|Year : 2015 | Volume
| Issue : 4 | Page : 319-323
Evaluation of the accuracy of Demirjian method for estimation of dental age among 6-12 years of children in Navi Mumbai: A radiographic study
Rahul J Hegde, Sumedh Suhas Khare, Tanvi A Saraf, Sonal Trivedi, Sonal Naidu
Department of Pedodontics and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India
|Date of Web Publication||18-Sep-2015|
Dr. Rahul J Hegde
Bharati Vidyapeeth Dental College and Hospital, Sector-7, C.B.D. Belpada, Navi Mumbai - 400 614, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Dental formation is superior to eruption as a method of dental age (DA) assessment. Eruption is only a brief occurrence, whereas formation may be related at different chronologic age levels, thereby providing a precise index for determining DA. The study was designed to determine the nature of inter-relationship between chronologic and DA. Materials and Methods: Age estimation depending upon tooth formation was done by Demirjian method and accuracy of Demirjian method was also evaluated. The sample for the study consisted of 197 children of Navi Mumbai. Results: Significant positive correlation was found between chronologic age and DA that is, (r = 0.995), (P < 0.0001) for boys and (r = 0.995), (P < 0.0001) for girls. When age estimation was done by Demirjian method, mean the difference between true age (chronologic age) and assessed (DA) was 2 days for boys and 37 days for girls. Demirjian method showed high accuracy when applied to Navi Mumbai (Maharashtra - India) population. Conclusion: Demirjian method showed high accuracy when applied to Navi Mumbai (Maharashtra - India) population.
Keywords: Chronological age, Demirjian method, dental age
|How to cite this article:|
Hegde RJ, Khare SS, Saraf TA, Trivedi S, Naidu S. Evaluation of the accuracy of Demirjian method for estimation of dental age among 6-12 years of children in Navi Mumbai: A radiographic study. J Indian Soc Pedod Prev Dent 2015;33:319-23
|How to cite this URL:|
Hegde RJ, Khare SS, Saraf TA, Trivedi S, Naidu S. Evaluation of the accuracy of Demirjian method for estimation of dental age among 6-12 years of children in Navi Mumbai: A radiographic study. J Indian Soc Pedod Prev Dent [serial online] 2015 [cited 2020 Mar 29];33:319-23. Available from: http://www.jisppd.com/text.asp?2015/33/4/319/165693
| Introduction|| |
During the complex and dynamic process of growth, the systems in a child's body pass through a series of multiple changes eventually arriving at a maturity state. Dental development is one of these systems. Dental development is associated with the rate at which general maturation occurs. It too shows great variability among the population. Therefore, chronological age (CA) is not a very precise method of judging maturity. 
Eruption and calcification of dental tissues has been used to determine dental age (DA). Eruption represents the progressive emergence of tooth from its alveolus into functional occlusion whereas calcification represents stage sequence of tooth development from the first appearance of cusp or cusps to root apical closure. 
DA may be accessed by tooth eruption dates or by the progress of tooth calcification of a single tooth or a group of teeth. The limitations to use of tooth eruption are; it is altered by local factors such as lack of space, premature loss of primary teeth, crowding of permanent teeth, and decayed teeth, it is altered by systemic factors like nutritional factors, they cannot be applied between ages of 3 to 6 and beyond 13, it is dependent upon on the timing of observation and when determined longitudinally, it is dependent on time span between observations, it is a discontinuous process, that is, the time of emergence of third molars show a large variation and is absent in 29% of population. 
The dental formation is superior to eruption as a method of DA assessment. Eruption is only a brief occurrence, whereas formation may be related at different chronologic age levels, thereby providing a precise index for determining DA. 
Demirjian et al. introduced a new method for estimating dental maturity or DA, by reference to the radiological appearance of seven teeth on left side of the mandible using panoramic radiographs. 
Aim and objective
- To evaluate nature of inter-relationship between chronologic age and DA.
- DA determination from orthopantomograph using Demirjian method.
- To evaluate the accuracy of Demirjian's method for estimation of CA based on tooth formation when applied to Navi Mumbai boys and girls.
| Materials and Methods|| |
The present study was conducted in the outpatient department of Pedodontics and Preventive Dentistry in Bharati Vidyapeeth Deemed University Dental College and hospital, Navi Mumbai. A large population was surveyed and after following inclusion and exclusion criteria 197 children with 115 boys and 82 girls who were selected randomly for the present study from the age group of 6 to 12 years.
Demirjian system utilizes a technique of panoramic radiographs; weight scores are assigned to each of seven left mandibular teeth. 8 stages of development, from calcification of the tip of the cusp to the closure of the apex, were designed 0 (from no calcification) and by letters corresponding to eight stages. Letters rather than numbers were selected so as not to leave the false impression that each stage is equidistant from the others.
The criteria for selection of cases for the present study were as follows:
- Children of either gender aged between 6 and 12 years.
