learning modelling -namely support vector regression (SVR) with linear and polynomial kernel, and regression tree - was tested and compared with the multiple linear regression model. CBCT scans from 99 patients aged between 20 to 59.99 was collected. Eighty eligible teeth including maxillary canine, lateral incisor, and central incisor were used in this study. Enamel to dentine volume ratio, pulp to dentine volume ratio, lower tooth volume ratio, and sex was utilized as independent variable to predict chronological age. No multicollinearity was detected in the models. The best performing model comes from maxillary lateral incisor using SVR with polynomial kernel ( = 0.73). The lowest error rate achieved by the model was given also by maxillary lateral incisor, with 4.86 years of mean average error and 6.05 years of root means squared error. However, demands a complex approach to segment the enamel volume in the crown section and a lengthier labour time of 45 minutes per tooth.

Assessment of dental age estimation using dentinal translucency in ground sections of single rooted teeth: a digital image analysis.

Human dentition is unique to individuals and helps in identification of individuals in forensic odontology. This study proposes to study the manually ground sections of single rooted teeth using digital methods for dental age estimation. To assess the dentinal translucency from the scanned digital images of manually ground section of teeth using commercially available image edition software. Corroborating the root dentinal translucency length and region of interest (ROI) of translucency zone in pixels (as a marker of dental age) with the chronological age of the subject, as stratified by different age groups. Twenty single-rooted extracted teeth from 20 patients each from 6 groups divided as per age. Manual sectioning of the teeth followed by scanning the sections was done. Root area in pixels and ROI of translucency zone were measured. From the observed values, translucency length percentage (TLP) and percentage of ROI in pixels (TPP) was calculated and tabulated. Pearson's correlation coefficients were obtained for age with TLP and TPP. Positive correlation existed between age and TLP and also between age and TPP. With the obtained data, multilinear regression equations for specific age groups based on 10-year intervals were derived. By a step-down analysis method, age was estimated with an average error of around ±7.9 years. This study gives a novel method for age-estimation that can be applied in real-time forensic sciences.

Evaluating legal age of 18 years through observation of third molars using Gambier et al. method in an orthopantomographic sample of subadults from South India

In forensic practice, medicolegal physicians are often tasked with estimating age using dental evidence. This calls for an uncomplicated, reliable, and reproducible method for dental age estimation, enabling physicians to proceed without specific odontological expertise. Among various dental methods, third molar eruption analyses are less complicated and easier to perform. In our study, we explored the effectiveness of Gambier et al.'s scoring system, which examines the eruption of all third molars. We retrospectively analysed 1032 orthopantomograms (528 males and 504 females) of individuals aged between 15 and 24 years. The mean chronological age increased with the progression of stages (1 to 3) and phases (A to D) of the third molar eruption for both sexes. In terms of stages, none showed significant discrimination between minors (<18 years) and adults (>18 years), especially for males. However, Gambier’s phase D displayed a relatively high likelihood of being 18 years or older, with an overall 85.9 % of males and 95.7 % of females having all third molars in stage 3 being 18 years or older. While the tested method could be helpful in indicating the completion of the 18th year of life, caution is advised (due to a high percentage of false positives), and it should be used alongside other age assessment methods by experts.

Deep learning methods for fully automated dental age estimation on orthopantomograms.

This study aimed to use all permanent teeth as the target and establish an automated dental age estimation method across all developmental stages of permanent teeth, accomplishing all the essential steps of tooth determination, tooth development staging, and dental age assessment. A three-step framework for automatically estimating dental age was developed for children aged 3 to 15. First, a YOLOv3 network was employed to complete the tasks of tooth localization and numbering on a digital orthopantomogram. Second, a novel network named SOS-Net was established for accurate tooth development staging based on a modified Demirjian method. Finally, the dental age assessment procedure was carried out through a single-group meta-analysis utilizing the statistical data derived from our reference dataset. The performance tests showed that the one-stage YOLOv3 detection network attained an overall mean average precision 50 of 97.50 for tooth determination. The proposed SOS-Net method achieved an average tooth development staging accuracy of 82.97% for a full dentition. The dental age assessment validation test yielded an MAE of 0.72years with a full dentition (excluding the third molars) as its input. The proposed automated framework enhances the dental age estimation process in a fast and standard manner, enabling the reference of any accessible population. The tooth development staging network can facilitate the precise identification of permanent teeth with abnormal growth, improving the effectiveness and comprehensiveness of dental diagnoses using pediatric orthopantomograms.

