Accuracy of age estimation in children using radiograph of developing teeth

Correlations between Dental Age, Skeletal Age, and Mandibular Morphologic Index Changes in Turkish Children in Eastern Anatolia and Their Chronological Age during the Pubertal Growth Spurt Period: A Cross-Sectional Study

In age determination, different methods aiming to obtain the closest result to chronological age have been investigated so far. The most commonly used one among these is the radiological method, which is usually used to evaluate the developmental stages of wrist bones or teeth. In our study, we assessed bone age estimations using the Gilsanz-Ratib atlas (GRA), which has recently become commonly used for children aged 9 to 15 years; evaluated the dental age, determined with Cameriere's European method; conducted morphometric measurements of the mandibular bone; and then examined their relationships with chronological age. The results of our study reveal that, in children during the puberty growth spurt, Cameriere's EU formula might have higher accuracy in estimating chronological age in younger age groups, while the GRA might be more accurate for older ages. Additionally, we conclude that of the mandibular morphometric measurements, condylar height and tangential ramus height show strong positive correlations with age. As a result, we conclude that the morphometric measurements evaluated in the present study can be used as auxiliary methods in forensic anthropology and forensic dentistry.

Dental age estimation: development and testing of a reference data set for Qatari children, adolescents, and young adults aged between 5 and 25 years

The purpose of this study is to establish and test a reference data set of dental development of Qatari subjects aged between 5 and 25 years. Radiographs of individuals aged between 5 and 25 years were re-used to establish a reference data set (RDS). A scheme comprising 8 tooth development stages (TDS) was used to assess all the teeth on the left side of the maxilla and mandible. The accuracy of dental age estimation (DAE) was tested with a separate sample of radiographs - the validation sample (VS) comprised 50 females and 50 males of known chronological age (CA). Dental panoramic tomographs (DPT) of 1,597 Qataris were assessed. The summary data for the individual TDS comprising the number (n-tds), mean ( x ¯ -tds), standard deviation (sd-tds), 0th%-ile (the minimum), 25th%-ile, 50th%-ile (the median), 75th%-ile, and 100th%-ile (the maximum) were used to estimate the age of the VS subjects using the simple average method (SAM). There is a significant difference in dental age of 4.8 months in the female group when compared to the CA. The difference in the male group is 4.5 months. This shows similar differences to assessments of other ancestral or ethnic groups.

Comparing the relative influence of obesity and ancestry on timing of dental development

INTRODUCTION

The dentition is one of the most accurate features for age estimation in children. However, there is some evidence that timing of dental development varies across populations. Recent research suggests that dental development may also be susceptible to influence by environmental factors, such as obesity. Given that there are also population differences in average body mass, it is possible that this may be a confounding variable that was not accounted for in prior work. We aim to compare the relative association between body mass index (BMI) and ancestry with timing of dental development.

METHODS

A retrospective cross-sectional chart review was undertaken using panoramic radiographs of 6- to 12-year-olds (n = 281). Age, ancestry, sex, height, and weight were obtained. Dental development was assessed using the Demirjian method, and chronological age was subtracted from estimated dental age to determine relative timing of dental development (ΔAge). BMI was calculated based upon recorded height/weight within 6 months of time of radiograph.

RESULTS

We found no difference in timing of dental development (accelerated/delayed) across ancestry groups (African-American, Euro-American, Hispanic, Asian; P = .15). Overweight/obese subjects had statistically significantly advanced (precocious) dental development (P < .001). Compared to normal-weight subjects, children who were overweight's age were overestimated by 5.76 months (0.48 years) and children with obesity by 5.97 months (0.49 years) on average.

CONCLUSIONS

BMI appears to have a greater impact on relative timing of dental development than ancestry in this population. Our results support other findings that obesity results in accelerated growth and development.

The accuracy of Cameriere methods in Turkish children: chronological age estimation using developing teeth and carpals and epiphyses of the ulna and radius

The aim of the present study was to develop a specific formula by measuring the developing teeth, carpal bones, and epiphyses of the ulna and radius to determine the chronological age in Turkish children. The left developing permanent mandibular teeth were evaluated, and the number of teeth with closed apex was recorded. The distance between the inner sides of open apex/apices was measured by using the ImageJ program and divided by the tooth length. The sum of the normalized open apices was also calculated. The carpal area (Ca), covering the epiphyses of ulna and radius and the carpal bones, was measured on the X-rays of left hand. The areas of each carpal bone and epiphyses of the ulna and radius were measured, and these measurements were added together to obtain the bone area (Bo). The Bo/Ca ratio between the total area of carpal bones and the carpal area was calculated to normalize the measurements. The accuracy of the equations formulated by Cameriere was evaluated, and a new regression equation was developed accordingly. The new formula showed no statistically significant difference between the chronological and the estimated age for females, males, and total sample. The new formula, which hit the age with 72.80% accuracy, was more successful in predicting chronological age than other adjusted regression equations. The new regression model, created for the Turkish children by using both developing teeth and hand-wrist bones, was considerably successful in estimating the chronological age.

Evaluation of Relationship between Body Mass Index (BMI) and Dental Development in the Children in Age-group of 6-13 years of Malwa Region: A Cross-sectional Study

Aim

To evaluate the relationship between body mass index (BMI) and dental development in the children in age-group of 6-13 years of Malwa region.

Materials and methods

A total of 250 orthopantomograms (OPGs) of children aged 6-13 years (130 males and 120 females) collected from the Department of Paediatric and Preventive Dentistry, Government College of Dentistry, Indore, Madhya Pradesh, India, who came for their routine dental treatment. The chronological age, height, and weight were recorded, followed by calculating the BMI of each patient using Centers for Disease Control and Prevention (CDC) growth charts. The dental age was calculated using Cameriere's method. The comparison of the dental and chronological age was done using Wilcoxon signed-rank test.

