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ORIGINAL ARTICLE
Year : 2021  |  Volume : 39  |  Issue : 4  |  Page : 363-368
 

Evaluating the accuracy of two different age estimation methods in growing children in Navi Mumbai using Orthopantomograph: A radiographic study


Department of Pedodontics and Preventive Dentistry, DY Patil University School of Dentistry, Navi Mumbai, Maharashtra, India

Date of Submission23-Jun-2021
Date of Decision06-Oct-2021
Date of Acceptance21-Oct-2021
Date of Web Publication29-Jan-2022

Correspondence Address:
Dr. Kiran Dattatray Ghule
Kasturi Plaza, B-1/435, Manpada Road, Dombivli East, District Thane - 421 201, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisppd.jisppd_227_21

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   Abstract 


Background: Age estimation through dental maturity indicators is relatively more accurate, reliable, and valid for living as well as dead individuals. It acts as an important tool in diagnosis and treatment planning in clinical as well as in forensic dentistry. There are various methods to estimate the dental age. Out of which, Demirjian's method has been widely used in various populations. However, there is a dearth of literature on Indian population comparing Demirjian's method to Cameriere's method. Aim: The purpose of this study was to evaluate the accuracy of Demirjian's and Cameriere's age estimation methods to chronological age in growing children using orthopantomograph (OPG). Setting and Design: The sample consisted of digital OPGs of 280 children in Navi Mumbai aged 5–16 years. Materials and Methods: Digital OPGs were used to assess the dental maturity of seven mandibular left teeth using Demirjian and Cameriere's method and were compared to the chronological age. Statistical Analysis Used: Data were analyzed using Student's t tests. Result: Irrespective of gender, dental age estimated by Cameriere's method (mean 10.23 ± 2.79 years), underestimated the chronological age (mean 11.74 ± 2.86 years) for overall population which showed statistically significant difference. Demirjian's method overestimated (mean 12.24 ± 3.06 years) the chronological age for the overall population but was statistically insignificant. Conclusion: Demirjian's method is more closely in correlation with the chronological age of growing children as compared to the Cameriere method when applied to children of age 5–16 years in Navi Mumbai.


Keywords: Cameriere's method, Demirjian's method, dental age estimation, Indian population


How to cite this article:
Naik S, Rajadhyaksha N, Ghule KD. Evaluating the accuracy of two different age estimation methods in growing children in Navi Mumbai using Orthopantomograph: A radiographic study. J Indian Soc Pedod Prev Dent 2021;39:363-8

How to cite this URL:
Naik S, Rajadhyaksha N, Ghule KD. Evaluating the accuracy of two different age estimation methods in growing children in Navi Mumbai using Orthopantomograph: A radiographic study. J Indian Soc Pedod Prev Dent [serial online] 2021 [cited 2023 Feb 2];39:363-8. Available from: http://www.jisppd.com/text.asp?2021/39/4/363/336803





   Introduction Top


Dental age estimation is important for pediatric dentists who deal with preventive, interceptive, and corrective treatment.[1],[2] Two such widely used methods of dental age assessment which are dependent upon predescribed stages of tooth mineralization are Demirjian method and Cameriere method. However, several authors had found results to be less accurate when these were applied to different populations necessitating creation of a larger database including different population.[3],[4]

Dearth of literature on the Indian population and racial variation in the relationships have therefore encouraged to conduct a study to evaluate the accuracy of Demirjian's and Cameriere's dental age estimation methods in growing children using orthopantomograph (OPG).


   Materials and Methods Top


The study was a retrospective, cross sectional on conducted at the DY Patil University School of Dentistry, Nerul, Navi Mumbai.

The sample consisted of panoramic radiograph and clinical records of children aged between 5 and 16 years. A total of 623 digital OPGs were found in the database of the Department of Oral Medicine and Radiology from the year January 2015 to June 2017 at DY Patil University School of Dentistry, Nerul, Navi Mumbai. The record of each subject from the database was thoroughly examined to collect all information needed (i.e., name, record number, date of birth, date of X-ray was taken, sex and the medical status of the subjects).

Inclusion criteria

  • Healthy children of either gender between 5 and 16 years of age
  • Subjects with chronological birth records, detailed dental and medical records
  • Subjects with healthy status without any systemic disease and growth disorders
  • High-quality digital OPG images with high contrast between radiolucent and radiopaque regions, presence of seven left mandibular permanent teeth (erupted or unerupted) with no jaw-related deformities were considered.[3],[5],[6],[7],[8],[9]


Exclusion criteria

  • Subjects with missing records related to date of birth and date of exposure
  • Subjects with any history of chronic disease, illness, or syndrome known to significantly affecting the dental development that was obtained from their medical records
  • Subjects with congenital anomalies of teeth or jaw, history of jaw surgery, tumor, cyst or fracture.
  • Panoramic radiographs with image deformity affecting the lower permanent tooth visualization.
  • Unclear radiographic images with errors such as distortion, blurring, overlapping images of teeth
  • Third molars are excluded. [3],[5],[6],[7],[8],[9],[10]


Out of digital OPGs of 623 children, 280 subjects were considered for the study based on selection criteria. Selected OPGs were categorized as 136 girls and 144 boys aged between 5 and 16 years.

