The third molar maturity index in indicating the legal adult age in Kosovar population

Abstract

The third molar tooth, known as the "wisdom tooth," is the only tooth that can be used to determine legal adult age. This study aimed to test the accuracy of Cameriere's third molar maturity index (I) in assessing the legal adult age of 18 years in the Kosovar population. Orthopantomographs (OPTs) of 1221 healthy living Kosovar individuals, aged between 12 and 23 years and with no congenital or developmental anomalies, were analyzed. Intra-class correlation coefficients were 0.858 (95% CI, 0.786 to 0.906) and 0.852 (95% CI, 0.779 to 0.903) for intra-rater and for inter-rater agreement, respectively. The sample was divided into training dataset (800 OPTs) and test dataset (421 OPTs). The training dataset was used to generate the logistic regression model, while the test dataset was used to study the performance of the model. I and gender as independent variables and adult age (≥ 18 years) or minor age (< 18 years) as the dependent variable were used for logistic regression analysis. The receiver operating curve (ROC) analysis was used to determine the specific cut-off value of I for predicting adult age. The results showed that only I statistically significantly contributed to discriminating adults and minors. ROC analysis showed that the cut-off value of I < 0.08 was the best in discriminating adults and minors. An analysis of the test dataset (421 OPTs) showed that as I decreased the age gradually increased. The performance of the cut-off value of I < 0.08, to discriminate between adults and minors, was analyzed by contingency tables for both sexes. In males, the accurate classification (Acc) was 0.968 (95% CI, 0.926 to 0.985), the sensitivity (Se) was 0.962 (95% CI, 0.925 to 0.978), and the specificity (Sp) was 0.976 (95% CI, 0.929 to 0.995). The Bayes post-test probability (Bayes PTP) was 0.975 (95% CI, 0.905 to 1.00). In females, Acc was 0.909 (95% CI, 0.870 to 0.917), Se and Sp were 0.826 (95% CI, 0.787 to 0.834) and 0.991 (95% CI, 0.953 to 1.00) respectively, while Bayes PTP was 0.989 (95% CI, 0.926 to 1.00). Our data support the usefulness of I < 0.08 to indicate legal adult age in a Kosovar population.

Third molar maturity index and legal age in different ethnic populations: Accuracy of Cameriere’s method

“…The overall results show a lower sensitivity of 84.3% and higher specificity of 94.4% compared to a previous meta-analysis (94.6% and 88.8%, respectively) that did not include nine recently published research studies 19,22,23,25,33–35,37,38 dealing with the application of the I 3M to other ethnical subgroups (e.g. Chinese, Japanese, South African and Chilean people).…”

“…In terms of geographical distribution, for the European population, the lowest sensitivity value was 78.3% found in Holland, 19 while the highest was 91% reported in Serbia. 36 The minimum and maximum values of specificity were 92.1% in Poland 34 and 98.3% in Kossovo, 33 respectively. The overall proportion of individuals correctly classified (accuracy) ranged between 85.1% (Sardinia) 35 and 93% (Serbia).…”

“…In terms of sex, for the male sample only, the sensitivity ranged from 52.3% (Saudi Arabia) 21 to 96.2% (Kossovo) 33 and the specificity from 85% (Australia) 31 to 100% (Saudi Arabia, Libya and Turkey). 21,28,32 For the female sample, the sensitivity was between 51.3% (Saudi Arabia) 21 and 95.1% (Colombia), 29 and the specificity was between 67.2% (Brazil) 30 and 100% (Libya and Turkey).…”

“…A total of 22 research studies were identified and were included in the critical literature review. 2,12,16,19,21–38 In Table 1, the main findings of the 22 studies are summarised, including country, sample size (male and female), age range, sensitivity, specificity and data accuracy according to sex and 95% confidence interval.…”

Validation of the Third Molar Maturation Index (I3M) to assess the legal adult age in the Portuguese population

“…Estimated post-test probability of both male (94.7%; 95% CI 93.1–96.3%) and female (96.2%; 95% CI 94.8–97.5%) demonstrated results compatible with other European studies 2 , 14 , 15 , 19 – 23 , 44 , 51 . It is important to refer that Zelic et al 20 and Kelmendi et al 21 reported results very close to 100% in females, and Gulsahi et al 19 reported results of 100% in both sexes, although the sample size was one of the smallest in all European studies (n = 293), which may influence these results.…”