Age Assessment through Third Molar Teeth Developmental Stage in Children
1
Department of Orthodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
2
Department of Pediatric Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
3
Department of Periodontology and Oral Implantology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
4
Department of Oral and Maxillofacial Surgery, Maurice and Gabriela Goldschleger School of Dentistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
*
Author to whom correspondence should be addressed.
Appl. Sci. 2023, 13(4), 2069; https://doi.org/10.3390/app13042069
Submission received: 22 December 2022
/
Revised: 30 January 2023
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Accepted: 3 February 2023
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Published: 5 February 2023
(This article belongs to the Special Issue Art and Science in Facial, Orthognathic and Maxillofacial Surgery)
Abstract
:Age determination is important for forensic evaluation and for determining criminal responsibility. Based on the development of permanent teeth, the Demirjian staging evaluation key is commonly used in research for estimating age using teeth developmental stage. The purpose of the current study was to correlate the dental developmental age of third molar teeth with the chronological age of adolescent patients. This study evaluated 324 panorex images of Israeli patients aged 8–21 years with known birth dates and genders. The dental developmental stage was compared to the patient’s chronological age by gender and side (right/left and upper/lower jaws). This study also attempted to predict the patient’s age using the third molar developmental stage. The study included 179 male and 145 female patients. There was no statistical difference between the right and left sides of the upper or lower teeth. A strong correlation was found between third molar development and chronological age for both the maxilla and mandible. In 100% of cases, patients in developmental stage >5 were over 12 years old in the maxilla and in 97% of cases, were over 12 years old in the mandible. Patients in developmental stage >6 were over 14 years old in 100% of cases in both the maxilla and mandible. Patients in developmental stage >7 were over 16 years old in 100% of cases in both the maxilla and mandible. This study found that third molars can be used to accurately estimate age in a narrow age range, with a strong correlation between third molar development and chronological age. Further research may be needed to understand the utility of this method and its possible usage in different countries around the world.
1. Introduction
There are multiple reasons for the importance of age determination, such as forensic evaluation; criminal responsibility age; and other factors concerning legal and social benefits, employment and marriage [1,2,3,4,5]. Age assessment can be performed in different ways including morphological age (weight and height), sexual development, skeletal hand and wrist development, and dental development, with the latter two as the more common methods [6]. However, a study conducted in Brazil found that estimating age by examining teeth development is more accurate than estimating age by hand and wrist development [7].
By adolescence, dental age estimation becomes more difficult, as most teeth are in the process of completing their apical formation. Therefore, the remaining third molars can be used in age evaluation in late adolescence [6].
Most research using third molars for age evaluation are based on the Demirjian evaluation key, which is divided into eight stages of tooth development. The assessment is based on three main components during the development of permanent dentition: crown formation, root formation and root apex closure [8,9].
The purpose of the current study was to correlate the dental developmental age of third molar teeth with the chronological age of adolescent patients and to estimate the third molar developmental stage at which it can be assumed with a high probability that the subject is over the age of criminal responsibility.
2. Materials and Methods
This cross-sectional study involved the evaluation of 324 consecutive panorex of Israeli patients aged 8–21 years, based on the database of Tel Aviv University between the years 1997 and 2021. The research was approved by the Tel-Aviv University local international review board (IRB, approved proposal 120.19). The inclusion criteria comprised non-syndromic patients with valid panorex, with documented dates of birth and genders. The chronological age of subjects was determined by subtracting the panorex date from the patient’s birth date.
Data retrieved from the panorex included the dental developmental stage (according to Demirijian et al., Figure 1) of all third molars in the specific X-ray, the side of the tooth (left or right) and the jaw (maxilla or mandible). All X-rays were analyzed by the same senior pediatric dentistry resident.
An analysis of the data included comparing the right and left sides, and the upper and lower jaws, followed by checking the correlation between the dental developmental stage and the chronologic age of the patient, by gender. In the end, we attempted to predict the patient’s age using the third molar developmental stage.
A statistical analysis was performed using SPSS software (IBM SPSS Statistics for Windows, version 25.0, IBM Corp, Armonk, NY, USA). Categorical variables were analyzed using Chi-squared test, and continuous variables were analyzed using t-test. The p-value of <0.05 was considered statistically significant.
3. Results
A total of 324 panorex had been analyzed in the study. Of note, not all panorex had all third molars evident in the X-ray. There were 179 males and 145 females. The t-test comparing the developmental stage differences between the right and left side, in the maxilla and mandible separately, found no statistical difference for the right and left sides, both on upper teeth (p = 0.656) and on the lower teeth (p = 0.873). Therefore, for further statistics, only one tooth (using the developmental stage of the tooth) was used for further statistics on each jaw. Most cases demonstrated equal stages on the right and left sides. However, when there was inconsistency between the right and left sides, the higher developmental stage was used as the developmental stage for the analysis.