Results

The dental age of underweight patients was significantly lesser than that of the normal, overweight, and obese patients (p-value of <0.05). The dental age of the obese patients were greatest and significantly greater than that of the underweight, normal, and overweight patients (p-value of <0.05).

Conclusion

Dental age is significantly associated with the BMI of children aged 6-13 years. The dental age of obese and overweight children is significantly greater than the chronological age.

Clinical significance

Predicting the stage of dental development and eruption periods in children with mixed dentition can help with the sequencing and timing of orthodontic, prosthodontic, and surgical procedures.

How to cite this article

Selkari V, Saxena A, Parihar A, et al. Evaluation of Relationship between Body Mass Index (BMI) and Dental Development in the Children in Age-group of 6-13 years of Malwa Region: A Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(2):333-337.

The Cameriere, Haavikko, Demirjian, and Willems methods for the assessment of dental age in Croatian children

AIM

This study aimed to evaluate the accuracy and precision of the Cameriere European formula, Demirjian, Haavikko, and Willems methods for estimating dental age in a sample of children with permanent dentition in Croatia.

MATERIAL AND METHODS

The study consisted of a sample of 1576 panoramic radiographs; a sub-sample of 84 OPGs, in which all first seven mandibular teeth were maturated, was excluded from the study. A final sample of 1492 (704 males and 788 females) aged 6.0 to 13.9 years was evaluated. Seven mandibular teeth from the left side of the mandible were analyzed, and dental age (DA) was determined by the Cameriere European formula, Demirjian method from 1976, Haavikko, and Willems methods and compared to chronological age (CA). In addition, the mean age difference (DA-CA), the mean absolute error (MAE) between dental and chronological age, the percentage of the individuals of dental age within ± 0.25 to ± 2 years of chronological age, and intra-observer and inter-observer statistics were calculated.

RESULTS

The Cameriere European formula estimated the best dental age compared to the chronological age; the mean underestimation was - 0.4 years for both sexes, Haavikko underestimated by - 0.17 years, while Demirjian and Willems overestimated by 1.02 years and 0.48 years, respectively. The most significant difference showed the Demirjian method in 11-year-old and 12-year-old females. The MAE were 0.50 years, 1.01 years, 0.61 years, and 0.78 years in males and 0.51 years, 1.18 years, 0.61 years, and 0.70 years in females for the Cameriere European formula, Haavikko, Willems, and Demirjian methods, respectively. Furthermore, the Cameriere European formula showed the highest proportions of individuals with DA within ± 0.5 year difference of the CA, 61.5% in males and 59.6% in females. In addition, the Cameriere method showed the best intra-observer and inter-observer agreements.

CONCLUSIONS

Although the Demirjian method was used previously in Croatian children for legal, medical, and clinical purposes, the Cameriere European formula, Haavikko, and Willems were more accurate in the tested sample. According to our findings, the Cameriere European formula showed the best accuracy and precision in dental age assessment in Croatian children following Haavikko, and we recommend it as the method of the first choice in forensic and clinical analyses.

The Application of the Cameriere's Methodologies for Dental Age Estimation in a Select KwaZulu-Natal Population of South Africa

Background: The estimation of an individual’s age is a fundamental component of forensic odontology. Literary reports found that the efficiency of Cameriere methodology for age estimation varied among many population groups. Therefore, this study aimed to determine the applicability of the Cameriere methods to a select South African population of the KwaZulu-Natal (KZN) province. Materials and Methods: This cross-sectional retrospective study was conducted on 840 digital panoramic radiographs that met the inclusion criteria. Dental maturity was determined through the morphometric analysis of the seven left permanent mandibular and maxillary teeth in accordance with Cameriere et al. (2006). Moreover, the dental age was also calculated using the South African Black Bayesian formulae of the Cameriere method by Angelakopoulos et al. (2019). The paired sample t-test or Wilcoxon’s signed rank test assessed the significant difference between the chronological age and estimated dental age for the various formulae. A p-value < 0.05 was considered to be statistically significant. Results: The Cameriere et al. (2006) Italian formula and the South African Black Bayesian formulae of the Cameriere method by Angelakopoulos et al. (2019) underestimated and overestimated age in the South African Black and Indian population groups of the KZN province, respectively. Therefore, the authors generated a novel population-specific regression formulae (including and excluding third molars) using “step-wise regression analysis” and a “best-fit model” for the South African Black and Indian population groups of KZN. Conclusion: This study recommends that the population-specific formulae generated in this study be utilized in the KZN population to improve the accuracy of dental age estimation within this region.

Validation of the Italian, European, North German, Malaysian, and South African black formulas on Cameriere method using panoramic radiographs in Kenyan children

This study aimed to validate the accuracy of five different formulas based on the Cameriere method for age estimation in Kenyan children. We analyzed panoramic radiographs of 350 Kenyan children (184 males and 166 females) aged between 6 and 13 years. The dental development of each child was estimated by the analysis of the first seven left permanent teeth in the left mandible. Dental age was calculated by the Italian, European, North German, Malaysian, and South African black formulas previously published in peer-review journals. The children's mean chronological age (CA) was 9.34 ± 2.02 years and 9.26 ± 2.01 years for males and females. In males, the South-African formula overestimated CA least, by 0.12 years, followed by the Italian formula by 0.22 years, the European formula by 0.37 years, the Malaysian formula by 0.48 years, and the North-German formula overestimated the most, by 0.57 years. In females, the South-African formula underestimated CA by - 0.12 years. The Italian overestimated by 0.12 years, followed by the North-German formula by 0.29 years, the European formula by 0.31 years, and the Malaysian formula by 0.40 years. The Italian formula provided the best accuracy in the absolute difference within ± 1 year, by 75.72% and 75%, following the North-German formula by 66.47% and 70.27% for males and females, respectively. Therefore, the findings suggest that the Italian formula best estimates dental age in Kenyan children.

