Molar Maturity Index Research Articles

Applicability of Cameriere’s third molar maturity index on orthopantomograms and computed tomography scans from a French population

Cameriere developed a method on orthopantomograms (OPG) to assess adult age of 18 years based on the relationship between age and the third molar maturity index I3M. The aim of this study was to evaluate whether Cameriere’s method could be applied to computed-tomography scans (CT-scans) from a population of French juveniles and young adults and compare the results obtained from OPG of the same individuals. Our sample comprised 200 examinations that had been performed at the radiological department of a French University hospital between 2007 and 2020. Each patient had received an OPG and a cranial CT scan for medical purposes, and we used a similar adaptation of I3M based on OPG to determine the I3M based on CT scans. Due to exclusion criteria, our final sample comprised 71 OPGs and 63 CT scans. Based on the 71 OPGs, there was concordance between chronological age and estimated age, with a sensitivity of 78.57%, a specificity of 89.47%, and a misclassified rate of 18.03% based on tooth 38, and a sensitivity of 78.79%, a specificity of 91.67%, and a misclassified rate of 17.78% based on tooth 48. Our results based on CT scans presented concordance between chronological age and estimated age for tooth 38 described by a sensitivity of 77.78%, a specificity of 94.12%, and a misclassified rate of 16.98%. The concordance between chronological age and estimated age based on 48 had a sensitivity of 75.00%, a specificity of 93.75%, and a misclassified rate of 19.23%. The > 90% ICC indicate an excellent similarity between measurements of teeth 38 and 48 based on OPGs and CT scans. This study has revealed the applicability of the Cameriere’s method to calculate the I3M based on CT scans from a French population. The results based on CT scans are similar to results based on OPGs from the same individuals.

Integrating artificial intelligence and adult dental age estimation in forensic identification: A literature review

Age estimation is crucial in various forensic fields, including forensic medicine, anthropology, and demographic studies. Adult dental age estimation is affected by multiple factors, resulting in discrepancies between dental age and chronological age. The development of artificial intelligence (AI) technology has led to extensive investigations in forensic sciences, encompassing several areas such as facial recognition, age, sex identification, and DNA analysis. Adult age estimation methods commonly used include the pulp-tooth ratio approach, the Harris & Nortje method, and the Van Heerden method. AI approaches such as Fuzzy Logic (FL), Evolutionary Computing (EC), and Machine Learning (ML) are being extensively applied. These techniques use algorithms to imitate human thinking and behavior. Deep learning techniques, explicitly using deep convolutional neural networks (DCNN), enable age estimation by segmenting images and making measurements, replicating the cognitive processes of radiologists when computing indices such as the third molar maturity (I3M) index. Also, DCNNs automatically optimize teeth segmentation in dental X-ray images, improving image refining and analysis efficiency. AI integration in forensic dentistry improves the precision and effectiveness of dental data processing while significantly accelerating individual identification procedures. Incorporating this technology shows potential for enhancing the caliber and dependability of evidence in forensic investigations.

Accuracy of the third molar maturity index (I3M) for diagnosing the legal majority of young southern Brazilians.

The numerous techniques for identifying adulthood require research testing the accuracy of each method in different populations. This study verified the accuracy of the third molar maturity index (I3M) proposed by Cameriere et al. (2008) for diagnosing the age of majority in a southern Brazilian population sample. Panoramic radiographs of patients with dental element 38 treated at the School of Dentistry of the University of Passo Fundo (UPF), RS, Brazil, were analyzed. The patients were separated into age groups between 15.00 and 22.99 years. The Cameriere (2008) method was applied to each radiograph. The study sample comprised 671 individuals, with 385 women (mean age 19.67 ± 2.05) and 286 men (mean age 19.5 ± 2.11). The original cut-off value of I3M≤0.08 classified individuals younger and older than 18 years. ROC curve plotting resulted in an overall accuracy of 0.69 and 0.84 for women and men, respectively. The most favorable cut-off value for southern Brazilian men was 0.06, and women showed better results with an I3M adjusted to 0.13. The new cut-off values produced an accuracy of 0.78 for women and 0.84 for men. The original cut-off point to the I3M (0.08) was not the most appropriate for the studied sample. Thus, index adjustments to 0.13 for women and 0.06 for men may improve method performance among southern Brazilian individuals. Key words:Molar, third, radiography, panoramic, forensic dentistry, age groups, imputability.

