Age Estimation in Brazilian Adults Using the Pulp/Tooth Ratio of the Maxillary Canine and Mandibular Second Premolar.

(1) Background/Objectives: Accurate determination of chronological age is crucial in legal dental identification. This study aimed to compare the effectiveness of different formulas in estimating the age of a Brazilian subpopulation by analyzing the pulp/tooth ratio of the maxillary canine and mandibular second premolar in panoramic and periapical radiographs. (2) Methods: The sample consisted of panoramic and periapical radiographs of 247 individuals. The file of each radiograph was opened in the Adobe Photoshop CS4® program to outline and obtain values in pixels for calculating the pulp/tooth ratio. Statistical analysis was conducted using the SPSS program, with a significance level set at 5%. (3) Results: The interclass correlation coefficient demonstrated excellent intra-observer agreement (0.990-0.999). The determination coefficients (R2) suggested that only 30-35% of the actual age results could be explained by the pulp/tooth ratio. The smallest differences were observed with Cameriere's formula for the mandibular second premolar on panoramic radiographs (+4.1 years). The greatest differences were found with the formulas for the mandibular second premolar in panoramic radiographs of the Korean (+12.5 years) and Portuguese (-12.1 years) populations. (4) Conclusions: The equations employed showed little agreement between the actual age and the estimated age.

Dental age estimation methods applied to Indian children and adolescents: A systematic review and meta-analysis.

Country-specific systematic reviews and meta-analyses have been proposed to compile the available literature and rank methods based on their performance for a target population. India is a country with a vast scientific literature on dental age estimation. This systematic review aimed to provide evidence to help the decision of experts regarding the method of choice for dental age estimation in India. The research protocol was registered in Open Science Framework. Literature Search was performed in Embase, LILACS, MedLine (via PubMed), SciELO, Scopus and Web of Science. Grey Literature was searched in Google Scholar and ProQuest. Observational cross-sectional studies that compared chronological and estimated ages using Demirjian (original [DEM] and Chaillet's modification [modified-DEM]) and Acharya (ACH) methods were included. JBI tool was used to assess the risk of bias. The search detected 9799 studies, out of which 56 were eligible (n=13,107 panoramic radiographs of Indian individuals). Low risk of bias was registered for 48 studies, while 8 presented a moderate risk of bias. The meta-analysis showed a standardized mean difference between chronological and estimated ages of -0.11 (95%CI: -0.29; 0.07), 0.74 (95%CI: 0.39; 1.09), and -0.01 (95%CI: -0.23; 0.22) years for DEM, modified-DEM and ACH, respectively. High heterogeneity (I2=88-93%) was observed across studies for all the methods, including subgroup analyses based on sex. This study ranked ACH, DEM and modified-DEM (from the best to the worse) performances in the Indian population.

Pulp volume quantification methods in cone-beam computed tomography for age estimation: A critical review and meta-analysis.

The secondary dentin deposition that occurs after the tooth formation process results in a decrease in pulp cavity volume in adolescents and adults. The purpose of this critical review was to correlate pulpal and/or dental volume on cone-beam computed tomography (CBCT) with chronological age approximation. A subobjective was to investigate which methodology and CBCT technical parameters would be most appropriate to evaluate this correlation. This critical review followed the PRISMA guidelines, and it was conducted by a search through PubMed, Embase, SciELO, Scopus, Web of Science, Cochrane Library databases, as well as gray literature. Primary studies that used pulp volume, or pulp chamber to tooth volume ratio measured using CBCT were included. Seven hundred and eight indexed and 31 non-indexed records were identified. A qualitative analysis was performed including 25 selected studies with a total of 5100 individuals, age ranging from 8 to 87 years without sex predilection. The most used method was pulp volume/tooth volume. CBCT voxel size ranged between 0.09 and 0.5. Manual segmentation associated with threshold algorithms was used in most of the studies. Correlation between the pulp volume/tooth volume ratio was moderate: -0.66 for the upper central incisors, -0.59 for upper canines and -0.56 for lower canines. High heterogeneity was observed among the studies. It is concluded that pulp volume should be used with caution in age estimation. Evidence supports the preferable use of upper incisors with pulp volume/tooth volume ratio for age estimation. There is not enough evidence that voxel size interferes in age estimation by pulp volume.