Age estimation in humans through the analysis of aspartic acid racemization from teeth: A scoping review of methods, outcomes, and open research questions

Teeth are considered the most resistant structures in the human body. In forensic odontology, teeth are useful for human identification, especially when dental age estimation is necessary. Despite numerous studies, there is no consensus regarding the best methods for dental age estimation. The analysis of aspartic acid racemization, however, has shown promising results. This scoping review aimed to present a descriptive synthesis of the current literature regarding dental age estimation through aspartic acid racemization. Four electronic databases were screened: PubMed, Scielo, Web of Science, and Scopus. Cross-sectional studies published before April 2021 were selected. From 206 articles found, 26 met the eligibility criteria. Several experimental protocols and laboratory settings were detected, but the different protocols did not seem to significantly reduce error rates in dental age estimation. The analysis of aspartic acid racemization in human dental tissues produced accurate and potentially reliable results for age estimation. Aspartic acid racemization stands out especially in the adulthood - age category in which other methods struggle to deliver proper performances. Studies with larger samples, independent testing, and standardized laboratory procedures are necessary. Equator-like reporting guidelines are encouraged to enable future systematic reviews and meta-analyses.

A test to study the influence of impaction on mandibular third molar development and forensic age estimation in a sample of south Indian children and young adults

It has been argued that the impaction of the third molars could result in delayed maturation, which, in turn, could affect age estimations in criminal proceedings. In view of this, the present study was undertaken to determine whether the impaction status could delay the chronological process of third molar mineralization in a sample of south Indian children and young adults. The orthopantomograms (OPGs) of 915 children and young adults of south Indian origin aged between 15 and 22 years were evaluated. Mineralisation stage and impaction status were determined for all lower third molars. Descriptive statistics were performed at stages D to H of Demirjian staging system. The results of independent t-test show that the impaction resulted in statistically significant slower mineralization in impacted lower third molars at stages D to F in both sexes. It was ascertained that the mean ages with the impacted lower third molars at stage G were 0.98-1.38 years higher in males and 0.50-0.80 years higher in females than those with non-impacted lower third molars. For stage H, the mean ages were 0.14-0.21 years higher in males and 0.25-0.44 years higher in females. The probabilities of being 18 years and above is higher for non-impacted lower third molars at stages G and H than those with impacted ones. It is concluded that the impaction could result in delayed maturation in the lower third molars of the studied sample. Further studies are warranted in a more diverse sample.

Evaluating the accuracy of two different age estimation methods in growing children in Navi Mumbai using Orthopantomograph: A radiographic study

BACKGROUND

Age estimation through dental maturity indicators is relatively more accurate, reliable, and valid for living as well as dead individuals. It acts as an important tool in diagnosis and treatment planning in clinical as well as in forensic dentistry. There are various methods to estimate the dental age. Out of which, Demirjian's method has been widely used in various populations. However, there is a dearth of literature on Indian population comparing Demirjian's method to Cameriere's method.

AIM

The purpose of this study was to evaluate the accuracy of Demirjian's and Cameriere's age estimation methods to chronological age in growing children using orthopantomograph (OPG).

SETTING AND DESIGN

The sample consisted of digital OPGs of 280 children in Navi Mumbai aged 5-16 years.

MATERIALS AND METHODS

Digital OPGs were used to assess the dental maturity of seven mandibular left teeth using Demirjian and Cameriere's method and were compared to the chronological age.

STATISTICAL ANALYSIS USED

Data were analyzed using Student's t tests.

RESULT

Irrespective of gender, dental age estimated by Cameriere's method (mean 10.23 ± 2.79 years), underestimated the chronological age (mean 11.74 ± 2.86 years) for overall population which showed statistically significant difference. Demirjian's method overestimated (mean 12.24 ± 3.06 years) the chronological age for the overall population but was statistically insignificant.

CONCLUSION

Demirjian's method is more closely in correlation with the chronological age of growing children as compared to the Cameriere method when applied to children of age 5-16 years in Navi Mumbai.

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.

Age estimation based on Willems method versus country specific model in Saudi Arabia children and adolescents

BACKGROUND

The aims of this study were to create a method for estimation of dental age in Saudi children and adolescents based on the Willems model developed using the Belgian Caucasian (BC) reference data and to compare the ability of the two models to predict age in Saudi children.

METHODS

Development of the seven lower left permanent mandibular teeth was staged in 1146 panoramic radiographs from healthy Saudi children (605 male, 541 female) without missing permanent teeth and without all permanent teeth fully developed (except third molars). The data were used to validate the Willems BC model and to construct a Saudi Arabian-specific (Willems SA) model. The mean error, mean absolute error, and root mean square error obtained from both validations were compared to quantify the variance in errors in the sample.

RESULTS

The overall mean error for the Willems SA method was 0.023 years (standard deviation, ± 0.55), indicating no systematic underestimation or overestimation of age. For girls, the error using the Willems SA method was significantly lower but still negligible at 0.06 years. A small but statistically significant difference in total mean absolute error (11 days) was found between the Willems BC and Willems SA models when the data were compared independent of sex. The overall mean absolute error for girls was slightly lower for the Willems BC method than for the Willems SA method (1.33 years vs. 1.37 years).