Validation of method for estimation age of majority by the third molar maturity index on the sample of Ufa population

To test diagnostic accuracy of majority age assessment method by 3rd molar (Cameriere index) in the Ufa sample. The number of orthopantomograms equal 120 from males and females aged from 14 to 23 years without apparent pathological changes of the pulp of teeth 38 and 48 was examined. The measures were conducted using the standard R. Cameriere method. The method of logistic regression, determination of predictive values of sensitivity and specificity were used. The Im3 cut-off point, that was equal 0.08, had a sensitivity of 89% and specificity of 95% in the male sample, accuracy of age group determination was 93%. In the female sample the method sensitivity was 93%, specificity - 97%, accuracy - 97%. The study results confirmed the absence of population variability of the Cameriere index value, that makes it possible to use the majority age determination method by 3rd molar for practical application in the examination of a living person at the territory of the Russian Federation.

Comparison of the Cameriere's third molar maturity index and Olze et al.'s stages of radiographic visibility of the root pulp in a Turkish population.

The purpose of this study was to compare the Cameriere's third molar maturity index and Olze et al.'s stages of radiographic visibility of the root pulp in estimating the age of maturity in the Turkish population. The age of majority, which is legally significant, marks the transition from childhood to adulthood. In Turkey, the age of majority is set at 18 years. As the third molars continue to develop at this age, they can serve as an indicator of dental age. A total of 705 panoramic radiographs obtained from individuals aged 15 to 22 years, including children and adults, were included in this study. The left mandibular third molars were evaluated on panoramic radiographs using Cameriere's third molar maturity index and Olze's method of radiographic root pulp visibility (RPV) stages. Minimum and maximum values were noted for each stage, and a median with upper and lower quartiles, as well as mean and standard deviation were calculated. Sensitivity and specificity values were calculated. In males, Cameriere's third molar maturity index demonstrated a sensitivity of 0.77% and specificity of 0.96%, while in females, it showed a sensitivity of 0.57% and specificity of 0.92%. Regarding Olze et al.'s stage 0, the sensitivity and specificity values were 0.86% and 0.79% in males, and 0.85% and 0.75% in females, respectively. Although both methods can be used to distinguish individuals below or above the age of 18, the cut-off value suggested by Cameriere's method resulted in a higher rate of type 2 error (false negativity). Therefore, the method proposed by Olze et al., based on the radiographic visibility of the root pulp, can be employed to differentiate between adults and minors in the Turkish population.

Forensic Age Estimation from Lower Third Molar Maturity Index

Objective: To estimate age from mandibular third molar maturation stages in the patient presenting to the Combined Military Hospital, Peshawar Pakistan.
 Study Design: Cross-sectional.
 Place and Duration of Study: Department of Dentistry, Combined Military Hospital, Peshawar Pakistan, from Jun to Jul 2021.
 Methodology: One hundred and fifty participants of either gender, ages 14 to 24 years, with good quality orthopantomogram (OPG) showing mandibular third molar tooth germs and Pakistani nationals were included. Participants with hypodontia, oligodontia, Amelogenesisimperfecta, Dentinogenesisimperfecta, history of trauma /fracture in the third molar region and any systemic disease were excluded. Data like age, gender and tooth maturation stages of right mandibular molars were recorded. 
 Results: The mean age was 16.76±2.19 years. In 111(74.9%) cases, the variation in chronological age can be explained by mandibular third molar maturation stages. The only statistically significant predictor for age was Demirjian's stage of lower third molar (p=0.002,95% CI=3.643-15.442), while gender was not a significant predictor.
 Conclusion: The age can be estimated from the mandibular third molar with reliability in our population.

Artificial Intelligence as a Decision-Making Tool in Forensic Dentistry: A Pilot Study with I3M.