Estimativa da idade aplicada a investigações arqueológicas utilizando espectroscopia RPE ­ uma revisão / Dental age estimation applied to archaeological investigations using spectroscopy ESR ­ a review

A estimativa da idade utilizando dentes humanos é realizada por várias ciências. Enquanto na odontologia e antropologia forense o significado desta estimativa está associado à idade cronológica em indivíduos vivos ou mortos, na arqueologia o significado é outro, e reflete o tempo decorrido desde a formação do dente até a sua descoberta no sítio arqueológico, a chamada datação arqueológica. Diante do potencial uso da datação para identificação de corpos antigos (fossilizados) na área forense, o objetivo deste trabalho é abordar a estimativa da idade de dentes sob a perspectiva da arqueologia, por meio do principal método de datação utilizado: o da espectroscopia por ressonância paramagnética eletrônica (RPE). Com o intuito de verificar as principais aplicações deste método na datação de dentes humanos, foi realizada uma revisão da literatura. Os 18 artigos selecionados mostram que a espectroscopia RPE encontra-se consolidada como método de datação para dentes humanos e tem sido aplicada com sucesso nas últimas décadas, na solução de problemas de diversas pesquisas arqueológicas, ajudando a elucidar questionamentos acerca da dinâmica de ocupação, interações interespecíficas e extinção de várias espécies humanas que habitaram a Terra nas últimas centenas de milhares de anos

Age estimation using human teeth is performed by several fields of knowledge. While in forensic dentistry and anthropology the meaning of this estimate is associated with chronological age in living or dead individuals, in archaeology, the meaning is different and reflects the time elapsed from the formation of the tooth until its discovery at the archaeological site, the so-called archaeological dating. Faced with the potential use of archaeological dating to identify ancient (fossilized) bodies in the forensic area, the aim of this work is to approach the age estimation of teeth from the perspective of archaeology, through the main dating method used: Electron spin resonance (ESR) spectroscopy. In order to verify the main applications of this method for the dating of human teeth, a literature review was carried out. 18 articles were selected and show that ESR spectroscopy is consolidated as a dating method for human teeth and it has been applied, successfully over the last few decades, in the solution of problems of several archaeological researches, helping to clarify questions about the dynamics of occupation, interspecific interactions and extinction of several human species that have inhabited the Earth in the last few hundred thousand years

Age Estimation from Attrition of Permanent Molars.

BACKGROUND: The average stage of attrition in permanent first and second molars is an established method of age estimation in the adult population. The study was conducted with an objective of age estimation from the average stage of attrition of permanent molars. METHODS: A total of 451 individuals of age more than 20 years were examined. Nepalese individuals with intact first and second permanent molars in the maxillary and mandibular arch on either side were included. The average stage of attrition of the maxillary first and second permanent molars on either side was calculated and subjected to regression analysis to derive equations. RESULTS: Among a total of 451 participants, 231 (51.22%) were females and 220 (48.78%) males, with a mean age of 44.3 ± 13.9 years. There was a strong correlation between age and average stage of attrition of molars. The correlation was stronger for upper molars compared to the lowers. Additionally, the mean of the difference between real age and estimated age was lower for maxillary compared to mandibular molars. Compared to age estimation by univariable regression, multivariable regression had greater accuracy. Similarly, estimation of age from maxillary molars was more accurate as compared to mandibular (difference in years: 3.82 ± 3.03 for maxillary molars and 5.17 ± 4.2 for mandibular molars). CONCLUSIONS: Maxillary teeth are better for age estimation and using both maxillary first and second permanent molars gives better accuracy.

Age Estimation Using Monoradicular Teeth by comparing Pulp/Tooth Area Ratios between Bucco-lingual and Mesio-distal Periapical Radiographs.

