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Article

Employing the London Atlas in the Age Estimation of a Select South African Population

by
Sundika Ishwarkumar
1,2,
Pamela Pillay
2,*,
Manogari Chetty
3 and
Kapil Sewsaran Satyapal
2
1
Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, Doornfontein Campus, P.O. Box 524, Auckland Park, Johannesburg 2006, South Africa
2
Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa
3
Department of Craniofacial Biology, Faculty of Dentistry, University of Western Cape, Cape Town 7535, South Africa
*
Author to whom correspondence should be addressed.
Dent. J. 2022, 10(9), 171; https://doi.org/10.3390/dj10090171
Submission received: 12 July 2022 / Revised: 2 August 2022 / Accepted: 5 August 2022 / Published: 9 September 2022
(This article belongs to the Special Issue Forensic Dentistry)
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Abstract

:
Dental age estimation in the living and deceased is a fundamental aspect of forensic sciences, civil cases, medico-legal proceedings and clinical dentistry. Accordingly, this study aimed to validate the accuracy and reproducibility of the London Atlas in a select South African sample of KwaZulu-Natal. In this cross-sectional study, 760 digital panoramic radiographs (n = 760) aged between 5.00 and 23.99 years were retrospectively reviewed through consecutive sampling. Each radiograph was assessed and assigned a dental age in accordance with the London Atlas of Human Tooth Development and Eruption by AlQahtani et al. (2010). The London Atlas overestimated age with a mean difference of −0.85 to −1.26 years in the selected South African sample of KwaZulu-Natal. A statistically significant difference between the chronological and estimated dental ages was recorded. Furthermore, the South African Black and Indian males had a higher overestimation of age than their female counterparts, with a mean difference of 0.13 and 0.07 years, respectively. This overestimation was less in the South African Indian population in comparison to the SA Black population. This outcome resulted in the creation of the KZN population- and sex-specific charts and atlases for the two selected cohorts of KwaZulu-Natal. The KZN Atlases were found to be more accurate in the selected sample, with a mean absolute error of 0.57 years and no statistically significant differences between the chronological and estimated dental ages.

1. Introduction

The estimation of age in the living has become a fundamental aspect of forensic sciences and medico-legal situations involving unidentified individuals awaiting adoption, asylum applications, civil issues and judicial procedures [1,2]. It is also used to determine if an individual is of legal age for criminal responsibility [1,2]. Moreover, age estimation is important for the identification of unknown remains, particularly in crime scenes and mass or natural disasters [1,2]. Clinically, age estimation is required for orthodontic, pediatric and endocrinology treatment planning [1,3].
Over the last few decades, forensic dentistry has gained significant “popularity” in the field of forensic science, as dental development is primarily controlled by genes and is less affected by extrinsic factors (i.e., nutrition and environmental factors) in comparison to skeletal development [3,4]. According to literature reports, the assessment of dental development using panoramic radiographs is an exceedingly reliable and precise method for dental age estimation [3,4]. In fact, this has emerged as the preferred technique for dental age estimation due to it cost-effectiveness, ease of use and low radiation exposure.
Similarly, dental atlases are considered to be a useful tool in estimating dental age in mortuaries and in the event of mass disasters by narrowing the search for unidentified individuals, as this method is simple, easy and quick to perform relative to other methods [3,4,5,6]. In particular, AlQahtani et al. [7] established the London Atlas of Human Tooth Development and Eruption in 2010. This atlas consists of thirty-one age categories (28 weeks in-utero to 23 years) based on dental development and eruption sequences. The tooth development and alveolar eruption stages were identified in accordance with the modified Moorrees stages [8,9]. Sharma and Wadhwan [3] and Koc et al. [4] concluded that the London Atlas is advantageous, as it is more user friendly due to its simplicity and convenience. However, Alkandiri et al. [6] and Sezer and Carikcioglu [10] reported that the London Atlas was less accurate in their samples than the Simple Average and Haavikko methods in the Kuwaiti and Turkish populations, respectively. Moreover, Carl [11] noted that the Willems method outperformed the London Atlas in their doctoral thesis conducted on a German population.
Alshihri et al. [12] recommended that the universal applicability of the London Atlas must be verified in different population groups to prove its practicality and validity. Currently, it is used for age estimation in Western population groups only, viz., Portugal, the Netherlands, the United States, Canada, France, and the United Kingdom [7,8]. However, there is paucity of literature regarding the applicability of the London Atlas to other population groups, e.g., Sub-Saharan Africa. In 2018, Esan and Schepartz [13] compared the London Atlas with the WITS Atlas, which the aforementioned authors created using the Demirjian method for the SA Black population of Gauteng province in South Africa. Unfortunately, the comparison revealed that the London Atlas was not suitable for age estimation in this population group [13]. The study by Esan and Schepartz [13] compared the developmental stages of the London Atlas to the WITS Atlas; however, they did not directly investigate the applicability of the London Atlas to the South African (SA) population. It should be noted that dissimilarities between the London and WITS Atlases may be attributed to the established methodology: the London Atlas is based on the Moorrees Classification Scheme, with a median value used to formulate the atlas, while the WITS Atlas utilized the Demirjian method and was formulated using the modal values of their sample [2]. Moreover, uneven sample distribution was noted for the sex and age groups in the sample of the WITS Atlas, while the London Atlas sampled an equal distribution in their study [8,13]. Furthermore, Esan and Schepartz conducted a community-based study in the Gauteng region of South Africa, and literary reports documented variation among local sub-population groups and regional differences [12,14,15,16,17]. These differences should be taken into consideration, as the best estimates for age estimation are obtained from local population-specific standards [14,15,16,17].
Therefore, the current study aimed to validate the accuracy and repeatability of the London Atlas in a select SA sample of KwaZulu-Natal.

2. Materials and Methods

2.1. Research Design and Data Acquisition

Through consecutive sampling, a total of 760 digital panoramic radiographs (n = 760), within the 5.00 and 23.99 years of age range, were retrospectively reviewed in this cross-sectional study. These radiographs were captured using the Carestream Dental: CS 8100 unit and obtained from private dental practices within the KwaZulu-Natal region. The selected sample included 380 SA Black individuals and 380 SA Indian individuals equally distributed according to sex and age cohorts (yearly intervals). For statistical purposes, ten digital panoramic radiographs per demographic group was required to ensure an equal sample distribution. Consequently, the SA White and SA Colored population groups were excluded from the analysis as an insufficient number of radiographs were obtained. In line with the demographic conformation of the KwaZulu-Natal province, the investigated population groups (i.e., SA Black and SA Indian population groups) were reflective of the majority provincial population [18]. Within South Africa, there are four main population groups according to the “modern systems of racial classification”, which this study utilized to classify ancestry [19,20,21]. Chronological age was calculated by subtracting the date the radiograph was taken from the date of birth. All radiographs were assigned a number so the investigator was blinded to the demographic data at the time of the assessment.

