|FORENSIC ODONTOLOGY: ORIGINAL ARTICLE
|Year : 2018 | Volume
| Issue : 1 | Page : 64-67
Tooth coronal index: Key for age estimation on digital panoramic radiographs
Ravleen Nagi1, Supreet Jain1, Priyanka Agrawal2, Swati Prasad3, Sumit Tiwari4, Giridhar S Naidu1
1 Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
2 Department of Oral Medicine and Radiology, Ekta Hospital, Kondagoan, Chhattisgarh, India
3 Department of Oral Medicine and Radiology, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
4 Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
|Date of Submission||23-Dec-2017|
|Date of Acceptance||17-Feb-2018|
|Date of Web Publication||23-Apr-2018|
Dr. Ravleen Nagi
Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Assessment of age through teeth is one of the most reliable and simple method than skeletal remains, to calculate age of an individual. Objectives: The study was carried out with an aim to evaluate reliability of dental age assessment through tooth coronal index (TCI) method. Materials and Methods: The digital panoramic radiographs of 100 subjects of Chhattisgarh aged 20–70 years were selected for the study. The measurements were performed on the JPEG images of selected panoramic radiographs by using Adobe Acrobat 7.0 professional software. The height of the crown, i.e., coronal height, and the height of the coronal pulp cavity, i.e., coronal pulp cavity height, of mandibular second premolars and first molars were measured in millimeter (mm) and then TCI was calculated for each tooth. Actual age of a subject was compared with TCI of tooth and the acquired data were subjected to Pearson's correlation and unpaired t-tests. Results: Negative correlation was observed between the real age and TCI of mandibular first molar (r = −0.092, P = 0.365) and second premolar (r = −0.168, P = 0.096). Statistically significant difference was observed between real age and TCI for mandibular second premolar and first molar (P = 0.000) by unpaired t-test. Conclusion: TCI has the potential to estimate age of an individual on dental radiographs. It is simple, cost effective than histological methods and can be applied to both living and unknown dead.
Keywords: Age estimation, panoramic radiograph, tooth coronal index
|How to cite this article:|
Nagi R, Jain S, Agrawal P, Prasad S, Tiwari S, Naidu GS. Tooth coronal index: Key for age estimation on digital panoramic radiographs. J Indian Acad Oral Med Radiol 2018;30:64-7
|How to cite this URL:|
Nagi R, Jain S, Agrawal P, Prasad S, Tiwari S, Naidu GS. Tooth coronal index: Key for age estimation on digital panoramic radiographs. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2021 Nov 30];30:64-7. Available from: https://www.jiaomr.in/text.asp?2018/30/1/64/230886
| Introduction|| |
Forensic odontology is an emerging science that uses teeth for assessment of age of an individual. Accurate age estimation is required for pediatric issues, orthodontic treatments to legal matters, etc. Although skeletal methods could be used for age estimation, but variability of bone maturation is influenced by several environmental factors. Tooth development shows less variability than other developmental features and shows low variability in relation to chronological age. Moreover, dental tissues are more resistant to thermal, chemical, and mechanical stimuli and are less affected by endocrine diseases or nutritional variations than other tissues. Therefore, teeth form a unique and suitable parameter for dental age estimation. Nowadays, they have become important tool for age estimation for both deceased and living person and for medico-legal purposes.,
In children age calculation from teeth is simple and accurate and is based mainly on stages of development and eruption of tooth. In adults various methods have been developed to calculate age from dental tissue and tooth morphology. These methods are classified as: radiologic and morphologic methods. Morphologic methods are sub classified into clinical, histological, and biochemical examination. Radiographic methods are simple, nondestructive, requires comparatively less duration of time, and expertise than morphologic methods.
