Saudi Journal for Health Sciences

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 8  |  Issue : 3  |  Page : 133--136

Reliability of two dental age estimation methods in children and comparison with their chronological age


Yasser R Souror1, Harshkant P Gharote2,  
1 Department of Basic and Preventive Sciences, Batterjee Medical College, Jeddah, Saudi Arabia; Department of Pediatric Dentistry and Dental Public Health, Faculty of Dental Medicine, Al-Azhar University, Assiut Branch, Cairo, Egypt
2 Department of Oral Medicine and Radiology, Faculty of Dentistry, Batterjee Medical College, Jeddah, Saudi Arabia

Correspondence Address:
Prof. Yasser R Souror
Head of Basic and Preventive Sciences Department, Batterjee Medical College; P.O. Box 6231, Jeddah 21442, Saudi Arabia; Department of Pediatric Dentistry and Dental Public Health, Faculty of Dental Medicine. Al-Azhar University, Assiut Branch, P.O Box 71511, Egypt

Abstract

Background: Dental age estimation is being performed since Demirjian proposed dental maturity scores. Subsequently, numerous methods were proposed and were estimated worldwide. Although these methods showed high degrees of reliability, ethnic differences were found to affect the accuracy of the dental age. Objectives: The present study evaluated the relationship between chronological age and dental age using Demirjian and Willems methods in children using digital panoramic radiographs. Materials and Methods: Dental age of 60 digital panoramic radiographs of children (males: 34, females: 26) were calculated using the Demirjian scoring method and Willems scoring method. These age values were compared among themselves as well as with chronological age of the children. Further, the comparison was made by dividing all children in the age ranges of 5-7, 7.1-9, 9.1-11, and 11.1-13 years. The correlations between ages among all parameters were statistically significant except age groups 9.1-11 and 11.1-13 years. Conclusion: A significant correlation was observed between chronological age and dental age estimated by Demirjian and Willems methods. Both methods can be useful in the estimation of chronological age in children.



How to cite this article:
Souror YR, Gharote HP. Reliability of two dental age estimation methods in children and comparison with their chronological age.Saudi J Health Sci 2019;8:133-136


How to cite this URL:
Souror YR, Gharote HP. Reliability of two dental age estimation methods in children and comparison with their chronological age. Saudi J Health Sci [serial online] 2019 [cited 2020 Jul 2 ];8:133-136
Available from: http://www.saudijhealthsci.org/text.asp?2019/8/3/133/272435


Full Text



 Introduction



The importance for accurate age estimation has never been so immense. In the last couple of decades, the need has increased for two main reasons-increasing number of unidentified human remains and cases requiring age estimation in living individuals without valid proof of birth date. These developments have greatly emphasized the importance of age estimation in human remains and living beings.[1]

The assessment of a child's chronological age and stage of maturation is particularly important in fields such as pediatrics, orthopedics, and orthodontics, forensic and anthropological studies.[2] Dental age estimation has gained recognition as it is less changeable when compared to other maturity indices and less influenced by environmental factors. Numerous methods have been evolved in estimating dental development that includes anatomy, histology, tooth eruption timings, and radiographic evaluation. Among them, the radiological method is most promising. Several methods for the dental age determination from radiographs have been described, namely by Nolla (1960), Demirjian and Goldstein (1973, 1974), Haavikko and Willem's (2001).[3],[4],[5],[6],[7],[8] Among these, Demirjian and Goldstein system has been widely accepted due to the maturity scoring system as it is universal in application and the conversion to dental age can be made with ease. In 2001, Willem'set al. evaluated the accuracy of Demirjian method in Belgian Caucasian population, and he provided modified scoring system.[8]

There are very few studies for correlation of chronological age with dental age estimation in the Saudi population. Most of these studies are based on the Demirjian method that evaluates dental maturity. Willems method of dental age estimation is easy and calculates dental age by direct scoring of tooth development.[8] However, there are no comparative studies between various age estimation methods to prove the accuracy of one method over other. The purpose of the present study was to evaluate relationship between chronological age and dental age estimated by Demirjian and Willems methods. Furthermore, it was attempted to find the accuracy of one method over the other.

 Materials and Methods



A sample of 60 panoramic digital radiographs of healthy children aged 6-13 years old (34 males and 26 females) who fulfilled the inclusion criteria like clear digital panoramic radiographs without blurring or artifacts and free of any pathology that might affect tooth/root development/maturation like carious or pulpal involvement. Careful screening of patients' records was done to rule out the presence of any medical condition that may affect tooth development. The radiographs were evaluated at the Batterjee Medical College for Science and Technology, Jeddah.

