Accuracy of age estimation of radiographic methods using developing teeth

Introduction: Dental age estimation using orthopantomogram is very useful in pediatric dentistry, orthodontics in clinical diagnosis and treatment planning and also has forensic application. Demirjian method is widely used for age estimation and Willems method has been suggested to be accurate than Demirjian in various populations. To estimate the dental age of children in a specific population of Nepal by Demirjian and Willems method, compare them with the chronological age and assess their applicability. Materials and Method: Digital orthopantomograms of 5 to 14 years of children were used to estimate the dental age by Demirjian’s 7- teeth method and Willems method. Descriptive statistics was used and mean with standard deviation was calculated for gender and age of the samples. Paired t-test was used for comparison of chronological age with dental age. P < 0.05 was considered as statistically significant.Pearson correlation was used to assess the correlation between chronological and dental age in both the genders. Result: By Demirjian method, there was an underestimation of 0.276 years in males and 0.194 in females and by Willems method, 0.652 in males and 0.847 in females which were statistically significant. There was an underestimation of dental age in all the age groups except in the age group of 5,7 and 14 for Demirjian age which was statistically nonsignificant. Pearson correlation demonstrated strong positive correlation between chronological age and dental age. Conclusion: The underestimation of dental age was more by Willems method as compared to Demirjian method. There was a strong positive relationship between chronological age and dental age in both the genders. Demirjian’s 7- teeth method was more applicable as compared to Willems method when tested in selected Nepalese children population

Dental age estimation in Spanish children

Background: Chronological age does not always accurately reflect biological matura-tion in children, particularly in the presence of systemic diseases. Dental age assess-ment is widely used as a biological maturity indicator; however, the effect of juvenile diabetes mellitus on dental maturation remains insufficiently clarified, with incon-sistent findings reported across populations. Objective: This study aimed to compare dental age estimated using the Demirjian method with chronological age in children with juvenile diabetes and in age- and sex-matched healthy controls. Materials and Methods: This observational comparative study included panoramic radiographs from 30 children aged 8–15 years: 15 patients diagnosed with juvenile diabetes mellitus and 15 systemically healthy controls, all presenting Angle Class I malocclusion. Dental age was assessed using the Demirjian method and compared with chronological age. Ap-propriate parametric or non-parametric statistical tests were applied based on data distribution. Results: Children with juvenile diabetes exhibited a statistically signifi-cant advancement in dental age relative to chronological age, with a mean DA–CA difference of 1.36 years (p = 0.0066). No statistically significant differences between dental and chronological age were observed in the control group. Sexual dimorphism was evident from crown completion stages onward, with females demonstrating earli-er dental maturation. Conclusions: Juvenile diabetes mellitus is associated with accel-erated dental maturation. These findings have clinical implications for orthodontic treatment timing and growth assessment and indicate a potential risk of age overesti-mation in forensic contexts. Dental age should therefore be interpreted alongside skel-etal and chronological indicators, particularly in pediatric patients with systemic metabolic conditions.

Dental age and tooth development in children with molar-incisor hypomineralization: A case-control study

The primary aim of this study is to compare the chronological age with the dental age of Saudi patients with non-syndromic cleft lip and palate (CLP). The patients' demographics (gender and age group) were analyzed further. In total, 401 panoramic radiographs were assessed (195 and 206 for the control and the CLP groups, respectively). The subjects' ages ranged from 3 to 17 years, from both genders. The root and crown developmental stages of the mandibular permanent teeth were evaluated using Demirjian's method to calculate dental age. The subjects were separated into three groups according to chronological age. One investigator collected all the data, the intra-class correlation (ICC) coefficient test showed good reliability (0.984). A paired t test was then used to determine any statistically significant difference between the mean dental and chronological ages of the control and the cleft samples. The mean difference between chronological and dental ages was then calculated for the control and the cleft groups. A Student's t test was then used to compare the two mean differences. The dental age of normal subjects was ahead of their chronological age by 8.1 months. The CLP group had delayed dental development by 9.6 months (p < 0.01) when compared with normal subjects. The males with CLP had an extended delay in dental development by 6.5 months when compared with females with CLP. Saudi subjects affected with CLP had significantly delayed dental development when compared with the control group. Dental age is commonly used to assess dental development in comparison with chronological age. Reporting dental age accuracy for CLP cases would be of value for proper management and diagnosis.