CONCLUSIONS

The difference in ability to predict dental age between the Willems BC and Willems SA methods is very small, indicating that the data from the BC population can be used as a reference in the Saudi population.

Dental age and skeletal maturity assessment in patients with cerebral palsy

The aims of this study were to calculate the estimated dental age and the degree of skeletal maturity in patients with cerebral palsy and control patients (i.e., without a diagnosis of cerebral palsy) and to compare the findings with the chronological age of patients in both study groups. In this cross-sectional study, the European formula and the Willems method were used to estimate the dental age of 52 patients with cerebral palsy and 104 control patients, all aged between 7 and 15 years. For all patients, their estimated dental age was compared with their chronological age. The degree of skeletal maturity of 35 patients with cerebral palsy and 104 control patients was estimated according to Baccetti's method. There was no statistically significant difference in the deviation of the estimated dental age from the chronological age between patients with cerebral palsy and control patients when the European formula or the Willems method was applied. No difference was found in the frequency of Baccetti's stages between patients with cerebral palsy and control patients in the same age category, for both sexes. To estimate dental age in patients with cerebral palsy, the European formula is preferable for orthodontic purposes and the Willems method is preferable for forensic purposes. Using Baccetti's method it was not possible to detect potential differences in skeletal maturity between patients with cerebral palsy and controls.

Age Estimation Using the Cameriere Methods of Open Apices: A Meta-Analysis

Purpose: To evaluate the actual variability of the mean difference between chronological and dental age using the Cameriere method of open apices and to test its accuracy in variable age groups. Method: We selected studies that contained data about the mean, standard deviation, and number of cases for chronological age, dental age and gender. We used a random-effects model. Statistical significance was estimated, at a p < 0.05, using prediction intervals. For the analysis of publication bias we used the funnel plot and Egger’s regression test for plot asymmetry. I² was used to test the presence of heterogeneity between studies. The Z test was used to test for statistical differences between subgroups, with p < 0.05 being considered statistically significant. We also used 95% for confidence intervals and prediction intervals. Results: In boys, the average difference between chronological and dental age was 0.44 (0.26–0.63) years, while in girls the average difference between chronological and dental age was 0.34 (0.19–0.49) years. In the 6–7 years age group and in the 14–15 years age group, there was a statistically significant difference between dental and chronological age. Our study shows that the Cameriere method is useful for estimating the chronological age, with errors of less than one year. Conclusions: The Cameriere method of evaluating dental age using open apices is sufficiently accurate for forensic practice, at least in the 7–14 age-interval.

Dental Subphenotypes in Infants With Orofacial Clefts-A Longitudinal Population-Based Retrospective Radiographic Study of the Primary and Secondary Dentitions

OBJECTIVES

To determine the developmental patterns of primary and secondary dentitions in infants with orofacial clefts.

DESIGN

Retrospective, longitudinal, population-based cohort study.

MATERIALS

Longitudinal records and radiographs of 192 nonsyndromic Northern European infants with isolated unilateral cleft lip (UCL, n = 111) and isolated cleft palate (CP, n = 81).

METHODS

Radiographic assessments of primary and secondary dentition anomalies and dental maturation, by gender and cleft severity for comparisons between the groups and with historical controls.

RESULTS

In infants with UCL, the frequencies of dental anomalies were high in both primary (38.7%) and secondary (18.0%) dentitions. Primary and secondary dentition anomalies were not observed in infants with CP and different in the UCL group (P = .003). Risk differences involved primary supernumerary teeth (P = .0001) and talon cusp formation (P = .0001), and secondary tooth agenesis (P = .001) of the maxillary lateral incisor on the side of the cleft lip. Delayed primary and secondary dental maturation occurred in the UCL and CP groups, greater in infants with UCL (P < .0001). Primary and secondary dental maturation featured sexual dimorphism with greater delay in males (UCL, P < .0001; CP, .0001 > P = .001). The effect of cleft severity on dental maturation was significant in infants with UCL (P = .0361) and CP (P = .0175) in the primary but not in the secondary dentition.

CONCLUSIONS

There were different dental anomalies in the primary and secondary dentitions in operated infants with UCL and no dental anomalies in unoperated infants with CP. Dental maturation was delayed in infants with UCL and CP with greater delay in males compared to females.

Dental Age Estimation According to European Formula and Willems Method: Comparison Between Children With and Without Cleft Lip and Palate

OBJECTIVE

To assess dental age and deviations of dental from chronological age according to the Willems and Cameriere methods (European formula) in patients with cleft lip and/or cleft palate (CL/P) and compare it with control group.

DESIGN

Retrospective cross-sectional study.

SETTING

Clinic of Orthodontics.

PARTICIPANTS

Sixty-nine patients with CL/P between 6 and 15 years of age (55 with unilateral and 14 with bilateral CL/P) with 148 panoramic radiographs. The same number of radiographs was examined in the age-matched control group.

MAIN OUTCOME MEASURES

Estimation and comparison of dental age and differences of dental from chronological age in relation to the type of cleft, sex, and age in the group of patients with and without CL/P according to Willems and Cameriere method.

RESULTS

No significant intersex and intergroup differences were found in deviations of dental from chronological age according to Cameriere method (P > .05). Significant difference in deviation of dental from chronological age was found between the patients with and without CL/P according to Willems method (P < .001).

