Ivan Galić

Dental age estimation using Demirjian and Willems methods: Cross sectional study on children from the Former Yugoslav Republic of Macedonia

To evaluate applicability of Demirjian and Willems methods for calculating dental age of children in the Former Yugoslav Republic of Macedonia we analyzed panoramic radiographs of 966 children (485 female and 481 male, aged 6-13 years) treated at the University and Community Dental Clinics in Skopje using four Demirjian methods and a Willems method for determining dental ages. Intra-rater and inter-rater agreement of mineralization stages were 0.86 and 0.82, respectively. All methods significantly overestimated dental age when compared to the chronological age (p<0.001). In males, the lowest overestimation was shown using Willems method (0.52±0.87 years), followed by Demirjian methods from 1976 using PM1, PM2, M1, M2 teeth (0.69±0.92 years) and using I2, PM1, PM2, M2 teeth (0.80±0.98 years). The greatest overestimation were shown using Demirjian methods using 7 teeth from 1976 (0.92±0.99 years) and method from 1973 (1.06±1.07 years). In females, the lowest overestimation was shown using Willems method (0.33±0.83 years) than the Demirjian method using PM1, PM2, M1, M2 teeth (1.00±1.01 years), following methods from 1976 using 7 teeth (1.03±1.01 years) and I2, PM1, PM2, M2 teeth (1.12±0.96 years). The greatest overestimation was for method from 1973 using 7 teeth (1.17±0.98 years). Willems method was the most accurate while Demirjians methods for dental age calculation are not suitable on children from the Former Yugoslav Republic of Macedonia.

Assessment of legal adult age of 18 by measurement of open apices of the third molars: Study on the Albanian sample

The third molar tooth is one of the few anatomical structures in development available for estimating the age of individuals in the late adolescence. This study tests the accuracy of Camerieres cut-off value of the third molar index (I3M) in assessing legal adult age of 18 years in an Albanian sample. For this purpose, a sample of orthopantomograms (OPTs) of 286 living subjects (152 female and 134 male) aged between 15 and 22 years was analyzed. Intra-rater and inter-raters agreement of I3M were 0.998 and 0.998, respectively and Cohen Kappa for intra-rater and inter-rater agreement in decision on adult or minor was 1.0 and 1.0, respectively. Age distribution gradually decreases as I3M increases in both males and females. The mean age of females is higher than that of males when I3M is between 0.04 and 0.08. Sensitivity test for males was 94.1%, with a 95% confidence interval (95% CI) 85.6-98.4%, and specificity was 90.9% (95%CI 81.3-96.6%). The proportion of correctly classified individuals was 92.5%, with a 95%CI of (86.7%, 96.4%). For females, the sensitivity test was 75.4%, with a 95%CI of (63.1%, 85.2%) and specificity was 96.6%, with a 95%CI of (90.3%, 99.3%). The proportion of correctly classified individuals was 87.5%, with a 95%CI of (81.2%, 92.3%). The results indicate that Camerieres cut-off value of the third molar index (I3M=0.08) is useful in discriminating between Albanian adults and juveniles, and encourage us to test its suitability for determining the adult age in individuals from other populations.

Cameriere's third molar maturity index in assessing age of majority

Estimation of chronological age of an individual is one of the main challenges in forensic science. Legally to be able to treat a person as a minor or an adult, it is necessary to determine whether their age of majority (if they are older or younger than 18, in most countries). Methods for estimating age are especially important when an individual in question lacks personal documents or other means of identification. As the dental age differs in various populations, the aim of this study was to evaluate applicability of third molar method for assessing age of majority in Croatia. Camerieres third molar maturity index (I3M) value of 0.08, measured by the open apices of the teeth, was verified in sample of 1336 panoramic images aged between 14 and 23 years. Chronological age gradually decreased as I3M increased in both genders. Males showed statistically significant advanced maturation when I3M was between 0.0 and 0.3 value. The results indicate that the sensitivity of the test for 0.08 value was 84.3% (95%CI 80.6%, 87.5%) for females and 91.2% (95%CI 88.7%, 93.1) for males. Specificity was 95.4% (95%CI 92.5%, 97.5%) and 91.9% (95%CI 88.8%, 94.3%). The proportions of accurately classified males were 88.8% and that of females 91.5%. The estimated post-test probabilities, of individuals, in other word the probability that a Croatian individual with an I3M<0.08 is 18 years or older is 94.5% for females, and 96.5% for males. With high accuracy, the third molar maturity index should be used as a determinant of the age of majority in Croatia.

