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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 30  |  Issue : 3  |  Page : 281-285

Age estimation using comprehensive chart for dental age estimation in Haryana population: A pilot study


1 Department of Oral Medicine and Radiology, GDC Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
2 Department of Genetics, Maharshi Dayanand University, Rohtak, Haryana, India
3 Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India

Date of Submission30-Jun-2018
Date of Acceptance26-Aug-2018
Date of Web Publication18-Oct-2018

Correspondence Address:
Dr. Cheena Singh
Officers Colony, House No. 10, Type 5, Near Agro Mall, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_112_18

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   Abstract 


Background: Dental age estimation by radiographic methods for forensic rationale is routinely applied to serve the judicial system. Of these, Demirjian system is most widely used, but its applicability in the Indian population, specifically Haryana population, is still lacking. Aim and Objective: This is a pilot study to evaluate Demirjian method in Haryana population using a comprehensive chart for dental age estimation (DAEcc) and establish a correlation between the chronological age (CA) and estimated age. Materials and Methods: Sample comprised 100 subjects (49 males and 51 females) 7–16 years of age. Orthopantomograms of these patients were traced and evaluated for Demirjian dental age computation using DAEcc and compared with CA. Results: A positive correlation was observed between CA and estimated age (R2 = 0.82 in males, R2 = 0.78 in females, and R2 = 0.80 in combined population). The paired t-test between CA and estimated age demonstrated that Demirjian method underestimates the dental age by 5.1 months, that is, 153 days in males (P = 0.04) and by 7.9 months, that is, 237 days in females (P = 0.01). There was an overall underestimation by 6.3 months (P = 0.001) in the entire study population. Conclusion: This pilot study supports the applicability of Demirjian method for age estimation in Haryana population and paves way for further studies in a larger sample in the same population to accurately establish the association between CA and dental age.

Keywords: Age estimation, chronological age, Demirjian method, dental age


How to cite this article:
Singh C, Singal K, Kapoor P. Age estimation using comprehensive chart for dental age estimation in Haryana population: A pilot study. J Indian Acad Oral Med Radiol 2018;30:281-5

How to cite this URL:
Singh C, Singal K, Kapoor P. Age estimation using comprehensive chart for dental age estimation in Haryana population: A pilot study. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2019 Jun 25];30:281-5. Available from: http://www.jiaomr.in/text.asp?2018/30/3/281/243647




   Introduction Top


Federation dentaire Internationale defines forensic odontology as “that branch of dentistry which, in the interest of justice, deals with the proper handling of dental evidence, and with proper evaluation and presentation of dental findings.” There are various applications of forensic odontology, and one of them is age estimation in neonates, adolescent, and adult. Dental age estimation (DAE) in adults plays an important role in forensic odontology. Nowadays in India, age estimation of an adult has been an archaic exercise. However, age estimation can be done in various cases including juvenile crime, sexual assault, and domestic disputes.[1],[2] An internationally known newspaper the “Times of India” (dated September 11, 2015) highlighted the need for determination of exact chronological age (CA) of players by means other than birth certificate.[3],[4] A viable alternative for the estimation of age is DAE method and the establishment of its correlation with CA of the individual.[5]

The method of DAE is simple, user-friendly, and a less time-consuming method which can be easily applied by undergraduate students. The techniques routinely used for DAE are based on emergence and eruption sequence of the teeth, or by developmental stage analysis using orthopantomogram (OPG) or Panorex.[6],[7] Demirjian method is one nondestructive radiographic strategy which was at first conducted in 1973 using OPGs for assessing the age of children and adolescents by measurement of the apical opening of the mandibular teeth. It is considered to be the best method and gold standard because it is less prone to intraobserver error.[8],[9],[10] A number of studies on different population and different ethnic groups were conducted using this method.[11],[12]

This study was conducted in Haryana population with the aim to check the applicability of Demirjian method. The purpose of this study is to derive a method of estimating overall dental maturity or dental age by observing the stage of development of each tooth. The study is conducted over child population in Haryana and it is a pioneer study.

Aims

The study was aimed to evaluate Demirjian method using a comprehensive chart for dental age estimation (DAEcc) and to establish a correlation between CA and estimated age in Haryana population.


   Materials and Methods Top


Sample collection

This study was conducted with an aim to assess dental age using DAEcc and to establish a correlation between CA and estimated age. A total sample of 100 panoramic radiographs (49 males and 51 females) were collected and evacuated within age ranging from 7 to 16 years. Each subject who participated in the study was briefed about the purpose of the study, and a written informed consent was obtained. Relevant data were collected and performa was filled. Study proposal was approved by the Institutional Human Ethical Committee, PDIDS Rohtak. The following inclusion and exclusion criteria were considered.

Inclusion criteria

  • Age ranging from 7 to 16 years
  • Orthodontic treatment
  • Good oral hygiene.


Exclusion criteria

  • Any patients undergoing treatment from a psychiatrist for psychological disorders
  • Full denture wearer
  • Patients with ankylosis
  • Agenesis of teeth/any congenital anomalies
  • Poor quality/image artifacts of panoramic radiographs
  • Subjects with a history of third molar extraction.


Materials

The study group comprised 100 OPGs, 51 were females and 49 were males, with age ranging from 7 to 16 years.

Armamentarium

  1. Panorex (printed film)
  2. DAEcc
  3. REGE-LED view box
  4. Tracing sheets
  5. Sharpened lead pencil (Camel)
  6. Camel eraser.