Kvaal’s dental age estimation method applied to Brazilian adults—a cross-sectional test of validity

BackgroundDental age estimation of adults is a challenging procedure in forensic odontology. Radiographic techniques have enabled non-invasive age estimation of adults since the 90’s. Kvaal’s method based on the deposition of secondary dentin has demonstrated broad applicability in several populations. Population-specific studies with this method, however, are scarce in South America. This study tested the validity of Kvaal’s method in a sample of radiographs of Brazilian adults. The sample consisted of 192 periapical radiographs of 106 females (55.2%) and 86 males (44.8%) with ages between 20 and 80 years old. The permanent maxillary right (n = 84, 43.8%) and left (n = 108, 56.2%) central incisors were assessed based on Kvaal’s method.ResultsLin’s coefficient of concordance between estimated (EA) and chronological (CA) ages was 0.800 (IC95% = 0.753; 0.847) (p < 0.001). The mean difference between EA and CA was − 2.84 years (p < 0.001). For females and males, separately, the mean differences between EA and CA were − 3.82 years (CI95% = − 5.38; − 2.25) (p < 0.001) and − 1.86 years (CI95% = − 3.56; − 0.17) (p = 0.031), respectively. Underestimations were predominant and increased with time.ConclusionAfter 28 years of the original publication, Kvaal’s method remains reliable for non-invasive dental age estimation of adults, especially for the analysis of the permanent maxillary central incisors of Brazilian individuals.

A comparison of estimated age based on pulp volume from cone beam computed tomography (CT) images and panoramic radiography data with chronological age.

This retrospective study was conducted to evaluate different methods for dental age estimation in children and to examine the feasibility of using cone beam computed tomography (CBCT) data for age estimation. A total of 200 radiographic records (both digital panoramic radiographs and CBCTs) were acquired from 100 children aged 9 to 16 years, all taken on the same dates. Radiographic data was acquired from archived records and included both panoramic radiography and CBCT data belonging to the same individual. CBCT was used when panoramic radiographic data was insufficient. The pulp volume and pulp/tooth volume ratio of the left first molar teeth in the mandible were calculated from the CBCT data using MIMICS software. In addition, age was estimated by the Demirjian and Willems methods from data obtained from panoramic radiography images. Statistical analyses and linear regression analysis were performed as necessary. There was a statistically significant difference between the mean difference between the Demirjian method and chronological age, and between the Willems method and chronological age (p < 0.001). Statistically significance was achieved in a linear regression model created from pulp volume (R2 = 0.098) and pulp/tooth volume ratio (R2 = 0.395) data for the estimated dental age analysis (p < 0.001) and a negative correlation was observed with chronological age. When compared estimated dental age from CBCT data with chronological age, the pulp/tooth volume ratio method yielded results closer to chronological age than using only pulp volume data. When considering both panoramic radiographic age estimation methods and age estimation methods using CBCT data, we found that the results obtained with the Willems method, a panoramic radiographic age estimation technique, provided the closest results to the chronological age. More contributions should be made to the literature regarding the feasibility of age estimation using pulp and tooth volume as an alternative method.

Radiological Evaluation of the Accuracy of Demirjian, Nolla, and Willems Methods for Dental Age Estimation in 3-17-Year-Old Iranian Children.

