|FORENSIC ODONTOLOGY: ORIGINAL ARTICLE
|Year : 2019 | Volume
| Issue : 4 | Page : 359-362
Age estimation using pulp tooth area ratio in North Indian population
Munish Kumar1, Sweta Choudhary2
1 Department of Oral Medicine and Radiology, SGT University, Gurugram, Haryana, India
2 Department of Pedodontics and Preventive Dentistry, SGT University ,Gurugram, Haryana, India
|Date of Submission||10-Aug-2019|
|Date of Acceptance||19-Nov-2019|
|Date of Web Publication||03-Mar-2020|
Dr. Munish Kumar
183, Jagat Colony, Bhiwani, Haryana - 127 021
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: One of the most common dental expert advice asked by the law enforcing agencies is to provide identity and age of the accused or person involved. Age determination is done for various causes including that of dead bodies for reasons as unlawful cases and also in badly disfigured bodies in disasters, such as natural calamities or manmade like fires, accidents, etc., In living individual, the age estimation is done to crosscheck whether an individual has attained the age for lawful liability when records are not available or suspected. Materials and Methods: Study was done on 300 individuals (150 males-females each) using RVG of Right maxillary canine and data is processed by AutoCAD 2006. Results: Intraclass correlation coefficients (r) for reliability of predicted age calculated have significant P value (<0.05). Discussion: The purpose of this study was to validate the Modified Cameriere's method of age estimation using pulp tooth area ratio given by Jeevan et al. on North Indian population. Conclusion: We can conclude from this study that AutoCAD is definitely a tool for measurements of pulp/tooth area ratio which can further be used for age estimation in forensic odontology; Gender has no significant influence on age estimation..
Keywords: Age estimation, North Indian, pulp tooth area ratio
|How to cite this article:|
Kumar M, Choudhary S. Age estimation using pulp tooth area ratio in North Indian population. J Indian Acad Oral Med Radiol 2019;31:359-62
|How to cite this URL:|
Kumar M, Choudhary S. Age estimation using pulp tooth area ratio in North Indian population. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2020 Jul 2];31:359-62. Available from: http://www.jiaomr.in/text.asp?2019/31/4/359/279852
| Introduction|| |
Forensic odontology an integral department of dentistry which is intended for the handling, examination and evaluation of evidences generated by dental structures, which are to be then evaluated, tabulated, and presented to jurisprudence. Forensic dentists compare surviving teeth with dental records or look for distinctive marks left on teeth by a person's lifestyle. The forensic odontology is reliable with the following disciplines: Age determination, Sex determination, Bite mark analysis, Lip print analysis, periodontal identification, etc.
It is established fact that age estimation could be done with the dental evidence as the teeth are the most durable organs, and humankind's history and evolution rely mostly on dental evidence found in fossils. Teeth can persist even longer after other skeletal structures have decomposed or destruction by some other calamites, such as fire, etc.
Traditional methods such Gustafson's and Johanson's dental age estimation require tooth extraction and processing., While extracting normal healthy teeth, unless indicated, is unethical and not practical in living individuals, it may also not permitted even in the deceased when preservation of human remains is deemed essential for a variety of legal and cultural reasons; on the other hand tooth processing has the added disadvantage that it necessitates destruction of dental evidentiary material thereby creating a huge lacunae in age estimation on practical and clinical grounds and requiring a promising new method.
Hence one of the non-destructive and simple method is radiography as radiographs of teeth doesn't requires tooth extraction or processing; in post-mortem scenarios also, teeth can be easily radiographed using X ray machines which are readily available in most mortuary. Eventually, dental radiography is also applicable to the living owing to minimum radiation exposure as compared to other whole body radiographic examination such as CT scan etc.
Roberto Cameriere et al. in 2004 introduced the method of age estimation using pulp/tooth area ratio and AutoCAD 2000 software at the international level and later in South Indian population the same was applied by Jeevan et al. 2010 with Adobe photoshop CS3 and concluding that it gives more acceptable results.
