Mariano Cingolani

Variations in Pulp/Tooth Area Ratio as an Indicator of Age: a Preliminary Study ∗

This paper details a method for age determination of adults from single rooted teeth. The sample consisted of 100 Italian white Caucasian patients (46 men, 54 women) aged between 18 and 72 years. The single rooted maxillary right canine was utilized in this preliminary study. Pulp/root ration, tooth length, pulp/tooth length ratio, pulp/tooth area and pulp/root width ratios at three different levels were computed. Pearsons correlation coefficients between age and these variables showed that the ratio between pulp and tooth area correlated best with age (r2 = 0.85). Stepwise multiple regression models yielded a linear relationship between pulp/root width at mid-root level and chronological age and a linear relationship when pulp/tooth area was compared to age. Statistical analysis indicated that these two variables explain 84.9% of variations in estimated chronological age. The median of the absolute value of residual errors between actual and estimated ages was less than four years.

Age Estimation by Pulp/Tooth Ratio in Canines by Peri‐Apical X‐Rays

ABSTRACT: Estimation of age in individuals has received considerable attention in forensic science, in which it is a widely used method for individual identification, together with paleo‐demographic analyses to establish mortality patterns in past populations. The present investigation, which is a continuation of a previously published pilot study, was conducted to examine the possible application of the pulp/tooth area ratio by peri‐apical images as an indicator of age at death. A total of 200 peri‐apical X‐rays of upper and lower canines were assembled from 57 male and 43 female skeletons of Caucasian origin, aged between 20 and 79 years. They belong to the Frassetto osteological collection of Sassari (Sardinia) and are housed in the Museum of Anthropology, Department of Experimental and Evolutionistic Biology, University of Bologna. For each skeleton, dental maturity was evaluated by measuring the pulp/tooth area ratio on upper (x1) and lower (x2) canines. Very good agreement was found between intraobserver measurements. Statistical analysis was performed in order to obtain multiple regression formulae for dental age calculation, with chronological age as dependent variable, and gender, and upper and lower canines as independent variables. Stepwise regression analysis showed that gender did not contribute significantly to the fit (p=0.881) whereas variables x1 and x2 and the first‐order interaction between them did. These two variables explained 92.5% of variations in estimated chronological age and the residual standard error was 4.06 years. Lastly, two simple linear regression equations were obtained for age estimation using canines from the maxilla and mandible separately. Both models explained 86% of variations in estimated chronological age and allowed an age‐at‐death estimate with a residual standard error of about 5.4 years.

Age estimation by pulp/tooth ratio in lower premolars by orthopantomography

Accurate age estimation has always been a problem for forensic scientists, and apposition of secondary dentine is often used as an indicator of age. Since 2004, in order to examine patterns of secondary dentine apposition, Cameriere et al. have been extensively studying the pulp/tooth area ratio of the canines by panoramic and peri-apical X-ray images. The main aim of this paper is to examine the relationship between age and age-related changes in the pulp/tooth area ratio in monoradicular teeth, with the exception of canines, by orthopantomography. A total of 606 orthopantomograms of Spanish white Caucasian patients (289 women and 317 men), aged between 18 and 75 years and coming from Bilbao and Granada (Spain), was analysed. Regression analysis of age of monoradicular teeth indicated that the lower premolars were the most closely correlated with age. An ANCOVA did not show significant differences between men and women. Multiple regression analysis, with age as dependent variable and pulp/tooth area ratio as predictor, yielded several formulae. R(2) ranged from 0.69 to 0.75 for a single lower premolar tooth and from 0.79 to 0.86 for multiple lower premolar teeth. Depending on the available number of premolar teeth, the mean of the absolute values of residual standard error, at 95% confidence interval, ranged between 4.34 and 6.02 years, showing that the pulp/tooth area ratio is a useful variable for assessing age with reasonable accuracy.

Reliability in age determination by pulp/tooth ratio in upper canines in skeletal remains

ABSTRACT: Estimation of age of skeletal remains is one of the most complex questions for anthropologists. The most common macroscopic methods are based on dental wear and histological evaluation of bone remodeling. These methods are often qualitative, require great technical expertise, and have proved inexact in the estimation of ages over 50 years. Certain dental methods investigate the apposition of secondary dentine, in the study of tooth cross‐sections, and X‐rays to study width, height, and pulp area. The primary author previously proposed a method of estimating the age of a living person based on the pulp/tooth ratio (PTR) method in the upper canines. The aim of the present study is to verify whether the PTR method can also be used to estimate the age at death of skeletal remains. This paper investigates the study of historical samples of known age as a means to validate the proposed method.