Table 1 presents the mean age (and standard deviation) in the different groups of the third molar developmental stage. Since there were only a few cases of teeth development stages 7 and 8, they were merged into a single group.
A Pearson correlation was conducted to analyze the correlation between the third molar developmental stage (Demirjian stage) and the chronologic age of the patient, based on the date of birth. A high correlation was found between third molars and the chronological age, both in the maxilla and in the mandible (Pearson correlation of 0.767, 0.793 for maxillary and mandibular teeth, respectively, p < 0.0001)
On one-way ANOVA, statistical significance was found between the different developmental stages for each jaw (p < 0.001). Tukey’s HSD test for multiple comparisons found that the mean value of the developmental stage was significantly different between stages 6 and 7; stage 5; and stages 2, 3, and 4 in the maxilla and between stages 6 and 7, stage 5, stage 4, and stages 2 and 3 in the mandible.
In order to characterize the possible differences between males and females, a two-way ANOVA was executed. Statistical significance was found for the developmental stage (p < 0.0001) with no statistical significance for gender (p = 0.409 for the maxilla and p = 0.368 for the mandible). The only difference was seen in stage 1: girls reach stage 1 at an earlier age (around 10 years in girls, and 11–12 years in boys). Figure 2 shows the marginal means for males and females in the maxilla and mandible, according to tooth developmental stage.
The correlation between the chronological age and tooth developmental stage was analyzed, classifying the chronological age into three different categories: age higher and lower than 12 years, age higher and lower than 14 years, and age higher and lower than 16 years. A Chi-square analysis was conducted, with statistical significance (p < 0.0001) for all three categories. Patients in developmental stage > 5 were older than 12 years in 100% of cases in the maxilla and in 97% of cases in the mandible. Patients in developmental stage > 6 were older than 14 years in 100% of cases both in the maxilla and the mandible. Patients in developmental stage > 7 were older than 16 years in 100% of cases both in the maxilla and the mandible.
A stepwise linear regression model was calculated to predict age based on maxillary and mandibular third molar developmental stage (Table 2). A significant regression equation was determined based on maxillary and mandibular third molar development stage with R2 = 0.66.
4. Discussion
People with unknown chronological age are not uncommon around the world, especially in developing countries. This may pose serious legal problems or rarely even lead to international conflicts [10]. In addition, age assessment is essential in relation to social regulations and state laws such as school attendance, social benefits, employment, and marriage and for differentiating between a juvenile and adult status in criminal law cases [1].
Over the years, several studies on dental age assessment have been conducted. The mean chronological age for Demirjian’s stages varies between studies, with a dental assessment accuracy of approximately one year [6,11,12]. However, it has been found that assessing the development of wisdom teeth is an essential and effective tool and that the degree of development of the wisdom tooth is a reliable indicator of the age of the subject [8,13,14,15].
The current research found no difference in third molar developmental stage between males and females and a high correlation between the developmental degree of the third molar and the chronological age. These findings are consistent with other studies that also found no significant difference in the development of third molars between boys and girls but a close relationship between the degree of development of third molars and chronological age [2,8,16,17]. In contrast to most studies, Sisman, who analyzed a population of 900 Turkish individuals, found a statistically significant difference between sexes in stages 4 and 7, with maturation occurring earlier in men than in women [18].
The age of criminal responsibility differs worldwide, with a median age of 12 years and a range between 6 and 18 years [19]. This is important in the sense of juvenile delinquency (which refers to a crime committed by a person under the age of criminal responsibility), as children above that age can be arrested, detained, and imprisoned. Previous studies tried to predict a chronological age of 18 using third molar development, using the ratio between the apical pulp width and tooth length of the third molars [20,21]. However, using this ratio is more difficult to use for younger patients with non-developed roots, and therefore, the Demirjian stages were used [11,17]. A study conducted in China found that the probability of the subject being over 14 is over 50% when the third molar is at stage 4 but over 85% when the tooth is developed at stage 5 [22]. In the Spanish population, 14 years of age presents with at least stage 5 development, while 16 years of age presents with at least stage 7 development [23]. We found that, in developmental stage 5, the chronological age of the patient would be over 12 years old in 97% of cases for mandibular third molars and in 100% of cases for maxillary third molars. Patients with third molars at developmental stage 6 would be at least 14 years old in 100% of the cases, and for those at developmental stage 7, the patient would be 16 years or older.
5. Conclusions
Based on the results of this study, it appears that third molars can be effectively used to estimate the age of patients within a narrow age range. The strong correlation found between third molar development and chronological age suggests that this method may be a reliable way to determine age in forensic or legal contexts. Further research may be needed to fully understand the utility of this method and to generalize age estimation using the third molar developmental stage to different countries around the world.