Methodology

  • Using REGE-LED view box, tracings of 100 panoramic radiographs (only seven permanent left mandibular teeth 31–37) were done on tracing paper to see the calcification stages of the seven permanent left mandibular teeth [Figure 1], [Figure 2], [Figure 3], [Figure 4]
  • Comparison of traced teeth was done with DAEcc to identify the correct stage, assign the corresponding score, and finally calculate the total score for subsequent dental age assessment, that is, estimated age [Figure 5]
  • Data were recorded, analyzed, and sent for statistical analysis for results.
Figure 1: OPG film placed on viewer box

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Figure 2: Tracing paper irt 31–37 placed over OPG film

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Figure 3: Traced OPG

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Figure 4: Traced paper showing all the scores irt 31–37 as well as calculated age and estimated age

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Figure 5: Comprehensive chart for dental age estimation. (Image taken from the sources have been obtained with a due permission)

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   Results Top


The study sample consisted of 100 subjects (49 males and 51 females) with age range of 7–16 years [Figure 6]. T-tests were used to assess the difference between CA and estimated age [Table 1]. There were no significant differences between the two age categories when the whole sample was analyzed (P = 0.298). A strong correlation was found between CA and estimated dental age [Table 2]. The R value is 0.655 which represents the simple correlation and, therefore, indicates a high degree of correlation. Chronological age can be explained by the Independent variable, Estimated age using the Demerijians method. In this case, 42.9% can be explained, which is very large [Table 3]a. Also, the regression model predicts the outcome variable significantly well. This indicates the statistical significance of the regression model that was applied. Here, P < 0.0005 which is less than 0.05 and indicates that, overall, the model applied is significantly good enough in predicting the outcome variable [Table 3]b. There was no significant difference between Chronological Age (in years) and Estimated age using the Demerijians method (in years) [Figure 7]. Pearson's correlations revealed strong positive associations between dental and CA [Figure 8].
Figure 6: Gender-wise sample distribution

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Table 1: Frequency and percentage of study samples

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Table 2: Comparison of chronological age and estimated dental age using paired t-test

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Figure 7: Graphical representation of mean chronological age and mean estimated age using Demirjian method

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Figure 8: Scatter plot between chronological age and estimated age (R2 = 0.429)

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R2 value indicates how much of the dependent variable, CA, can be explained by the independent variable, estimated age, using Demirjian method. In this case, 42.9% can be explained, which is very large [Table 4]. Regression model predicts the outcome variable significantly well. This indicates the statistical significance of the regression model that was applied. Here, P < 0.0005 which is less than 0.05 and indicates that overall, the model applied is significantly good enough in predicting the outcome variable [Table 5]. The table of coefficients provides us with information on each predictor variable and necessary information to predict CA from estimated age [Table 6].
Table 4: Regression statistics for the whole sample

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Table 5: Regression model for the whole study sample

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Table 6: Showing table of Coefficients

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   Discussion Top


Tooth eruption and tooth calcification are the two occasions that can be used to quantify dental age in kids and teenagers. The strategy by Demirjian et al. is the most profoundly suggested and created of all dental age studies.[13] Numerous examinations have explored the precision of Demirjian's strategy and their outcomes shift. A few creators found that Demirjian's strategy was precise on the contemplated population, while others featured different impediments of the technique.[14],[15] Consequently, this technique was evaluated by Griffin and Malan with accentuation on its conceivable legal utilize and delivered that this simple method can be used as a part of age estimation in the field of forensic dentistry due to its less error rate.[16],[17]

Literature shows DAE using Demirjian strategy in Northeastern Turkish children, Malay population, Western Chinese children, Malaysian children, Belgaum population, and Lucknow children.[18],[19],[20],[21]

This study was conducted with the aim and objective to assess the dental age using OPGs in Haryana population and to compare the CA of the individual with dental age using Demirjian method. The study included 49 males and 51 females. A strong correlation was found between CA and estimated dental age in this study, which in accordance with outcomes of the other studies conducted by different researchers.[18],[19],[20],[21]

Higher R-value shows a significant correlation. Regression statistics and regression model indicate a higher degree of correlation between the independent variable with estimated age. In any case, our investigation approves the utilization of Demirjian framework in North Indian population. The condensed DAEcc as demonstrated in our examination is less tedious and is anything but difficult to translate, consequently making it a potential device for measurable age estimation in a vast example of North Indian population in future investigations.


   Conclusion Top


In the light of the finding of this study, it can be concluded that in the evaluation of dental age, the phase of calcification can be a solid marker as the teeth logically calcify with unequivocal age. It is based on the substantial development of teeth and is the nondestructive approach forage estimation in children. The sensibly great outcomes acquired in this study declare the utilization of Demirjian's 8 teeth strategy in Haryana Population. It is a beneficial method to apply the Indian equations locally inside particular areas, but in huge examples, and furthermore test the strategy on population-specific tests in genuine measurable situations where all-encompassing radiographs are available. This would in future prompt the advancement of the provincial database in different populations.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the parents of minors have given their consent on the behalf of their children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Muller-Bolla M, Lupi-Pégurier L, Quatrehomme G, Velly AM, Bolla M. Age Estimation from Teeth in Children and Adolescents. J Forensic Sci 2003;48:1-9.  Back to cited text no. 4
    
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Sushil NB, Patil N, Swapnil N, Kamble D, Seema D, Tushar M, et al. Reliability of Third Molar Development for Age Estimation by Radiographic Examination (Demirjian's Method). J Clin Diagn Res 2014;8:ZC25-8.  Back to cited text no. 14
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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