CONCLUSION

Cameriere European formula for dental age estimation, which is not influenced by sex and tooth morphology, showed similar dental development of children with and without CL/P. However, Willems method detected that deviation of dental from chronological age significantly differed between children with and without clefts.

Application of Cameriere's method for dental age estimation in children in South China

The aim of this study was to evaluate the applicability of Cameriere’s European formula for age estimation in children in South China and to adapt the formula to establish a more suitable formula for these children. Moreover, the performance of dental age estimation based on Cameriere’s method combining the developmental information of permanent teeth (PT) and third molar (TM) was also analysed. Orthopantomographs of 720 healthy children in Group A, and orthopantomographs of 320 children and 280 subadults in Group B were assessed. The samples of Group A were divided into training dataset 1 and test dataset 1, and the samples of Group B were also divided into training dataset 2 and test dataset 2. A South China-specific formula was established based on the training dataset 1, and the comparison of accuracy between the Cameriere’s European formula and the South China-specific formula was conducted with the test dataset 1. Additionally, a PT regression model, a TM regression model, and a combined regression model (PT + TM) were established based on the training dataset 2, and the performance of these three models were validated on the test dataset 2. The Cameriere’s European formula underestimated chronological age with a mean difference (ME) of −0.47 ± 1.11 years in males and −0.69 ± 1.19 years in females. However, the South China-specific formula underestimated chronological age, with a mean difference (ME) of −0.02 ± 0.71 years in males and −0.14 ± 0.73 years in females. Compared with PT model and TM model, the PT and TM combined model obtained the smallest root mean square error (RMSE) of 1.29 years in males and 0.93 years in females. In conclusion, the South China-specific formula was more suitable for assessing the dental age of children in South China, and the PT and TM combined model can improve the accuracy of dental age estimation in children.

Key points

Orthopantomographs of 720 healthy children in Group A, and orthopantomographs of 320 children and 280 subadults in Group B were assessed.

A South China-specific formula was established based on the training dataset 1, and the comparison of accuracy between the Cameriere’s European formula and the South China-specific formula was conducted with the test dataset 1.

A PT regression model, a TM regression model, and a combined regression model (PT + TM) were established based on the training dataset 2, and the performance of these three models were validated on the test dataset 2.

The South China-specific formula was more suitable for assessing the dental age of children in South China, and the PT and TM combined model can improve the accuracy of dental age estimation in children.

Deep orofacial phenotyping of population-based infants with isolated cleft lip and isolated cleft palate

Isolated orofacial clefts (OFC) are common with poorly understood aetiology. Heterogeneous phenotypes and subphenotypes confound aetiological variant findings. To improve OFC phenome understanding, population-based, consecutive, pre-treatment infants with isolated unilateral cleft lip (UCL, n = 183) and isolated cleft palate (CP, n = 83) of similar ancestry were grouped for deep phenotyping. Subphenotypes stratified by gender and cleft severity were evaluated for primary dental malformations and maturation using radiographs. We found that cleft severity and tooth agenesis were inadequate to distinguish heterogeneity in infants with UCL and CP. Both groups featured slow dental maturity, significantly slower in males and the UCL phenotype. In 32.8% of infants with UCL, supernumerary maxillary lateral incisors were present on the cleft lip side, but not in infants with CP, suggesting a cleft dental epithelium and forme fruste cleft dentoalveolus of the UCL subphenotype. The findings underscored the importance of deep phenotyping to disclose occult OFC subphenotypes.

In search of identity: The field of forensic anthropology in Brazil-Profession and practice

The existing divergencies in the development of forensic anthropology (FA) around the world justify an analysis of its situation in each country/region. Our objective is to report information gathered directly from professionals acting in the field of forensic anthropology in Brazil, with the aim of highlighting the challenges of the discipline and contributing to its advancement. The research consisted of personal visits in Medico-Legal Institutes (IMLs) in nine states of the country and semi-structured interviews with 16 professionals. Detailed analysis of the Results suggests the field of forensic anthropology, despite the engagement and dedication of its professionals, cannot yet be considered a well-structured discipline across the country. The academic background of professionals is highly heterogenous. The applied methods vary, and common protocol is not always followed. The demand highly exceeds the available human resources. The lack of comparative material Results in high percentage of cases remaining unsolved. Important divergences exist in terms of infrastructure and professional resources between the states. The limited cooperation between different IMLs and between different sections of the same IML-together with a general disbelief in the usefulness of anthropological examination in forensic cases-hampers FA's development. There is a great openness for scientific collaboration and an abundance of material for research. Our research demonstrated structural, political, and academic limitations that affect the FA field in Brazil. However, the expertise and dedication of professionals point to human potential as the chief strength of this discipline that supports and enables research, providing high-quality services in a challenging context.

Accuracy of the Demirjian, Willems and Nolla methods for dental age estimation in a northern Chinese population

OBJECTIVE

The objective of the present study was to evaluate the accuracy of the Demirjian, Willems, and Nolla methods for dental age estimation on a sample of the northern Chinese population.

DESIGN

The study consisted of 2000 panoramic radiographs (1000 boys and 1000 girls) with an age range between 5 and 14 years. The mean error and absolute mean error were calculated according to each method, and the accuracy was statistically analysed.

RESULTS

The three methods used for Chinese subjects overestimated the dental age by 1.16, 0.50, and 0.07 years. The absolute mean error was largest in most age groups for the Demirjian method, which was considered inaccurate in age estimation for teenagers, and it was more than 1.00 years for only several age groups for the Willems method and only girls aged 14 years for the Nolla method. The mean error and absolute mean error were lowest for the Nolla method and highest for the Demirjian method.