2.2. Ethical Consideration

This study received ethical approval from the institutional Biomedical Research Ethics Committee (BE: 405/17).

2.3. Inclusion and Exclusion Criteria

Digital panoramic radiographs with no impaction or extraction of dentition; no embryological defects; and/or no trauma or osteological pathologies to the maxillofacial region were included in this study. This study only included high-resolution radiographs that were free of any distortion.

3. Methodology

3.1. London Atlas of Human Tooth Development

Each radiograph was assessed utilizing the CS Imaging Software (Version: 7.0.20) and assigned a dental age in accordance with the London Atlas charts by AlQahtani et al. [7]. If the mandibular and maxillary dentition denoted inter-stage development, then an average age of the two stages was assigned.

3.2. Intra-Observer and Inter-Observer Agreement

To ensure standardization of the methodology, two examiners jointly assessed ten radiographs. The principal investigator conducted the intra-observer reliability test on two separate occasions in four-week intervals to ensure accuracy and reproducibility. A second examiner re-analyzed forty-two digital panoramic radiographs using an identical methodology to certify inter-observer reliability and validity. The data were then analyzed using the intraclass correlation coefficient test.

3.3. Development of the KZN Atlas of Dental Development

As the London Atlas was found to be not applicable to the selected KwaZulu-Natal population, population-specific reference charts and atlases were developed in this study. Four KZN Atlases were developed for SA Black and Indian male and female population groups of KwaZulu-Natal in accordance with the guidelines outlined by AlQahtani et al. [7]. This study evaluated the developmental stage of each tooth, in the right quadrant of the mandible and maxilla, on each radiograph in accordance with the Moorrees et al. [9] methodology. Thereafter, descriptive statistics in the form of frequency tables were categorically established for each age cohort, sex and population group sampled in this study. The dental developmental stage with the highest frequency (mode) in the aforementioned categories was assigned and utilized to develop the KZN Atlases (Appendix A: Table A1, Table A2, Table A3, Table A4, Table A5, Table A6, Table A7 and Table A8). If a category displayed an equal frequency for two or more developmental stages, then the more advanced stage was assigned [13]. The mode value was used instead of the median value for each stage, as not every variable has a median stage if there is an even number of stages [22]. Moreover, in accordance with AlQahtani et al. [7] and Esan and Schepartz [13], the age cohorts in the KZN Atlases were represented in mid-year intervals. The first author illustrated the individual teeth and assembled the KZN Atlases (Figure 1, Figure 2, Figure 3 and Figure 4).

3.4. Statistical Analysis

The statistical analysis was conducted utilizing the R Statistical Computing Software of the R Core Team 2020 (R version 3.6.3, Vienna, Austria). Descriptive statistics (frequencies, mean and standard deviation) were conducted. The performance of the London Atlas was assessed using the mean error (chronological age–dental age). In addition, a statistical comparison between the chronological age and the estimated dental age was conducted using the Wilcoxon test and paired samples t-test. A p-value less than 0.05 was considered statistically significant.

4. Results

4.1. Accuracy of the London Atlas of Human Tooth Development

The London Atlas overestimated age with a mean difference of −0.85 to −1.26 years in the select SA sample of KwaZulu-Natal (Table 1). Notably, the London Atlas overestimated age more in males than females for both population groups (Table 1). Furthermore, the London Atlas overestimated age more in the selected SA Black (>1 year) sample than the SA Indian population group (<1 year) (Table 1). Moreover, a statistically significant difference between the chronological age and estimated dental age was found using the London Atlas for the selected sample (Table 1). Furthermore, the mean absolute error using the London Atlas for the total selected sample was 1.05 years. Therefore, this study developed population-specific charts for the SA Black and Indian population groups of KwaZulu-Natal to evaluate whether or not these charts would enhance the accuracy of age estimation within this region.

4.2. KZN Atlas of Dental Development

In the KwaZulu-Natal population, the most prevalent developmental stages recorded in the maxilla and mandible at 5.00 to 5.99 years were “R 1 4 ” and “R 3 4 ”, respectively (Appendix A: Table A1). Moreover, in the KZN Atlases, dental maturity occurred at 20.5 years in the SA Black population group and 21.5 years in the SA Indian population (Appendix A: Table A1, Table A2, Table A3, Table A4, Table A5, Table A6, Table A7 and Table A8). Furthermore, it was noted that the SA Black population group reached complete dental maturity a year before the selected SA Indian population group (Appendix A: Table A1, Table A2, Table A3, Table A4, Table A5, Table A6, Table A7 and Table A8).

4.3. Efficiency of the KZN Atlas of Dental Development

The efficiency of the KZN Atlases was tested on 60 digital panoramic radiographs that met the inclusion criteria. The mean chronological age of the sample was 15.48 ± 5.41 years, and the estimated dental age using the KZN Atlases and London Atlas was 15.30 ± 5.13 years and 16.84 ± 5.82 years, respectively. A mean difference of 0.18 years and mean absolute estimate of 0.57 years were recorded between the chronological age and estimated dental age for the KZN Atlases, which indicated a slight underestimation. However, this study’s statistically significant difference between the aforementioned parameters using the KZN Atlases was negligible (p-value = 0.1). Furthermore, a strong positive correlation between the chronological and dental ages was observed (R2 = 0.9862).

4.4. Reliability and Validity

The intra- and inter-rater agreement in this study were 0.93 and 0.90, respectively, which denotes excellent and good agreement among the examiners according to guidelines outlined by Koo and Li [23]), respectively.