Radiographic study of delayed tooth development in patients with dental agenesis

Accuracy of the estimation of dental age in comparison with chronological age in a Spanish sample of 2641 living subjects using the Demirjian and Nolla methods

Introduction: The Demirjian's method has been advocated since 1973 as a universal method in dental age (DA) estimation. Several studies in different populations have shown that DA was overestimated compared with chronological age (CA). The Objective of the Study: The aim of this study was to assess the DA in Jordanian children aged 4–17 years using the Demirjian method and compare it with the standard values provided by Demirjian. Design of the Study: This was a cross-sectional study. Subjects and Methods: Five hundred and eighty four panoramic radiographs of healthy children of both genders. The CA was scored from the medical record of the child and the dental age scored on all seven left mandibular teeth in the panoramic radiograph based on demirjian's method. Statistical Testing: All data were collected, tabulated, and statistically analyzed using SPSS version 25. The statistical analyses were performed using an independent samples t-test and a correlation coefficient to analyze quantitative data and a scatter plot. Results: The DA was overestimated than CA, especially in the intervals between 6–7, 14–15, and 16–17 years in females, and in the interval 12–13 and 16–17 years in males. Furthermore, there were significant correlations between CA and DA according to the girls in the intervals 9–14 years, and there were significant correlations between CA and DA related to boys in the intervals 6–7, 8–11, and 15–16 years. The results from this study have shown that Demirjian “s method cannot be applicable to be used to determine the estimated DA of the Jordanian population. Conclusion: The Demirjian's method for dental estimation is not valid for the Jordanian population, and there should be another method for dental age estimation.

In the modern era, identification and determination of age is imperative for diversity of reasons that include disputed birth records, premature delivery, legal issues and for validation of birth certificate for school admissions, adoption, marriage, job and immigration. Several growth assessment parameters like bone age, dental age and the combination of both have been applied for different population with variable outcomes. It has been well documented that the chronological age does not necessarily correlate with the maturational status of a child. Hence, efforts were made to determine a child's developmental age by using dental age (calcification of teeth) and skeletal age (skeletal maturation). The present study was aimed to correlate the chronological age, dental age and skeletal age in children from Southeastern region of Andhra Pradesh, India. Out of the total 900 screened children, only 100 subjects between age groups of 6-14 years with a mean age of 11.3±2.63 for males and 10.77±2.24 for females were selected for the study. Dental age was calculated by Demirjian method and skeletal age by modified Middle Phalanx of left hand third finger (MP3) method. Pearson's and Spearman's correlation tests were done to estimate the correlation between chronological, dental and skeletal ages among study population. There was a significant positive correlation between chronological age, dental age and all stages of MP3 among males. Similar results were observed in females, except for a non-significant moderate correlation between chronological age and dental age in the H stage of the MP3 region. The results of the present study revealed correlation with statistical significance (p<0.05) between chronological, dental and skeletal ages among all the subjects (48 males and 52 females) and females attained maturity earlier than males in the present study population.

Dental age estimation charts are frequently used to assess maturity and estimate age. The aim of this study was to assess the accuracy of estimating age of three dental development charts (Schour and Massler, Ubelaker, and the London Atlas). The test sample was skeletal remains and dental radiographs of known-age individuals (N = 1,506, prenatal to 23.94 years). Dental age was estimated using charts of Schour and Massler, Ubelaker, and The London Atlas. Dental and chronological ages were compared using a paired t-test for the three methods. The absolute mean difference between dental and chronological age was calculated. Results show that all three methods under-estimated age but the London Atlas performed better than Schour and Massler and Ubelaker in all measures. The mean difference for Schour and Massler and Ubelaker was -0.76 and -0.80 years (SD 1.27 year, N = 1,227) respectively and for the London Atlas was -0.10 year (SD 0.97 year, N = 1,429). Further analysis by age category showed similar accuracy for all three methods for individuals younger than 1 year. For ages 1-18, the mean difference between dental and chronological ages was significant (P < 0.05) for Schour and Massler and Ubelaker and not significant (P > 0.05) for the London Atlas for most age categories. These findings show that the London Atlas performs better than Schour and Massler and Ubelaker and represents a substantial improvement in accuracy of dental age estimation from developing teeth.

