Age estimation of Brazilian individuals using the London Atlas

Technical note: RP Atlas-an unprecedented proposal for a Brazilian population dental development chart based on the London atlas

Age estimation methods through developmental atlases are simplified by image comparison using radiographs. Atlas-based methods have been utilized to create population-specific charts addressing population diversity. To tackle the absence of a dedicated atlas for the Brazilian population, the objective of the present study was to create a new atlas for dental development in Brazil based on the London Atlas chart. The new atlas (RP Atlas) is based on the median of tooth development, eruption, and resorption in individuals aged 5 to 23. The sample (567 individuals) was divided between females (n = 290) and males (n = 277). The RP Atlas was handcrafted, scanned, colored, and clustered in two atlases divided by sex. The development of a specific atlas for the Brazilian population has the potential to enhance the accuracy of age estimation in forensic scenarios, notably in a mixed country like Brazil. Further research is needed to assess the suitability of the newly developed atlas for the Brazilian population.

Validation of London Atlas for forensic age estimation in Koreans by comparing with Lee's and Willems' methods

This cross-sectional study aimed to evaluate the applicability of the London Atlas for age estimation in the Korean population by comparing with Lee's and Willems' methods. Dental ages of 475 orthopantomographs from Korean individuals aged 4-15 years (mean 10.32 ± 3.31 years) were estimated using the London Atlas, Lee's and Willems' methods. Correlation between dental and chronological age was determined using Pearson's correlation coefficient, and the statistical difference between dental and chronological age was analyzed using a paired t-test. The bias (mean differences), mean absolute error, and root mean square error between dental and chronological age, stratified by age groups and estimation methods, were calculated. Differences in bias and absolute error between sexes were scrutinized using an independent-samples t-test. Age estimates of the three tested methods were combined and compared to those of each individual method. The London Atlas and Willems methods resulted in overestimations, whereas the Lee method led to an underestimation on the entire sample. The overall accuracy was observed in the order of Lee's method, the London Atlas, and Willems' method. The London Atlas demonstrated superior consistency of estimation performance across age groups and no significant differences in estimation performance between sexes. The combination of estimates from the London Atlas and Lee's method resulted in an enhancement in bias and accuracy. We conclude that the London Atlas, due to its bias and accuracy comparable to Lee's and Willems' methods, is applicable for forensic practice in the Korean population.

Dental age assessment: scoring systems and models from the past until the present-how is it presented in the court?

OBJECTIVE

The aim of this study is to evaluate the accuracy of the methods from the past and present, such as Demirjian, Cameriere, and AlQahtani, as well as to determine the most reliable method for human age estimation under the request from the courts according to the effect size from each method in age estimation.

DESIGN

Four hundred eighty-three orthopantomographic images were selected from 318 patients from Centro Hospitalar Universitário Lisboa Norte aged between 6 and 15 years old. Several measurements of widths and lengths and classification of tooth development stages were performed, according to each age estimation method. The listing of patients and orthopantomographic images were consulted through SECTRA®. All data was entered and analysed using SPSS version 28. Observations' validity was verified through inter- and intraobserver validation.

RESULTS

The correlation coefficients between age and age estimates by the three methods on both sides were close to 90%. Regarding the estimation error correlation coefficient, Demirjian and AlQahtani values were low, whereas Cameriere's was significantly negative; i.e., underestimation increases as age increases. Between left and right, any significant difference in age estimation in AlQahtani and Cameriere methods was not observed, but there were great variability and large effect for the Demirjian method. Comparing females and males, the statistical analysis showed no significant differences and quite small effects in the precision of the estimates for any of the methods. Finally, although significant differences were detected when comparing estimated values and age, small effects were revealed except for the Demirjian method which attained a medium effect and, therefore, less consistency of estimation.

CONCLUSIONS

Since it was not possible to determine the most reliable method for age estimation, a combined application of different age estimation methodologies is recommended to be use in the courts with relevant statistical data such as effect size.