5. Discussion

Dental age estimation is considered to be one of the most reliable and accurate biological markers for age estimation, as dental development (calcification) is less affected by environmental conditions, diet and hormonal changes than skeletal bones [1,3,6]. In addition, teeth can be used for age estimation several years after death, as they are relatively indestructible [1]. In 2014, AlQahtani et al. [8] reported that the London Atlas more accurately assigned dental age than the Schour and Massler [24,25] and Ubelaker [26] atlases. This was due to the large sample size on which the atlas was based [27]. Sousa et al. [2] also mentioned that “more studies on different populations using the London Atlas would be fundamental to test how it performs in different population groups”. Most currently used dental age estimation methods have been developed on American and/or European population groups [7,24,26]. There are also limited studies on the applicability of these charts in a SA sample, specifically in the coastal regions of KwaZulu-Natal. KwaZulu-Natal is frequently affected by natural disasters (i.e., flooding and landslides), with more than 400 lives lost in the recent flooding in April 2022 [28]. Therefore, dental age methods are especially valuable to identify unknown remains.
The London Atlas overestimated age in the selected KwaZulu-Natal population of SA. The mean chronological age was 14.50 ± 5.48 years for the overall sample, while the estimated dental age utilizing the London Atlas was 15.55 ± 5.86 years, with a mean difference of 1.05 years. This correlated with the findings of previous studies [1,3,4,6,26]. However, Alsudairi and AlQahtani [29] and Sankoung et al. [30] reported that the London Atlas underestimated age in the Saudi and Senegalese population, respectively. Moreover, Alshihri et al. [12] assessed the applicability of the London Atlas in the Saudi Arabian population; the authors reported that 65.5% of the dental age estimates were within 12 months of the subject’s chronological ages. In addition, Alshihri et al. [12] concluded that these differences emphasized the need to develop sex-specific charts. This study noted a statistically significant difference between the chronological age and estimated dental age, which correlated with Sharma and Wadhwan [3].
Notably, the overestimation in this study was less in females than males. This corroborated the findings of Pavlovic et al. [27]. This may be attributed to females reaching dental maturity earlier than males [2,16]. On the contrary, Sousa et al. [2] and Alkandiri et al. [6] noted a lower overestimation in males than females in Brazilian and Kuwaiti samples, respectively.
Previous literary reports noted no statistically significant difference between the chronological age and estimated dental age on the right and left side of the jaw [22,27,31]. Pavlovic et al. [27] further elaborated that the side used for age estimation will not influence the results. Therefore, this study only evaluated the right side of the mandible and maxilla, which was in keeping with the studies conducted by AlQahtani et al. [7], Esan and Schepartz [13] and Putri et al. [22].
As a rule of thumb, estimated dental age is considered accurate in forensic and clinical cases if it is within six to twelve months of the chronological age; however, the former is preferred [13,32]. In the current study, the overestimation of dental age using the London Atlas in the selected sample was greater than six months. Sousa et al. [2] explained how the utilization of population-specific formulae may be essential for more accurate age estimation, thus highlighting the importance of establishing population-specific databases. According to McCloe et al. [33], the applicability of the London Atlas should be assessed in different ethnic groups to determine if inter-population variability exists. In addition, Esan and Schepartz [13] reported that dental development charts and tables based on mixed population samples may not be accurate for specific age estimation. In an attempt to mitigate the overestimation using the London Atlas, this study developed separate population- and sex-specific atlas charts and tables for the SA Black and Indian population groups of KwaZulu-Natal, with the latter recommended by Pavlovic et al. [27].
The median stages in the London Atlas for the central incisor at 5.5 years were “Ri” and “R 1 4 ” in the maxilla and mandible, respectively [7]. In contrast, at this age range, development was more advanced in the KwaZulu-Natal population with stage “R 1 4 ” in the maxilla and stage “R 3 4 ” in the mandible. Moreover, the median age for dental maturity was 23.5 years in the London Atlas [7]. However, dental maturity occurred at 20.5 and 21.5 years in the SA Black and Indian populations in the KZN Atlases, respectively. In addition, the Indonesian Atlas of Tooth Development recorded dental maturity between 22 and 24 years in the Indonesian population [22]. Literary findings reported that children of African ancestry have advanced tooth development and emergence compared to those of European ancestry, hence attributing to the slightly earlier dental maturity in the SA Black population [13,34,35,36]. No inference can be made for the SA Indian population as the literature did not provide a comparison between African, European and Asian using the London Atlas.
The present study noted some differences between the WITS and KZN Atlases. The WITS Atlas reported dental maturity at 17.5 years [13], while in the KwaZulu-Natal population this occurred at 20.5 and 21.5 years in the SA Black and Indian populations, respectively. These differences may be attributed to variation among local sub-populations or regional differences [14,15,16]. The WITS Atlas was developed from a community-based study in the Gauteng province of South Africa, while this study was based on a KwaZulu-Natal population. This correlated with literary reports that noted differences in the development of dentition among individuals and different populations within the same geographical areas or cities [37,38]. Therefore, it is essential to adapt classification schemes to suit local sub-populations [38,39]. Moreover, Putri et al. [22] noted that even in the sample population group, variations in dental development may exist. These differences may be attributed to dietary and environmental factors, socioeconomic status and sociocultural differences [10].
The efficiencies of the KZN Atlases were tested on 60 additional digital panoramic radiographs. The mean chronological age of this sample was 15.48 ± 5.41 years, while the mean estimated dental age was 15.30 ± 5.13 years with a mean absolute estimate of 0.57 years. A slight statistically insignificant underestimation of 0.18 years was noted between the chronological age and estimated dental age, which denotes no statistical difference between the chronological age and estimated dental using the KZN Atlases (p-value = 0.1). The KZN Atlases are based on SA Black and Indian individuals aged between 5.00 and 21.99 years, with equal sample distribution between the different age cohorts, sex and population groups. The large sample distribution is one of the advantages to the KZN Atlases, in addition to being population-specific and sex-specific. The current study utilized 10 radiographs per age cohort for each sex and population group, which was similar to the London Atlas, which utilized 12 radiographs in each age cohort for males and females, respectively [7]. Alsudairi and AlQahtani [29] noted that, due to the large sample size used to establish the London Atlas, studies conducted on small sample sizes and uneven sample distribution may make it difficult to establish comparisons, thus justifying the comparisons drawn in this study.
This study recommends that the newly established KZN Atlases should be validated in different regions of South Africa and neighboring countries to assess their reproducibility. Furthermore, it is recommended that future studies investigate artificial intelligence for forensic age estimation, viz., machine learning and/or neural networks, using this methodology. The investigators acknowledge that a limitation of this study was excluding the SA Colored and SA White populations from the analysis. However, insufficient data were obtained to ensure statistically reliability for the aforementioned groups. This is attributed to the demographic composition of KwaZulu-Natal with the SA Black and SA Indian population groups being predominately located within this region [18]. In addition, this study was unable to access radiographs of children younger than 5 years old, since in South Africa it is not recommended to expose young children to radiation useless it is imperative for specific medical procedures.