Dental development, one of the most reliable indicators of chronological age (CA), has been believed to be fundamentally influenced by genetics rather than environmental factors. The study aims (i) to compare dental ages (DAs) in monozygotic (MZ) and dizygotic (DZ) twins using three different DA methods and determining the most appropriate method, and (ii) to determine the possible effects of genetics on DA by evaluating the differences in the estimated DAs of MZ and DZ twins. The study sample consisted of 171 twin pairs (47 monozygotic, 124 dizygotic) between the ages of 5.0 and 12.9. In order to estimate DA, Demirjian, Willems and Nolla methods were used. The mean CA of group was 8.42 (2.05) years. The Demirjian, Willems and Nolla methods overestimated the DAs by 0.69, 0.60 and 0.56 years, respectively. The estimated DAs in age groups were similar, and differences were not statistically significant for intrapair DZ and MZ twins. As a result, it was not correct to state that any method was more appropriate and better than others for studies of twins. All methods’ standards were not suitable for any age groups of MZ and DZ twins, except for twins aged 12–12.9 years. Country-wide samples are needed to gather enough data to create valuable results and to establish the applicability of methods used.

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. 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 13.9years 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, Demirjianmethod 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 ± 2years of chronological age, and intra-observer and inter-observer statistics were calculated. The Cameriere European formula estimated the best dental age compared to the chronological age; the mean underestimation was - 0.4years for both sexes, Haavikko underestimated by - 0.17years, while Demirjian and Willems overestimated by 1.02years and 0.48years, respectively. The most significant difference showed the Demirjian method in 11-year-old and 12-year-old females. The MAE were 0.50years, 1.01years, 0.61years, and 0.78years in males and 0.51years, 1.18years, 0.61years, and 0.70years 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 ± 0.5year 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. 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.

Objective: The aim of this study is to discuss the reliability and utility of Demirjian method used at calculating dental age determination with the help of using the data of other countries.Materials and Methods: The data of 22 studies, in which dental age determination was done by Demirjian method between the age of 7 - 11 age range from different countries or different regions from the same country, was examined. The inclusion standard in the studies was defined as this study; examining on healthy children, using panoramic films, researching on left bottom mandibular seven teeth. Data belong to girls and boys at the age range of 7-11 and data related with their chronological age and dental ages defined by Demirjian method was organized in tabular and the differences between dental age and chronological age were evaluated. After variance analysis at the factorial order in the data analysis, Bonferroni test was used for multiple comparisons. Type 1 error was pegged at 0,05 (α=0,05).Results: As a result of assessments, from the point of dental age designated by Demirjian method and chronological age, a difference has been detected between the children who live at different countries and live at different regions of the same country. Negative and positive differences has been detected with regards to the utility of Demirjian method by the samples taken from Netherlands, Turkey, Sudan, China, Serbia, Italy, Pakistan, New Zealand, Bosnia-Herzegovina, Malaysia and India. The difference between the results of the Belgian children who live in Romania, Iran, India and children who live in other societies were not that meaningful.Conclusion: Juvenescence and development at children differ from person to person and society to society because of reasons such as heritage, gender, hormones, nutrition, socio-cultural and environmental factors and previous diseases. Development of teeth are under the influence of familiar factors and because of this reason when scoring system in order to designate dental age of French-Canadian origin children, applied to different societies, important differences could be seen between chronological age and dental age. In order to overcome this difference, this method needs modification according to the social features.

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).

Objectives: Age estimation plays an important role in forensic medicine and orthodontics. Many methods of age estimation have been suggested. Demirjian method is the most frequently used one of these. In the literature, there is a little known about applicability of this method in Turkish children. The aim of the present study was to evaluate the reliability of Demirjian method of dental age estimaiton and for description of mandibular permanent tooth formation in Turkish children from the southwest Eastern Anatolia region. Materials and Methods: A retrospective study was performed on 1015 panoramic radiographs and 5-15 years of age South western of Eastern Anatolia Regionof 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’s method were evaluated. A pired t-test was used for statistical analysis. Results: The mean difference between the chronological and dental ages ranged 0,28 to 1,10 years in boys and from 0,18 to 0,68 years in girls. South western of Eastern Anatolia Region ofTurkish children were generally delayed in dental maturity compared with children in Demirjian sample. The differences between the chronological and dental ages were statistically significant in 6-6.9, 8-8.9, 9-9.9, 10-10.9, 11-11.9 years in boys and in 8-8.9, 9-9.9,11-11.9 years in girls. Conclusions: Turkish children from the southwest Eastern Anatolia region are significantly more delayed in dental maturity compared to Demirjian’s French-Canadian sample. The applicability of Demirjian data is not suitable for Southwestern of Eastern Anatolia Region of Turkish children.