BACKGROUND: Age estimation is an integral tool in identification of the victims when visual identification is not possible. Secondary dentin deposition is a regular ageing process and can be utilized in dental age estimation when development and eruption parameters cannot be utilized. METHODS: In total, 38 monoradicular teeth of Nepalese subjects were assessed for tooth pulp ratio. Intraoral periapical radiographs of these teeth were taken, and pulp tooth ratio was calculated and dental age was estimated. RESULTS: The mean chronological age was 46.79 years and the mean estimated age was 44.32 years. The pulp/tooth area ratios calculated were in the range of 0.012 to 0.195, and 0.052 to 0.256 for mesio-distal and bucco-lingual planes respectively. CONCLUSIONS: Pulp tooth ratio of maxillary lateral incisors and mandibular lateral incisors showed the highest correlation with values of 90% and 76% respectively. Mesio-distal assessment was more accurate in dental age estimation than bucco-lingual view.

Transition analysis applied to third molar development in a Danish population.

INTRODUCTION: Age assessment based on dental development is often requested in order to assess whether an individual is older or younger than 18 years of age. There are several statistical approaches to estimate age based upon third molar development. The aim of this study was to apply the principles of transition analysis (TA) to a Danish reference material and to evaluate whether it was indicated to include a model that allows for logistic non-linearity as opposed to applying a model only allowing for logistic linearity. For this we chose to use the generalized additive model (gam) and the generalized linear model (glm), respectively. MATERIAL AND METHOD: A cross-sectional sample comprising 1302 panoramic radiographs of Danish subjects in the chronological age range of 13-25 years was included. All present third molars had been scored according to the 10-stage method of Gleiser and Hunt. Each transition from one stage to the subsequent stage was analyzed according to the statistical approach of TA and fitted with both the generalized linear model (glm) and the generalized additive model (gam). In order to assess whether gam or glm was more parsimonious for each transition individually, the Akaikon information criterion (AIC) was applied. RESULTS: The results emphasized the importance of applying a statistical model that sufficiently captures the spread of the age estimate. The AIC values showed that some transitions were sufficiently described by glm whereas for others the gam curves fitted significantly better. CONCLUSION: We recommend that for an age assessment tool based on TA, both a fitting allowing for non-linearity and one allowing only for linearity should be included.

Maduración de dientes permanentes en niños venezolanos entre 3 y 6 años: aplicabilidad en la estimación de la edad dental con fines forenses / Permanent teeth maturation in 3-6 year old Venezuelan children: applicability in dental age estimation with forensic purposes

El objetivo de este trabajo fue estudiar la maduración de dientes permanentes en niños venezolanos entre tres y seis años de edad y su aplicabilidad en la estimación de la edad dental (ED) con fines forenses. Se realizó un estudio descriptivo, retrospectivo, transversal y de campo. La muestra consistió en 107 radiografías panorámicas de individuos venezolanos (56 mujeres y 51 hombres). Se asignaron los estadios de maduración a los dientes permanentes de los cuatro cuadrantes de acuerdo al método de Demirjian et al. (1973) original, mientras que la ED fue calculada por el método de Demirjian et al. y sus modificaciones (Demirjian & Goldstein, 1976), Willems et al. (2001) y Chaillet et al. (2005). Las mujeres alcanzaron los estadios de maduración a edades más tempranas que los hombres. Se observó en el total de la muestra la sobre-estimación de la edad cronológica (EC) por todos los métodos, siendo el método de Chaillet et al. el más preciso. Al estudiar los sexos por separado, el método de Chaillet et al. presentó la menor diferencia EC-ED para los hombres y el de Chaillet et al. en las mujeres. El método de Demirjian et al., original mostró la mayor diferencia EC-ED para ambos sexos. Los métodos de Chaillet et al. y Willems et al., son aplicables con fines de determinación de la edad en la muestra estudiada, siendo su utilidad dependiente del sexo.

