Dental age assessment: the applicability of Demirjian method in eastern Turkish children

In the literature, little is known about the applicability of this method in Turkish children. The aim of this study was, therefore, to evaluate the reliability of Demirjian method of age estimation when used for eastern Turkish children. A retrospective study was performed on a sample of panoramic radiographs taken from 807 healthy eastern Turkish children. The stages of dental maturity of the mandibular left seven permanent teeth for each subject using the eight radiographic dental maturity stages demonstrated by Demirjian were evaluated. A paired t-test was used for statistical analysis. The mean difference between the chronological and dental ages ranged from 0.2 to 1.9 years in girls and from 0.4 to 1.3 years in boys. The differences between the chronological and dental ages were statistically significant in all age groups. The applicability of Demirjian method is not suitable for eastern Turkish population.     

应用Demirjian法进行法医学年龄推断的评价

目的对应用Demirjian法进行法医学年龄推断的准确度及可靠性进行初步评价。方法应用Demirjian法测定828名上海地区青少年(男279名,女549名,11～19周岁)的牙龄,比较所测牙龄和实际年龄的差异。结果在11～14岁年龄段Demirjian法测定的牙龄比实际年龄高估,在15～16岁年龄段低估,在17岁及17岁以上年龄段具有局限性。结论Demirjian法可以用于测定上海地区11～16岁年龄段青少年的牙龄,使用时需进行适当的修正。     

Accuracy of age estimation of radiographic methods using developing teeth

Developing teeth are used to assess maturity and estimate age in a number of disciplines, however the accuracy of different methods has not been systematically investigated. The aim of this study was to determine the accuracy of several methods. Tooth formation was assessed from radiographs of healthy children attending a dental teaching hospital. The sample was 946 children (491 boys, 455 girls, aged 3-16.99 years) with similar number of children from Bangladeshi and British Caucasian ethnic origin. Panoramic radiographs were examined and seven mandibular teeth staged according to Demirjian's dental maturity scale [A. Demirjian, Dental development, CD-ROM, Silver Platter Education, University of Montreal, Montreal, 1993-1994; A. Demirjian, H. Goldstein, J.M. Tanner, A new system of dental age assessment, Hum. Biol. 45 (1973) 211-227; A. Demirjian, H. Goldstein, New systems for dental maturity based on seven and four teeth, Ann. Hum. Biol. 3 (1976) 411-421], Nolla [C.M. Nolla, The development of the permanent teeth, J. Dent. Child. 27 (1960) 254-266] and Haavikko [K. Haavikko, The formation and the alveolar and clinical eruption of the permanent teeth. An orthopantomographic study. Proc. Finn. Dent. Soc. 66 (1970) 103-170]. Dental age was calculated for each method, including an adaptation of Demirjian's method with updated scoring [G. Willems, A. Van Olmen, B. Spiessens, C. Carels, Dental age estimation in Belgian children: Demirjian's technique revisited, J. Forensic Sci. 46 (2001) 893-895]. The mean difference (+/-S.D. in years) between dental and real age was calculated for each method and in the case of Haavikko, each tooth type; and tested using t-test. Mean difference was also calculated for the age group 3-13.99 years for Haavikko (mean and individual teeth). Results show that the most accurate method was by Willems [G. Willems, A. Van Olmen, B. Spiessens, C. Carels, Dental age estimation in Belgian children: Demirjian's technique revisited, J. Forensic Sci. 46 (2001) 893-895] (boys -0.05+/-0.81, girls -0.20+/-0.89, both -0.12 y+/-0.85), Demirjian [A. Demirjian, Dental development, CD-ROM, Silver Platter Education, University of Montreal, Montreal, 1993-1994] overestimated age (boys 0.25+/-0.84, girls 0.23+/-0.84, both 0.24 y+/-0.86), while Nolla [C.M. Nolla, The development of the permanent teeth, J. Dent. Child. 27 (1960) 254-266] and Haavikko's [K. Haavikko, The formation and the alveolar and clinical eruption of the permanent teeth. An orthopantomographic study, Proc. Finn. Dent. Soc. 66 (1970) 103-170] methods under-estimated age (boys -0.87+/-0.87, girls -1.18+/-0.96, both -1.02 y+/-0.93; boys -0.56+/-0.91, girls -0.79+/-1.11, both -0.67 y+/-1.01, respectively). For individual teeth using Haavikko's method, first premolar and second molar were most accurate; and more accurate than the mean value of all developing teeth. The 95% confidence interval of the mean was least for mean of all developing teeth using Haavikko (age 3-13.99 years), followed by identical values for Demirjian and Willems (sexes combined).     