Expert determination of the third molar maturity index (I3M) constitutes one of the most common approaches for dental age estimation. This work aimed to investigate the technical feasibility of creating a decision-making tool based on I3M to support expert decision-making. Methods: The dataset consisted of 456 images from France and Uganda. Two deep learning approaches (Mask R-CNN, U-Net) were compared on mandibular radiographs, leading to a two-part instance segmentation (apical and coronal). Then, two topological data analysis approaches were compared on the inferred mask: one with a deep learning component (TDA-DL), one without (TDA). Regarding mask inference, U-Net had a better accuracy (mean intersection over union metric (mIoU)), 91.2% compared to 83.8% for Mask R-CNN. The combination of U-Net with TDA or TDA-DL to compute the I3M score revealed satisfying results in comparison with a dental forensic expert. The mean ± SD absolute error was 0.04 ± 0.03 for TDA, and 0.06 ± 0.04 for TDA-DL. The Pearson correlation coefficient of the I3M scores between the expert and a U-Net model was 0.93 when combined with TDA and 0.89 with TDA-DL. This pilot study illustrates the potential feasibility to automate an I3M solution combining a deep learning and a topological approach, with 95% accuracy in comparison with an expert.

Evaluation of Third Molar Maturity Index by Cone Beam Computed Tomography in Legal Age Estimation: A Preliminary Study.

This retrospective study aimed to evaluate the accuracy and applicability of the third molar maturity index (I 3M ) for discriminating Turkish minors from adults, and its relationship with chronological age using cone beam computed tomography (CBCT). A total of 122 CBCT scans of Turkish individuals (55 boys and 67 girls) aged 13 to 23 years were evaluated using the I 3M cutoff value. Chronological age gradually decreased as the I 3M value increased. The overall accuracy was 95.9%. The sensitivity and specificity of this test were 93.5% and 97.4%, respectively. Positive predictive value was 95.6%. The intraclass correlation coefficient values of the I 3M for the intraobserver and interobserver agreements were 0.998 and 0.996, respectively. This study showed relatively higher reproducibility of measurements on CBCT scans than on panoramic radiographs in the literature. Cone beam computed tomography may be advantageous and preferred over panoramic radiographs in distinguishing the legal age threshold of 18 years according to Cameriere's method when a more extensive investigation is needed to support the solution of challenging and uncertain cases in forensic medicine.

Third molar maturity index (I3M) assessment according to different geographical zones: a large multi-ethnic study sample

Identification of living undocumented individuals highlights the need for accurate, precise, and reproducible age estimation methods, especially in those cases involving minors. However, when their country of origin is unknown, or it can be only roughly estimated, it is extremely difficult to apply assessment policies, procedures, and practices that are accurate and child-sensitive. The main aim of this research is to optimize the correct classification of adults and minors by establishing new cut-off values for four different continents (Africa, America, Asia, and Europe). For this purpose, a vast sample of 10,701 orthopantomographs (OPTs) from four continents was evaluated. For determination and subsequent validation of the new third molar maturity index (I3M) cut-off values by world regions, a cross-validation by holdout method was used and contingency tables (confusion matrices) were generated. The lower third molar maturity indexes, from both left and right side (I3ML and I3MR) and the combination of both sides (I3ML_I3MR) were calculated. The new cut-off values, that aim to differentiate between a minor and an adult, with more than 74.00% accuracy for all populations were as follows (I3ML; I3MR; I3ML_I3MR, respectively): Africa = (0.10; 0.10; 0.10), America = (0.10; 0.09; 0.09), Asia = (0.15; 0.17; 0.14), and Europe = (0.09; 0.09; 0.09). The higher sensitivity (Se) was detected for the I3ML for male African people (91%) and the higher specificity (Sp) of all the parameters (I3ML; I3MR; I3ML_I3MR) for Europeans both male and female (> 91%). The original cut-off value (0.08) is still useful, especially in discriminating individuals younger than 18years old which is the goal of the forensic methods used for justice.

THIRD MOLAR MATURITY INDEX IN INDONESIAN JUVENILES: COMPARING LINEAR AND POLYNOMIAL KERNEL PERFORMANCE IN SUPPORT VECTOR REGRESSION FOR DENTAL AGE ESTIMATION

Dental age estimation is a branch of forensic odontology that plays a pivotal role in identifying, examining, or determining the legal status of the living and the dead. This research explores the capability of support vector regression to estimate chronological age from the third molar maturity index (I3M) in Indonesian Juveniles and compares the linear and kernel performance. Two hundred and twenty-two orthopantomo-graphy were measured using I3M in the lower left third molar and processed using R Studio with Caret extension. The analysis was separated into two groups, group 1 using only I3M as a predictor, and group 2 using both I3M and sex. Both groups were analyzed using SVR with the linear and polynomial kernel. The result suggests that using polynomial kernel SVR in group 1 produces the best results, with an R2 value of 0.64, RMSE of 1.588 years, and MAE of 1.25 years using degree = 3, c = 0.25. However, the addition of a sex predictor in the model reduces its accuracy when using the polynomial kernel.

