Comparison of the third molar maturity index (I3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample

Angelakopoulos N 1 , Galić I 2 , Balla SB 2 , Kiş HC 3 , Gómez Jiménez L 4 , Zolotenkova G 5 Show all authors , Mohd Yusof MYP 6 , Hadzić Selmanagić A 7 , Pandey H 8 , Palmela Pereira C 9 , Nóbrega JBM 10 , Hettiarachchi K 11 , Mieke SM 12 , Kumagai A 13 , Gulsahi A 2 , Zelić K 14 , Marinković N 15 , Kelmendi J 16 , Bianchi I 17 , Soriano Vázquez I 2 , Spinas E 18 , Velezmoro-Montes YW 19 , Oliveira-Santos I 20 , De Luca S 21 , Arrais Ribeiro IL 10 , Moukarzel M 22 , Cameriere R 2

Affiliations 

  • 1 Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland
  • 2 AgEstimation Project, Macerata, Italy
  • 3 Faculty of Dentistry, Oral and Maxillofacial Radiology, Nuh Naci Yazgan University, Kocasinan, Kayseri, Turkey
  • 4 Instituto Nacional de Patología Dr. Sergio Sarita Valdez, Santo Domingo, República Dominicana
  • 5 Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
  • 6 Centre for Oral & Maxillofacial Diagnostics and Medicine Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
  • 7 Department of Dental Morphology With Dental Anthropology and Forensics Faculty of Dentistry, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  • 8 Department of Forensic Medicine and Toxicology, Seth GS Medical College and KEM Hospital, Mumbai, India
  • 9 Facultade de Medicina Dentária da Universidade de Lisboa, Lisboa, Portugal
  • 10 Postgraduate Program in Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brasil
  • 11 Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Kandy, Central Province, Sri Lanka
  • 12 Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
  • 13 Division of Forensic Odontology and Disaster Oral Medicine, Department of Forensic Science, Iwate Medical University, Iwate, Japan
  • 14 Laboratory of Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia
  • 15 Clinic for Orthodontics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
  • 16 Department of Orthodontics, Faculty of Medicine Alma Mater Europaea, University of Prishtina, Campus Rezonanca, Prishtina, Kosovo
  • 17 Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy
  • 18 Department of Surgical Sciences, Section of Dentistry, University of Cagliari , Cagliari, Italy
  • 19 Forensic Dentistry, Scientific University of the South, Lima, Peru
  • 20 Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
  • 21 AgEstimation Project, Macerata, Italy. sdeluca@sml.gob.cl
  • 22 Private Dental Office, Beirut, Lebanon
Int J Legal Med, 2021 Nov;135(6):2423-2436.
PMID: 34228192 DOI: 10.1007/s00414-021-02656-2

Abstract

The diagnostic accuracy of the I3M to assess the legal age of 18 years has already been tested in several specific-population samples. The left lower third molar has been extensively used for discriminating between minors and adults. This research aimed to compare the usefulness of lower third molar maturity indexes, from both left and right side (I3ML and I3MR), in samples originating from four distinct continents in order to examine possible differences in their accuracy values. For this purpose, a sample of 10,181 orthopantomograms (OPGs), from Europe, Africa, Asia and America, was analysed and previously scored in other studies. The samples included healthy subjects with no systemic disorders with both third molars and clear depicted root apices. Wilcoxon Signed Rank test for left and right asymmetry did not show any significant differences. Data about sensitivity, specificity, predictive values, likelihood ratio and accuracy were pooled together and showed similar results for I3ML and I3MR, respectively. In addition, all these quantities were high when only the I3MR was considered to discriminate between adults and minors. The present referable database was the first to pool third molar measurements using panoramic radiographs of subjects coming from different continents. The results highlighted that both I3ML and I3MR are reliable indicators for assessing the legal age of 18 years old in those jurisdictions where this legal threshold has been set as the age of majority.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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