Background: The stage of tooth formation is one of the most reliable indicators for predicting a patient's developmental age by radiographs. This study compared the accuracy of three distinct dental age estimation methods (Demirjian, Nolla, and Willems) in children aged 3-17 in the northern Iranian population. Methods: This cross-sectional study examined panoramic radiographs of 434 children aged 3-17 from Mazandaran Province, Iran, who had teeth 31-37 present on the left mandible. This study employed the Demirjian, Nolla, and Willems methods to estimate the dental age of the sample and compare it with the chronological age. The data were analyzed using SPSS v16. A paired t-test was used to compare chronological and dental ages. The Pearson correlation was used to correlate the chronological and dental ages. The errors of different methods were compared using the Wilcoxon test. P values < 0.05 were considered significant for all tests except Wilcoxon. For Wilcoxon, a P value < 0.017 was considered significant. Results: The three methods presented differing mean estimated ages. The Demirjian method delivered the highest mean, and all three methods differed significantly when compared in pairs. The results showed that the Demirjian method overestimated chronological age by 0.25 years (P < 0.001) in girls and 0.09 years (P = 0.28) in boys. The Willems method underestimated chronological age by 0.05 years (P = 0.47) in girls and 0.12 years (P = 0.13) in boys. The Nolla method underestimated chronological age by 0.41 years (P < 0.001) in girls and 0.40 years (P < 0.001) in boys. The accuracy of each method varied with the patient's age. Conclusion: According to the findings, the Willems method outperformed the Demirjian method, and the Demirjian method exceeded the Nolla method for estimating dental age in Iranian children aged 3-17. Overall, the Demirjian method overestimated the age of the study population, whereas the other two underestimated it.

Accuracy of different dental age assessment methods to determine chronological age among children with special needs.

This study aimed to validate the accuracy of dental age (DA) based on the dental development of permanent teeth in children with special needs using Demirjian, Willems, and London Atlas methods and to correlate the dental and chronological age (CA) of children with special needs in Malaysia. The panoramic radiographic images belonging to children with special needs from the two teaching dental hospitals in Malaysia aged between 5 and 16 years were included in the study. The evaluation was performed by two observers using three methods (London Atlas, Demirjian, and Willems methods) to estimate the accurate DA. The outcome was determined by comparing the mean of the DA and CA. A total of 52 panoramic radiographs were available for the analysis. The London Atlas and Demirjian methods overestimated the DA with a mean of 0.05 and 0.20 years, respectively, while the Willems method underestimated by 0.19 years. The London Atlas method was highly precise and accurate, while Demirjian and Willems methods were the least precise and accurate. The London Atlas method of DA estimation is highly accurate and valid for children with special needs in the Malaysian population, followed by the Willems and Demirjian methods.

Dental age estimation methods applied to Indian children and adolescents: A systematic review and meta-analysis

Country-specific systematic reviews and meta-analyses have been proposed to compile the available literature and rank methods based on their performance for a target population. India is a country with a vast scientific literature on dental age estimation. This systematic review aimed to provide evidence to help the decision of experts regarding the method of choice for dental age estimation in India. The research protocol was registered in Open Science Framework. Literature Search was performed in Embase, LILACS, MedLine (via PubMed), SciELO, Scopus and Web of Science. Grey Literature was searched in Google Scholar and ProQuest. Observational cross-sectional studies that compared chronological and estimated ages using Demirjian (original [DEM] and Chaillet's modification [modified-DEM]) and Acharya (ACH) methods were included. JBI tool was used to assess the risk of bias. The search detected 9799 studies, out of which 56 were eligible (n=13,107 panoramic radiographs of Indian individuals). Low risk of bias was registered for 48 studies, while 8 presented a moderate risk of bias. The meta-analysis showed a standardized mean difference between chronological and estimated ages of -0.11 (95%CI: -0.29; 0.07), 0.74 (95%CI: 0.39; 1.09), and -0.01 (95%CI: -0.23; 0.22) years for DEM, modified-DEM and ACH, respectively. High heterogeneity (I2=88-93%) was observed across studies for all the methods, including subgroup analyses based on sex. This study ranked ACH, DEM and modified-DEM (from the best to the worse) performances in the Indian population.

