Comparison of three methods to estimate dental age in children.

OBJECTIVES: In 1973, Demirjian and colleagues introduced a staging for tooth mineralization. Staging of the teeth of the left mandible generates a dental maturity score and an estimate of dental age. An update of this method was published in 2001 by Willems and colleagues. The London Atlas (2008) is another method used to assess dental age. This study compared the precision of these three methods for forensic age estimation. MATERIALS AND METHODS: A total of 500 panoramic images of 251 boys and 249 girls aged 6-16 years had dental maturity evaluated by the same observer using the London Atlas and the methods of Demirjian and Willems. Individuals with syndromes potentially affecting dental maturation were excluded. The three methods were compared with respect to their precision in estimating chronological age. RESULTS: Age estimates using Willems' method were significantly more precise than those obtained using Demirjian's method, while estimates obtained using the London Atlas method were comparable with both the others. The highest precision was obtained using the average of age estimates from Willems' method and the London Atlas. CONCLUSIONS: To estimate age in individuals suspected of being below 16 years of age, we suggest first applying the London Atlas then computing age from the Demirjian stages of particular teeth using Willems' method, and finally using the average age estimate of both methods. CLINICAL RELEVANCE: Combining the London Atlas and Willems' scoring method provides more precise estimates of dental age than the current practice of applying a single preferred method.

Impact of overbite and overjet on oral health-related quality of life of children and adolescents.

BACKGROUND: Usually, morphological parameters of the teeth are recorded to help assess the indication for orthodontic treatment. It is assumed that significant deviations from average values compromise the quality of life. The aim of this study is to analyse the impact of overbite and overjet on oral health-related quality of life (OHRQoL) of children and adolescents. PATIENTS AND METHODS: A total of 748 subjects, aged 9.5-15.5 years, participated in the LIFE child project of the University of Leipzig, where they underwent a general medical and dental examination. Overbite and overjet were measured, and aberrations of the OHRQoL were recorded by the probands themselves, who completed the German version of the Child Perceptions Questionnaire (CPQ-G11-14). The OHRQoL is divided into four domains ("oral symptoms", "functional limitations", "emotional well-being" and "social well-being") and is analysed by means of a CPQ score depending on age, gender, socioeconomic status and orthodontic treatment. RESULTS: On average, the participants listed 10.5 (±13.1) problem issues on a CPQ scale ranging from 0 to 140. Subjects with current orthodontic treatment had a CPQ score about 2.5 (±2.4) higher than those without treatment. The aberrations were mainly observed in the domains "oral symptoms" and "functional limitations". Multiple linear regression showed that deviations of the overbite had only little influence on the OHRQoL, but deviations of an overjet-especially of >6 mm increased the CPQ summary score about 6 points. CONCLUSION: Children and adolescents with overjet deviations of >6 mm in comparison to the norm are associated with significant limitations of the OHRQoL. However, overbite deviations have only little influence.

Agenesis of second premolars and delayed dental maturation.

AIM: The purpose of this work was to examine the relationship between second-premolar agenesis and how rapidly permanent dentition develops. METHODS: Panoramic radiographs of 678 girls and boys aged 6-14 years were evaluated. Subjects with syndromes or history of tooth extraction were excluded. The permanent dentition's stages of mineralization (scale 1-10) and eruption (1-7), and the resorption (1-5) of deciduous teeth were assessed. RESULTS: Adjusted for age and sex, subjects with one or more missing second premolars revealed earlier developmental stages (mineralization: average -0.37 stages per tooth, 95% CI -0.23 to -0.50; eruption: -0.42, 95% CI -0.60 to -0.24; resorption: -0.36, 95% CI -0.49 to -0.24; all p < 0. 001). Canines, premolars, and second molars were particularly affected, regardless of their location in the same or opposing jaw, and independent of the number of missing teeth. Overall dental development was delayed by 8.6 months (95% CI 5.4-11.8) in subjects with missing second premolars. CONCLUSION: These results have implications for several areas of medicine. Joint biological etiology for the agenesis and late maturation of permanent teeth should be considered in developmental research. Orthodontists should be aware of the delay associated with missing second premolars when timing interventions. Forensic age assessment based on tooth development should adjust for missing teeth to avoid underestimating the subject's age.

Combining wrist age and third molars in forensic age estimation: how to calculate the joint age estimate and its error rate in age diagnostics.

BACKGROUND: Forensic age estimation in living adolescents is based on several methods, e.g. the assessment of skeletal and dental maturation. Combination of several methods is mandatory, since age estimates from a single method are too imprecise due to biological variability. The correlation of the errors of the methods being combined must be known to calculate the precision of combined age estimates. AIM: To examine the correlation of the errors of the hand and the third molar method and to demonstrate how to calculate the combined age estimate. SUBJECTS AND METHODS: Clinical routine radiographs of the hand and dental panoramic images of 383 patients (aged 7.8-19.1 years, 56% female) were assessed. RESULTS: Lack of correlation (r = -0.024, 95% CI = -0.124 to + 0.076, p = 0.64) allows calculating the combined age estimate as the weighted average of the estimates from hand bones and third molars. Combination improved the standard deviations of errors (hand = 0.97, teeth = 1.35 years) to 0.79 years. CONCLUSION: Uncorrelated errors of the age estimates obtained from both methods allow straightforward determination of the common estimate and its variance. This is also possible when reference data for the hand and the third molar method are established independently from each other, using different samples.