Frontal Sinuses for Identification: Quality of Classifications, Possible Error and Potential Corrections

Many studies have examined the characteristics of the frontal sinuses and their use for forensic purposes, particularly when an individual is edentulous. One of the most widespread classification systems is that proposed by Yoshino et al. The aim of this study was to improve the performance of Yoshinos method for identifying unknown skeletal remains by replacing the first two morphological items, frontal sinus size and bilateral asymmetry, by SOR1 = left frontal sinus area/left orbit area, and SOR2 = right frontal sinus area/right orbit area. According to the bivariate distribution of SOR = (SOR1, SOR2) and available data, we also estimated the probability of positive misclassification.

Age estimation by pulp/tooth ratio in canines by mesial and vestibular peri-apical X-rays

Abstract:  Changes in the size of the pulp canal, caused by apposition of secondary dentine, are the best morphometric parameters for estimating age by X‐rays. The apposition of secondary dentine is the most frequently used method for age estimation in adult subjects. In two previous papers, we studied the application of the pulp/tooth area ratio by peri‐apical X‐rays as an indicator of age at death. The aim of the present study was to test the accuracy of age evaluation by combined analysis of labio‐lingual and mesial peri‐apical X‐rays of lower and upper canines. A total of 200 such X‐rays were assembled from 57 male and 43 female skeletons of Caucasian origin, aged between 20 and 79 years. For each skeleton, dental maturity was evaluated by measuring the pulp/tooth area ratio according to labio‐lingual and mesial X‐rays on upper (x1, x2) and lower (x3, x4) canines. Very good agreement was found between intra‐observer measurements. Statistical analysis showed that all variables x1, x2, x3, and x4 and the first‐order interaction between x1 and x3 contributed significantly to the fit, so that they were included in the regression model, yielding the following regression formula:

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.

Accuracy of Cameriere's cut-off value for third molar in assessing 18 years of age

Due to increasingly numerous international migrations, estimating the age of unaccompanied minors is becoming of enormous significance for forensic professionals who are required to deliver expert opinions. The third molar tooth is one of the few anatomical sites available for estimating the age of individuals in late adolescence. This study verifies the accuracy of Camerieres cut-off value of the third molar index (I3M) in assessing 18 years of age. For this purpose, a sample of orthopantomographs (OPTs) of 397 living subjects aged between 13 and 22 years (192 female and 205 male) was analyzed. Age distribution gradually decreases as I3M increases in both males and females. The results show that the sensitivity of the test was 86.6%, with a 95% confidence interval of (80.8%, 91.1%), and its specificity was 95.7%, with a 95% confidence interval of (92.1%, 98%). The proportion of correctly classified individuals was 91.4%. Estimated post-test probability, p was 95.6%, with a 95% confidence interval of (92%, 98%). Hence, the probability that a subject positive on the test (i.e., I3M<0.08) was 18 years of age or older was 95.6%.

Accuracy of Three Age Estimation Methods in Children by Measurements of Developing Teeth and Carpals and Epiphyses of the Ulna and Radius

Abstract:  The aim of this study was to compare the accuracy of three methods for age estimation in children: the measurements of open apices in tooth roots (T), the ratio between the total area of carpal bones and epiphyses of the ulna and radius (HW), and the combined method (THW). The sample consisted of 288 Caucasian Italian children (152 boys and 136 girls) aged between 5 and 15 years. Accuracy was determined as the difference between estimated age and chronological age, and accuracy was assessed by analyzing individuals’ orthopantomograms and hand‐wrist radiographs. Accuracies were 0.41 years for girls and 0.54 years for boys with the THW method; for the HW method, 1.00 years for girls and 0.92 years for boys; and for the T method, 0.62 years for girls and 0.71 years for boys. THW is the most accurate technique for age estimation in these children.

Precision and Reliability of Pulp/Tooth Area Ratio (RA) of Second Molar as Indicator of Adult Age

This paper discusses a method for assessing adult age based on the relationship between age and measurement of the pulp/tooth area ratio (RA) of the second molar teeth. The sample consisted of 312 Italian white Caucasian patients (135 men, 177 women) aged between 14 and 24 years. Orthopantomograph samples (OPGs) were analyzed by the same observer and calibrated by kappa statistics. Probabilities of an individual being older than 18 years of age (adult age) were derived using measurements of the ratio pulp/tooth area (RA) of the second molar teeth and the dichotomized stages of third molar development (Tm) as explanatory variables. These results were exploited to establish a threshold value to assign an individual to juvenile or adult age. A cut-off value of RA* = 0.088 was applied if Tm = 0 and RA* = 0.097 if Tm = 1. The sensitivity of this test was 91% and its specificity 94.5%. The proportion of individuals with correct classifications was 92%.