|Year : 2022 | Volume
| Issue : 3 | Page : 657-661
Age assessment by dental and skeletal maturity pattern: A cross-sectional study
Mohd Malik Afroz1, Avinash Tejasvi2, Prashanth Shenai3, Laxmikanth Chatra3, C K Anulekha Avinash4
1 Department of Oral and Maxillofacial Diagnostic Sciences, Majmaah University, Al Majma'ah, Saudi Arabia
2 Department of Oral Medicine and Radiology, Kamineni Institute of Dental Sciences, Nalgonda, Telangana, India
3 Department of Oral Medicine and Radiology, Yenepoya Dental College, Mangalore, Karnataka, India
4 Department of Prosthodontics, Kamineni Institute of Dental Sciences, Nalgonda, Telangana, India
|Date of Submission||26-Dec-2019|
|Date of Decision||14-Dec-2020|
|Date of Acceptance||14-Mar-2021|
|Date of Web Publication||2-Nov-2022|
Dr. Avinash Tejasvi
Department of Oral Medicine and Radiology, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda - 508 254, Telangana
Source of Support: None, Conflict of Interest: None
Aim: An attempt was made to estimate the chronologic age of an individual using the dental and skeletal maturity in the Mangalore population. Sample: This study sample comprised 150 individuals (75 males and 75 females) ranging from 10 to 20 years of age. We have divided our sample as ≤16 years and individuals >16 years from 1 month to 20 years for better accuracy. Methodology: Dental age was assessed using the Demirjian method based on seven mandibular teeth. The skeletal age was assessed using a hand-wrist radiograph by applying the method of Bjork, Grave, and Brown. Results: We have found a positive correlation between the chronologic age, estimated dental and skeletal age in individuals ≤16 years. There was a negative correlation seen in the individuals who are >16 years. We propose a linear regression equation obtained using the dental and skeletal method separately for males and females; this can be used to decrease the difference between the estimated age and chronologic age. Conclusion: Both the dental and skeletal methods can be used for age estimation, with the dental method being more accurate than the skeletal method in our population.
Keywords: Age assessment, Bjork, Demirjian method, Grave, and Brown method
|How to cite this article:|
Afroz MM, Tejasvi A, Shenai P, Chatra L, Avinash C K. Age assessment by dental and skeletal maturity pattern: A cross-sectional study. J Datta Meghe Inst Med Sci Univ 2022;17:657-61
| Introduction|| |
Estimation of age has gained a lot of importance in recent years due to various reasons such as medico-legal purposes where age acts as a deciding factor for the degree of punishment, monetary pension payments to name a few. The importance of age assessment in a living person has gained importance and hence the radiographic method. Various teeth show maturation at different stages, which can be seen on radiographs by which age can be assessed. This has led to the development of the method described by Demirjian et al. who have given scoring criteria in 1973 based on the maturation stages of 7 teeth. The other modality that has gained a lot of importance is the skeletal maturation pattern of the hand and wrist, which show maturation and ossification at an estimated age and can be effectively used till the age of 18 years.
The main objectives of the study were to explore the feasibility of using dental age estimation in the Mangalore population and to compare this with the skeletal age estimation and chronologic age.
| Methodology|| |
A prospective study was planned and conducted among the outpatients attending the Department of Oral Medicine and Radiology, Yenepoya Dental College and Hospital, Mangalore for 3 years with 150 samples aged between 10 and 20 years. A standard format was prepared to record the details required for this study. After the study design, the project was presented in front of institutional ethical committee and clearance was taken.
Later immediately, after the individual was selected for the study, patient consent was taken in a prefabricated format. Later individuals were involved in the present study.
Selection of patients
The chronologic age of a patient was calculated from the date of birth to the date when a radiograph was taken. Patients with no abnormality or pathology of the left hand and anyone mandibular quadrant were included in this study.
Methods of collection of data
The patient's dental panoramic and hand-wrist radiographs were obtained and assessed. Dental age is assessed by tooth calcification, as was rated by Demirijian et al., in 1973. Skeletal age is assessed using hand-wrist bone maturity on a radiograph using a Bjork, Grave, and Brown method.
| Ethical clearance|| |
The Institutional Ethics Committee of Yenepoya Dental College and Hospital, Mangalore has approved the Research work proposed to be carried out at Yenepoya Dental College and Hospital. Date : 16th March 2018 with Reference no YENEDC/EC/2018-19/155..
| Results|| |
Correlation of total sample
The chronologic age, dental age, and bone age was assessed using Student's t-test and Spearman's correlation coefficient, using SPSS software (SPSS Inc, Chicago, Illinois, USA) the probability value (P value) obtained in our study is 0.001 indicating the error or success lies within + or –1.
The dental method shows more correlation than the skeletal method in both males and females. Second, males have a higher correlation than females except between the dental and the skeletal method, where females show a higher correlation. The sample was divided into two groups (individuals from 10 years to 16 years and the other from 16 years 1 month to 20 years) as the Demirjian method detects age till 16 years. At the same time, the skeletal method also becomes ineffective in males after 18.5 years and in females from 16 years.
[Table 1] shows a good correlation by both methods with the dental method showing a higher correlation.
|Table 1: Correlation of sample divided into less than and more than 16 years|
Click here to view
[Table 2] shows a chronologic age to dental age estimation in minimum, maximum, mean, and standard deviation.
[Bar Graph 1] shows the mean between the chronologic age and dental age in males and females.
Keeping the sample same as was seen in a dental method for males and females, [Table 3] describes minimum, maximum, mean, and standard deviation of the skeletal method in males and females, respectively.