6. Conclusions

The London Atlas significantly overestimated age by −0.85 to −1.26 years in the selected SA Black and Indian population groups of KwaZulu-Natal (p-value > 0.05). Therefore, this study created the KZN Atlases, which are population- and sex-specific charts for the aforementioned populations groups of KwaZulu-Natal. The KZN Atlases were found to be more accurate than the London Atlas in the selected sample, as the estimated dental age derived from the KZN Atlases were closest to the chronological age. Moreover, insignificant statistical differences between the chronological age and estimated dental ages using the KZN Atlases were found in this study. Therefore, the KZN Atlases could be utilized in forensic, medico-legal and civil cases in KwaZulu-Natal to enhance the accuracy of dental age estimation.

Author Contributions

S.I., P.P., M.C. and K.S.S. contributed to the study conceptualization and methodological design; S.I. performed the investigation, data acquisition, interpretation and analysis, drafting the first draft of the manuscript and illustration of the atlases; P.P., M.C. and K.S.S. reviewed and edited the manuscript and supervised. All authors of this study have read and approved the final manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethical clearance was granted from the institutional Biomedical Research Ethics Committee (BE: 405/17).

Informed Consent Statement

Not applicable.

Acknowledgments

We would like to express our appreciation to the dental practitioners who granted access to their practices and the Biostatistician that aided with the analysis of the statistical components.

Conflicts of Interest

The authors declare no conflict of interest.