A systematic overview of dental methods for age assessment in living individuals: from traditional to artificial intelligence-based approaches

Dental radiographies have been used for many decades for estimating the chronological age, with a view to forensic identification, migration flow control, or assessment of dental development, among others. This study aims to analyse the current application of chronological age estimation methods from dental X-ray images in the last 6 years, involving a search for works in the Scopus and PubMed databases. Exclusion criteria were applied to discard off-topic studies and experiments which are not compliant with a minimum quality standard. The studies were grouped according to the applied methodology, the estimation target, and the age cohort used to evaluate the estimation performance. A set of performance metrics was used to ensure good comparability between the different proposed methodologies. A total of 613 unique studies were retrieved, of which 286 were selected according to the inclusion criteria. Notable tendencies to overestimation and underestimation were observed in some manual approaches for numeric age estimation, being especially notable in the case of Demirjian (overestimation) and Cameriere (underestimation). On the other hand, the automatic approaches based on deep learning techniques are scarcer, with only 17 studies published in this regard, but they showed a more balanced behaviour, with no tendency to overestimation or underestimation. From the analysis of the results, it can be concluded that traditional methods have been evaluated in a wide variety of population samples, ensuring good applicability in different ethnicities. On the other hand, fully automated methods were a turning point in terms of performance, cost, and adaptability to new populations.

Dental radiographic information of term newborn babies within the first month: Analyzing five radiographic cases along with physical attributes in Japan

BACKGROUND

Although dental radiography is a valuable tool for age estimation in forensic anthropology and odontology, very limited radiological data are available regarding tooth development in healthy newborn babies during the first month of life.

AIM

This study aimed to describe the radiological findings of tooth development in babies aged 0 days to 1 month.

DESIGN

We analyzed the postmortem findings of five newborn babies with no known natural cause of death who had undergone autopsy, computed tomography (CT), and dental radiography. We estimated the gestational age for the babies aged 0 days and analyzed the condition of mandibular symphysis, existence of tooth germs, and presence or absence of calcification of the first permanent molars of all the babies.

RESULTS

The calcified form of 20 deciduous teeth, tooth germs of the permanent upper and lower first molars, and non-calcified mandibular symphysis were observed in each case. However, calcification of the first permanent molar was observed in only two 1-month-old babies.

CONCLUSION

The dental radiographic findings and anthropometric measurements of non-skeletonized, non-mummified term babies confirmed calcification of all the deciduous teeth and the first permanent molar at the age of 0 days and 1 month, respectively.

Applicability of the London Atlas method in the East China population

BACKGROUND

Dental age estimation is important for developmental assessment and individual identification. The London Atlas, a recently proposed method for dental age estimation, has been reported to perform satisfactorily in various populations.

OBJECTIVE

In this study, we assessed the reproducibility, repeatability and applicability of the London Atlas method in the East China population and compared it with the Demirjian method.

MATERIALS AND METHODS

We assessed panoramic radiographs of 835 pediatric patients ages 6.0-19.9 years using the London Atlas and the Demirjian method. We employed the intraclass correlation coefficient and Bland-Altman analysis to evaluate reproducibility and repeatability, respectively. We assessed the agreement between dental age and chronological age and calculated 95% and 80% prediction intervals for each dental age stage. Sensitivity, specificity and predictive values were calculated to assess the performance of both methods for identifying threshold ages.

RESULTS

The London Atlas has better reproducibility and repeatability (intraclass correlation coefficients: 0.98 and 0.99; 95% limits of agreement: - 1.34 to 1.56 and - 1.22 to 0.88, respectively). Dental age estimated using the London Atlas was closer to chronological age in both genders (median absolute error = 0.58). The 95% prediction intervals for chronological age were wide (0.99 to 9.89 years).

CONCLUSION

The London Atlas has excellent reproducibility and repeatability. Thus, it might offer an alternative method for developmental assessment. We observed considerable variation in dental development in the East China population, which needs further research.

