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ORIGINAL ARTICLE
Year : 2022  |  Volume : 40  |  Issue : 1  |  Page : 43-47
 

Estimation of dental age using Willems method and comparing it with Demirjian's method in 7–14-year-old children of Uttarakhand


1 Department of Paediatric and Preventive Dentistry, ITS-CDSR, Ghaziabad, Uttar Pradesh, India
2 Department of Paediatric and Preventive Dentistry, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
3 Department of Oral and Maxillofacial Pathology and Radiology, Ohio State University, Columbus, Ohio, USA
4 Paediatric and Preventive Dentistry, Dent-A-Hub, Jalandhar, Punjab, India

Date of Submission19-Sep-2021
Date of Decision14-Mar-2022
Date of Acceptance16-Mar-2022
Date of Web Publication13-Apr-2022

Correspondence Address:
Dr. Keerti Chandail
ITS-CDSR, Muradnagar, Ghaziabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisppd.jisppd_333_21

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   Abstract 


Age is one of the essential factors, which plays an important role in every aspect of life. Age is estimated on the basis of chronological age, bone age, dental age, mental age and others. This study represents the objective of an ideal age estimation technique to arrive at an age as close to the chronological age as possible. Aim: The aim of this comparative study was to estimate the dental age using Willems method by assessing the developmental stages of left seven permanent mandibular teeth in 7–14 years of age groups with the help of digital orthopantomogram and comparing it with Demirjian's method to conclude which method was more appropriate and better in Indian population of Uttarakhand region. Materials and Methods: A total of 100 digital orthopantomogram films of patients in the age group of 7-14 years was collected over the study period of 3 years from July 2014 to January 2017 and was equally distributed by convenience sampling. Group I included 50 boys and Group II included 50 girls aging 7–14 years of age (as permanent 7 teeth in the 3rd quadrant were to be assessed and scored according to the Demirjian's table, the 7–14 age group was selected). The date of birth of the subject was documented against their allocated identification number. Dental age according to Willem's method was calculated using Willem's table and Demirjian and Goldstein's table scores were used to calculate dental age by Demirjian's method. Results: Willems method was more accurate and better than Demirjian's method as it showed less mean percentage error, i.e., 0.34% as compared to 15.94% obtained from Demirjian's method in Group II and 2.19% as compared to 8.05% obtained from Demirjian's method in Group I. Conclusion: The results suggested that Willems method of dental age estimation was an effective method of age estimation and was better and more accurate than Demirjian's method.


Keywords: Demirjian's method, dental age, forensics, Willems method


How to cite this article:
Chandail K, Goyal V, Kaul M, Dutt S, Koul T, Misgar BA. Estimation of dental age using Willems method and comparing it with Demirjian's method in 7–14-year-old children of Uttarakhand. J Indian Soc Pedod Prev Dent 2022;40:43-7

How to cite this URL:
Chandail K, Goyal V, Kaul M, Dutt S, Koul T, Misgar BA. Estimation of dental age using Willems method and comparing it with Demirjian's method in 7–14-year-old children of Uttarakhand. J Indian Soc Pedod Prev Dent [serial online] 2022 [cited 2022 Jun 25];40:43-7. Available from: https://www.jisppd.com/text.asp?2022/40/1/43/343016





   Introduction Top


Age is one of the essential factors which plays an important role in every aspect of life. Age is estimated on the basis of chronological age, bone age, dental age, mental age, and others.[1] Edwin Saunders in 1837 was the first dentist to publish information regarding dental implications in age assessment by presenting a pamphlet entitled “Teeth A Test of Age” to the English parliament. Methods employed for determining dental age are based on the degree of the calcification observed in radiographic examinations of permanent teeth.[1] Most methods make use of panoramic radiographs for the assessment, although Moorrees et al.[2] made use of periapical radiographs.

Demirjian et al. tried to simplify dental age estimation and restricted the number of stages of tooth development to 8 giving them a score of “A” to “H,” but a considerable number of studies, however, have reported overestimation and inaccuracy of its use in their respective populations.[3] To overcome the drawbacks of Demirjian's method, Willems et al.[4] modified the Demirjian technique by creating new tables, from which a maturity score could be directly expressed in years. The cumbersome step of conversion of maturity score to dental age was deleted, making it simpler, yet retaining the advantages of the Demirjian technique.[5] This method has been tested only a few times in North Indian children, so little was known about this method's applicability in the same.[5] For that reason, the aim of the present study was to evaluate the applicability of Willems method and compare it with Demirjian's method for dental age estimation in 7–14-year-old children of the Uttarakhand region of North India.