Appendix A

Table
Table A1. Frequencies of the tooth development stages of the central incisors for the SA Black and Indian population groups.
Table A1. Frequencies of the tooth development stages of the central incisors for the SA Black and Indian population groups.
Maxillary Central Incisors (I1)Mandibular Central Incisors (I1)
Age RangeFemaleMaleGrand
Total		Age RangeFemaleMaleGrand
Total
Tooth StagesBlackIndianTotalBlackIndianTotalTooth StagesBlackIndianTotalBlackIndianTotal
5.00–5.99101020101020405.00–5.9910102010102040
Cr3/4 111Ri 111
Crc23523510R1/4 112245
Ri1234158R1/22351349
R1/433613410R3/48513641023
R1/24 41237Rc 111 12
R3/4 222 24
6.00–6.99101020101020406.00–6.9910102010102040
Crc 222R1/4 111
R1/414524611R1/21123146
R1/252751613R3/4257281017
R3/413433610Rc5495 514
Rc314 4Ac2 2 2
7.00–7.99101020101020407.00–7.9910102010102040
Crc 111R3/4 111123
R1/2 1122Rc371035818
R3/4561151617A1/252753815
Rc44827917Ac2 21124
A1/21 12 23
8.00–8.99101020101020408.00–8.9910102010102040
R3/42 2 335R3/4 111
Rc4812371022Rc3252 27
A1/22245 59A1/2581335821
Ac2 22 24Ac2 254911
9.00–9.99101020101020409.00–9.9910102010102040
R3/4 1 11R3/4 1 11
Rc24617814Rc 1122
A1/251622410A1/2224 226
Ac35861715Ac8816871531
10.00–10.991010201010204010.00–10.9910102010102040
Rc 2 22Rc 1 11
A1/23251238A1/21121 13
Ac7815781530Ac99188101836
11.00–11.991010201010204011.00–11.9910102010102040
A1/2 11 1Ac10102010102040
Ac1091910102039
12.00–12.99 to
23.00–23.99		12012024012012024048012.00–12.99 to
23.00–23.99		120120240120120240480
Ac120120240120120240480Ac120120240120120240480
Key: Ci—initial cusp formation; Cco—coalescence of cusp; Coc—cusp outline complete; Cr1/2—crown half completed; Cr3/4—crown three-quarters completed; Crc—crown completed; Ri—initial root formation; R1/4—root length less than crown length; R1/2—root length equals crown length; R3/4—three-quarters of root length developed; Rc—root length completed; A1/2—apex closed with wide periodontal ligament width; Ac—apex closed with normal periodontal ligament width.
Table
Table A2. Frequencies of the tooth development stages of the lateral incisors for the SA Black and Indian population groups.
Table A2. Frequencies of the tooth development stages of the lateral incisors for the SA Black and Indian population groups.
Maxillary Lateral Incisors (I2)Mandibular Lateral Incisors (I2)
Age RangeFemaleMaleGrand
Total		MaleFemaleMaleGrand
Total
Tooth StagesBlackIndianTotalBlackIndianTotalTooth StagesBlackIndianTotalBlackIndianTotal
5.00–5.99101020101020405.00–5.9910102010102040
Cr1/2 111Ri 111345
Cr3/4 1122R1/42132136
Crc358461018R1/2551054919
Ri123 114R3/433622410
R1/44153149
R1/22131 14
R3/4 111 12
6.00–6.99101020101020406.00–6.9910102010102040
Crc 2355R1/4 11 112
Ri1 11123R1/212334710
R1/435831412R3/4551045919
R1/252744815Rc4263 39
R3/4134 115
7.00–7.99101020101020407.00–7.9910102010102040
Crc 222R1/2 111 12
R1/4 111R3/4 442248
R1/22462139Rc8513581326
R3/424654915A1/21 12 23
Rc62832513Ac1 1 1
8.00–8.99101020101020408.00–8.9910102010102040
Crc 111R3/4 111123
R1/2112 113Rc35834715
R3/42 23257A1/2641043717
Rc581326821Ac1 12245
A1/21125 57
Ac1 1 1
9.00–9.99101020101020409.00–9.9910102010102040
R1/2 111Rc1123257
R3/4 1233A1/2651125718
Rc35835816Ac34753815
A1/25162139
Ac24641511
10.00–10.991010201010204010.00–10.9910102010102040
Rc1 12245R3/4 1 11
A1/224633612A1/21232 25
Ac7613551023Ac98177101734
11.00–11.991010201010204011.00–11.9910102010102040
Rc 1 11A1/2 11 1
A1/2 22 113Ac1091910102039
Ac10818991836
12.00–12.99 to
23.00–23.99		12012024012012024048012.00–12.99 to
23.00–23.99		120120240120120240480
Ac120120240120120240480Ac120120240120120240480
Key: Ci—initial cusp formation; Cco—coalescence of cusp; Coc—cusp outline complete; Cr1/2—crown half completed; Cr3/4—crown three-quarters completed; Crc—crown completed; Ri—initial root formation; R1/4—root length less than crown length; R1/2—root length equals crown length; R3/4—three-quarters of root length developed; Rc—root length completed; A1/2—apex closed with wide periodontal ligament width; Ac—apex closed with normal periodontal ligament width.
Table
Table A3. Frequencies of the tooth development stages of the canines for the SA Black and Indian population groups.
Table A3. Frequencies of the tooth development stages of the canines for the SA Black and Indian population groups.
Maxillary Canines (C)Mandibular Canines (C)
Age RangeFemaleMaleGrand
Total		Age RangeFemaleMaleGrand
Total
Tooth StagesBlackIndianTotalBlackIndianTotalTooth StagesBlackIndianTotalBlackIndianTotal
5.00–5.99101020101020405.00–5.9910102010102040
Cr1/2 1 11Cr1/2 111
Cr3/4 111Cr3/4 1 11
Crc8816691531Crc25727916
Ri 3 33Ri32552712
R1/4112 2R1/44262 28
R1/2112 2R1/21 1 1
R3/4 11 1
6.00–6.99101020101020406.00–6.9910102010102040
Crc14534712Crc1 13478
Ri 114267Ri2 22135
R1/4841224618R1/4761344821
R1/21 1 1R1/2 331 14
R3/4 111 12R3/4 11 112
7.00–7.99101020101020407.00–7.9910102010102040
Crc 333Cr3/4 1 11
Ri2 2 2Crc 111
R1/432553813Ri 222
R1/235833614R1/431434711
R3/42351127R1/245931413
Rc 1 11R3/434722411
Rc 1 11
8.00–8.99101020101020408.00–8.9910102010102040
Crc 333Crc 1 11
Ri 1 11R1/41341237
R1/4 222246R1/224635814
R1/21452138R3/4731053818
R3/4941354922
9.00–9.99101020101020409.00–9.9910102010102040
R1/4 11 1Ri 111
R1/24151349R1/4 11 1
R3/46713971629R1/22131 14
Rc 11 1R3/45510971626
Rc336 228
10.00–10.991010201010204010.00–10.9910102010102040
R1/21 11 12R1/21 11 12
R3/45611671324R3/44610681424
Rc44833614Rc54932514
11.00–11.991010201010204011.00–11.9910102010102040
R3/422415610R3/41232469
Rc7714951428Rc8715861429
A1/2112 2A1/2112 2
12.00–12.991010201010204012.00–12.9910102010102040
R3/41 11345R3/4112 224
Rc7916961531Rc68141071731
A1/22 2 113A1/2213 114
Ac 11 1Ac1 1 1
13.00–13.991010201010204013.00–13.9910102010102040
R3/4 111R3/42 2 113
Rc9918571230Rc8816481228
A1/2 113256A1/2 225168
Ac1 12 23Ac 1 11
14.00–14.991010201010204014.00–14.9910102010102040
Rc43733613Rc43733613
A1/2551054919A1/244814513
Ac1232358Ac23563914
15.00–15.991010201010204015.00–15.9910102010102040
Rc 22 113Rc 11 112
A1/23251349A1/234713411
Ac7613961528Ac7512961527
16.00–16.99 to 23.00–23.998080160808016032016.00–16.99 to 23.00–23.9980801608080160320
Ac80801608080160320Ac80801608080160320
Key: Ci—initial cusp formation; Cco—coalescence of cusp; Coc—cusp outline complete; Cr1/2—crown half completed; Cr3/4—crown three-quarters completed; Crc—crown completed; Ri—initial root formation; R1/4—root length less than crown length; R1/2—root length equals crown length; R3/4—three-quarters of root length developed; Rc—root length completed; A1/2—apex closed with wide periodontal ligament width; Ac—apex closed with normal periodontal ligament width.
Table
Table A4. Frequencies of the tooth development stages of the first premolar for the SA Black and Indian population groups.
Table A4. Frequencies of the tooth development stages of the first premolar for the SA Black and Indian population groups.