Accuracy of Cameriere's third molar maturity index in assessing legal adulthood on Serbian population

At the moment, a large number of asylum seekers from the Middle East are passing through Serbia. Most of them do not have identification documents. Also, the past wars in the Balkan region have left many unidentified victims and missing persons. From a legal point of view, it is crucial to determine whether a person is a minor or an adult (≥18 years of age). In recent years, methods based on the third molar development have been used for this purpose. The present article aims to verify the third molar maturity index (I3M) based on the correlation between the chronological age and normalized measures of the open apices and height of the third mandibular molar. The sample consisted of 598 panoramic radiographs (290 males and 299 females) from 13 to 24 years of age. The cut-off value of I3M=0.08 was used to discriminate adults and minors. The results demonstrated high sensitivity (0.96, 0.86) and specificity (0.94, 0.98) in males and females, respectively. The proportion of correctly classified individuals was 0.95 in males and 0.91 in females. In conclusion, the suggested value of I3M=0.08 can be used on Serbian population with high accuracy.

Demirjian’s stages and Cameriere’s third molar maturity index to estimate legal adult age in Peruvian population

OBJECTIVE To compare the accuracy of Demirjians stages (DS) and Camerieres third molar maturity index cut-off value (I3M<0.08) to estimate the age of majority on panoramic radiographs (OPTs) from the dental clinic of the Scientific University of the South (UCSUR), Lima, Peru. METHODS An observational cross-sectional study was conducted on the sample of 208 digital panoramic radiographs of patients aged 14-22years examined during 2015 in UCSUR. The left lower third molars were analyzed using Adobe Photoshop® CS6. An effectiveness of specific DS and I3M<0.08 was evaluated by using accurate classification, sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios and Bayes post-test probability (p). RESULTS Only G and H stages were practical for classify adults and minors in the tested sample, while I3M<0.08 showed the best performance in both sexes. For I3M<0.08, the accurate classification, sensitivity and specificity were 0.96, 0.96, 0.96 and 0.90, 0.84 and 0.95 in males and females, respectively. Values of LR+, LR- and p were 24.96, 0.04, 0.97 and 15.68, 0.17, 0.95 in males and females, respectively. CONCLUSION The specific cut-off value of third molar maturity index (I3M<0.08) showed to be more accurate in discriminating adults and minors in Peruvian sample when a test with high sensitivity and specificity is required.

Time of mineralization of permanent teeth in children and adolescents in Gaborone, Botswana

The mineralization sequence of permanent dentition can be used to assess the stage of development and age of individuals. The most commonly used methods are based on the assessment of developmental stages of target groups of teeth on one side of the lower jaw. When compared with the rest of the world, fewer studies have been done on dental age in Sub-Saharan Africa, particularly in the region of Southern Africa. The aim of this study was to determine the chronology of mineralization of permanent teeth by the evaluation of developmental stages according to the Demirjians method from 1973 and to evaluate dental age by using sex-specific self-weighted scores for dental stages and 50th percentile conversion tables of total maturity scores of seven mandibular teeth. We used a sample of panoramic radiographs (OPTs) of black African children and adolescents from the city of Gaborone, Botswana, with the aim of forming an appropriate sample to evaluate the development of the teeth in this socio-geographic environment. The final sample consisted of 1760 OPTs (807 males and 953 females) of individuals aged 6-23 years. The developmental stages of the all permanent teeth in the left side of the maxilla and the mandible were evaluated. Comparing the maxilla and the mandible, we found similar development within different stages for most of the teeth. In comparison to the average age at each stage of development, including the third molars between males and females, it is evident that females are slightly faster in developing permanent teeth, but without statistical significance for most of the developmental stages. Applying 50th percentile conversion tables for calculating the dental age for the first seven mandibular teeth, 616 OPTs of the children (299 males and 317 females), aged 6.08-16.80 years, were evaluated and their dental age was calculated. Mean dental age was overestimated in comparison to chronological age by 1.25±1.11 years and 0.72±1.02 years for males and females, respectively (p<0.001). These findings indicate that Demirjians method from 1973 is not suitable for routine use and that there is a need for establishing specific standards for Botswana children of black African origin for dental age estimation.