   Materials and Methods Top


A total of 100 orthopantomograms of age group (7–14 years) from outpatient Department of Pedodontics and Preventive Dentistry and Department of Orthodontics, Seema Dental College and Hospital, Rishikesh, were collected over the study period of 3 years from July 2014 to February 2017 and were equally divided into 2 groups for the comparative study of dental age estimation using two different methods following the guidelines based on the study design. Group I included 50 boys and Group II included 50 girls. The rationale for this equal distribution was that the maturity scores for each tooth in radiographic method were gender specific. The children of North Indian descent and having parents of the same ethnicity, age group of 7–14 years with mixed or permanent dentition, no medical history of systemic diseases/disorders, no idiopathic short stature, no gross malocclusion, and no missing left mandibular teeth were included in the study. The cases excluded were children with serious medical illness, age <7 years or >14 years, physically or mentally challenged children, gross malocclusion, impacted or ankylosed teeth, and children who had undergone previous orthodontic treatment or extraction of any permanent teeth. The chronological age of the subjects was calculated by subtracting his or her date of birth from date of examination. In the panoramic images, the calcification stages of all the seven permanent teeth on the left (3rd) quadrant were assessed and graded using [Figure 1] and [Table 1]. Dental age according to Willem's method was calculated using Willem's table [Table 2]a and [Table 2]b which directly converted stages into years and Demirjian and Goldstein's table scores were used to calculate dental age by Demirjian's method. For Demirjian's method, gender-specific maturity score was given to each grade using Demirjian's individual maturity score table [Table 1]a and [Table 1]b.
Figure 1: Graphical presentation of the developmental stages as presented by Demirjian et al. (1973)

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   Results Top


The statistical analysis was done using SPSS (the Statistical Package for the Social Sciences and Service solutions) version 21.0 developed by IBM in 2012, statistical analysis software. Mean, standard deviation, frequency, range, and Wilcoxon signed-rank test were used for the analysis of the data.

Mean chronological age for Group I was found to be 10.93 ± 2.34 and for Group II, it was 11.48 ± 2.54 whereas mean dental age calculated using Demirjian's method in Group I was 10.05 ± 2.13 and in Group II, it was 13.31 ± 3.11. By Willems method, mean dental age established for Group I was 10.69 ± 2.28 and for Group II was 11.52 ± 2.61. Dental age estimated by Willems method had less standard deviation than Demirjian's method. In Willems method, SD was 0.70 (Group I) and 0.46 (Group II) whereas by Demirjian's method, it was 1.10 (Group I) and 0.78 (Group II).

As per [Table 3], mean difference in assessing dental age using Demirjian's method in Group I was found to be 1.06 ± 1.10 whereas in Group II, it was found out to be 1.83 ± 0.78. While using Willems method, in Group I mean difference came out to be 0.59 ± 0.70 where as in Group II, it came out to be 0.45 ± 0.46. Hence, it was concluded that mean difference in age estimation was higher in Demirjian's method than Willems method. Hence, Willems method is more accurate than Demirjian's method in estimating age.
Table 3: Mean difference in assessing dental age by two methods

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[Table 4] shows comparison of mean age difference estimation between chronological and dental age using two methods and from the statistics obtained, it was shown that in Group 1, Demirjian's method and Willems method both underestimated the age as compared to chronological age, 1.06 ± 1.10 by Demirjian's method and 0.59 ± 0.7 by Willems method whereas in Group II both Demirjian's method and Willems method overestimate the dental age as compared to chronological age but Demirjian's method overestimated it more, i.e., 1.83 ± 0.78 as compared to Willems method, i.e., 0.45 ± 0.46.
Table 4: Comparison of mean age difference estimation between chronological and dental age using two methods

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[Table 5] shows mean percentage error in age estimation by two different methods, and after comparing these two methods, it was evident that Willems method was more accurate and better as it showed less mean percentage error, i.e., 0.34% as compared to 15.94% obtained from Demirjian's method in Group II and 2.19% as compared to 8.05% obtained from Demirjian's method in Group I.
Table 5: Comparison of error in measurement of two methods

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   Discussion Top


Various methods for the age determination do exist, a universal system has not been achieved due to varying differences in different ethnic population groups.[6] The aim of an ideal age estimation technique was to arrive at an age as close to the chronological age as possible.[5] Dental maturity can be determined by the stage of tooth eruption or by the stage of tooth formation.[7] One of the major purposes of pediatric dentistry is to maintain primary teeth in anatomical and functional conditions up to their physiological exfoliation and eruption of permanent teeth.[8] The teeth of males differ from the teeth of females in a great many developmental respects. There is sex difference in the relative frequency of the premolar-molar formation sequence too.[9] All these factors can lead to different results in the dental age estimation of boys and girls. Demirjian et al. using OPGs tried to simplify dental age estimation and restricted the number of stages of tooth development to 8 giving them a score of “A” to “H” and confined the analysis to the first seven permanent teeth of the left lower quadrant.[3] Willems in 2001 adapted Demirjian's method for dental age estimation in a Belgian Caucasian population and modified the scoring system when a significant overestimation was reported.[4] In the present study, it was found that Demirjian's method overestimated the mean age in Group II whereas underestimated the mean age in Group I. Koshy and Tandon[10] also reported an overestimation of 3.04 and 2.82 years in males and females, respectively, in South Indian Children using Demirjian's method[10] whereas Prabhakar et al.[11] reported an overestimation of 1.20 and. 90 years in males and females, respectively, in Davangere children (South India).[11] When comparison among genders was done, girls mature earlier than boys [Graph 1], but the mean difference between dental age and chronological age calculated among girls was not found to be statistically significant (P > 0.05). However, in the present study, Willems method was better applied for Group II when compared with Group I with mean percentage error of only 0.34% as compared to 2.19% in case of Group I which was in agreement with the studies conducted by Grover et al. (2011) and Mohammed et al.[12]