The objective of this work was to study the maturation of permanent teeth in Venezuelan children between three and six years, and its applicability in the estimation of dental age (DA) for forensic purposes. A descriptive, retrospective, cross-sectional and field study was carried out. The sample consisted of 107 panoramic radiographs of Venezuelan individuals (56 females and 51 males). The stages of maturation were assigned to the permanent teeth of the four quadrants according to the original Demirjian et al. (1973) method, while the DA was calculated by Demirjian´s et al. method and its modifications (Demirjian & Goldstein, 1976), Willems et al. (2001) and Chaillet et al. (2005). It was found that females reached the maturation stages at younger ages than males. The overestimation of the chronological age (CA) by all methods was observed in the total sample, being the method of Chaillet et al., the most accurate. When studying the sexes separately, the method of Chaillet et al., presented the lowest CA-DA difference for males and Chaillet et al., in females. The method of Demirjian et al., showed the greatest CA-DA difference for both sexes. The methods of Chaillet et al. and Willems et al. are applicable for age determination purposes in the studied sample, its utility being sex dependent.

Third molar development in a contemporary Danish 13-25year old population.

We present a reference database for third molar development based on a contemporary Danish population. A total of 1302 digital panoramic images were evaluated. The images were taken at a known chronological age, ranging from 13 to 25years. Third molar development was scored according to the Köhler modification of the 10-stage method of Gleiser and Hunt. We found that third molar development was generally advanced in the maxilla compared to the mandible and in males compared to females; in addition, the mandibular third molar mesial roots were generally more advanced in development than were the distal roots. There was no difference in third molar development between the left and right side of the jaws. Establishing global and robust databases on dental development is crucial for further development of forensic methods to evaluate age.

Morphological analysis of the lower second premolar for age estimation of Korean adults.

OBJECTIVES: This study aimed to examine the applicability of the pulp/tooth area ratio in the lower premolar teeth using panoramic radiography in age estimation of Korean adults. METHODS: 402 digital panoramic images of Korean adults between 20 and 78 years were analyzed. Following Cameriere et al.'s method, two observers measured the pulp and tooth areas of the lower second premolar on digital panoramic images, and the ratio of pulp to tooth area in the whole tooth (PTR) was calculated. In addition, the whole tooth was divided into coronal and root parts at the cementoenamel junction, and the ratios in the coronal part (PcCR) and root part (PrRR) were also calculated separately. Independent t-test, Analysis of covariance, linear regression, and the standard error of the estimate (SEE) were computed using statistical software. To justify the use of linear regression models for purposes of prediction, diagnostic tests of principal assumptions were also performed. RESULTS: Independent t-test revealed significant differences in genders. PrRR produced the best age correlation (male, SEE=10.8; female, SEE=9.8; total, SEE=10.4 years), followed closely by PTR (male, SEE=11.1; female, SEE=10.3; total, SEE=10.7 years) and a relatively lower accuracy for PcCR (male, SEE=14.7; female, SEE=14.4; total, SEE=14.6 years). Model assumptions and accuracy for purposes of prediction in PTR and PrRR were satisfied. CONCLUSIONS: The pulp/tooth area ratio using panoramic radiography has the potential as an effective tool for age estimation in the Korean adult population, and the pulp/tooth area ratio in the root part is more accurate than that of the whole tooth. Notably, female has shown higher accuracy compare to male subject.

Reality of forensic odontology in Saudi Arabia / A realidade da odontologia forense na Arábia Saudita