Comparison of Demirjian's comprehensive chart with the London atlas of tooth development in children and adolescents: a pilot study.

No study has compared Demirjian's comprehensive chart and London atlas method in the Indian population.The dental age estimated by London method was closer to chronological age as compared to Demirjian's method in our study sample.Significant difference was found in chronological age and estimated age using London atlas method in both males and females.

Dental Age Estimation Methods Tested in a Sample of the Pakistani Population: Cross-Sectional Study

Forensic dentistry is still an emerging field in Pakistan. The lack of scientific literature on the topic may lead to difficulties in situations where age estimation has a significant part such as in criminal and civil litigation. In mass disasters such as earthquakes and accidents, the correct investigation of the chronological age can be less troublesome if population-specific evidence is available. This is the rationale that justifies dedicated dental age estimation studies. This cross-sectional study aimed to test the time efficiency, validity and applicability of four dental age estimation methods: two invasive (Bang and Ramm and Lamendin) and two non-invasive (Kvaal and Cameriere) in an adult Pakistani population. A total of 37 teeth collected from a dental hospital in Islamabad, Pakistan, were used. Teeth included the central and lateral incisors, canines, and first and second premolars of males and females. Results were calculated using a Microsoft Office 2007 excel spreadsheet. Overall, Kvaal’s method mean absolute error between chronological and estimated ages (MAE: 12.33) showed the highest variation and Bang and Ramm showed more accurate results in comparison with other methods (MAE: 4.80). It was both time-efficient and practical to use. It can be stated that these were preliminary cross-sectional outcomes and that studies with larger samples are necessary.

Evaluation of the Accuracy of Demirjian's Method for Dental Age Estimation in Northern Sudanese Children and Adolescents

A variety of methods have been used worldwide in dental age assessment in the living. However, since dental development varies between populations, population-specific studies are necessary. This study aimed at investigating the accuracy of age estimation using developing teeth from panoramic radiographs according to the method devised by Demirjian and colleagues in a sample of Northern Sudanese children and adolescents (2) Methods: A total sample of 917 X-Rays from patients aged between 6-16 years of age was available, but only 527 were suitable (265 boys, 272 girls). (3) Results: The mean difference between chronological and dental age for Northern Sudanese boys, ranged between (–0.389 to +0.571) while, for the Northern Sudanese girls, the mean difference ranged between (–0.056 to+0.732); (4) Conclusions: The results showed that the Demirjian's method did not accurately predict age in this Northern Sudanese population. Standards were produced to convert the maturity scores calculated by Demirjian's method to a new dental age assessment for Northern-Sudanese population

Do Nutritional Status Parameters such as Body Mass Index &amp; Mid Upperarm Circumference Need to be Taken into Account when Estimating Dental Age? A Cross-sectional study with Tooth Count as Variable

Context: Age estimation is playing a very important role in the criminal justice system and also in the forensic human identifi cation process. Over the past several decades, the scientifi c community has done extensive work on age estimation from biological markers of growth, the dental structure being one among them. The routine dental age estimation methods usually apply the mineralization and/or the eruption parameters of the developing dentition. Certain factors like the nutritional status and the socio-economic status of the individual also may infl uence dental development and eruption. Aim: The objective of the study was to assess the link between the nutritional status and the dentition status of children and adolescents in the age range of 12 to 18 years. Settings and Design: This is a cross-sectional population based, descriptive study. Materials and Methods: The body mass index (BMI) and the mid-upper arm circumference (MUAC) values were measured to assess the nutritional status of the children with a mean age of 14.35 years (± 1.36). The oral examination was done to count the number of teeth present. The tooth count was compared with the BMI and the MUAC values of the children. Results: The mean BMI of the study population was 17.36 Kg/m2 ± 3.40 and the mean MUAC value was 21.53cm ± 2.93. There was a strong positive correlation between BMI and MUAC and a signifi cant diff erence in the deciduous tooth count among the BMI categories. (2 =12.161, df 3, p&lt;0.05). Conclusion: There is no signifi cant association between BMI and deciduous tooth count in the study sample. Key Messages: The BMI and MUAC values are markers of nutritional status in growing children. Though nutritional status has a link with the tooth development, the present study could not establish a signifi cant association between BMI and deciduous tooth count in children in the age range of 12 to 18 years.