When Demirjian's and Willems method were tested on the same population as it was done in the present study, differences between dental and chronological age were significantly lower and accuracy was better for the Willems method when compared to the Demirjian's method. Being a modification of the Demirjian's method, Willems method was more reliable, as Demirjian's method was framed almost 30 years ago and there may be a difference in the present-day comparisons due to positive secular trends. A possible explanation for the difference in the estimated dental age between the French-Canadian children and the children on whom the present study was carried out can be attributed to the considerable time gap between two studies on the dental development of these children.[13] Other possible causes of difference could be the environmental factors, such as the socioeconomic status, nutrition, and dietary habits that vary in different population groups.[14]

The results obtained from the current study also support the latter suggesting that Willem's method should be used to estimate dental age accurately because there was less variation in calculating dental age using Willem's method as compared to Demirjian's method. However, further studies are needed to compile the full table of dental age conversion from the maturity score for Indian specific population. Furthermore, studies are also required to formulate new scoring measures for Indian children.


   Conclusion Top


The present results imply that Willems method of dental age estimation was a better and reliable method of age estimation, easy to calculate, and more accurate than Demirjian's method in North Indian population of the Uttarakhand region.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Priyadarshini C, Puranik MP, Uma SR. Dental age estimation methods: A review. Int J Adv Health Sci 2015;1:19-25.  Back to cited text no. 1
    
2.
Moorrees CF, Fanning EA, Hunt EE Jr. Age variation of formation stages for ten permanent teeth. J Dent Res 1963;42:1490-502.  Back to cited text no. 2
    
3.
Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol 1973;45:211-27.  Back to cited text no. 3
    
4.
Willems G, Van Olmen A, Spiessens B, Carels C. Dental age estimation in Belgian children: Demirjian's technique revisited. J Forensic Sci 2001;46:893-5.  Back to cited text no. 4
    
5.
Eid RM, Simi R, Friggi MN, Fisberg M. Assessment of dental maturity of Brazilian children aged 6 to 14 years using Demirjian's method. Int J Paediatr Dent 2002;12:423-8.  Back to cited text no. 5
    
6.
Mani SA, Naing L, John J, Samsudin AR. Comparison of two methods of dental age estimation in 7-15-year-old Malays. Int J Paediatr Dent 2008;18:380-8.  Back to cited text no. 6
    
7.
Kumar V, Hegde S, Bhat SS. The relationship between dental age, bone age and chronologic age in children with short stature. Int J Contemp Dent 2011;2:6-11.  Back to cited text no. 7
    
8.
Dutt S, Chandail K, Kaul M, Singh P. A comparative study to evaluate the antibacterial efficacy of various intracanal medicaments over anaerobic microorganisms in infected root canals of primary teeth. Int J Sci Res 2020;9:73-7.  Back to cited text no. 8
    
9.
Garn SM, Lewis AB, Koski K, Polacheck DL. The sex difference in tooth calcification. J Dent Res 1958;37:561-7.  Back to cited text no. 9
    
10.
Koshy S, Tandon S. Dental age assessment: The applicability of Demirjian's method in south Indian children. Forensic Sci Int 1998;94:73-85.  Back to cited text no. 10
    
11.
Prabhakar AR, Panda AK, Raju OS. Applicability of Demirjian's method of age assessment in children of Davangere. J Indian Soc Pedod Prev Dent 2002;20:54-62.  Back to cited text no. 11
[PUBMED]    
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Mohammed RB, Krishnamraju PV, Prasanth PS, Sanghvi P, Lata Reddy MA, Jyotsna S. Dental age estimation using Willems method: A digital orthopantomographic study. Contemp Clin Dent 2014;5:371-6.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Shilpa PH, Sunil RS, Sapna K, Kumar NC. Estimation and comparison of dental, skeletal and chronologic age in Bangalore south school going children. J Indian Soc Pedod Prev Dent 2013;31:63-8.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Cheraskin E, Ringsdorf WM Jr. Biology of the orthodontic patient. 3. Relationship of chronologic and dental age in terms of vitamin C state. Angle Orthod 1972;42:56-9.  Back to cited text no. 14
    


    Figures

  [Figure 1]
 
 
    Tables

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



 

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