Application of Third Molar Maturity Index (I3M) for Assessing Adult Age of 18 Years in a Southern Italian Population Sample.

Age estimation of living or dead individuals has a strategic importance in medicine, anthropology, and forensic science, in the context of mass disasters and in civil or criminal matters such as adoption or asylum. Teeth play a major role in this context in particular, the third molars are useful for determining whether an individual has reached the legal age of 18 years because they are still in development from the age of 14. In this study, a sample of 307 panoramic radiographs performed on healthy subjects aged between 13 and 23 was analyzed to consider the correlation between the maturity index of the third molar (I3M) and age to verify the reliability of the cutoff 0.08 indicated by Cameriere et al in a sample of Italian subjects living in the Province of Messina (Sicily, South Italy) to discern the adult subjects from the minors. The analysis of 307 panoramic radiographs resulted in a sensitivity of 89.2% with a confidence interval of 95%, a specificity of 96.5% with a confidence interval of 95%, and a positive predictive value of 96.7%. The method proved itself reliable in estimating adulthood in the population of the Messina- Sicily, but the I3M should not be used as the sole indicator to determine whether a person is younger or older than 18 years because age estimation based on dental methods alone has limitations as the third molars suffer from many variations related to their morphology, their location, and their development. We recommend a combination of several methods that are available to increase accuracy of age estimation, depending on the different legal requirements in civil or criminal cases.

Diagnostic accuracy of the third molar maturity index (I3M) to assess the age of legal majority in Northern Brazil-population-specific cut-off values.

International guidelines for dental age assessment have recommended the use of methods based on available population-specific data. The Third Molar Maturity Index (I3M) was previously validated in several populations worldwide. This was the first study to evaluate the I3M in a northern Brazilian population and to test the diagnostic accuracy of the method to distinguish between minors and adults. The sample consisted of 1.070 panoramic radiographs retrospectively collected from females (n = 595) and males (n = 475) with ages between 16 and 22years. I3M's original cut-off value of 0.08 was used to classify individuals below and above the age of 18. Receiver operating characteristic (ROC) curves were plotted to assess the accuracy (ACC) of the method. In females and males separately, the overall ACC was 73.1% and 80%, respectively. The overall ACC for the combined sample was 76.1%. For northern Brazilian males, the best cut-off value remained 0.08, while for females, an adjustment to 0.12 showed optimal outcomes. The new cut-off value led to an ACC of 98.5% for females, which reflected an increase of 25.5% compared to the original cut-off value. The original cut-off value proposed by I3M was applicable to the present sample of northern Brazilian individuals. Adjustments to 0.12, however, may be encouraged to enhance the performance of the method among females.

Accuracy of different dental age estimation methods for determining the legal majority of 18years in the Turkish population.

Radiographic evaluation of the third molar maturation is used to estimate dental age, especially in adolescence. This study aimed to assess the application of three age estimation methods (Cameriere's third molar maturity index (I3M), Demirjian's maturation stages, and The London Atlas) to determine whether an individual is 18years or older (adult) or younger than 18years (minor). The dental age was estimated using the I3M, Demirjian's maturation stages, and The London Atlas methods on panoramic radiograms of a total of 500 Turkish individuals aged 14-22years. A logistic model was derived with an individual's adult or minor status as the dependent variable, and each method and sex as predictive variables. The adult status was determined using dental age estimation methods and the performance of these methods in differentiating adults from minors was evaluated. The three methods were compared case-wise for their accuracy in predicting adult status. Logistic regression analysis showed that sex and each estimation method were statistically significant in discriminating adults and minors (p < 0.05). In the case-wise comparison for estimate adulthood, both Demirjian's stages and I3M methods tended to perform better than the London Atlas method, with this trend reaching statistical significance (p < 0.05). Cameriere's I3M and Demirjian's development stages are useful methods for adult age assessment in the tested population. In forensic medicine and legal practices, Cameriere's I3M and Demirjian's maturation stage methods based on the development of the third molar teeth can be used to determine whether an individual is a minor or an adult.