Age Estimation Using the Demirjian and Willems Methods in a Southern Thai Population

The objective of this study was to test the accuracies of the Demirjian and the Willems dental age estimation methods using the seven left permanent mandibular teeth (excluding the third molar tooth) in children in southern Thailand. Digital panoramic radiographs of 240 Thai children (120 males and 120 females) aged from 8 to 15 years were chosen and separated into eight age groups. Dental age was assessed using the Demirjian and the Willems methods. Differences between the dental age and the chronological age were statistically evaluated by the Wilcoxon signed-rank test. The results showed that the Demirjian method overestimated age by 0.28 years and 0.24 years for males and females, respectively, while the Willems method underestimated age by −0.04 years and −0.23 years for males and females, respectively. Moreover, the mean absolute errors were 0.68 years in males and 0.56 years in females for the Demirjian method and 0.55 years in males and 0.60 years in females for the Willems method. In conclusion, the Willems method was more accurate for dental age estimation compared to the Demirjian method. However, both methods can be applied to estimate the age of children in southern Thailand since the mean error and mean absolute error values were less than one year. Keywords: Dental age estimation, Demirjian method, Tooth developmental stage, Thai population, Willems method

Testing the accuracy of Foti’s dental age estimation methods on a London UK sample

Background and aimTooth development and eruption are widely used in assessing dental age estimation, and one of the methods in using tooth development and eruption is Foti’s method. However, the population used in the original study was French. Therefore, the aim of this study was to test the accuracy of Foti’s four dental age estimation regression models against the East London population, mainly of the Bangladeshi and Caucasian ethnicity. These count the number of erupted teeth and tooth germs using a radiograph (Foti 1), absence of a radiograph (Foti 2), maxillary erupted teeth (Foti 3) and mandibular erupted teeth (Foti 4). MethodsThe test sample was archived panoramic radiographs of 754 healthy patients aged 6–20 years (380 males and 374 females). The difference between dental and chronological ages was tested using a t-test. The mean absolute difference was also calculated for all models. The most accurate method was defined as the smallest mean difference, smallest standard deviation (SD) and mean absolute difference between dental and chronological ages. ResultsFoti model 2 was most accurate with a mean difference of 0.11 years (SD 1.70 years) and a mean absolute difference of 1.33 years. Models 3 (maxillary erupted teeth) and 4 (mandibular erupted teeth) were marginally less accurate, whilst model 1 (radiograph) overestimated age on average by more than 5 years. ConclusionOur findings show that estimating age using erupting teeth was most accurate using Foti model 2 (least bias).

Application of Kvaal’s Age Estimation Method in Maxillary Central Incisor: A CBCT Study

Background: Radiographic dental age estimation methods are viable both for living and deceased people. One such method is the indirect assessment of quantified secondary dentinal deposition through measurements of tooth and pulp. Kvaal, et al., developed a method for chronological age estimation based on pulp size using periapical dental radiographs. There is a need to test this method of age estimation in the Indian population on living individuals not requiring tooth extraction. The current study aimed to assess the applicability of Kvaal’s method in maxillary permanent central incisor using CBCT. Materials and Methods: The study included 185 CBCT images of the individuals, ranging in age from 14 to 64 years. CBCT images were evaluated for the maxillary central incisor and metric measurements were taken from which ratios were derived. Using the ratios, a linear regression equation was derived, from which the age of an individual was predicted. Result and Conclusion: The correlation between the individual ratio and the chronological age was calculated using the Pearson correlation coefficient. The age of the individual was predicted using a linear regression equation with a SEE ranging from 10.05 to 12.78 years. When the samples were divided into various age groups, the Standard Error of Estimate has drastically reduced. The radiographic pulpal morphometric analysis used in present study can be recommended to assess the age of an adult for forensic purposes.