[Bar Graph 2] shows the mean between chronologic age and skeletal age in males and females.
[Table 4] shows the minimum, maximum, mean, and standard deviation between the dental and the skeletal age in males and females.
[Bar Graph 3] indicates the mean of dental and skeletal age in males and females.
Linear regression equation – Y = B × X + A.
Where A and B are constant.
X = is the obtained dental age using the Demirjian method,
Y = unknown age of the patient.
In males ≤16 years Linear regression equation is,
Y = 0. 791 × obtained dental age + 2.689.
E.g., Y = 0.791 × 13 + 2.689 = 12.972 years. Patient actual age is 13.2 years.
In males >16 years to 20 years the linear regression coefficient,
Y = 8.485 × obtained dental age + (−117.071).
−ve value equation is obtained as the age becomes constant after 16 years in males using the Demirjian method, hence this method is inadequate for individuals above 16 years.
In the case of females ≤16 years,
Y = 0.674 × obtained dental age + 4.093
For example, 0. 674 × 13. 7 + 4. 093 = 13. 3268 or 1 month variation.
Patients' actual age is 13.1 years,
In the case of females >16 years to 20 years,
Y = 2.061 × obtained dental age + (−14.373).
−ve equation is obtained as the age becomes constant after 16 years in females using the Demirjian method, hence this method is inadequate for individuals >16 years.
Chronologic age to skeletal age
Linear regression coefficient in males up to 16 years of age,
Y = 0.750 × obtained skeletal age + 3.590,
For example, Y = 0.750 × 12 + 3.590 = 12. 59 (patient actual age is 13.8 years).
Linear regression coefficient in males >16 years,
Y = (−0.165) × obtained skeletal age + 21.568.
Linear Regression Coefficient in females ≤16 years of age,
Y = 0.459 × obtained skeletal age + 7.131.
For example, Y = 0.459 × 13 + 7.131 = 13. 098.
Patients' actual age is 13.3 years,
Linear regression coefficient in females >16 years of age,
Y = (−0.292) × obtained skeletal age + 23.202.
Our results indicate that the dental method in both males and females is more accurate when compared to the skeletal method in individuals <16 years. This correlation decreases drastically as the age goes over 16 years. In individuals ≤16 years, males have a better correlation than females using the dental method.
| Discussion|| |
An attempt was made in this study to identify the age in individuals who were native of Mangalore. The radiological method is among one of the most reliable methods available for age estimation, which is widely used for both dental and skeletal method. In our study, the dental age was assessed using the Demirjian method, which is widely accepted and has been studied extensively on various populations by many authors.
Demirjian et al. – have introduced a method on the French Canadian population, which is based on the seven mandibular teeth maturation pattern in the year 1973, which was based on estimating dental maturity using seven mandibular teeth from central incisor to the second molar. This method has gained a lot of importance and is very widely followed as more number of teeth means the ability of the method to identify variations based on months. This method has been used by Demirjian later studies of 1976 and 1985 also. This method has an advantage as one can estimate not only the year of an individual but also the month of his/her age. This method does not utilize any specific modification, but only a routine orthopantomography of adequate contrast is sufficient as has been reported by other studies of Liversidge et al., Leurs et al., Meinl et al., Heras et al., Kalinowska et al. who have followed Demirjian method.
Keeping the Demirjian method as many standard authors have successfully developed newer methods of age assessment such as Foti et al. Our study had enrolled 150 individuals aged from 10 years to 20 years. There were an equal number of males and females enrolled, i.e., 75 males and 75 females. There was a high correlation seen between the dental age, chronologic age, and skeletal age to each other suggesting that both dental and skeletal methods have an association to the chronologic age of the patient and hence, both the methods can be used successfully as was seen in other studies done by Krailassiri et al. In our study, dental age and skeletal age were overestimated compared to the chronologic age of an individual, this overestimation was obtained when chronologic age was subtracted from the dental and skeletal age, and a positive result suggested an overestimation. In contrast, a negative result meant an underestimation. This calculation was carried out on the total sample, and the difference which is more commonly obtained is taken. There is a linear regression equation put forth based on our study which closely calculates the chronologic age of an individual in our population and brings the difference between the dental age to chronologic age as 3 months for males, 2 months for females who are ≤16 years, while the difference between dental age to skeletal age is 5 months for boys and 4 months for girls. In individuals >16 years, the equation has a negative value; hence, the age obtained has high variation to the chronologic age. A similar type of linear equations has been put forth by other studies such as Sisman et al. to name a few. It was found in our study that the males showed less variation between the chronological age to the obtained age using the Demirjian method; however, a variation of 5 months was seen. It was also seen that males showed an overestimation of age using both dental and skeletal methods. In females, we have noticed that the dental method overestimates the age while the skeletal method underestimates. Similar data has been noticed by some of the authors in there respective study populations like; Liversidge et al., Leurs et al. In both males and females, the dental method gives more approximate age when compared to the skeletal method. In our study, males mature earlier than females. Similar variations are seen in populations like Meinl et al., Heras et al., Kalinowska et al [Table 5] and [Table 6].
| Conclusion|| |
We have found a good correlation between the chronologic, dental, and skeletal age. The chronologic age of females can be assessed more appropriately by the Demirjian method. The skeletal method also gives a good correlation, and the age variation is equal to that of the dental method. We have found a high positive correlation in individuals who are ≤16 years after which the correlation becomes negative, suggesting the inability of both methods. A linear regression equation is put forth independently for males and females, which can be used to decrease the gap between the chronologic age and obtained ages. Our study can be used effectively in individuals ≤16 years and can be applied in various conditions of the Indian judiciary till the Indian population-specific studies are developed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]