Saudi Arabia (SA), an oil rich developing country with a population of 31 million people, yet only 33% of whom are Saudis. Wealth, work opportunities and religious status make SA a hub for people from around the world whether it be through legal or illegal routs. As a developing country, SA faces many challenges in regard to mass disasters in light of its underdeveloped infrastructure and the annual Haj (Islamic pilgrimage) that attracts nearly 3 million people in a small area over a short period of time. Moreover, the numbers of unregistered births is high. These factors necessitate the importance of having a strong human identification and age estimation practice. Aim: To assess the reality of Forensic Odontology in Saudi Arabia in regard to: number of personnel and their training, number of forensic odontology cases and the way these cases are referred and documented. Materials and Methods: This project consisted of two parts: Observational study to assess how the system works in regard to forensic odontology cases, how these cases are dealt with and how they are referred. Part two: Cross-sectional survey aimed at all registered Forensic personnel to assess their qualifications, training, level of expertise, expert witness experience and involvement in specialized Forensic Odontology cases, namely: human identification, age estimation and bite mark analysis. Results: Out of 51 participants, only one dentist is registered with some form of Forensic training, 42 have a medical background, 39 of whom received medical Forensic training. Looking at forensic odontology in particular, only 11 out of 51 have had Forensic Odontology training. Participants who don't have any training in Forensic Odontology, yet have worked on cases that required Forensic Odontology training, were 37 on age estimation cases, 27 on bite mark analysis and 36 on human identification cases. There are no designated programs on Forensic Odontology in Saudi Arabia, nor is there a Forensic Odontology entity. There are no clear national guidelines or protocols to personnel when dealing with forensic cases and no detailed forms that documents oral findings. Conclusion: There is no solid Forensic Odontology system in Saudi Arabia that is objective, preserves the integrity of the law and protects human rights. There are many areas that can be improved to achieve that aim and a list of recommendations is presented.

Arábia Saudita, um país desenvolvido e rico em petróleo, com uma população de 31 milhões de habitantes, onde apenas 33% das pessoas são sauditas. Riqueza, oportunidades de trabalho e situação religiosa faz do país um centro de atração para pessoas de todo o mundo, tanto por rotas legais como ilegais. Como um país em desenvolvimento, enfrenta muitos desafios relacionados a desastres em massa em virtude de uma infraestrutura subdesenvolvida e o Haj anual (peregrinação islâmica) que atrai aproximadamente 3 milhões de pessoas em uma pequena área durante um curto período de tempo. Além disso, o número de nascimentos não registrado é alto. Nesse sentido, todos esses fatores reforçam a importância de um sistema de identificação humana e estimativa de idade eficientes. Objetivos: Avaliar a realidade da Odontologia Legal na Arábia Saudita em relação à equipes e treinamento que recebem, número de casos envolvendo a Odontologia Legal e como esses casos são conduzidos e documentados. Material e Métodos: a metodologia consistiu em dois momentos ­ estudo observacional para avaliar como o sistema funciona com relação a casos envolvendo a Odontologia Legal, como esses casos são conduzidos, analisados e referenciados. Em outro momento, um estudo focado em todo o pessoal de área pericial para avaliar sua formação e qualificação profissional, treinamento, experiência e envolvimento com casos de Odontologia Legal envolvendo identificação humana, estimativa de idade e análise de marcas de mordida. Resultados: dos 51 participantes, apenas um cirurgião-dentista está registrado com algum treinamento forense, 42 têm formação médica, dos quais 39 receberam treinamento forense na área médica. Analisando a Odontologia Legal, de maneira particular, somente 11 dos 51 participantes tiveram treinamento em Odontologia Legal. Dos participantes que não tiveram nenhum treinamento em Odontologia Legal, mas trabalharam em casos que necessitavam de tal especialidade, 37 foram casos de estimativa de idade, 27 casos de marcas de mordida e 36 casos de identificação humana. Na Arábia Saudita não há nenhum programa voltado para a Odontologia Legal e nenhuma entidade oficial nessa especialidade. Não há protocolos claros para as equipes forenses quando envolvidas em casos odontolegais, bem como formulários para achados odontológicos. Conclusão: Não há um sistema estruturado em Odontologia Legal na Arábia Saudita que seja objetivo, juridicamente embasado e que proteja os direitos humanos. Há muitas áreas que precisam ser melhoradas a fim de atingir a lista de recomendações apresentada.

Evaluation of third molar development in the estimation of chronological age.