CONCLUSIONS

Although the Demirjian method is frequently used in Chinese subjects for legal and medical purposes, the Willems and Nolla methods were more reliable than the Demirjian method. Among the three methods, the accuracy in the northern Chinese subjects was highest for the Nolla method. Therefore, it is recommended to evaluate the accuracy of different methods before assessing the age in specific populations.

Accuracy assessment of dental age estimation with the Willems, Demirjian and Nolla methods in Spanish children: Comparative cross-sectional study

Background

The objective of this study was to evaluate and compare the validity and accuracy of the Willems, Demirjian and Nolla methods in predicting chronological age in a Spanish ethnicity population.

Methods

A sample of 604 orthopantomographs of Spanish children aged 4 to 13 years was evaluated by two independent evaluators. Descriptive statistics were applied to calculate the chronological age and dental age, presenting the mean and standard deviation. The difference between dental age and chronological age was calculated for each method. A positive result indicated an overestimation and a negative figure indicated an underestimation. The Wilcoxon test for paired data and Spearman’s correlation coefficient were applied by age groups and sex to compare the chronological age and dental age of each method (that of Willems, Demirjian and Nolla). Statistical tests were performed at a 95% confidence level.

Results

The interexaminer agreement was 0.98 (p = 0.00), and the intraexaminer agreement was 0.99 (p = 0.00). The Willems method significantly overestimated the age of boys (0.35 years (0.93)) and girls (0.17 years (0.88)). The Demirjian method significantly overestimated the age of boys (0.68 years (0.95)) and girls (0.73 years (0.94)). The Nolla method significantly underestimated age in boys (0.44 years (0.93)) and girls (0.82 years (0.98)).

Conclusions

In the Spanish population, the use of the Demirjian method for legal and medical purposes is frequent. This study reveals that the Willems method is more appropriate due to its greater precision in estimating dental age.

Deep Neural Networks for Chronological Age Estimation From OPG Images

Chronological age estimation is crucial labour in many clinical procedures, where the teeth have proven to be one of the best estimators. Although some methods to estimate the age from tooth measurements in orthopantomogram (OPG) images have been developed, they rely on time-consuming manual processes whose results are affected by the observer subjectivity. Furthermore, all those approaches have been tested only on OPG image sets of good radiological quality without any conditioning dental characteristic. In this work, two fully automatic methods to estimate the chronological age of a subject from the OPG image are proposed. The first (DANet) consists of a sequential Convolutional Neural Network (CNN) path to predict the age, while the second (DASNet) adds a second CNN path to predict the sex and uses sex-specific features with the aim of improving the age prediction performance. Both methods were tested on a set of 2289 OPG images of subjects from 4.5 to 89.2 years old, where both bad radiological quality images and images showing conditioning dental characteristics were not discarded. The results showed that the DASNet outperforms the DANet in every aspect, reducing the median Error (E) and the median Absolute Error (AE) by about 4 months in the entire database. When evaluating the DASNet in the reduced datasets, the AE values decrease as the real age of the subjects decreases, until reaching a median of about 8 months in the subjects younger than 15. The DASNet method was also compared to the state-of-the-art manual age estimation methods, showing significantly less over- or under-estimation problems. Consequently, we conclude that the DASNet can be used to automatically predict the chronological age of a subject accurately, especially in young subjects with developing dentitions.

Dental age estimation using radiographs: Towards the best method for Sri Lankan children

Research supports the need for regionally and ethnically specific validated data as the reference base for age estimation techniques. This retrospective study evaluated the accuracy of three dental age estimation methods; Demirjian et al. (1973), Willems et al. (2001), and Blenkin and Evans (2010), for use in Sri Lanka for medico-legal purposes. Panoramic radiographs of 688 Sri Lankan children ranging in age from 8.00 to 16.99 years were used to determine their appropriateness to a Sri Lankan population. The mean age and standard deviations (±SD) were calculated separately for males and females of each age group. Paired t-test and mean absolute errors (MAE) were calculated to compare the calculated dental age (DA) with the chronological age (CA) across the nine age groups. The results revealed the mean CA of the entire sample was 12.38 ± 2.68 years, while the mean DA calculated using the Blenkin and Evans method was 11.83 ± 2.20 years, using the Demirjian et al. method was 12.57 ± 2.53 years, and using the Willems et al. method was 11.99 ± 2.43 years. The Demirjian et al. method consistently overestimated the age of males except in the 2 groups aged over 15 years, whereas the Blenkin and Evans method consistently underestimated the age except for the 11.00-12.99 age range. The method of Willems et al. produced DA quite close to CA up until 12.99 years of age, and then underestimated the age for all higher age groups. In females, the Demirjian et al. method consistently overestimated the age up until 13.99 years and then underestimated the higher age groups, while the Willems et al. method underestimated the age in all age groups except 10.00-10.99 years. The Blenkin and Evans method also consistently underestimated the age except in the 10.00-10.99 and 12.00-12.99-year age groups. The percentages of either overestimation or underestimation calculated for ±0.5 years of the true age were 41.0% for the Blenkin and Evans method, 42.8% for the Demirjian et al. method and 49.1% for the Willems et al. method. In conclusion, while all three methods could be applicable in the estimation of dental age for medico-legal purposes, the Willems et al. method appears to be more appropriate in overall measures for the Sri Lankan reference sample, up to the age of 12.99 years.

Assessment of the Dental Age of Children in the Polish Population with Comparison of the Demirjian and the Willems Methods

Background

Dental age is less affected than the bone age by nutritional and hormonal factors. The assessment of dental age in children is of value in clinical and forensic practice. The aims of this study were to compare the Demirjian method and the Willems method in the assessment of dental age in children in Poland and to consider the need to standardize dental age assessment.