Several studies have used canine, first premolar, and second premolar on intraoral periapical and panoramic radiograph to estimate dental age as these teeth have good delineation of pulp chamber.,,,, Some studies used mandibular first molar to predict dental age ,, and literature also revealed that only few studies were performed on mandibular second molars to estimate dental age., The present study was undertaken in the Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India with the aim to evaluate reliability of dental age assessment through tooth coronal index (TCI) on digital panoramic radiographs.
| Materials and Methods|| |
A total of 100 digital panoramic radiographs, obtained through SINORA ORTHOPHOS XG Panoramic Machine, were selected for the study from the archives of department based on the inclusion and exclusion criteria. The digital panoramic radiographs of 100 subjects of Chhattisgarh aged 20–70 years were analyzed for the following criteria:
- It should have good contrast and should have no distortion.
- Radiograph should present good image and good morphology of selected tooth with complete root formation, i.e., mandibular second premolar and mandibular first molar.
Digital panoramic radiographs with distorted image, carious/grossly decayed second premolar, molars or periapical pathology, prosthesis, restored selected teeth, missing selected teeth, severely attrited or fractured selected teeth, rotated or malaligned selected teeth, and teeth with any developmental anomalies were excluded from the study.
All 100 panoramic radiographs were subjected to radiographic measurements. They were exported to JPEG image format by using trophy Sidexis, Digital Image and Communications in Medicine (DICOM) software (Dentsply, Sirona). The measurements were performed on these JPEG images by using Adobe Photoshop 7.0 software (Adobe, California). All the measurements were recorded in millimeters (mm).
Measurement of TCI
A straight line (cervical line) was traced from the cemento enamel junction, which is the division between anatomical crown and root. Coronal height (CH) was measured vertically straight from the cervical line to the tip of the highest cusp according to Moss et al. Coronal pulp cavity height (CPCH) was measured vertically from the cervical line to the tip of the highest pulp horn according to Ikeda et al. The measurements provided the TCI of each tooth, which was then calculated as follows [Figure 1], [Figure 2], [Figure 3].
|Figure 1: Panoramic image showing measurements on right mandibular first molar. To calculate TCI, CH was measured vertically (yellow line) straight from the cervical line to the tip of the highest cusp (represented by red line). CPCH was measured (yellow line) vertically from the cervical line to the tip of the highest pulp horn (red line)|
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|Figure 2: Panoramic image showing measurements on right mandibular second premolar to calculate TCI|
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|Figure 3: Schematic representation of measurements taken of a panoramic radiograph for mandibular first molar and second premolar|
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TCI = CPCH × 100/CH
The measurements were displayed in mm along with captured image for further identification and reference. Intra observer measurements of three variables (CH, CPCH, and TCI) were also done. In the present study, mean estimated age by TCI was correlated with the real age of the subject.
The calculated data were entered in a Microsoft Excel spreadsheet. Statistical analysis was done using the statistical analysis software, Statistical Package for the Social Sciences, Version 20.0 (SPSS Inc., Chicago, IL, USA). Pearson's correlation coefficient was applied between the actual age and TCI of mandibular second premolar and first molar. Unpaired t-test was used to compare the difference between the actual age and TCI for both mandibular first molar and second premolar. P value ≤ 0.05 was considered statistically significant.
| Results|| |
Digital panoramic radiographs of 100 subjects were analyzed, and by using TCI, there was negative correlation observed between the real age and TCI of mandibular first molar (r = −0.092, P= 0.365) [Table 1] and second premolar (r = −0.168, P= 0.096) [Table 2]. Using unpaired t-test, statistically significant difference was observed between the mean real age (38.3100 ± 13.30276) and TCI (36.5847 ± 8.34997) for mandibular first molar with a P- value 0.000 [Table 3]. Also, for mandibular second premolar, the difference between TCI (34.1821 ± 7.511759) and mean real age (38.3100 ± 13.30276) was statistically significant (P = 0.000) [Table 4].