Dental age in Central Poland

Precise evaluation of the developmental stage of a child is an integral part of both diagnosis and treatment of pediatric patients; it is also essential in forensic medicine and dentistry. Among radiological methods for dental age estimation in children the Demirjian's method is widely used, however original standards elaborated for the French-Canadian population are mostly not suitable for other populations. The aim of the study was to compare the dental age of children from the region of Mazovia (Central Poland) with the developmental standards presented by Demirjian, to analyse sexual dimorphism of dental age in the studied group and to estimate validity of the Demirjian's standards for the studied Polish population. The material consisted of clinical files and panoramic X-ray images of 994 children aged from 6 to 16 in good general health, without development impairments. Chronological ages of the patients were established. Next dental ages were estimated by means of the Demirjian method based on developmental maturity of seven left mandibular permanent teeth. It was found that the standards were significantly different from the chronological ages in the studied population, which means that dental development was considerably accelerated. The most significant acceleration was observed in girls aged 11 and 12, as well as in 13-year-old boys; in both groups a considerable acceleration of the dental age was seen in 6-year-olds. No statistically significant differences between dental ages of girls and boys were observed in particular age groups. There were devised gender-specific equations allowing for adaptation of original Demirjian's scores for estimation of dental age in the population of Mazovia (Central Poland). In conclusion, the developmental standards used by Demirjian are not suitable in the case of the population of children of Central Poland. Therefore, it is necessary to establish new tables for this population.     

Excretion of Delta9-tetrahydrocannabinol in sweat

The aims of this study were: first, to determine the accuracy of the Cameriere method for assessing chronological age in children based on the relationship between age and measurement of open apices in teeth and, second, to compare the accuracy of this method with the widely used Demirjian et al. method and with the method proposed by Willems et al. Orthopantomographs taken from white Italian, Spain and Croatian children (401 girls, 355 boys) aged between 5 and 15 years were analysed following the Cameriere, Demirjian and Willems methods. The difference between chronological and dental age was calculated for each individual and each method (residual). The accuracy of each method was assessed using the mean of the absolute values of the residuals (mean prediction error). Results showed that the Cameriere method slightly underestimated the real age of children. The median of the residuals was 0.081 years (interquartile range, IQR=0.668 years) for girls and 0.036 years for boys (interquartile range, IQR=0.732 years). The Willems method showed an overestimation of the real age of boys, with a median residual error of -0.247 years and an underestimation of the real age of girls (median residual error=0.073 years). Lastly, the Demirjian method overestimated the real age of both boys and girls, with a median residual error of -0.750 years for girls and -0.611 years for boys. The Cameriere method yielded a mean prediction error of 0.407 years for girls and 0.380 years for boys. Although the accuracy of this method was better for boys than for girls, the difference between the two mean prediction errors was not statistically significant (p=0.19). The Demirjian method was found to overestimate age for both boys and girls but the mean prediction error for girls was significantly greater than that for boys (p=0.024), and was significantly less accurate than the Cameriere method (p<0.001). The Willems method was better than that of Demirjian (p=0.0032), but was significantly less accurate than that of Cameriere (p<0.001).     

Approaches to chronological age assessment based on dental calcification

The aim of the present study was to find an accurate estimation of chronological age using a small number of selected teeth. For this purpose, the method devised by Nolla [C. Nolla, The development of the permanent teeth, J. Dent. Child. 27 (1960) 254-266.] was used: the development of each of the teeth was determined according to this method on 374 radiographs, 195 of boys (mean age 8.59) and 179 of girls (mean age 8.75). The 28 variables representing the calcification stages were analyzed using cluster analysis followed by multivariate analysis (multiple linear regression model). Patient age was considered to be a dependent variable. Our study showed that antimere teeth are the most homogeneous as regards stages of development. The prediction was more accurate for boys and girls below 10 years of age, using teeth 21, 43 and 46 from boys and teeth 21, 46 and 47 from girls. These teeth accounted for 80% total variance of chronological age for dental calcification. Standard error was +/-1.4 years for boys and +/-1.2 years for girls. When the age of the children remained completely unknown, the best estimates were provided by teeth 43, 47, 46 and 44 from boys and teeth 44, 47 and 43 from girls.     