Material/Methods

Polish children of Caucasian ethnicity (n=1,002) who were treated at a single orthodontic center between 1994–2016 included girls (n-540) and boys (n=462) aged between 4–17 years, and 1,002 panoramic radiographs were reviewed. Dental age was assessed using the Demirjian method and the Willems method, the findings of the two methods were compared with the chronological age of the study participants.

Results

Following statistical analysis, both the Demirjian method and the Willems method overestimated the dental age of the younger study participants, and underestimated the dental age of the older study participants. Both the Demirjian method and the Willems method had similar accuracy in estimating the chronological and dental age in the Polish population.

Conclusions

In the assessment of dental age in Polish children from panoramic radiographs, both the Demirjian method and the Willems method were accurate and should still be used as a method of choice. However, it seems reasonable to create international standards for the assessment of dentition maturity for this population to obtain a more acceptable range of error values between the dental age and chronological age.

Dental age estimation in children with chromosomal syndromes

When the age of an individual is unknown, age assessment refers to the procedures through which authorities try to establish the chronological age of an individual. Dental evidence demonstrated to be very effective in estimating age and dental mineralization is largely deemed a process scarcely influenced by major diseases and nutritional or environmental factors which can affect child growth. This research aims to understand the possible influence of genetic syndromes on dental maturation of affected individuals. The sample is composed of a test sample of 159 chromosomal affected children, 69 males and 90 females, and a control sample of 157 healthy children, 77 males and 80 females aged between 4,49 and 19,8years. London Atlas was applied to estimate dental age on OPGs (orthopantompographies). No statistical significant difference has been found in dental estimates between syndromic and healthy individuals. Moreover no statistical significant difference emerged between sexes and age cohorts. Children affected by Down or Williams syndromes nor mean error neither the mean accuracy per cohort of age show differences compared to non-affected subjects. The London Atlas can be validly applied to age estimation of individuals with multiple agenesis as in Down and Williams syndromes, even if it a slight overestimation of age occurs systematically in syndromic as well as in healthy samples. The current findings suggest that dental maturation is a very stable biological process scarcely affected by even serious illnesses as genetic syndromes.

Dental age estimation using four Demirjian's, Chaillet's and Willems' methods in Kosovar children

BACKGROUND

Tooth formation was recognized as useful body system to assess maturity and predict age. Tooth mineralization is much less affected by the endocrine and different nutritional status than bone mineralization, and teeth formation provides a more reliable indication of chronological age. Demirjian et al. in 1973 presented a scoring system and method for dental age estimation on a sample of French-Canadian children. Chaillet et al. and Willems et al. modified original Demirjian method. This study aimed to evaluate the accuracy of four Demirjian's, Chaillet and Willems methods for age estimation in the children of Kosovo.

MATERIALS AND METHODS

The cross-sectional study was based on the evaluation of the sample of 1022 orthopantomograms (OPTs) of healthy Kosovar children, aged between 5 and 14 years. OPTs were taken from the Radiology unit of University Dentistry Clinical Center of Kosova, as part of random clinical treatment. We tested the accuracy of four methods based on seven mandibular teeth, Demirjian from 1973 (Dem73) and 1976 (Dem76), Chaillet from 2005 (Chaillet) and Willems from 2001 (Willems) and two Demirjian's methods based on different sets of four teeth (Dem76PM1 and Dem76IN2).

RESULTS

For most tested methods, we found statistically significant differences between the chronological age (CA) and dental age (DA) (p < 0.05). In males, the most accurate method were those using four teeth, Dem76IN2 (0.03 years) following by Dem76PM1 (-0.05 years), following those using seven teeth, Willems (-0.14 years), Chaillet (-0.24 years) and Dem73 (0.43 years). In females, dental age was the most accurate for the Willems method (-0.24 years) following Chaillet (-0.35 years), Dem76 (0.43 years) and Dem73 (0.55 years), while Dem76PM1 and Dem76IN2 overestimated by 0.45 years and 0.46 years, respectively. The mean absolute difference between DA and CA were between 0.61 years for the Willems, to 0.78 years for the Dem73 in males, and 0.64 years for the Willems to 0.75 years for the Dem76IN2 in females.

CONCLUSION

The Willems method was the most accurate for estimating a dental age if all seven mandibular teeth are available for analysis, and we found the similar accuracy of Dem76PM1 and Dem76IN2 methods. Therefore, we may encourage their use for age estimation on the Kosovar children.

The WITS Atlas: A Black Southern African dental atlas for permanent tooth formation and emergence

Current dental maturity charts, such as the widely applied London atlas, do not take into consideration advanced tooth emergence and formation patterns observed in children of African ancestry. The result is inaccurate age estimation in Southern Africa, a region where there is great forensic and anthropological need for reliable age estimation.

OBJECTIVES

To develop a population-specific atlas of permanent tooth emergence and formation for age estimation of Black Southern Africans.

MATERIALS AND METHODS

Using data from a cross-sectional study of 642 school children aged 5-20 years, panoramic radiographs taken during routine dental examination in a mobile treatment van were analyzed using the Demirjian method of eight (A-H) tooth formation stages. Tables of the stages of tooth development for each tooth, including the third molars, were generated separately for age cohorts and by sex. The most frequently occurring (modal) stage of tooth formation was considered the signature developmental stage for the age. The relationship of the third molar occlusal surfaces with occlusal tables on the radiographs were checked and compared with the findings recorded during intra oral examination.