Age estimation using London Atlas methodology: A systematic review and meta-analysis

Age estimation is a fundamental competence of Forensic Anthropologists and Odontologists. The London Atlas is a dental development chart by AlQahtani et al. (2010) that gained recent notoriety due to its applicability in forensic scenarios. This study aimed to answer, by a systematic review of literature and meta-analysis, the following question: "on average, what is the deviation between real and estimated ages, when applying the London Atlas method in sub-adults?". This study was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO). Five electronic databases were screened (PubMed, SciELO, Scopus, Web of Science, and LILACS), and active search was carried out. The quality assessment was performed by means of Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews. The initial search resulted in 1021 studies, from which 24 filled the inclusion criteria. For the meta-analysis, 17 studies provided sufficient data. Out of these, eleven studies enabled meta-analysis of mean absolute difference values. Standardized mean differences were 0.02 years for MD and 0.78 for MAD. Analysis of subgroups was also accomplished by sex, and did not indicated heterogeneity between males and females. The London Atlas is an accurate age estimation method, presenting acceptable error and bias values worldwide. Despite the high heterogeneity of the studies, majority of studies presented a low risk of bias. Meta-analysis showed a non-significant and slight tendency of overestimating age, in total. Sub-group analysis showed modestly better results for boys than girls.

Performance of the London Atlas, Willems, and a new quick method for dental age estimation in Chinese Uyghur children

BACKGROUND

Numerous dental age estimation methods have been devised and practised for decades. Among these, the London Atlas and Willems methods were two of the most frequently adopted, however dependent on atlantes or tables. A new estimation method less reliant on external measurement could be efficient and economical.

AIM

This study aimed to evaluate the utility and applicability of the dental age estimation methods of London Atlas, Willems, and a new quick method that subtracts the number of developing teeth from the universal root mature age of 16 years in one of the lower quadrants reported in this work among Chinese Uyghur children.

METHODS

A comparative cross-sectional study was conducted. Subjects enrolled in the study were screened according to preset inclusion and exclusion criteria. The observer then obtained the dental age from the subjects' panoramic radiographs based on the estimated rules of the London Atlas, Willems, and a new quick method. Paired t-test was used to compare the accuracy and precision of the above three estimation methods. Independent-sample t-test was used to find the difference between gender.

RESULTS

Totally, 831 radiographs entered the analyses of this study. Among the three methods evaluated, the Willems method, in particular, showed a distinct underestimated tendency. The mean error of the dental age predicted by the London Atlas, the Willems method, and the quick method was 0.06 ± 1.13 years, 0.44 ± 1.14 years, and 0.30 ± 0.63 years, respectively. The mean absolute error was 0.86 ± 0.75 years according to the London Atlas, 1.17 ± 0.89 years under the Willems method, and 0.70 ± 0.54 years under our quick method. No significant difference was found between the chronological age and dental age using the London Atlas, generally for the 10 to 15 years group (p > 0.05), but our quick method for the 15-16 years children (p < 0.05) and Willems method (p < 0.001).

CONCLUSION

The London Atlas outperformed the Willems method with better accuracy and precision among 10-15 years Chinese Uyghur children. Our new quick method may be comparable to the London Atlas for children aged 10-14 and potentially become a more straightforward dental age prediction instrument.

Assessing Children's Dental Age with Panoramic Radiographs

(1) Background: The aim of the study was to assess the dental age of the subjects and compare it to their chronological age; to assess the dominant tooth for evaluation of dental age; and to investigate possible individual differences between the left and right side of the dental arch. (2) Methods: This study involved evaluating panoramic radiographs of patients aged 7-13 years. A separate assessment was performed for each tooth according to the degree of germ development. Each subject's dental age was estimated. (3) Results: The study involved evaluating 349 panoramic radiographs. No difference was found between stages of tooth development on the right side and left side. Correlation between the stages of tooth development and the chronological age was found to be highest in the second permanent molar teeth. The age can be predicted with the estimated age of tooth #37 and the gender of the patient. (4) Conclusions: The chronological age of children aged 7-13 may be estimated based on a modified seven-stage London Atlas of tooth development, where the most accurate landmark(s) of use are second molars.

Employing the London Atlas in the Age Estimation of a Select South African Population