Dental Age Assessment in Children: A Comparison of Four Methods in a Recent French Population

The aim of this study was to analyze the accuracy and the reliability of four methods of dental age estimation (Demirjian, Willems I, Willems II, and Chaillet standards) in a French population. Orthopantomograms of 743 children aged between 4 and 15 years were used. The Demirjian standards gave a consistent overestimation of dental age compared with chronological age (+0.45 and +0.46 years for girls and boys, respectively). We found that three modified methods were more accurate for both sexes than Demirjian's method: the Willems I method appeared to be more suitable when the sex and ethnicity are both known (?0.09 and +0.14 years for girls and boys, respectively); the Willems II method was more accurate for children of unknown sex (mean difference = 0.00 years), and the Chaillet method was found to be more accurate than the Demirjian method, but less accurate than the Willems I method (?0.59 and ?0.18 years for girls and boys, respectively).     

Testing the Demirjian and the international Demirjian dental aging methods on a mixed ancestry urban American subadult sample from Detroit, MI

This paper tests the Demirjian and international Demirjian dental aging methods for forensic use when ancestry and ethnicity are unknown. A radiographic sample of 187 boys and girls was collected from the Department of Pediatric Dentistry at the University of Detroit Mercy and aged using both methods. The total sample and the sample by age categories (young, middle, and old) were analyzed using t-tests. The Demirjian method was found to better estimate age to a statistically significant degree for the total sample, as well as the middle and old age categories. The young category was aged better using the international Demirjian method. The results indicate that while the Demirjian method accurately estimates age, caution must be used with the method. Further research is needed to determine whether the international Demirjian method can be used for forensics in the U.S.     

Age Estimation from the Teeth Using a Modified Demirjian System*

Abstract: The estimation of age at time of death is often an important step in the identification of human remains. The purpose of this study was to test the applicability of the Demirjian system on a sample of the Sydney child population and to develop and test age‐prediction models using a large sample of Sydney children (1624 girls, 1637 boys). The use of the Demirjian standards resulted in consistent overestimates of chronological age in children under the age of 14 by as much as a mean of 0.99 years. Of the alternative predictive models derived from the Sydney sample, those that provided the most accurate age estimates are applicable for the age ranges 2–14 years, with R‐square = 0.94 and a 95% confidence interval of ±1.8 years. The Sydney‐based standards provided significantly different and more accurate estimates of age for that sample when compared to the published standards of Demirjian.     

Dental and Chronological Age in Children Under Oncological Treatment

The current oncology treatment has improved the survival of children with several types of cancer, and the effect of radiotherapy and/or chemotherapy treatment on dental maturation in comparison with chronological age is not widely known. The aim of this work was to evaluate and compare the impact of radiotherapy and/or chemotherapy treatment during dental maturation with chronological age in Chilean children diagnosed with cancer. Study Design was cross‐sectional study on children diagnosed with different types of cancer and treated with radiotherapy and/or chemotherapy when they were ages of 0.1 to 13 years. Demirjian tables for both girls and boys are used to determine the dental age. The association between chronological and dental age was highly significant. Nevertheless, a linear relation between chronological and dental age was not observed when the data were stratified by BMI and type of treatment. This study confirmed that dental age is an indicator of chronological age but that other variables, such as body mass index, in children with cancer could be confounder variables. Thus, further studies are necessary to investigate the influence of BMI on tooth eruption/maturation in children under oncological treatment.     

Age estimation in children by measurement of open apices in tooth roots: Study of a Mexican sample

The aim of this cross-sectional study was to test the accuracy of Cameriere's European formula for age assessment in a large sample of Mexican children. The accuracy of dental age estimation was defined as how closely real age, measured as the difference between chronological age (CA) and dental age (DA), could be predicted. Digitalized orthopantomographs of 502 Mexican children (254 girls and 248 boys), aged between 5 and 15 years, were analyzed. The seven left permanent mandibular teeth were evaluated using Cameriere's method. Intra- and inter-observer variability for this technique was tested on a small random sample. Dental age was estimated for each individual and compared with known chronological age. Accuracy was measured as the difference between known chronological age and dental age and tested for significance with the mean prediction error (ME). The standard deviation and 95% confidence interval of the mean difference were also calculated. ME was 0.63 years for girls and 0.52 years for boys. ME was found to be slightly overestimated by 0.10 years for girls, but was correctly estimated for boys with an accuracy of 0.00. In conclusion, this method is very useful and may be recommended for practical application both in clinical dentistry and forensic procedures on the Mexican population.     