Estimation of chronological age

The chronological ages of the subjects were calculated by subtracting the birth date from the date on which the panoramic radiograph was taken for that particular subject. Chronological ages considered were calculated in decimal points, i.e., complete years for statistical convenience. Example: Ten years 6 months is equal to 10.5 years. Calculated chronological ages were tabulated in an excel sheet.[7],[8],[11],[12]

Dental age estimation by Demirjian's method

OPGs of selected subjects were analyzed for developmental stages of all the teeth present on the left side of the mandible as per Demirjian's seven teeth system (1973). The left mandibular permanent teeth were rated in the following order: second molar (M2), first molar (M1), second premolar (PM2), first premolar (PM2), canine (C), lateral incisor (I2), and central incisor (I1). All teeth were rated on a scale of A to H according to the stage of development and converted into a score using the conversion table given by Demirjian et al. for boys and girls, respectively.[4],[13],[14]

Dental age estimation by Cameriere's regression formula

The lower left permanent mandibular teeth from radiographic images of selected subjects were calibrated using Kodak CR digital radiography system, with trophy Dicom software. The number of teeth with complete root development, apical ends of the roots completely closed (N0), was calculated. Furthermore, the teeth with incomplete root development and therefore with open apices were considered. For teeth with one root, the distance (Ai, i = 1.,5) between the inner sides of the open apex was measured. For teeth with two roots (Ai, i = 6, 7), the sum of the distances between the inner sides of the two open apices was calculated. To take into account the effect of possible differences in magnification and angulations among X-rays, measurements were normalized by dividing it by the tooth length (Li, i = 1.,7). Finally, dental maturity was evaluated using the normalized measurements of the seven permanent mandibular teeth (xi = Ai/Li, i = 1.,7), the sum of the normalized open apices (s), and the number of teeth with complete root development (N0). All measurements were carried out by the same observer. All the morphological variables, xi, i = 1., 7, s, N0 and subjects' gender, were entered in an excel sheet for use as predictive variables for age estimation in the subsequent statistical analysis. Then, the following linear regression formula was used to calculate the dental age:[15],[16]

Dental Age = 8.971 + 0.375 g + 1.631 × 5 + 0.674 N0-1.034 s‒0.176 s N0

Where g is a variable equal to 1 for boys and 0 for girls.

The data collected by studying the OPGs were tabulated and subjected to descriptive and inferential statistical analysis. Statistical significance was set at ≤ 0.05.


   Results Top


The sample distribution was done according to gender [Table 1]. On gender comparison, both boys and girls showed underestimation of age by 1.43 years and 1.57 years for Cameriere method [Table 2] and [Table 3]. On the other hand, both boys and girls showed overestimation of age by 0.54 years and 0.47 years, respectively, by Demirjian's method [Table 4] and [Table 5]. There was also statistically significant difference between dental age obtained by Cameriere's method and Demirjian's method for boys, girls and overall, thus proving no correlation between both the methods [Table 6], [Table 7], [Table 8].
Table 1: Demographic characteristics of the study participants

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Table 2: Comparison of chronological age and the age obtained by applying Cameriere formula in boys using unpaired t-test

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Table 3: Comparison of chronological age and the age obtained by applying Cameriere formula in girls using unpaired t-test

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Table 4: Comparison of chronological age and the age obtained by applying Demirjian formula in boys using unpaired t-test

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Table 5: Comparison of chronological age and the age obtained by applying Demirjian formula in girls using unpaired t-test

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Table 6: Comparison of the mean difference (boys) in terms of chronological age to age obtained by Cameriere formula and Demirjian method using Mann–Whitney U-test

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Table 7: Comparison of the mean difference (girls) in terms of chronological age to age obtained by Cameriere formula and Demirjian method using Mann–Whitney U-test

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Table 8: Comparison of the mean difference (overall) in terms of chronological age to age obtained by Cameriere formula and Demirjian method using Mann–Whitney U-test

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   Discussion Top


The dental system is an integral part of the human body and one of the measures of physiological development.[17] Teeth may be better preserved than other parts of the body and thus give a better indication of age.[18] Teeth can survive in most of the conditions, encountered at death, and during decomposition, even when the body is exposed to extreme forces and/or temperatures. It is also observed that tooth development is not perceptibly affected by diseases, drugs, as well as the endocrine status as compared to the bones, consequently making them the preferred tissue in forensic and archaeological investigations. Thus, they can serve as reliable biomarkers of aging.[19]

Of the numerous techniques employed for age assessment, DAA and its correlation with chronological age have been of great significance in the recent past. Dental age is of particular interest to the pediatric dentist and orthodontist in planning the treatment of different types of malocclusion in relation to the maxillofacial growth. Basically, there are two concepts in dental age assessment. One is by assessing the age of tooth eruption in the oral cavity, and the other is by recording the stages of root and crown mineralization in primary and permanent dentition.[20],[21] Many studies have concluded that tooth formation is a more reliable indicator of dental maturity than gingival emergence or eruption. Several authors have shown that dental calcification stages are more suitable parameter for age estimation in children because the variability is lower since calcification rates of teeth are controlled more by genes than by environmental factors.[4]