Orthodontic anomalies and malocclusions in Late Antique and Early Mediaeval period in Croatia

OBJECTIVE Malocclusions are relative infrequently analysed in bioarchaeological investigations and if investigated the samples are very small. This research provides analysis of orthodontic anomalies of even 1118 individuals from the Late Antique (LA) and Early Mediaeval (EM) period. Aims were to describe the prevalence of orthodontic anomalies in this historical period and to analyse which orthodontic anomalies are best suitable for bioarchaeological investigations. METHODS 1118 skulls were examined for anomalies of tooth number, tooth displacement (rotation, malposition, diastema and crowding) as well as for malocclusions. RESULTS The prevalence of hypodontia in the LA was 41.02% and 30.61% in the EM sample. Tooth displacement was noticed in 15.63% individuals from the LA and in 12.42% individuals from EM. About 26% of the LA sample and 7.19% of the EM sample were affected with tooth crowding and the difference was statistically significant. CONCLUSION Orthodontic anomalies affecting only one tooth or group of teeth are more suitable for examination in bioarchaeological investigations than orthodontic features requiring presence of both jaws and all or almost all teeth. Clinical investigation protocols and methodology should be adopted for bioarchaeological researches and international standards and recommendations should be established for this kind of investigation on skeletal remains.

Age of majority assessment in Dutch individuals based on Cameriere’s third molar maturity index

Radiological examination of the third molar is done in living individuals for estimation of chronological age, especially in the late adolescence. The aim of this study was to assess the application of Camerieres third molar maturity index (I3M) to determine whether an individual is 18 years or older (adult) or younger than 18 years (minor) in a sample of Dutch individuals. The sample consisted of panoramic images of 360 individuals aged between 14 and 22 years old. Three observers performed the measurements. Gender was not statistically significant in discriminating adults and minors. The highest value of the Youden index of the receiver operating curve analysis was for the value of I3M<0.08 in discriminating individuals as minor or adult. The specificity (Sp) and sensitivity (Se) results for females were 96.3% and 72.7% respectively. The Sp and Se for males were 95.0% and 84.0% respectively. The probabilities of correctly classified individuals were 83.3% and 88.9%, and Bayes post-test probability was 96.3% and 95.7% in females and males respectively. Obtained results showed that the specific cut-off point of I3M<0.08 may be a useful and reliable method for adult age assessment in a Dutch population.

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 Steiners 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.

Dental Age and Tooth Development in Orthodontic Patients with Agenesis of Permanent Teeth

Objective. To compare the development of permanent teeth in a group of children with the congenitally missing permanent teeth (CMPT) and corresponding nonaffected group. Methods. The formation stages of all developing permanent teeth were determined on 345 panoramic radiographs (OPTs) by the method of Haavikko (1970), and dental age was calculated. The paired samples t-test was used to compare the differences between dental age (DA) and chronological age (CA) in those with CMPT and those not affected. Spearman test was used to evaluate the correlation between DA-CA and the number of missing teeth. The Wilcoxon signed rank test was used to compare the development of the teeth adjacent to the place of the agenesis with matched pair in corresponding nonaffected group. Results. Dental age was significantly delayed in CMPT children compared to the nonaffected group (p < 0.001). The mean differences were −0.57 ± 1.20 years and −0.61 ± 1.23 years in males and females, without difference between sexes (p = 0.763). The number of missing teeth affected the delay only in females (p = 0.024). Only mesial teeth in females were significantly delayed in development when compared to the nonaffected group (p = 0.007). Conclusion. Our findings show that the development of the permanent teeth is delayed when compared to the nonaffected group of the same sex and age.