Estimating age in Maori, Pacific Island, and European children from New Zealand

The islands of New Zealand are populated by persons of European, Maori, and Pacific Island extraction. The purpose of this research is to quantify the levels of dental maturation of each of these three populations, in order to obtain data that will be useful in forensic identification and age estimation. The sample consisted of 1383 orthopantomographs (660 males, 723 females) of 477 Maori, 762 European, and 144 Pacific Island children between the ages of 3 and 14 years. Each radiograph was digitized and the stages of mineralization of the seven left mandibular permanent teeth were assessed using the eight stages described by Demirjian. Values for 1, 3, 5, 50, 95, 97, and 99% confidence intervals are listed for each maturity score. Intra-observer reliability was evaluated using Bland-Altman's method on data from re-scoring one out of every 20 radiographs and standard dental maturation curves were constructed for the three populations by means of a quantile regression method. Despite the fact that quantile regression analysis showed that across the age group investigated there were differences between boys and girls, knowledge of the sex does not increase the accuracy of the age estimate, simply because the magnitude of the error of age estimation is greater than the difference between the sexes. Our analysis also shows that population divergence is most marked after the age of 9 years, with a peak difference seen at age 10.     

Secular Trend in the Development of Permanent Teeth in a Population of Istria and the Littoral Region of Croatia

The study evaluated secular trends in dental development during a period of 30 years, correlation between dental and chronological age in Istria and the littoral region of Croatia. The sample consisted of 1000 panoramic radiographs of children, aged 6–16 years (mean 10.0 ± 1.8), taken in the period 1977–1979 (N = 500; 243 females) and 2007–2009 (N = 500; 299 females). Dental age was assessed according to Demirjian's method. Correlation between chronological and dental age was linear, positive, high, and statistically significant in both periods and genders, ranging from 0.73 to 0.86. Dental age was underestimated when compared to chronological age by 1 year on average, more 30 years ago (?1.35 ± 1.17) than today (?0.63 ± 1.09), less for girls (?0.80 ± 1.22) than boys (?1.21 ± 1.10). A statistically significant positive secular trend in acceleration of dental development was present of 0.72 years during the 30‐year period and was more significant in girls than boys (0.83‐ and 0.51‐year acceleration).     

Reproducibility of radiographic stage assessment of third molars

The aim of this study was to determine intra- and inter-observer variability of the developing third molar from panoramic radiographs. Formation of third molars was assessed according to stages described by modified Demirjian et al.'s methods: Moorrees et al. [C.F.A. Moorrees, E.A. Fanning, E.E. Hunt, Age variation of formation stages for ten permanent teeth, J. Dent. Res. 42 (1963) 1490-1502] and Solari and Abramovitch [A.C. Solari, K. Abramovitch, The accuracy and precision of third molar development as an indicator of chronological age in Hispanics, J. Forensic Sci. 47 (2002) 531-535]; in addition, data were also analysed unmodified, i.e. Haavikko [K. Haavikko, The formation and alveolar and clinical eruption of the permanent teeth, an orthopantomograph study, Proc. Finn. Dent. Soc. 66 (1970) 104-170] and Demirjian et al. [A. Demirjian, H. Goldstein, J.M. Tanner, A new system of dental age assessment, Hum. Biol. 45 (1973) 211-227]. The sample was a random selection of 73 panoramic radiographs from patients aged 8-24 years. After training, the left maxillary and mandibular third molars were scored on two separate occasions without knowledge of previous scores. Cohen's Kappa and percentage agreement were calculated for each method, for maxillary, for mandibular third molars and combined. Percentage agreement for stages was also calculated. Intra-observer agreement was greater for mandibular third molars compared to maxillary third molars, and better for methods with fewer stages. Kappa values indicated good agreement for most methods; the best was Demirjian et al.'s method for mandibular third molar with very good agreement (K = 0.80) for the first author, good agreement for the second author (K = 0.75) and good agreement between observers (K = 0.75). The stages with best agreement were Demirjian's stage E [A. Demirjian, H. Goldstein, J.M. Tanner, A new system of dental age assessment, Hum. Biol. 45 (1973) 211-227] and Moorrees et al.'s stage Cc and R1/4 [C.F.A. Moorrees, E.A. Fanning, E.E. Hunt, Age variation of formation stages for ten permanent teeth, J. Dent. Res. 42 (1963) 1490-1502]. CONCLUSIONS: Having clearly defined stages and fewer stages allowed better reproducibility of third molar formation.     

Is the Assessment of Dental Age by the Nolla Method Valid for Eastern Turkish Children?

The aim of this study was to investigate whether or not the Nolla method is appropriate for Turkish children for the determination of the dental age (DA). A group of 719 children between the ages of 6 and 18 years were included in the study. DAs from orthopantograms by the Nolla method were estimated. The results obtained were compared with chronologic age (CA). Paired t and the Wilcoxon tests were performed. Both genders were underestimated in dental maturity when compared with the reference samples in total (-0.3 years) (p<0.01). The differences in girls were statistically significant in total and in all groups except for 7-7.9. The differences in boys between the CAs and DAs were not statistically significant in total and in all groups except for 7-7.9 and 8-8.9. Although the accuracy of this method was suitable for boys, according to our findings, it was not suitable for girls.     