Therefore, the primary purpose of this research was to verify if a modified Cameriere et al. formula given by Jeevan et al. is valid in north Indian population. We designed a study consisting of 300 subjects (equally divided males and females 150 each) of North Indian population in the age group of 15–45 year so as to compare and assess the age of an individual by pulp/tooth area ratio using AutoCAD.
| Materials and Methods|| |
A total of 300 Intraoral periapical radiographs, with the required radiation protection measures have been taken namely lead apron and thyroid collar as per ALARA principle by paralleling cone technique on RVG having advantages of reduced exposure with added benefits of adjustment of contrast, etc., Radiographic images were saved in a digital format (JPEG format) which is a standard and universally accepted by all the software. The saved JPEG format images of maxillary canines radiographs were processed using Auto CAD (Autodesk Inc., San Rafael, USA) to calculate the pulp/tooth area ratio which is a numerical variable obtained by dividing the surface area of pulp to tooth.
The areas of Maxillary canine tooth and the pulp were calculated using the command “area” in the AutoCAD software with 20 predesignated points for tooth surface outline and 10 for pulp in coronal and radicular portion outline.
The ratio derived used to calculate the predicted age using the formula as given by Jeevan et al. i.e. age = 96.795- 513.561× (p/t area ratio) for maxillary canine. The chronological/actual age was recorded as in the record or told by the patient. The age is then rounded off to the nearest number as per standard protocols.
For every radiograph, 2 measurements were done (one for pulp area and one for tooth) by AutoCAD. All measurements were carried out by the single observer and data collected and thus tabulated, recorded, and then subjected to statistical analysis.
Some radiographs predict age with a greater variance from the actual age as while doing the measurements there were some difficulties in outlining the pulp surface because of irregular or double pulp chambers, thus the pulp area measured was not accurate. Hence, those were excluded in accordance to observations of Jeevan et al., thus a total of 16 individuals (10 males and 6 females) were excluded from the study.
| Results|| |
To assess the reliability of morphological variables derived, statistical analysis was done with Intraclass correlation coefficients [ICC] as it is a descriptive statistics that can be used when quantitative measurements are made on units that are organized into groups. It describes how strongly units in the same group resemble each other.
The numerical variables derived, age, and the subject's gender were entered in Microsoft 2007 EXCEL spread sheet (Master chart). The Intraclass correlation coefficients (ICC) were evaluated between age and predictive variables and any difference in the morphologic variables in relation to gender. Statistical analysis was performed with Statistical Package for the Social Sciences software (SPSS version 16). Overall, all individual morphological values had statistically significant correlation with actual age. (P < 0.05)
Graph depicts actual versus predicted age by AutoCAD showing the data fits reasonably well with only few observations outside the boundary.
| Discussion|| |
The pulp/tooth area ratio which is a numerical variable obtained by dividing the surface area of pulp to tooth calculated by measuring the surface area of the outline of pulp in coronal and radicular portion and tooth on the radiograph. Assessment of pulp/tooth area ratio, in particular, is an indirect measurements of secondary dentine deposited. Secondary dentine has been preferred since it is encased not only by harder tissue such as enamel and cementum, but also by primary dentine. Past studies had demonstrated that the amount of secondary dentine deposited is correlated with chronological age of an individual and can be calculated using radiographic technique in forensic odontology. In order to reduce the effect of possible variation due to magnification and angulations while taking radiographs, the ratio between the tooth and pulp measurements were calculated and used for analyzing in this study.
Dehghani, Mahdieh et al. conducted Age estimation by canines' pulp/tooth ratio in an Iranian population using digital panoramic radiography in 2018 using AutoCAD software on maxillary and mandibular canines and concluded that the pulp/tooth area ratios of canines are a reliable method for age estimation in Iranians. The pulp/tooth area ratio of upper canine was better correlated with chronological age than that of lower canine.
Considering the above fact the study was taken up using pulp/tooth area ratio for age estimation in North Indian population and to assess whether results are accurate or subjected to simulate the same as done by M.B. Jeevan et al. therefore we included 300 individuals [Table 1]a equally divided males and females [Table 1]b as compared to M.B. Jeevan et al. who had 240 individuals. The age range of the present study included between 15 and 45 years divided into two groups i.e. Group 1–15 to 30 years and Group 2–31 to 45 years, as stated by M.B. Jeevan et al. that the modified R. Cameriere's equations derived for Indian population were better able to predict the age in younger ages, i.e. up to 45 years.