- Childs parent willing to give written informed consent.
- Children who were clinically free from any developmental, endocrine or nutritional disorder were selected in this study as this could affect the development of a subject.
- Children were also clinically free from any past prolonged illness.
- Children with their chronologic birth records.
- Patients with evidence of systemic disease.
- Children with history of extraction of permanent teeth should were not considered in the study.
DA assessment was done by Demirjian methods. 
| Results|| |
[Table 1] shows the distribution of a total number of boys and girls in all the age groups from 6 to 12 years and their respective percentages.
[Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10] shows mean, standard deviation, mean difference and T value of true and assessed age for 6-12 years.
|Table 2: True (chronological) and assessed (dental) age in boys and girls|
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|Table 10: Correlation of true (chronological) and assessed (dental) age in boys and girls|
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[Table 11] correlation of true (chronological) and assessed (dental) age in age groups.
|Table 11: Correlation of true (chronological) and assessed (dental) age in age groups|
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| Discussion|| |
Tooth formation (calcification) is superior to tooth emergence because emergence of a tooth is a fleeting event, and its precise time is very difficult to determine, whereas calcification is a continuous process that can be assessed by permanent records such as X-ray films. The emergence of a tooth is disturbed by different exogenous factors such as infection or premature extraction, crowding, ankylosis, etc. Furthermore, if clinical emergence is used as the criterion for DA assessment, it can only be applied up to the age of 30 months (completion of deciduous dentition) and after the age of 6 years (eruption of the first molar) till approximately 12 years of age (last permanent tooth emergence) excluding third molars.
Thus, we see that it is impossible, with emergence data alone, to assess the dental maturity of the child between 2 and 6 years and after 12 years of age. The third molar is not taken into consideration because of inconsistency and great variation in the timing of its emergence.
Methods for the determination of a child's growth and development are of great value from both the medical and odontologic points of view. Although various methods for the age determination do exist, a universal system has not been achieved due to the varying differences in different ethnic population groups. 
Demirjian's method of DA estimation was proposed nearly four decades ago and ever since it has emerged as the most widely researched and applied technique in DA estimation of children and adolescents. This is mainly because of the simplicity of the method, as well as radiographic and schematic illustrations of the tooth development and accompanying description, which the original and the subsequent works provided. 
A radiological examination of the development and mineralization of teeth gives substantially more information, however, and has been shown to correspond well with CA. Different types of radiography with several methods of estimating CA based on tooth formation have been devised namely; oblique jaw radiography (Lewis and Garn 1957),  intraoral radiography, , orthopantomography (Haavikko 1970,  Sapoka and Demirjian 1971  ). Only Nolla (1960), Nanda and Chawla (1966), Haavikko (1970) investigated mineralization of all permanent teeth. However, to study every tooth is prohibitively time-consuming and expensive and involves certain technical difficulty as well. Demirjian system utilizes technique of panoramic radiograph as they are easier to take than intraoral radiographs in young or nervous children they give less radiation for a full mouth radiograph and the picture of the mandibular region is little distorted. Though there is 5-10 % enlargement on the left side of the radiograph, this is not a serious drawback as the rating of Demirjian system is based on shape criteria and relative values rather than absolute length.
Various studies have been conducted to prove the validity of this method. Hagg and Mattson found high accuracy and precision in the method of age estimation in Swedish children.  Hegde and Sood checked the applicability of Demirjian method of age assessment in Belgaum children and concluded that this method of age assessment showed high accuracy when applied to Belgaum children.  However, Liversidge et al. found more advanced dental development in British children.  Eid et al. also found overestimation of DA in Brazilian children compared to the French-Canadian sample.  Koshy and Tandon found that this method was over estimating in South Indian children.  Prabhakar et al. checked the applicability of Demirjian's method in children of Davanagere (Karnataka) and found that children of Davanagere were dentally more advanced.  Numerous researches have shown that tooth development has variations among populations and these differences not just exist between several worldwide ethnic groups, but even in between cities in the same country. ,,
To the human biologist, the study of development of the dentition adds another dimension to the growing body of knowledge of human growth and development. Dental maturity should be considered along with skeletal development and stature as a major component of the developing physiological unit. To the pedodontist, the development life of individual teeth may be of prime importance, but they need a method of evaluating the overall development status of the mouth being treated - this is provided by dental maturity measure. 
| Conclusion|| |
Evaluation of nature of inter-relationship between chronologic age and DA was done in the study. DA determination from orthopantomograph using Demirjian method was done and this method showed high accuracy when applied to Navi Mumbai (Maharashtra - India) population.
Based on this study, the following conclusions were drawn:
- Significant positive correlation was found between chronologic age and DA that is, (r = 0.995), (P < 0.0001) for boys and (r = 0.995), (P < 0.0001) for girls.
- When age estimation was done by Demirjian method, mean the difference between true age (chronologic age) and assessed (DA) was 2 days for boys and 37 days for girls.
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], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11]