The chronological age was calculated from the valid birth date of the child up to the date of radiograph. The dental calcification stages were assigned for seven left mandibular teeth in all selected radiographs. These stages were used for estimating maturity scores, and dental age was determined as per the conversion value put forth by Demirjian.[7] Developmental tooth stages with corresponding age scores in years were used to calculate dental age by Willems method.[8]

Statistical analysis

Means and standard deviations for chronological age, ages calculated by Demirjian method and Willems method were determined. One-way ANOVA was used for the evaluation of the correlation between all these parameters. Differences between chronological and dental age were calculated for all parameters (total sample size, boys, girls, and four age groups). Pearson's correlation was used to find the possible relationship between chronological and estimated dental age by both methods.

 Results



Total children (n = 60) included in this study comprised 34 boys and 26 girls. Mean and standard deviations for chronological age, ages calculated by Demirjian and Willems method were calculated for boys, girls, and the total sample size. The mean age calculated by Willems method was less than the chronological age of all children as well as in boys and girls. Comparisons between all three mean ages were found to be statistically not significant in boys, girls, and total sample size [Table 1]. All the children were subdivided into four age groups. Comparisons of mean ages between all four age groups were statistically not significant [Table 2].{Table 1}{Table 2}

The difference between chronological age and dental age by Demirjian method was calculated for all children and for different age groups. Pearson's correlation was performed to observe their relationship. The difference between chronological age and dental age by Demirjian method showed that dental age was underestimated among boys, girls, and total sample except the age group of 5-7 years old. The correlation between these ages was significant among all parameters except the age group of 7.1-9 years [Table 3]. Similarly, difference between chronological age and age by Willems method were correlated for the total sample, boys, girls, and all age groups. Dental age was found to be underestimated in all the parameters. The correlations between ages among all parameters were statistically significant except the age groups of 9.1-11 and 11.1-13 years old [Table 4].{Table 3}{Table 4}

The differences between dental age by Demirjian and Willems methods were calculated and it was observed that latter was underestimated than former. The correlation between the two mean dental ages was significant in all the parameters [Table 5].{Table 5}

 Discussion



Age estimation has become important factor in individual identification in forensic dental science. It is useful in spotting unknown victims, qualifying individuals for social benefits, and finding unknown immigrants. Several studies have been proposed and used the human dentition for estimation of chronologic age. Age estimation in children and adolescents can be done by evaluating the development of deciduous and permanent teeth up to the age of 14 years on radiographs.[9],[10]

The present study aimed at evaluating the reliability of dental age assessment among children. Age estimation methods proposed by Demirjian and Willems were considered for dental age estimation. The study included 60 panoramic radiographs of children (36 males and 24 females) with an age range of 6-13 years. The mean chronological age of all the children was 8.79 ± 2.11 years, while dental age by Demirjian method was 8.72 ± 2.03 years, and on comparison was statistically not significant. Similarly, the comparison of these parameters was not significant for boys and girls. However, Nour El Deen et al. found the significant difference between chronological age and Demirjian dental age in the study of Saudi children and among boys and girls.[11]

The comparison of mean chronological age with Willem's dental age was found to be not significant. The chronological age was higher as compared to dental age in Willem's method. Among different age groups, the difference between the dental age and chronological age was found to be increasing as the age group advanced from smaller age group to higher age group. This suggests that dental age by Willems method is much closer to chronological age in younger children. Nevertheless, Willem etal. have observed overestimation of dental age over chronological age.[8]

In the present study, there was underestimation of dental age by both methods over chronological age among boys and girls and all children. These findings are not in accordance with Baghdadi who observed overestimation of age among Saudi children. There was overestimation of dental age by Demirjian method in age group of 5-7 years.[12] Correlation analysis of age groups showed a significant association between the chronological age and Demirjian dental age in all except 7.1-9 years group. While in Willems dental age, 7.1-9 years and 9.1-11 years age group did not show significant correlation. Alshihri et al. found no significant relation between chronological age and dental age by Demirjian method in these age groups among both genders in western Saudi children.[13] On contrary, Al-Dharrab et al. found overestimation in boys and underestimation in dental age by Demirjian method in certain age groups yet the age group of 5-7 years range exhibited underestimation of dental age.[14]