|Table 1: Pearson correlation test showing correlation between real age and TCI of mandibular first molar|
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|Table 2: Pearson correlation test showing correlation between real age and TCI of mandibular second premolar|
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|Table 3: Comparison between mean real age and TCIof mandibular second premolar by unpaired t-test|
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|Table 4: Comparison between mean real age and TCIof mandibular first molar by unpaired t-test|
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| Discussion|| |
Determination of age of the individual for administrative, ethical reasons, and medico-legal purposes is one of the most important aspect for the forensic odontologists, and various studies have suggested that dental pulp size decreases with increasing age due to apposition of secondary dentin, thus making secondary dentin apposition as the best method to estimate age even beyond 25 years., “Secondary dentin” is the calcified nontubular substance deposited by the pulp on the walls of the pulp chamber and root canal and it continues throughout the life. As regular secondary dentin is laid down on the pulpal surface of the primary dentin, the pulpal cavity decreases in size with age. It has been reported that this secondary dentin apposition is not uniform all over the pulpal cavity, i.e., in case of molars, it is more over the roof and floor, thus reducing the height rather than width of the pulpal chamber.,
Assessment of age by reduction of secondary dentin apposition can be measured by cross-sections of teeth, using histological and radiological methods. In our study, we used panoramic radiographs because in the same radiograph all the teeth along with alveolar bone in jaws can be measured, they have high reproducibility, digitization, and computerized storage of panoramic radiographs. Moreover, radiographic techniques are less time-consuming, need no extraction, can be applied to both living and dead, and there is no use of specialized equipment. Several studies in the literature used digital panoramic radiographs for assessment of age.,, Paewinsky et al. measured pulp chamber size of six types of teeth on digital panoramic radiographs of individuals aged 14–81 years and found significant correlation between decrease in pulp chamber size with age with r2 highest for maxillary lateral incisors. Talabani et al. measured TCI of 96 mandibular first molars on digital panoramic radiographs and strong negative correlation was observed between TCI and age (r2 = 0.49, P= 0.0000).
Gustafson was the first to introduce secondary dentin measurement method for age estimation. In 1925, Bodecker established the apposition of secondary dentin and correlated it with age. Later, various studies were conducted on periapical and panoramic radiographs using TCI and in these correlation of TCI with dental age was also done. In 1995, Kvaal et al. established significant correlation between TCI for molars and premolars and dental age (r2 = −0.650 to −0.799, P < 0.01). Results of the present study were consistent with the studies by Drusini et al., Igbigbi et al., Talabani et al., Zadzinska et al., and Veera et al., suggesting negative correlation between real age and TCI for both mandibular premolars and molars (P < 0.000), thus emphasizing that the height of pulpal cavity decreases with advancing age.,,,, Talabani et al. in their study found strong negative correlation (r2 = 0.49) between age and TCI for mandibular first molar. Similar results were observed in the studies by Igbigbi and Nyirenda  (r ranged from −0.650 to −0.799) for premolars and molars of Malawians adults, and Veera et al. where TCI values decreased with advancing age (age 21–30 years, premolars: r = −0.945, molars: r = −0.961; and for age 51–60 years, premolars: r = −0.886, molars: r = −0.863).
In the current study, mandibular premolars and molars are mainly preferred to estimate TCI as extent of pulpal chamber is clearly visible in these teeth, which was in accordance with Drusini et al. and Veera et al. Moreover, in our study, correlation was highly negative for mandibular second premolar (−0.168) than first molar (r=−0.0092), indicating second premolar as a more reliable indicator of dental age. Unpaired t-test showed statistically significant difference between real age and TCI of an individual mandibular second premolar and first molar, suggesting TCI as a better indicator of age and findings were comparable to Talabani et al. The results of the present study indicate that TCI is a reliable marker of dental age. Future studies on different population, in different geographical locations, on other teeth should be conducted and should also take into account various environmental, racial, dietary, genetic, and cultural factors.
| Conclusion|| |
Estimation of age using TCI by radiographs is one of the most simple, reliable, and cost-effective methods. From the results of the study, it could be concluded that dental age showed strong negative correlation with TCI, thus emphasizing the decrease of size of pulp cavity with advancing age, but in future studies on different population, in different geographical locations, and on other teeth should be encouraged.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shrestha A, Yadav RP, Shrestha S, Maharjan IK, Camelio S. Measurement of open apices in teeth for estimation of age in children. Health Renaissance 2014;12:33-7.