Root Dentin Translucency based Dental Age Estimation in Adults: A Systematic Review

Background: In Forensic practice and research, the Gustafson technique is the most popular dental age estimation method that uses six variables, among which Root Dentin Translucency (RDT) is considered to be the best single parameter for dental age estimation as it is the least affected by environmental and pathological factors. Dental age estimation by RDT has been tested on different geographic groups in order to determine its applicability and it has been found that there was an under/overestimation of the age of the subjects in different populations. No systematic review of these studies has yet been published to check the reliability and accuracy of this novel method in estimating chronological age. Objective: To assess the accuracy and reliability of RDT-based dental age estimation in different academic and forensic scenarios by qualitatively summarising the results of RDT-based dental age estimation studies in diverse population samples. Evidence Review: Studies were searched in the Medline, Embase, Directory of open access journals, Cochrane library and Google Scholar databases up to December 2019 with previously defined inclusion and exclusion criteria. The outcome of interest was the difference between chronological age and the age estimated from RDT. Results and Conclusion: A total of 1754 subjects from 16 published studies were included in the final review. Our findings proved that the RDT method tends to overestimate chronological age for both sexes in most of the study population. The overestimated dental age ranges from 2.24 to 15.1 years.

Cameriere's open apices methodology for dental age estimation in children: a scoping review from a Latin American perspective.

Dental age estimation (DAE) is key to establishing an individual's identity, and this is relevant in minors. A widely used method for DAE in children is Cameriere's open apices (CAM). Despite its wide dissemination, there are no clear reports of its use in Latin American populations. A scoping review was conducted using a search strategy in the PubMed/MEDLINE database, Web of Science, and a complementary manual search. Only papers using CAM or its regression equation models for evaluating Latin American populations were included. Ten studies published between 2007 and 2020 responded to the search objective. Brazil was the country with the most studies using CAM (7/10), and the University of Macerata (Italy) was the most declared affiliation (6/10). Seven studies used the original CAM formula in populations from Brazil and Peru, while the European formula (EuCAM) was applied in Mexico, Colombia, and Brazil. Although the method underestimated the age values with acceptable error margins, the correction factor substantially improved the predictive power of the method. Some limitations of the method are highlighted. CAM and its variants can be useful for validation in Latin American settings, but attention to population structures and terminologies is suggested for future research.

Demirjian method and Willems method to study the dental age of adolescents in Shanghai before and after 10 years.

The aim of this study was to assess whether the difference in dental ages between 2009 to 2011 and 2021 is affected by environmental factors such as environmental pollution, floating population, and dietary habits. Demirjian and Willems dental age estimation methods were conducted for a Han population of children aged 8 to 14 in Shanghai, China. A total of 1259 digital panoramic radiographs of children aged 8.00-14.99 were estimated. All digital panoramic radiographs were estimated using the Demirjian and Willems methods. Data collected in 2009 to 2011 and 2021 were statistically analysed by paired t-tests. The results show that the Demirjian method overestimates 2009 to 2011 and underestimates 2021 the children's chronological age. When using the Willems method, the age of males was overestimated and the age of females was underestimated from 2009 to 2011, and it was underestimated for both genders in 2021. In conclusion, the difference in dental ages between 2009 to 2011 and 2021 was statistically significant. Factors such as environment and dietary habits have been found to be affected by dental development. However, there are disputes among some researchers about the exact factors, so it is suggested to further study the effects of environmental factors on tooth development.