Estimating the 18-Year Threshold with Third Molars Radiographs in the Southern Italy Population: Accuracy and Reproducibility of Demirjian Method

Abstract

The estimation of the age of the majority of living subjects is widely required nowadays due to the presence of unidentifiable individuals, without documents and general information, involved in migration or legal procedures. Dental age estimation (DAE) is a valid method for investigating the age of subjects. The aim of this study was to evaluate the accuracy of the Demirjian method in a limited age group (16–24 years) in differentiating between older and younger than 18 years. From an initial sample of 17594 radiographs, 460 were selected meeting the inclusion criteria. Two dentists provided the age estimate according to the Demirjian method, with a simplified approach based on the development of the third molars. The presence of a developmental stage of H for at least one third molar allowed to establish the major age if the other third molars, inferior or superior, have reached a stage equal or superior to F, with an accuracy of 90.2% and a predictive positive value of 91.6%. Thirty-three patients showed the development of at least one third molar (Stage H) before the age of 18 years while six patients showed the development of all four third molars with root completion (stage H) before the age of 18 years. When all third molars reached stage H an individual was over 18 years old in 97.4% of cases. In presence of one third molar on stage H and a stage equal or superior to F for the other third molars the probability of being of major age was 91.6%.

Age Group Classification of Dental Radiography without Precise Age Information Using Convolutional Neural Networks

“…Demirjian’s “eight stages” is the most commonly used method for estimating age from oral anatomical structures [ 5 , 6 ]. This is a very simple method for scoring bone calcification and maturity, but it has limitations that apply to children and adolescents.…”

“…A new scoring method that corrects and supplements this has been proposed, but it is unsuitable because of the high error in age estimation resulting from the subjective judgment of the observer; therefore, a study on a more accurate method is needed [ 7 , 8 ]. According to Caggiano et al [ 6 ], as a result of a study using third molar radiographs in a population in southern Italy, the accuracy and reproducibility of the Demirjian method were confirmed over 90%, but it was suggested that additional research on a larger study population is needed. Recently, an age estimation method based on the methylation level of DNA extracted from teeth using a real-time methylation-specific polymerase chain reaction was reported as evidence that DNA methylation in the human genome isolated from bodily fluids changes with age [ 9 ].…”