Maxillary First Premolar (PM1)Mandibular First Premolar (PM1)
Age RangeFemaleMaleGrand
Total		Age rangeFemaleMaleGrand
Total
Tooth StagesBlackIndianTotalBlackIndianTotalTooth stagesBlackIndianTotalBlackIndianTotal
5.00–5.99101020101020405.00–5.9910102010102040
Cr1/2 333Cr1/2 222
Cr3/4 221 13Cr3/4 111 12
Crc10818971634Crc10919881635
Ri 1 11
6.00–6.99101020101020406.00–6.9910102010102040
Cr3/41 1 112Cr3/4 111
Crc8816981733Crc5712761325
Ri1 1 1Ri51622410
R1/4 221124R1/4 221124
7.00–7.99101020101020407.00–7.9910102010102040
Cr1/2 111Crc2242359
Crc235651116Ri23532510
Ri4 4 4R1/423524611
R1/4 442248R1/23251127
R1/2336 228R3/4 1 11
Rc1 12 23Rc1 11 12
8.00–8.99101020101020408.00–8.9910102010102040
Crc 111123Crc 1 11
Ri 111Ri 111
R1/4 4442610R1/417845917
R1/2641025717R1/262831412
R3/44153149R3/43142359
9.00–9.99101020101020409.00–9.9910102010102040
Ri 11 1
R1/4 1 11R1/4112 2
R1/245932514R1/242635814
R3/4527581320R3/4448651119
Rc1341 15Rc1231 14
10.00–10.991010201010204010.00–10.9910102010102040
R1/2 1233R1/2 1233
R3/431444812R3/433654915
Rc791644824Rc771444822
Ac 1 11
11.00–11.991010201010204011.00–11.9910102010102040
R3/4 111R3/4 11 112
Rc7714761327Rc4812871527
A1/23252249A1/251622410
Ac 111123Ac1 1 1
12.00–12.991010201010204012.00–12.9910102010102040
R3/4 11 1
Rc23516712Rc1 13 34
A1/2651151617A1/28614661226
Ac22443711Ac1341459
13.00–13.991010201010204013.00–13.9910102010102040
Rc 2 22Rc 111 12
A1/243721310A1/243731411
Ac6713691528Ac6612691527
14.00–14.991010201010204014.00–14.9910102010102040
Rc 1 11Rc 1 11
A1/21121 13A1/2 11 1
Ac99188101836Ac109199101938
15.00–15.991010201010204015.00–15.9910102010102040
A1/2 1 11
Ac1010209101939Ac10102010102040
16.00–16.99 to 23.00–23.998080160808016032016.00–16.99 to 23.00–23.9980801608080160320
Ac80801608080160320Ac80801608080160320
Key: Ci—initial cusp formation; Cco—Coalescence of cusp; Coc—Cusp outline complete; Cr1/2—crown half completed; Cr3/4—crown three-quarters completed; Crc—crown completed; Ri—initial root formation; R1/4—root length less than crown length; R1/2—root length equals crown length; R3/4—three-quarters of root length developed; Rc—root length completed; A1/2—apex closed with wide periodontal ligament width; Ac—apex closed with normal periodontal ligament width.
Table
Table A5. Frequencies of the tooth development stages of the second premolar for the SA Black and Indian population groups.
Table A5. Frequencies of the tooth development stages of the second premolar for the SA Black and Indian population groups.
Maxillary Second Premolar (PM2)Mandibular Second Premolar (PM2)
Age RangeFemaleMaleGrand
Total		Age RangeFemaleMaleGrand
Total
Tooth StagesBlackIndianTotalBlackIndianTotalTooth StagesBlackIndianTotalBlackIndianTotal
5.00–5.99101020101020405.00–5.9910102010102040
Cr1/2 55 338Cr1/2134 337
Cr3/42241348Cr3/41 11345
Crc8311941324Crc8715941328
6.00–6.99101020101020406.00–6.9910102010102040
Cr1/21231347Cr1/2 11 1
Cr3/4 2133Cr3/42 21124
Crc9716661228Crc7815871530
Ri 11 1Ri1 11123
R1/4 1 11R1/4 11 112
7.00–7.99101020101020407.00–7.9910102010102040
Coc 111Crc32554914
Crc6612751224Ri42623511
Ri112 224R1/4 551349
R1/41341237R1/2213 3
R1/21 1 1R3/4 1 11
Rc1 12 23Rc1 11 12
8.00–8.99101020101020408.00–8.9910102010102040
Crc 442359Crc 112134
Ri2 21124Ri 333
R1/445933615R1/4281054919
R1/22 22246R1/28 822412
R3/42132136R3/4 111 12
9.00–9.99101020101020409.00–9.9910102010102040
Crc 331236Ri 221 13
R1/42131125R1/42132247
R1/261734714R1/243745916
R3/413443711R3/443723512
Rc1231 14Rc 111 12
10.00–10.991010201010204010.00–10.9910102010102040
Ri 111R1/4 111 12
R1/231434711R1/22131347
R3/443735815R3/4459771423
Rc3694 413Rc4371 18
11.00–11.991010201010204011.00–11.9910102010102040
R1/2 11 1R1/2 221 13
R3/41232469R3/423523510
Rc8513651124Rc7512661224
A1/21231125A1/21 11123
Ac 1 11
12.00–12.991010201010204012.00–12.9910102010102040
R1/2 111
R3/4 11 334R3/4 331125
Rc561134718Rc33653814
A1/24264 410A1/2731033616
Ac1123368Ac 111234
13.00–13.991010201010204013.00–13.9910102010102040
Rc 112 23Rc1121 13
A1/262851614A1/252752714
Ac4711391223Ac4711481223
14.00–14.991010201010204014.00–14.9910102010102040
Rc1123 35Rc 11 112
A1/2 112 23A1/2 113 34
Ac98175101532Ac10818791634
15.00–15.991010201010204015.00–15.9910102010102040
Rc 11 1
A1/2 2 22A1/2 11 1
Ac1010208101838Ac1081810102038
16.00–16.99 to 23.00–23.998080160808016032016.00–16.99 to 23.00–23.9980801608080160320
Ac80801608080160320Ac80801608080160320
Key: Ci—initial cusp formation; Cco—coalescence of cusp; Coc—cusp outline complete; Cr1/2—crown half completed; Cr3/4—crown three-quarters completed; Crc—crown completed; Ri—initial root formation; R1/4—root length less than crown length; R1/2—root length equals crown length; R3/4—three-quarters of root length developed; Rc—root length completed; A1/2—apex closed with wide periodontal ligament width; Ac—apex closed with normal periodontal ligament width.
Table
Table A6. Frequencies of the tooth development stages of the first molar for the SA Black and Indian population groups.
Table A6. Frequencies of the tooth development stages of the first molar for the SA Black and Indian population groups.
Maxillary First Molar (M1)Mandibular First Molar (M1)
Age RangeFemaleMaleGrand
Total		Age RangeFemaleMaleGrand
Total
Tooth StagesBlackIndianTotalBlackIndianTotalTooth StagesBlackIndianTotalBlackIndianTotal
5.00–5.99101020101020405.00–5.9910102010102040
Ri 1344Ri 111
R1/41122 24R1/4 1233
R1/22132358R1/23143259
R3/4551032515R3/445954918
Rc2352249Rc3471129
6.00–6.99101020101020406.00–6.9910102010102040
R1/4 111R1/2 1122
R1/2 3 33R3/441542611
R3/441523510Rc5712571224
Rc5712561123A1/2123 3
A1/2123 3
7.00–7.99101020101020407.00–7.9910102010102040
R3/4 11 1Rc6612661224
Rc6511971627A1/234734714
A1/244813412Ac1 11 12
8.00–8.99101020101020408.00–8.9910102010102040
R3/4 1 11Rc31442610
Rc41543712A1/24913661225
A1/25914561125Ac3 3 225
Ac1 1 112
9.00–9.99101020101020409.00–9.9910102010102040
R3/4 1 11Rc 2 22
Rc 11 1A1/2661245921
A1/2651136920Ac44845917
Ac448641018
10.00–10.991010201010204010.00–10.9910102010102040
A1/21121124A1/21121124
Ac9918991836Ac9918991836
11.00–11.991010201010204011.00–11.9910102010102040
A1/2 11 1A1/2 11 1
Ac1091910102039Ac1091910102039
12.00–12.99 to 23.00–23.9912012024012012024048012.00–12.99 to 23.00–23.99120120240120120240480
Ac120120240120120240480Ac120120240120120240480
Key: Ci—initial cusp formation; Cco—coalescence of cusp; Coc—cusp outline complete; Cr1/2—crown half completed; Cr3/4—crown three-quarters completed; Crc—crown completed; Ri—initial root formation; R1/4—root length less than crown length; R1/2—root length equals crown length; R3/4—three-quarters of root length developed; Rc—root length completed; A1/2—apex closed with wide periodontal ligament width; Ac—apex closed with normal periodontal ligament width.
Table