Among the various methods developed for estimating the age, evaluation of tooth development by the radiographic method has been considered to be more accurate. Moreover, the different methods developed for age estimation based on tooth development do not provide a common formula for the whole world.[22] The panoramic radiograph is considered the best tool for age estimation in children owing to the reason that intraoral radiography is difficult to obtain in children without image distortion. When open apices were measured on digitized panoramic images of mandibular teeth, it was shown that there were no significant intra and interobserver differences.[23] Although there was 3%–10% of enlargement in OPGs, it is not a drawback because the rating system is based in sharp criteria and relative values rather than on absolute lengths. Moreover, alternative approaches based on digitalization of panoramic radiographs and their computerized storage have recently become available. These techniques are relatively precise and accurate and avoid the bias inherent in observer subjectivity. Thus radiographs have proved to be most accurate and less prone to interexaminer errors.[20],[24]

Demirjian's method is the most researched and applied technique in DAA of children and adolescents. Demirjian's method (1973) is based on OPGs which has eight stages of dental maturity observed in seven left mandibular teeth.[4],[25] Cameriere et al. in 2006 took a completely different approach and published a mathematical formula for calculating dental age of teeth based upon measuring the completeness of apical development of seven mandibular teeth through a computer method using special software. For both the methods, the maxillary teeth were not included as the apices of maxillary teeth are often obscured by superimposition from anatomical landmarks or errors from the radiographic procedures.[23]

The age range considered for the present study was 5–16 years as it remains the most critical with regard to estimating a child's dental age and consequently to determine the proper timing for orthodontic therapy.[23],[26] Dental age estimation was done separately for girls and boys because of sex-tooth interaction that is for one tooth being relatively more advanced in one sex than in other.[27]

In our study, the total number of samples were distributed according to gender [Table 1]. This was in accordance to studies conducted by Deepak et al.,[5] Patnana et al.,[27] Jayaraman et al.,[28] El-Bakary et al.,[7] Javadinejad et al.,[14] Babu et al.,[29] Rai and Anand,[30] and Shrestha et al.[31]

On gender comparison, both girls and boys showed underestimation 1.43 years and 1.57 years for Cameriere method, respectively [Table 2] and [Table 3]. These results were in accordance to studies conducted by some other researchers.[5],[7],[16],[31],[32],[33],[34] On contrary, overestimation in dental age by Cameriere method was observed in two studies conducted by Rai and Anand.[35] and Galić et al.[3]

On the other hand, both girls and boys showed overestimation by 0.54 years and 0.47 years for Demirjian methods, respectively [Table 4] and [Table 5]. These results were similar to studies conducted by Jurca et al.,[36] Hegde and Sood,[37] Al-Dharrab et al.,[11] Hegde et al.,[38] Liversidge et al.,[39] Eid et al.,[40] Bagherpour et al.,[41] Bagherian and Sadeghi[42] Ogodescu et al.[43] wherein overestimation with Demirjian method was noted and the dental age obtained was found to be in close relation to the chronological age of the targeted subjects. Thus, this method was found to be applicable for the targeted population as in case of our study.

On contrary to the above results, underestimation in dental age by Demirjian method was observed in studies conducted by Hegde et al.,[25] Qudeimat and Behbehani,[44] and Altunsoy et al.[45] out of which only Hegde et al.[25] showed high accuracy of Demirjian formula.

Our results also found that there was a statistically significant difference between the dental ages obtained by Cameriere method and Demirjian method for boys as well as girls [Table 6], [Table 7], [Table 8]. This showed that there was no correlation between both the methods. But the comparison of the two methods shows an advantage of the Demirjian method for both genders. This was in accordance with only one study conducted by Wolf et al.[13]

Irrespective of gender, the dental age obtained by Cameriere method underestimates the chronological age for the overall population by mean difference of 0.5 years [Table 9] and [Table 10]. This results in positive correlation of the Demirjian method to chronological age.
Table 9: Comparison of chronological age and the age obtained by applying Cameriere formula in overall samples using unpaired t-test

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Table 10: Comparison of chronological age and the age obtained by applying Demirjian method in overall samples using unpaired t-test

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In conclusion, although there was overestimation noted with Demirjian method, the P value was not statistically significant for the overall population and as well as for girls and boys separately [Table 4], [Table 5], [Table 6], [Table 7], [Table 8] [Table 9], [Table 10]. Thus, the Demirjian method appeared to be more accurate in the studied sample than the Cameriere method of age estimation.

Limitations

Smaller sample size, however, this did not affect the power of our study. Furthermore, certain conditions such as genetic, environmental factors, maternal factors are beyond the scope of the study.

Recommendations

Various methods of age estimations are available, but there is a need to formulate and develop newer methods specific to the Indian population.


   Conclusion Top


According to the result of this research, it may be concluded that Demirjian method (1973) was more closely in correlation with the chronological age of the growing children as compared to the Cameriere method (2006) and thus proving the applicability of Demirjian method in children of Navi Mumbai aged between 5 and 16 years.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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