After taking informed/written consent a total of 300 radiographs of canine as discussed earlier were made, analyzed, and processed. While some radiographs predicts age with a greater variance from the actual age as while doing the measurements there were some difficulties in outlining the pulp surface because of irregular or double pulp chamber, thus the pulp area measured was not accurate. Hence those were excluded in accordance to observations of Jeevan et al., thus a total of 16 individuals (10 males and 6 females) were excluded [Table 1]b.
We analyzed maxillary canine, for standardization (Right side i.e. 13) were used for age estimation as stated by Kvaal et al. 1995, that there were no significant differences between permanent teeth from the left and right side of the jaw.
Intra oral periapical-radiographs were taken using RVG similar to the M.B. Jeevan et al. as RVG - digital radiovisiography is one of the promising radiographic imaging modality in dentistry equipped with image processing and analysis software. Having added advantage of digital technology is reduced radiation exposure to the patient compared with classic X-ray using film-based system.
RVG with paralleling technique using XCP #2 RVG holder (blue color coded) was used for making radiographs as the long cone/paralleling technique provides periapical radiographs with minimum distortion, magnification and also standardization of the procedure with repeatability of the same. Added advantages are reducing back scattered radiation and further reducing the patient exposure. After making radiographs, Images were saved as JPEG files using highest available resolution as this format is universally accepted and processed by different software for the area measurements and age estimations.
Radiographic images of maxillary canine were then transferred to the software and processed using the AutoCAD 2006 and result data were noted down [Figure 1]. Figure is showing the Pulp and tooth area measurements separately.
|Figure 1: Tooth (a) and Pulp (b) area measurements separately using AutoCAD|
Click here to view
As previously stated measurements of the tooth and pulp outline are used to calculate the pulp/tooth area ratio which is a numerical variable obtained by dividing the surface area of pulp to tooth calculated. Then to determine the age the formula as given by Jeevan et al. i.e. Age = 96.795- 513.561× (p/t area ratio) is used where “p” is pulp area and “t” is tooth area calculated by using AutoCAD on the radiographic image.
The chronological/actual age was recorded as in the record or told by the patient. The age is then rounded off to the nearest number as per standard protocols.
Intraclass correlation coefficient was obtained and revealed that values which are close to 1 are highly significant as it was giving a picture of correlation of predicted age as accurate to actual age.
[Table 2] shows that even in both group 1 and 2 P value is highly significant; this shows that no is no difference in age estimation among the groups of age pertaining to 15–45 years.
The present study showed that there is no influence of gender on the area ratio of canines [Table 3]. This result was in accordance to studies R. Cameriere's et al., 6, ,, and Jeevan et al. This may be because pulp is surrounded by dentin and external influences like masticatory forces, attrition, abrasions etc., may have minimal influences on the pulp area in both males and females.
[Table 4] depicts Intraclass correlation coefficients (r) for reliability of predicted age calculated using maxillary canine separately compared with constant variable i.e. Actual age (r = 1.000). All the 'r' values of maxilla of both gender using AutoCAD 2006 have significant P value (<0.05) and can be used for age estimation.
|Table 4: Predicted age calculated from the measurements done on maxillary canines by the AutoCAD on total sample size|
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Additionally, the value for mean residual age predicted for AutoCAD 2006 is 3.36 year. As in forensics we can't predicts the exact age of an individual, age predicted is always given in a range from positive to negative value. Hence closer the predicted age better is the predilection and better is the method/software used.
| Conclusion|| |
We can conclude from this study that AutoCAD is definitely a tool for measurements of pulp/tooth area ratio which can further be used for age estimation in forensic odontology; Gender has no significant influence on the measurements of the pulp/tooth area ratio and its correlation with age.
The formula given by Jeevan et al. i.e. age = 96.795 – 513.561× (p/t area ratio) given after applying the study on south Indian population for maxillary canine is applicable in North Indian population. Further research should aim at involving larger samples which include varying geographic regions and also involving the newer 3D imaging protocols like CBCT can be used for future aspect of age estimation.
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]