Nolla C. The development of permanent teeth. J Dent Child 1960;27:254.
Veera SD, Kannabiran J, Suratkal N, Chidananada DB, Gujjar KR, Goli S. Coronal pulp biomarker: A lesser known age estimation modality. J Indian Acad Oral Med Radiol 2014;26:398-404. [Full text]
Shah PH, Venkatesh R. Pulp/tooth ratio of mandibular first and second molars on panoramic radiographs: An aid for forensic age estimation. J Forensic Dent Sci 2016;8:112.
] [Full text]
Jain RK, Rai B. Age estimation from permanent molar's attrition of Haryana population. Indian J Forensic Odontol 2009;2:59-61.
Juneja M, Devi YB, Rakesh N, Juneja S. Age estimation using pulp/tooth area ratio in maxillary canines: A digital image analysis. J Forensic Dent Sci 2014;6:160-5.
] [Full text]
Saxena S. Age estimation of Indian adults from orthopantomographs. Braz Oral Res 2011;25:225-9.
Jeevan MB, Kale AD. Age estimation by pulp/tooth area ratio in canines: Cameriere's method assessed in an Indian sample using radiovisiography. Forensic Sci Int 2011;30:204-9.
Cameriere R, De Luca S, Aleman I, Ferrante L, Cingolani M. Age estimation by pulp/tooth ratio in lower premolars by orthopantomography. Forensic Sci Int 2012;214:105-12.
Mathew DG, Rajesh S, Koshi E, Priya LE, Nair AS, Mohan A. Adult forensic age estimation using mandibular first molar radiographs: A novel technique. J Forensic Dent Sci 2013;5:56-9.
] [Full text]
Talabani RM, Baban MT, Mahmood MA. Age estimation using lower permanent first molars on a panoramic radiograph: A digital image analysis. J For Dent Sci 2015;7:158-62.
Cameriere R, Ferrante L, Cingolani M. Precision and reliability of pulp/tooth area ratio (RA) of second molar as indicator of adult age. J Forensic Sci 2004;49:1319-23.
Moss ML, Chase PS, Hower BI Jr. Comparative odontometry of the permanent post canine dentition of American Whites and Negroes. Am J Phys Anthropol 1967;27:125-42.
Ikeda N, Umetsu K, Kashimura S, Suzuki T, Oumi M. Estimation of age from teeth with their soft X-ray finding. Nihon Hoigaku Zasshi 1985;39:244-50.
Shrestha M. Comparative evaluation of two established age estimation techniques (two histological and radiological) by image analysis software using single tooth. J Forensic Res 2014;5:3-6.
Paewinsky E, Pfeiffer H, Brinkmann B. Quantification of secondary dentine formation from orthopantomograms–a contribution to forensic age estimation methods in adults. Int J Legal Med 2005;119:27-30.
Gustafson G. Age determination from teeth. J Am Dent Assoc 1950;41:45-54.
Drusini AG. The coronal pulp cavity index: A forensic tool for age determination in human adults. Cuad Med Forense 2008;14:235-49.
Kvaal SI, Kolltveit KM, Thomsen IO, Solheim T. Age estimation of adults from dental radiographs. Forensic Sci Int 1995;74:175-85.
Drusini AG, Toso O, Ranzato C. The coronal pulp cavity index: A biomarker for age determination in human adults. Am J Phys Anthropol 1997;103:353-63.
Zadzinska E, Drusini AG, Carrara N. The comparison between two age estimation methods based on human teeth. Anthropol Rev 2000;63:95-101.
Igbibi PS, Nyirenda SK. Age estimation of Malawian adults from dental radiographs. WAJM 2005;24:329-33.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]