Dental and Skeletal Imaging in Forensic Age Estimation: Disparities in Current Approaches and the Continuing Search for Optimization.

Medical imaging for forensic age estimation in living adolescents and young adults continues to be controversial and a subject of discussion. Because age estimation based on medical imaging is well studied, it is the current gold standard. However, large disparities exist between the centers conducting age estimation, both between and within countries. This review provides an overview of the most common approaches applied in Europe, with case examples illustrating the differences in imaging modalities, in staging of development, and in statistical processing of the age data. Additionally, the review looks toward the future because several European research groups have intensified studies on age estimation, exploring four strategies for optimization: (1) increasing sample sizes of the reference populations, (2) combining single-site information into multifactorial information, (3) avoiding ionizing radiation, and (4) conducting a fully automated analysis.

A systematic review and meta-analysis of the fully formed wisdom tooth as a radiological marker of adulthood.

Assessment of third molar development on dental radiograms is one of the most commonly used methods of forensic age estimation. Despite widespread use and numerous studies, there is a paucity of aggregated data on how well a fully mature third molar identifies adulthood (> 18 years), the most important threshold in a medicolegal context. Therefore, a systematic review and meta-analysis was conducted. A total of 1229 studies were screened, and 82 studies were assessed for inclusion. Twenty-four studies, with a pooled cohort of 19,690 individuals, presented true positive (TP), true negative (TN), false positive (FP), and false negative (FN) outcomes, enabling meta-analysis. The outcomes were based on using the third molar in the fully mature stage as a diagnostic test to indicate age 18 years or above. The false positive rate (fall-out/1-specificity) was 3.1% (95% CI 2.1-4.6%), and the true positive rate (recall/sensitivity) was 51% (95% CI 44-58%). Diagnostic accuracy was 71%. These findings, while reassuring in terms of the low false positive rate, highlight the need for complementary age estimation methods to avoid a significant number of false negatives.

[Age estimation of children in south-western Hungary using the modified Demirjian method]. / Dél-dunántúli gyermekek kormeghatározáisa a módosított demirjian-módszer alapján.

The biological age of a child, in contrast to his or her chronological age, may be described in terms of skeletal or dental maturity, the development of secondary sex characters etc. These factors can be applied separately or together to assess the degree of physiological maturity of a growing child. The determination of this physiological age and its correlation to the chronological age is of importance within many fields, such as archaeology, forensic medicine, endocrinology, orthodontics etc. Dental maturity was studied on 203 panoramic radiographs, taken between 1985 and 1995, of healthy Hungarian children aged 2.9 to 17.5 years from the south-west Transdanubian part of Hungary. The revised method of Demirjian was used for determination of the maturity score of each individual. For each tooth a score (on a scale A-H) was given according to the radiographic development, from first appearance of calcification to the closure of the apex. This score was then transformed into a self-weighted maturity score for the dental stages (0-19.3) as presented in the paper. The individual scores were then added giving a total maturity score (0-100). This total maturity score represents the biological maturity of the child and may then be compared with the known chronological age. The total maturity scores of the Hungarian population was plotted against the chronological (real) age, and a curve was fitted using the Lowess method of locally weighted least-square method. Our results show that each population needs its own standards. Hungarian boys and girls are approximately 1 year ahead of their French-Canadian counterparts at the age of 6-8. At older ages, the difference decreases. Similar to other studies, we found high individual variance up to 2 years, in tooth development, in the Hungarian population.