The present study showed the nonsignificant relationship between dental age (Willem) and chronological age in the children between the age ranges of 7-11 years. This suggests that there could be relative slowdown in dental maturation during this period. The possible reason behind this finding may be related to the cumulative growth pattern as there is a relatively slow growth during childhood as compared to postnatal growth and pubertal growth.[15] Dental mineralization patterns have shown that early stages of tooth development are almost the same in both genders. However, sexual dimorphism in developmental pace takes place around the completion of tooth crown and prolongs to increase during the stage of root formation. These findings suggest that tooth formation follows the pattern of general growth and may be affected by hormonal changes.[16]

When the difference between the two dental ages was calculated, it was observed that the age by Willems method was underestimated than age by Demirjian method. Further their correlations among all parameters were statistically significant. Although both the dental ages in the present study were underestimated, a meta-analysis by Esan et al. suggests that there is overestimation of dental age over chronological age in both the methods. They further observed that Willems method provides more accurate chronological age estimation in various population-based studies, whereas Demirjian method provides insight into maturity scores.[17]

 Conclusion



The present study was an attempt to establish an association between two most commonly used dental age estimation methods and evaluate their reliability in the estimation of chronological age. We observed underestimation of dental age over chronological age. Yet the proximity of both the age methods to chronological age supports their consistency in estimation of latter. Inclusions of larger sample size among larger strata of population are required to reach to more reliable conclusion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Ritz-Timme S, Cattaneo C, Collins MJ, Waite ER, Schütz HW, Kaatsch HJ, et al. Age estimation: The state of the art in relation to the specific demands of forensic practise. Int J Legal Med 2000;113:129-36.
2Baghdadi ZD. Dental maturity of Saudi children: Role of ethnicity in age determination. Imaging Sci Dent 2013;43:267-72.
3Mohammed RB, Sanghvi P, Perumalla KK, Srinivasaraju D, Srinivas J, Kalyan US, et al. Accuracy of four dental age estimation methods in Southern Indian children. J Clin Diagn Res 2015;9:HC01-8.
4Nykänen R, Espeland L, Kvaal SI, Krogstad O. Validity of the Demirjian method for dental age estimation when applied to Norwegian children. Acta Odontol Scand 1998;56:238-44.
5Priyadarshini C, Puranik MP, Uma SR. Dental age estimation methods: A review. Int J Adv Health Sci 2015;1:19-25.
6Nolla CM. The development of permanent teeth. J Dent Children 1960;27:254-66.
7Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol 1973;45:211-27.
8Willems G, Van Olmen A, Spiessens B, Carels C. Dental age estimation in Belgian children: Demirjian's technique revisited. J Forensic Sci 2001;46:893-5.
9Ajmal M, Assiri KI, Al-Ameer KY, Assiri AM, Luqman M. Age estimation using third molar teeth: A study on Southern Saudi population. J Forensic Dent Sci 2012;4:63-5.
10Lewis JM, Senn DR. Dental age estimation utilizing third molar development: A review of principles, methods, and population studies used in the United States. Forensic Sci Int 2010;201:79-83.
11Nour El Deen RE, Alduaiji HM, Alajlan GM, Aljabr AA. Development of the permanent dentition and validity of Demirjian and Goldstein method for dental age estimation in sample of Saudi Arabian children (Qassim region). Int J Health Sci (Qassim) 2016;10:21-8.
12Baghdadi ZD. Testing international dental maturation scoring system and population-specific Demirjian versions on Saudi sub-population. J Clin Exp Dent 2014;6:e138-44.
13Alshihri AM, Kruger E, Tennant M. Dental age assessment of 4-16 year old Western Saudi children and adolescents using Demirjian's method for forensic dentistry. Egypt J Forensic Sci 2016;6:152-6.
14Al-Dharrab AA, Al-Sulaimani FF, Bamashmous MS, Baeshen HA, Zawawi KH. Radiographic evaluation of dental age maturity in 3-17-years-old Saudi children as an indicator of chronological age. J Orthod Sci 2017;6:47-53.
15Ferguson D, Dean JA. Growth of the face and dental arches. In: McDonald and Avery Dentistry for the Child and Adolescent. 10th ed. Moby, Philadelphia: Eslevier; 2015. p. 375-89.
16Alshihri AM, Kruger E, Tennant M. Dental age assessment of Western Saudi children and adolescents. Saudi Dent J 2015;27:131-6.
17Esan TA, Yengopal V, Schepartz LA. The Demirjian versus the Willems method for dental age estimation in different populations: A meta-analysis of published studies. PLoS One 2017;12:e0186682.