Dental age estimation in the living and deceased is a fundamental aspect of forensic sciences, civil cases, medico-legal proceedings and clinical dentistry. Accordingly, this study aimed to validate the accuracy and reproducibility of the London Atlas in a select South African sample of KwaZulu-Natal. In this cross-sectional study, 760 digital panoramic radiographs (n = 760) aged between 5.00 and 23.99 years were retrospectively reviewed through consecutive sampling. Each radiograph was assessed and assigned a dental age in accordance with the London Atlas of Human Tooth Development and Eruption by AlQahtani et al. (2010). The London Atlas overestimated age with a mean difference of −0.85 to −1.26 years in the selected South African sample of KwaZulu-Natal. A statistically significant difference between the chronological and estimated dental ages was recorded. Furthermore, the South African Black and Indian males had a higher overestimation of age than their female counterparts, with a mean difference of 0.13 and 0.07 years, respectively. This overestimation was less in the South African Indian population in comparison to the SA Black population. This outcome resulted in the creation of the KZN population- and sex-specific charts and atlases for the two selected cohorts of KwaZulu-Natal. The KZN Atlases were found to be more accurate in the selected sample, with a mean absolute error of 0.57 years and no statistically significant differences between the chronological and estimated dental ages.

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

OBJECTIVES

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 (I_3M), Demirjian's maturation stages, and The London Atlas) to determine whether an individual is 18 years or older (adult) or younger than 18 years (minor).

MATERIALS AND METHODS

The dental age was estimated using the I_3M, Demirjian's maturation stages, and The London Atlas methods on panoramic radiograms of a total of 500 Turkish individuals aged 14-22 years. 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.

RESULTS

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 I_3M methods tended to perform better than the London Atlas method, with this trend reaching statistical significance (p < 0.05).

CONCLUSIONS

Cameriere's I_3M and Demirjian's development stages are useful methods for adult age assessment in the tested population.

CLINICAL RELEVANCE

In forensic medicine and legal practices, Cameriere's I_3M 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.

Accuracy of the London Atlas, Haavikko's Method and Cameriere's European Formula of dental age estimation in Turkish children

Age estimation is a mandatory procedure when the chronological age is unknown or uncertain. Dental development is the preferred characteristic for estimating a child's age. There are many methods for dental age estimation, but their reliability can differ between populations. This study compared the accuracy of three of these methods-the London Atlas (LA), Haavikko's method (HM), and Cameriere's European formula (CF)-in Turkish children living in northwestern Turkey. Panoramic radiographs of 980 children from northwestern Turkey aged between 6.00 and 14.99 years were examined for the whole study group and separately for different ages and sexes by all three methods. Statistical differences between chronological age and dental age were tested using the paired sample t-test and the Wilcoxon signed-rank test. The LA, HM, and CF accuracies were determined based on the mean absolute error. Spearman's rank correlation coefficient showed that the correlation between chronological age and dental age for both sexes was linear for all methods. The LA overestimated the chronological age by 0.09 years, while HM and CF underestimated it by 0.49 and 0.11 years, respectively. The difference between dental age and chronological age was significant in all samples, for all methods, except for the LA in boys. When boys, girls, and the total sample were evaluated, values with the lowest mean absolute error were obtained by HM and were statistically significant in all three groups. Therefore, HM is more accurate than the LA and CF for dental age estimation in Turkish children living in northwestern Turkey.

Dental age estimation in children that have undergone antineoplastic treatment

OBJECTIVE

Even though many studies have been performed to estimate DA in general population, limited research has been performed concerning medical compromised populations such as childhood cancer survivors. The aims of this case-control study were (a) to estimate dental age in a population of children that have undergone antineoplastic treatment with three different methods and (b) to compare it with the estimates from healthy subjects (control group).

MATERIALS AND METHODS

Seventy-three oncology patients and equal number of healthy control subjects from the Pediatric dentistry Department had their dental age estimated through recent orthopantograms using Dermijian's, Willems' and London Atlas methods. All OPGs randomly assessed by two calibrated observers. Mean age difference was calculated. Intraclass Correlation Coefficient was used to assess intra-observer reliability and the Concordance Correlation Coefficient used to assess inter-observer reliability.

RESULTS

Concerning the CCS group 35 subjects (48%) were males and 38 (52%) were females, with an overall mean chronological age 10.95 years, ranging between 5.37 and 15.83 years. Intra- and inter-examiner reliability was exceptional for all methods. Mean DA differences in both groups and were not statistically sinificant regardless of the method used. The marginally lower values when males and females were investigated separately is basically due to the corresponding reduction of the sample size.

CONCLUSION

An overestimation of DA observed in both groups by all methods was not significant. All three methods produced highly accurate comparable results when it comes to estimate the actual chronological age in both groups (CCS and control subjects) regardless of gender.