Third molar maturity index as an efficient tool for prediction of age in a sample Indian population - A retrospective study.

The age of 18 years is an important milestone for legal matters, and developmental parameters of teeth are often used for estimation of this age. The aim of this study is to assess the efficiency of third molar maturity index (I3M) in establishing age of 18 years in Dakshina Kannada population. A total of 700 orthopantomograms were retrieved from the archives of the radiology department of Manipal College of Dental Sciences, Mangalore. The length and the width of the open apex of the mandibular left third molar was assessed using Image J software and the Third molar maturity Index (I3M) was calculated and correlated with the age of the individual. Receiver operating characteristic (ROC) curve analysis showed the Area under curve of 0.94 and 0.96 in females and males, respectively, for prediction of age of 18 years. The cut-off of 0.08 predicted the 18-year cut-off with 97% specificity and 90.2% negative predictive value. The percentage of the accuracy was 80.23% if the I3M was <0.08. The efficiency of the cut-off of 0.08 of I3M has been tested in various population including Kosovar, Peruvian, South Indian, Libyan, Montenegro, Croatian, African (Botswana), Albanian, and Serbian. Our study also shows the efficiency of the same in South Indian Dakshina Kannada population.

Evaluation of modified demirjian and cameriere third molar maturity index (I3M) on dental age estimation in North Indian population: A comparative study

Evaluation of modified demirjian and cameriere third molar maturity index (I3M) on dental age estimation in North Indian population: A comparative study

Legal age determined by a new threshold value of third molar maturity index in subjects with impacted mandibular third molars: An orthopantomographic study in south Indian adolescents.

Third molars are one of the few biological markers available for age estimation in juveniles, especially for the estimation of the 18-year-age threshold. Literature has indicated that impaction has an influence on the development of third molars, which could possibly result in age misclassifications. The present study is intended to identify an alternative cut-off value of the third molar maturity index (I3M) in impacted mandibular third molars and also to evaluate its applicability in estimating the major (≥ 18years)/minor (< 18years) status. A total of 1330 digital orthopantomograms (OPGs) of 665 male and 665 female south Indian adolescents aged from 15 to 22years were collected and assessed. Eight hundred forty OPGs (63.1%) represented test sample, and 490 OPGs (36.9%) represented validation sample. I3M was measured for the total sample. Logistic regression, receiver operating characteristic (ROC) curve analysis, and Youden's index were used to test the performance of the method in the test sample. An alternative cut-off value of I3M < 0.17 was established for the highest value of the Youden's index of 0.598 for both sexes. When tested in validation sample, it has resulted in sensitivity and specificity values of 0.91 (95% CI; 0.86-0.95) and 0.90 (95% CI; 0.78-0.91) in males and 0.86 (95% CI; 0.80-0.92) and 0.90 (95% CI; 0.83-0.95) in females. In conclusion, cut-off value of I3M < 0.17 could accurately discriminate adults from minors with impacted mandibular third molars. However, more work is needed to be done among a more diverse sample to confirm these findings.

Mandibular third molar maturation stage as indicator for the legal adult age in an Egyptian sample.

Determination of the age of majority is of critical importance in forensic and legal practice. This study aimed to assess the mandibular third molar maturation stage in discriminating adults and minors in an Egyptian population sample using two methods: Cameriere's third molar maturity index (I3M) and Demirjian's stage of maturation; further, the I3M cut-off value of < 0.08 for age 18 years and older was tested. The study included 350 digital panoramic radiographs of 14-24 years old participants. The effectiveness of I3M < 0.08 and Demirjian's stages were assessed using sensitivity, specificity, accuracy, post-test probability, positive likelihood ratio, and negative likelihood ratio. Receiver operating characteristic (ROC) curves were constructed to detect the overall effectiveness of I3M and Demirjian's stages to determine adults. I3M < 0.08 showed accuracy, sensitivity, specificity, post-test probability, positive and negative likelihood ratios of 88.65%, 91.74%, 83.67%, 90.6%, 5.62 and 0.10 respectively in males, and 82.76%, 80.16%, 87.04%, 91.03%, 6.18 and 0.23 in females. Stage H showed the best specificity and post-test probability within Demirjian stages; 91.84% and 94.06% in males and 90.74% and 91.84% in females. Both I3M and Demirjian's stage H of the mandibular third molar were useful indicators for discriminating between Egyptian adults and minors. The cut-off value of I3M < 0.0625 in males and I3M < 0.104 in females showed a better discrimination performance than I3M < 0.08 among Egyptians.