The purpose of this study was to evaluate the correlation between chronological age and the degree of third molar mineralization by Demirjian's developmental stages (Demirjian et al., 1973) using panoramic radiography. From a total of 11.396 digital panoramic radiographs of patients from three oral radiology private clinics from the northeast region of Brazil, obtained from January to June 2009, 2097 radiographic images from patients aged between 6 and 22 years were selected. The images were analyzed individually by two obsevers using a 21-inch computer screen and Windows Picture and Fax Viewer. Reliability was achieved by intra- and interobserver evaluation, using the Kappa test. Chronological age, calcification stage, gender and third molar were interrelated using a multiple linear regression model, considering age as a response variable. There was reliability with Demirjian et al.'s developmental stage assesment, displaying a significant relationship between mineralization stages and patients' age (P<0.05). There was no significant difference between the average age and the calcification stage taking gender and localization of the third molar into consideration. It is possible to estimate chronological age based on Demirjian's stage of a third molar, regardless of gender and location.

Evidência documental X evidência biológica para estimativa da idade? Relato de caso pericial / Documental vs. biological evidence for age estimation? Forensic case report

Objetivo: a estimativa da idade em indivíduos vivos, com finalidade legal, reveste-se de complexidade e necessita de uma abordagem multidisciplinar para determinar um intervalo de tempo confiável para a idade cronológica do periciando. Objetivou-se relatar um caso de estimativa de idade no vivo em um indivíduo que alegou ter menos de 18 anos (idade de maior idade legal), a despeito de documentos oficiais apontarem o contrário. Relato de caso: indivíduo do sexo masculino, detido por prática criminosa executada em 21/01/2010 foi encaminhado para perícia odonto legal para exame de estimativa de idade. Durante aidentificação do indiciado, apresentou certidão que exibia data de nascimento de 05/04/1991, tendo 18 anos e 10 meses quando cometeu o crime. Porém, alegou ser menor de idade, tendo nascido em 12/07/1992, possuindo, então, a idade de 17 anos e 6meses na data do delito. A alegação de menoridade sustentava--se no fato de seu registro teria sido incorreto, com erro na data de nascimento. Realizados exames intraoral e radiográfico panorâmico constatou-se maioria de dentes hígidos e presentes. À análise do desenvolvimento dentário por quatro metodologias diferentes ao exame radiográfico carpal por outras seis metodologias,constatou-se que os caracteres de desenvolvimento ematuração óssea eram incompatíveis com indivíduo maior de18 anos. Baseado na análise pericial, a sentença judicial determinou a imputabilidade legal baseado na legislação aplicável a menores de idade, a despeito de documentos oficiais apontarem o contrário, destacando a importância do exame pericial para estimativa de idade no vivo, com finalidade de determinação de imputabilidade legal.

Objective: age estimation of live individuals with legal purposes is complex and requires a multidisciplinary approach to determine a reliable time interval for the examined person. Objective was to report a case of age estimation in live individual who claimed to be younger than 18 years (age of legal majority), in spite of official documents state otherwise. Case report: a male, arrested for criminal practice perpetrated on 01/21/2010 was sent for forensic examination to forensic dental age estimation. During the identification of the suspect, it was presented a birth certificate dating of 04/05/1991, wich therefore indicated age of 18 years and 10 months when crime was commited. However, suspect claimed to be a minor, having been born on 07/12/1992, therefore being 17 years and 6 months old at the time of the offense. The claim of minority based in the fact that his record would have been done incorrectly, with a mistake on the date of birth. Intraoral and orthopantomographic radiological exams showed up most of teeth present and sound. Analysis of dental development by four different methodologies and radiographic examinationcarpal bones by six other methodologies, pointed out that developmentaland maturation features were incompatible with an individual older than 18 years. Based on forensic analysis, the court of law determined legal liability of the suspect based upon legislation applicable to minors, despite official documents that suggested otherwise, highlighting the importanceof expert examination to estimate age in live individuals, when determining legal liability of suspects.