Table A7. Frequencies of the tooth development stages of the second molar for the SA Black and Indian population group.
Table A7. Frequencies of the tooth development stages of the second molar for the SA Black and Indian population group.
Maxillary Second Molar (M2)Mandibular Second Molar (M2)
Age RangeFemaleMaleGrand
Total		Age RangeFemaleMaleGrand
Total
Tooth StagesBlackIndianTotalBlackIndianTotalTooth StagesBlackIndianTotalBlackIndianTotal
5.00–5.99101020101020405.00–5.9910102010102040
Cco 111
Coc 2244Coc 111567
Cr1/2661245921Cr1/254952716
Cr3/41 11234Cr3/42241237
Crc3473 310Crc33631410
6.00–6.99101020101020406.00–6.9910102010102040
Coc1 1 1Ci 11 1
Cr1/222436913Cr1/22133258
Cr3/44151 16Cr3/42131125
Crc3710641020Crc6713671326
7.00–7.99101020101020407.00–7.9910102010102040
Cr1/21 1 1Cr1/21 1 1
Cr3/4 111123Cr3/4 11 1
Crc8412681426Crc5510581323
Ri 33 114Ri3141126
R1/4 221 13R1/4 332136
R1/21 11 12R1/2 1 11
R3/4 1 11R3/41 11 12
8.00–8.99101020101020408.00–8.9910102010102040
Cr1/2 11 1
Cr3/4 111
Crc134481216Crc 331347
Ri6392 211Ri3 31 14
R1/43253149R1/4549551019
R1/2 11 1R1/22243259
R3/4 1 11R3/4 11 1
9.00–9.99101020101020409.00–9.9910102010102040
Crc1231458Crc112 224
Ri1 1 1Ri 1 11
R1/443741512R1/423523510
R1/223534712R1/2641063919
R3/42242137R3/41231236
10.00–10.991010201010204010.00–10.9910102010102040
Crc 11 1Crc 11 1
Ri 111
R1/41123479R1/4 1122
R1/232534712R1/2336571218
R3/42683 311R3/4461041515
Rc4 41126Rc3 3 114
11.00–11.991010201010204011.00–11.9910102010102040
R1/4 11 1
R1/2 3255R1/2 1122
R3/4 112578R3/4235461015
Rc1081853826Rc871553823
12.00–12.991010201010204012.00–12.9910102010102040
R1/2 11 1
R3/4 331 14R3/41122246
Rc97169101935Rc7714681428
A1/21 1 1A1/22132 25
13.00–13.991010201010204013.00–13.9910102010102040
R3/4 11 1
Rc9615591429Rc123731013
A1/21343148A1/2981727926
Ac 2 22Ac 1 11
14.00–14.991010201010204014.00–14.9910102010102040
Rc34745916Rc235 227
A1/2551063919A1/275121071729
Ac213 225Ac123 114
15.00–15.991010201010204015.00–15.9910102010102040
Rc 11 1Rc1 1 1
A1/254945918A1/2641045919
Ac5510651121Ac369651120
16.00–16.991010201010204016.00–16.9910102010102040
A1/23143148A1/242631410
Ac7916791632Ac6814791630
17.00–17.991010201010204017.00–17.9910102010102040
Rc1 1 1Rc1 1 1
A1/21121 13A1/2213 3
Ac89179101936Ac791610102036
18.00–18.99 to 23.00–23.996060120606012024018.00–18.99 to 23.00–23.9960601206060120240
Ac60601206060120240Ac60601206060120240
Key: Ci—initial cusp formation; Cco—coalescence of cusp; Coc—cusp outline complete; Cr1/2—crown half completed; Cr3/4—crown three-quarters completed; Crc—crown completed; Ri—initial root formation; R1/4—root length less than crown length; R1/2—root length equals crown length; R3/4—three-quarters of root length developed; Rc—root length completed; A1/2—apex closed with wide periodontal ligament width; Ac—apex closed with normal periodontal ligament width.
Table
Table A8. Frequencies of the tooth development stages of the third molar for the SA Black and Indian population group.
Table A8. Frequencies of the tooth development stages of the third molar for the SA Black and Indian population group.
Maxillary Third Molar (M3)Mandibular Third Molar (M3)
Age RangeFemaleMaleGrand
Total		Age RangeFemaleMaleGrand
Total
Tooth StagesBlackIndianTotalBlackIndianTotalTooth StagesBlackIndianTotalBlackIndianTotal
5.00–5.99101020101020405.00–5.9910102010102040
Undeveloped10102010102040Undeveloped10102010102040
6.00–6.99101020101020406.00–6.9910102010102040
Ci1 1 1
Undeveloped10102010102040Undeveloped9101910102039
7.00–7.99101020101020407.00–7.9910102010102040
Ci 222 24Ci1232 25
Cco1 11 12Cco 1 11
Coc 1 11Cr1/2 2 22
Crc 1 11
Undeveloped98175101532Undeveloped98175101532
8.00–8.99101020101020408.00–8.9910102010102040
Ci1342359Ci63943716
Cco7 71 18Cco4 42 26
Coc2134 47Coc 22 2
Cr1/2 1 11Crc 1 11
Undeveloped6627915Undeveloped55371015
9.00–9.99101020101020409.00–9.9910102010102040
Ci 44 337Ci15645915
Cco4 43259Cco3142137
Coc1122135Coc1 12134
Cr1/231442610Cr1/21 1 223
Crc1 11 12Cr3/42 2 2
R1/2 11 1Crc1 11 12
Undeveloped134 226R1/2 11 1
Undeveloped1341126
10.00–10.991010201010204010.00–10.9910102010102040
Ci112 2Ci 22 224
Cco 112134Cco1121346
Coc 22 557Coc2 2 224
Cr1/24374 411Cr1/23474 310
Cr3/42242 26Cr3/41122135
Crc3 32136Crc2 23 46
Undeveloped11 334R1/41 1 1
Undeveloped22 224
11.00–11.991010201010204011.00–11.9910102010102040
Ci 222Ci 11 223
Cco 1 11Cco 1 11
Coc 111234Coc 111345
Cr1/21342359Cr1/21231125
Cr3/443741512Cr3/444841513
Crc3142248Crc3143259
Ri1 1 1Ri1 1 1
R1/41 1 1R1/41 1 1
Undeveloped22 2Undeveloped11 112
12.00–12.991010201010204012.00–12.9910102010102040
Coc 11 1Ci 11 1
Cr1/2123 114Coc 111123
Cr3/41 12134Cr1/2 221124
Crc5712881628Cr3/4213 3
Ri1 1 1Crc549771423
R1/22 2 2Ri 1 11
R1/4112 113
R1/22 2 2
13.00–13.991010201010204013.00–13.9910102010102040
Ci 11 1Ci 11 1
Cr1/2 221124Cr1/21232 25
Cr3/4 222Cr3/4 222
Crc369651120Crc15642612
Ri1 12 23Ri1 12467
R1/41121124R1/43 32247
R1/22 2 2R1/2224 4
R3/41 1 1R3/41 1 1
Rc2 2 2Rc1 1 1
Undeveloped 111Undeveloped
14.00–14.991010201010204014.00–14.9910102010102040
Cr3/4 11 1Cr3/4123 3
Crc2 22135Crc2462139
Ri35814513R1/41123146
R1/41123 35R1/24 426812
R1/21121346R3/42242248
R3/42132247Rc 111 12
Rc 111 12
Undeveloped1 1 1
15.00–15.991010201010204015.00–15.9910102010102040
Crc1232 25Crc1122135
Ri 111234R1/41451 16
R1/433633612R1/242644814
R1/22241126R3/4 221346
R3/41121235Rc3142248
Rc2132247A1/21 1 1
A1/21 1 1
16.00–16.991010201010204016.00–16.9910102010102040
Crc 22 2Cr1/2 11 1
Ri 22 2Crc 11 1
R1/4415 116R1/4 11 1
R1/214514510R1/236933615
R3/431452711R3/441544813
Rc2 24379Rc3 33258
A1/2 111
17.00–17.991010201010204017.00–17.9910102010102040
R1/42132 25R1/4112 2
R1/21122 24R1/22242 26
R3/434715613R3/434745916
Rc23544813Rc23534712
A1/21 1 1A1/22 2 2
Ac1121124Ac 1122
18.00–18.991010201010204018.00–18.9910102010102040
Crc 11 1R1/2 33 3
R1/2 22 2R3/4 11 112
R3/4 44 4Rc5510551020
Rc52725714A1/23141126
A1/231452711Ac2 24379
Ac2 23368
19.00–19.991010201010204019.00–19.9910102010102040
Rc25725714R3/4 111
A1/252751613Rc35835816
Ac33634713A1/243741512
Ac32533611
20.00–20.991010201010204020.00–20.9910102010102040
R3/4 11 1Rc1232136
Rc 221124A1/2 5515611
A1/214515611Ac9312741123
Ac9312841224
21.00–21.991010201010204021.00–21.9910102010102040
Rc 111Rc 11 223
A1/2 11 112A1/2 11 223
Ac109191081837Ac108181061634
22.00–22.99 to 23.00–23.992020402020408022.00–22.99 to 23.00–23.9920204020204080
Ac20204020204080Ac20204020204080
Key: Ci—initial cusp formation; Cco—coalescence of cusp; Coc—cusp outline complete; Cr1/2—crown half completed; Cr3/4—crown three-quarters completed; Crc—crown completed; Ri—initial root formation; R1/4—root length less than crown length; R1/2—root length equals crown length; R3/4—three-quarters of root length developed; Rc—root length completed; A1/2—apex closed with wide periodontal ligament width; Ac—apex closed with normal periodontal ligament width.