RESULTS

Comparison with the London atlas shows that at age 9.5 years, the canine and premolar emergence are at least one year ahead and the third molar formation completes four years earlier in the WITS Atlas.

DISCUSSION

Similarities in advancement in tooth formation and emergence across sub-Saharan Africa suggest that the WITS Atlas can be used for those populations as well.

The third molar maturity index in indicating the legal adult age in Kosovar population

The third molar tooth, known as the "wisdom tooth," is the only tooth that can be used to determine legal adult age. This study aimed to test the accuracy of Cameriere's third molar maturity index (I_3M) in assessing the legal adult age of 18 years in the Kosovar population. Orthopantomographs (OPTs) of 1221 healthy living Kosovar individuals, aged between 12 and 23 years and with no congenital or developmental anomalies, were analyzed. Intra-class correlation coefficients were 0.858 (95% CI, 0.786 to 0.906) and 0.852 (95% CI, 0.779 to 0.903) for intra-rater and for inter-rater agreement, respectively. The sample was divided into training dataset (800 OPTs) and test dataset (421 OPTs). The training dataset was used to generate the logistic regression model, while the test dataset was used to study the performance of the model. I_3M and gender as independent variables and adult age (≥ 18 years) or minor age (< 18 years) as the dependent variable were used for logistic regression analysis. The receiver operating curve (ROC) analysis was used to determine the specific cut-off value of I_3M for predicting adult age. The results showed that only I_3M statistically significantly contributed to discriminating adults and minors. ROC analysis showed that the cut-off value of I_3M < 0.08 was the best in discriminating adults and minors. An analysis of the test dataset (421 OPTs) showed that as I_3M decreased the age gradually increased. The performance of the cut-off value of I_3M < 0.08, to discriminate between adults and minors, was analyzed by contingency tables for both sexes. In males, the accurate classification (Acc) was 0.968 (95% CI, 0.926 to 0.985), the sensitivity (Se) was 0.962 (95% CI, 0.925 to 0.978), and the specificity (Sp) was 0.976 (95% CI, 0.929 to 0.995). The Bayes post-test probability (Bayes PTP) was 0.975 (95% CI, 0.905 to 1.00). In females, Acc was 0.909 (95% CI, 0.870 to 0.917), Se and Sp were 0.826 (95% CI, 0.787 to 0.834) and 0.991 (95% CI, 0.953 to 1.00) respectively, while Bayes PTP was 0.989 (95% CI, 0.926 to 1.00). Our data support the usefulness of I_3M < 0.08 to indicate legal adult age in a Kosovar population.

Measurement of open apices in tooth roots in Colombian children as a tool for human identification in asylum and criminal proceedings

Dental age estimation was recognized as an imperative issue in clinical and medico-legal practice. However, very few studies on dental age estimation in children have been published in Colombia. This study evaluated the accuracy of Cameriere's method of measurement of open apices on tooth roots in a sample of 526 digital panoramic radiographs (OPTs) of children (274 boys and 252 girls), aged between 6 and 14 years, from Bogotá, Valle del Cauca, Buga and Villavicencio, in Southwest Colombia. Only first seven permanent lower teeth, except third molar, from the left side of mandible were studied. Difference between dental age and chronological age was evaluated for boys and girls across nine age classes. Intra-class correlation coefficient and Kappa score was used to test intra- and inter-observer agreement error rate. Dental age was overestimated by 0.08 years and standard deviation (±SD) of 0.68 years in boys which was not statistically significant (p = 0.06), while in girls dental age underestimated by -0.25 ± 0.65 years which was statistically significant difference (p < 0.001). The absolute difference between DA and CA or mean prediction error (ME) was 0.57 ± 0.38 years in boys and 0.57 ± 0.41 in girls (p = 0.966) which implies that Cameriere's European formula is similarly accurate in both sexes in this sample of Colombian children.

Dental Age in Orthodontic Patients with Different Skeletal Patterns

Objective. To evaluate the difference between chronological and dental age, calculated by Willems and Cameriere methods, in various skeletal patterns according to Steiner's ANB Classification. Methods. This retrospective cross-sectional study comprised the sample of 776 participants aged between 7 and 15 years (368 males and 408 females). For each participant, panoramic images (OPT) and laterolateral cephalograms (LC) were collected from the medical database. On LC ANB angle was measured; on OPT dental age (DA) was calculated while chronological age (CA) and sex were recorded. The sample was divided into three subgroups (Class I, Class II, and Class III) with similar distribution based on the chronological age and ANB angle. CA was calculated as the difference between the date of OPT imaging and the date of birth, while DA was evaluated using Willems and Cameriere methods. ANB angle was measured on LC by two independent investigators using the cephalometric software. Differences between sexes and the difference between dental and chronological age were tested by independent and paired samples t-test, respectively; one-way ANOVA was used to test differences among ANB classes with Tukey post hoc test to compare specific pairs of ANB classes. Results. The significant difference was found between Class III and other two skeletal classes in males using both dental age estimation methods. In Class III males dental age was ahead averagely by 0.41 years when using Willems method, while Cameriere method overestimated CA for 0.22 years. Conclusion. In males with Class III skeletal pattern, dental development is faster than in Classes I and II skeletal pattern. This faster development is not present in females.

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

INTRODUCTION

Tooth development is extensively used for age estimation as a part of forensic science.

AIM

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.

MATERIALS AND METHODS

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.

RESULTS

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).

CONCLUSION

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.

Age Assessment in Children: A Novel Cameriere's Stratagem

Aim

Age 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 methods

This 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.

Results

Statistical 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).

Conclusion

Cameriere’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 article

Attiguppe 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.