Comparison of accuracy between dental and skeletal age in the estimation of chronological age of Down syndrome individuals

Abstract

This study aimed to evaluate the accuracy of dental age (DA) and skeletal age (SA) methods in order to estimate chronological age (CA) in individuals with Down syndrome (DS), contributing to the Forensic Dentistry and making the identification of these individuals age possible. For this, 278 images of individuals were selected and divided in 2 groups: 216 non-DS patients and 62 with DS. At first, DA was evaluated by Nolla method, on panoramic radiographs, followed by SA, evaluated by Greulich and Pyle method. The linear correlation coefficient of Pearson was used for the analysis of concordance between the methods. Paired t-test with confidence interval was used to evaluate the accuracy and Bland and Altman method was applied to estimate limits of concordance. Complementary to this first analysis, descriptive statistics and ANOVA test were applied for comparison among chronological age (CA), dental age (DA) and skeletal age (SA), with a significance level of 95% (p≥0.05), ordering to observe the differences among them. DA, estimated by Nolla, is underestimated in both, DS and non-DS individuals, and it is more notable in DS individuals. SA estimated by Greulich and Pyle method is overestimated, except for non-DS males. The range of variance is greater in SA and DS than DA and non-DS individuals, respectively. A greater accordance was found for DA×CA if compared to SA×CA, indicating that DA, estimated by Nolla method, is more accurate than SA, evaluated by Greulich and Pyle method, for estimating CA of both, DS and non-DS individuals. However, neither method seems to be precise and more caution is required for age estimation in DS individuals.

The role of cervical vertebrae maturation in defining the chronological age of Down syndrome children

“…It can therefore be said that establishing age by means of the Nolla method is more accurate than using the Greulich and Pyle method in determining skeletal and chronological age. AbouHala et al 1 support these results. In this study, there was a statistically significant correlation between dental age and skeletal age with a t-count of 4,539.…”

“…Down syndrome is one of the most common causes of skeletal retardation. 21 In their research, AbouHala et al 1 show that there is a closer value and a smaller difference between dental and chronological age compared to skeletal and chronological age in Down syndrome individuals. It can therefore be said that establishing age by means of the Nolla method is more accurate than using the Greulich and Pyle method in determining skeletal and chronological age.…”

“…Meanwhile, dental age is established based on the timing of the emergence of teeth and the stage of dental formation (calcification) which can also be observed radiographically. 1,3,7,8,10 The assessment of dental age based on tooth calcification using the Nolla method is more reliable than results obtained by other means, such as the Demirjian method. This is because the latter method uses two decimal fractions in the calcification stage, more than 90% researchers approved this method due to the more accurate result.…”

“…[1][2][3][4] Chronological age is defined as the length of time that has elapsed since an individual's birth 5,6 and can be used to identify the specific stage of child development. However, it is a weak predictor of growth, rendering physiological age more reliable for evaluating the developmental period.…”

“…1 Systemic delayed eruption is associated with numerous genetic conditions including: cleidocranial dysplasia, hemifacial atrophy, mucopolysaccharidosis, Turner syndrome and Down syndrome. 15 The latter is a genetic disorder afflicting more than 5.8 million people that has become the most common genetic disorder resulting in intellectual disability.…”