Age estimation of Korean children based on dental maturity

The aim of this study was to evaluate the relationship between age and dental maturity and to establish the standard database of dental maturity based on the Demirjian's stages, which can be used for the age estimation of Korean children. For this purpose, dental maturity was measured by the Demirjian's stages on a randomly selected sample of panoramic radiographs taken from 2706 patients between 1 and 20 years of age and analyzed by multiple linear regression analysis based on the method of least squares. The results showed that, except for the third molars, the development of permanent teeth in Korean children was more advanced in females. The Demirjian's stage G of the second molar appeared last in both male and female subjects by age 18, showing 95th percentile at age in the male and female subjects between 16.7-17.4 years and 17.1-17.3 years, respectively. Coefficients of determination (r(2)) of the Demirjian's stages relative to age in regression analysis were 0.9721 in male and 0.9740 in female subjects. The standard error was 0.63 years in male and 0.62 years in female subjects. The estimated age according to regression analysis was within +/-1.0 year of the actual age in 92.0% of male and 92.5% of female subjects. Collectively, the data of the present study can be used as a reference for dental maturity and a standard for age estimation of Korean children.     

Dental age estimation in Belgian children: Demirjian's technique revisited.

Aim: The purpose of this study was to evaluate the accuracy of Demirjian's dental age estimation in children in a Belgian Caucasian population and to adapt the scoring system in case of a significant overestimation as frequently reported. We selected 2523 orthopantomograms of 1265 boys and 1258 girls, of which 2116 (1029 boys and 1087 girls) were used for estimating the dental age with the Demirjian's technique. The 407 other orthopantomograms were beyond the original age limit. A second sample of 355 orthopantomograms was used to evaluate the accuracy of the original method and the adapted method. A signed-rank test was performed to search for significant age differences between the obtained dental age and the chronological age. A weighted ANOVA was performed in order to adapt the scoring system for this Belgian population. The overestimation of the chronological age was confirmed. The adapted scoring system resulted in new age scores expressed in years and in a higher accuracy compared to the original method in Belgian Caucasians.     

Optimal Dental Age Estimation Practice in United Arab Emirates’ Children

The aim of the study was to detect whether the Willems model, developed on a Belgian reference sample, can be used for age estimations in United Arab Emirates (UAE) children. Furthermore, it was verified that if added third molars development information in children provided more accurate age predictions. On 1900 panoramic radiographs, the development of left mandibular permanent teeth (PT) and third molars (TM) was registered according the Demirjian and the Kohler technique, respectively. The PT data were used to verify the Willems model and to develop a UAE model and to verify it. Multiple regression models with PT, TM, and PT + TM scores as independent and age as dependent factor were developed. Comparing the verified Willems‐ and the UAE model revealed differences in mean error of ?0.01 year, mean absolute error of 0.01 year and root mean squared error of 0.90 year. Neglectable overall decrease in RMSE was detected combining PM and TM developmental information.     

Third molar development in a London population of White British and Black British or other Black ethnicity

Population differences in dental development between Black and White ethnic groups have been debated but not previously studied in the UK. Using inappropriate data for dental age estimation (DAE) could lead to erroneous results and injustice. Data were collected from dental panoramic radiographs of 5590 subjects aged 6–24 years in a teaching hospital archive. Demirjian stages were determined for left-sided teeth and third molars and data collected regarding hypodontia and third molar agenesis. Third molar development in self-assigned Black British, including other self-assigned Black ethnicity, was compared with that of self-assigned White British subjects. Data were compared for males and females in the two ethnic groups using T-tests for Demirjian Stages A–G of third molar development and Mann-Whitney tests for Stage H once a cut-off age at the maximum age for Stage G had been imposed. Third molar development occurred earlier in subjects of Black ancestry compared to those of White ancestry. While both ethnic groups showed large age ranges for every third molar stage, in female subjects these generally occurred at least 1.5 years earlier, and in males at least one year earlier. Hypodontia and third molar agenesis were more prevalent in White British, but the ethnic difference in third molar development persisted in subjects with complete dentitions. This is a large study that confirms ethnic differences in a London population, emphasises the difficulties of establishing the 18-year-old threshold using DAE, and confirms the risk of overestimating the age of individuals of Black ethnicity using White ethnic reference data.