Study of the ethnicity's influence on the third molar maturity index (I3M) for estimating age of majority in living juveniles and young adults.

Estimation of age of majority has important applications in the forensic daily practice because of the increasing demand for age estimates of unaccompanied minors. Diagnostic accuracy of I3M to assess legal adult age of 18years has been already tested in several specific population samples. The aim of this work was to compare the available data about sensitivity and specificity of the third molar maturity index (I3M) from five different regional groups' radiographic samples to study possible ethnical difference. For this purpose, a sample of 6157 orthopantomograms (OPGs), coming from 15 countries, was analysed. Data about sensitivity and specificity were pooled using a bivariate modelling approach. The one-way MANOVA analysis was applied to assess the likelihood that sensitivity and specificity of the five regional groups are sampled from the same population. The result of the one-way MANOVA showed that both sensitivity and specificity did not depend from the regional groups. The obtained sensitivity was 84% (95% CI: 82% and 85%), and its specificity was 94% (95% CI: 93% and 95%). Based on these results, the I3M was a useful statistical tool to identify whether a subject has reached the legal age of 18years old, regardless of his or her ethnicity.

Third molar maturity index and legal age in different ethnic populations: Accuracy of Cameriere’s method

Molar development is widely accepted as a reliable indicator of chronological age in a forensic context. A quantitative method for age estimation has been proposed by Cameriere etal. based on the relationship between chronological age and the third molar maturity index (I3M), which is the ratio between the two apical pulp widths and the total tooth length. Cameriere's cut off value of 0.08 was found to be a reliable tool in assessing the threshold of 18 years of age. The aim of this study was to evaluate the accuracy of the I3M in different ethnic populations focusing on its specificity (subjects correctly classified as <18 years based on I3M >0.08) and sensitivity (subjects correctly classified as ≥18 years based on I3M <0.08). A review of 22 scientific articles was performed, representing data from panoramic radiographs of 12,286 individuals (5723 males and 6563 females) from all over the world, including some ethnical subgroups. The I3M showed an overall sensitivity for both sexes ranging from 51.8% to 93.4% and a specificity ranging from 86.2% to 100%. The proportion of correctly classified individuals ranged from 74% to 95%. These results can be useful to refer the age estimation with the margin of error of subjects correctly classified as minors (specificity) or adults (sensitivity), according to sex, ethnicity and geographical distribution. The I3M can be considered a suitable method for estimating adulthood in forensic settings, regardless of sex. However, ethnic group can affect the accuracy.

Forensic Validity of the Third Molar Maturity Index (I 3M) for Age Estimation in a Russian Population.

The aim of this cross-sectional study was to test the accuracy of the third molar maturity index (I3M) cut-off value (0.08) to distinguish between individuals above and below the adult age of legal responsibility (18 years) in a Russian population. A sample of 571 digital panoramic radiographs of healthy Russian minors and young adults (363 females and 208 males), aged between 14 and 24 years, was evaluated. The lower left third molars were analyzed by applying the cut-off value of 0.08 determined by Cameriere et al. (2008). Lin's concordance correlation coefficient (ρc) and Cohen's kappa coefficient (κ) showed that repeatability and reproducibility are high for both intra- and interobserver errors. The I3M value decreased with age in both sexes. Age distribution gradually decreases as I3M increases in both girls and boys. In the male group, molar maturity stages 0-0.04, 0.04-0.08, 0.08-0.3, 0.3-0.5, and 0.9-1.4 were reached slightly earlier than in the female group. The results demonstrated that sensitivity is 0.96 in boys and 0.93 in girls; associated specificity values were both 0.98. The cut-off value of I3M is statistically robust and thus valid for forensic application in a Russian population to determine whether or not a subject has reached 18 years of age. Finally, we compared our results with those of other studies in which the same I3M cut-off value was tested on different populations. The method is novel as it is reliable and easily reproducible, thus ensuring a universal way of comparing the results obtained (based on a cut-off value) among many populations, in order to develop an ever-increasing database.