Author Contributions
Conceptualization, N.S. and N.A.; methodology, N.S., N.A. and T.R.; formal analysis, N.A., T.R. and A.L.; investigation, N.S., N.A. and A.L. writing—original draft preparation, N.A., N.T.-G. and A.L.; writing—review and editing, A.L. and N.T.-G. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The research was approved by the Tel-Aviv University local international review board (IRB).
Informed Consent Statement
Patient consent was waived due to the retrospective analysis of the research, approved by the Tel-Aviv IRB.
Data Availability Statement
The data presented in this study are available on request from the corresponding author.
Conflicts of Interest
The authors declare no conflict of interest.
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Figure 1.
Dental developmental stage according to Demirijian et al. [9]: (A) beginning of crown formation; (B) the complete and fused tooth crown can be clearly seen; (C) half of the crown is complete, and the formation of the pulp chamber can be discerned; (D) the crown formation is completed; (E) the beginning of the formation of the furcation can be discerned, and the length of the root is smaller than the length of the crown; (F) the length of the root is at least the same as the length of the crown; (G) developed and parallel root walls can be seen, but the apexes are open; (H) the root apexes are closed.
Figure 1.
Dental developmental stage according to Demirijian et al. [9]: (A) beginning of crown formation; (B) the complete and fused tooth crown can be clearly seen; (C) half of the crown is complete, and the formation of the pulp chamber can be discerned; (D) the crown formation is completed; (E) the beginning of the formation of the furcation can be discerned, and the length of the root is smaller than the length of the crown; (F) the length of the root is at least the same as the length of the crown; (G) developed and parallel root walls can be seen, but the apexes are open; (H) the root apexes are closed.
Figure 2.
Mean comparison between males and females in the maxilla (upper) and mandible (lower). No statistical significance found between males and females regarding developmental stage difference.
Figure 2.
Mean comparison between males and females in the maxilla (upper) and mandible (lower). No statistical significance found between males and females regarding developmental stage difference.
Table 1.
Maxillary and mandibular Demirjian developmental stages—number of cases (N) and mean age distribution (+ standard deviation). Stages 7 and 8 were merged into a single group due too few cases.
Table 1.
Maxillary and mandibular Demirjian developmental stages—number of cases (N) and mean age distribution (+ standard deviation). Stages 7 and 8 were merged into a single group due too few cases.
| Developmental Stage | Maxillary 3rd Molar | Mandibular 3rd Molar | ||
|---|---|---|---|---|
| N | Mean ± SD | N | Mean ± SD | |
| 1 (a) | 4 | 11.32 ± 1.68 | 19 | 10.35 ± 1.27 |
| 2 (b) | 56 | 10.90 ± 1.37 | 61 | 11.05 ± 1.35 |
| 3 (c) | 65 | 11.65 ± 0.98 | 78 | 11.76 ± 0.98 |
| 4 (d) | 121 | 12.65 ± 1.11 | 96 | 12.90 ± 1.13 |
| 5 (e) | 29 | 14.92 ± 1.29 | 33 | 14.77 ± 1.48 |
| 6 (f) | 12 | 17.13 ± 1.38 | 9 | 17.49 ± 1.53 |
| 7 (g & h) | 9 | 18.28 ± 1.36 | 9 | 18.23 ± 1.38 |
| Total | 296 | 12.66 ± 2.12 | 305 | 12.57 ± 2.14 |
Table 2.
Stepwise linear regression model. The constant as well as the included parameters (maxillary and mandibular developmental stage) were statistically significant.
Table 2.
Stepwise linear regression model. The constant as well as the included parameters (maxillary and mandibular developmental stage) were statistically significant.
| β | p-Value | |
|---|---|---|
| Constant | 7.69 | <0.0001 |
| Developmental stage maxillary third molar | 0.72 | <0.0001 |
| Developmental stage mandibular third molar | 0.68 | <0.0001 |
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Sadan, N.; Aderet, N.; Tagger-Green, N.; Ratson, T.; Laviv, A. Age Assessment through Third Molar Teeth Developmental Stage in Children. Appl. Sci. 2023, 13, 2069. https://doi.org/10.3390/app13042069
AMA Style
Sadan N, Aderet N, Tagger-Green N, Ratson T, Laviv A. Age Assessment through Third Molar Teeth Developmental Stage in Children. Applied Sciences. 2023; 13(4):2069. https://doi.org/10.3390/app13042069
Chicago/Turabian StyleSadan, Noa, Netta Aderet, Nirit Tagger-Green, Tal Ratson, and Amir Laviv. 2023. "Age Assessment through Third Molar Teeth Developmental Stage in Children" Applied Sciences 13, no. 4: 2069. https://doi.org/10.3390/app13042069
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