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Dentistry 10 00171 g001 550
Figure 1. KZN Atlas of dental development for South African Black female.
Figure 1. KZN Atlas of dental development for South African Black female.
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Figure 2. KZN Atlas of dental development for South African Black males.
Figure 2. KZN Atlas of dental development for South African Black males.
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Figure 3. KZN Atlas of dental development for South African Indian females.
Figure 3. KZN Atlas of dental development for South African Indian females.
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Figure 4. KZN Atlas of dental development for South African Indian males.
Figure 4. KZN Atlas of dental development for South African Indian males.
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Table
Table 1. Dental age estimation using the London Atlas in the select KwaZulu-Natal sample (in years).
Table 1. Dental age estimation using the London Atlas in the select KwaZulu-Natal sample (in years).
Population GroupSexSample Size
(n)		Chronological Age (CA) ± SDDental Age (DA) ± SD* Mean
Error
(CA–DA)		Mean
Absolute
Error		p-Value
SA BlackFemale19014.50 ± 5.4715.63 ± 5.82−1.131.28<0.001
SA BlackMale19014.49 ± 5.4815.75 ± 5.89−1.261.40<0.001
SA IndianFemale19014.51 ± 5.4415.36 ± 5.64−0.851.10<0.001
SA IndianMale19014.48 ± 5.4715.46 ± 6.02−0.981.21<0.001
Total Sample76014.50 ± 5.48 15.55 ± 5.86−1.051.25<0.001
* Mean error (CA-DA): A negative value indicated overestimations and a positive value indicates underestimation.
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Ishwarkumar, S.; Pillay, P.; Chetty, M.; Satyapal, K.S. Employing the London Atlas in the Age Estimation of a Select South African Population. Dent. J. 2022, 10, 171. https://doi.org/10.3390/dj10090171

AMA Style

Ishwarkumar S, Pillay P, Chetty M, Satyapal KS. Employing the London Atlas in the Age Estimation of a Select South African Population. Dentistry Journal. 2022; 10(9):171. https://doi.org/10.3390/dj10090171

Chicago/Turabian Style

Ishwarkumar, Sundika, Pamela Pillay, Manogari Chetty, and Kapil Sewsaran Satyapal. 2022. "Employing the London Atlas in the Age Estimation of a Select South African Population" Dentistry Journal 10, no. 9: 171. https://doi.org/10.3390/dj10090171

APA Style

Ishwarkumar, S., Pillay, P., Chetty, M., & Satyapal, K. S. (2022). Employing the London Atlas in the Age Estimation of a Select South African Population. Dentistry Journal, 10(9), 171. https://doi.org/10.3390/dj10090171

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