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Testing the accuracy of Bedek et al's new models based on 1-to-7 mandibular teeth for age estimation in 7-15 year old south Indian children

Sheriff SO, Medapati RH, Ankisetti SA, Gurrala VR, Haritha K, Pulijala S, et al.

J Forensic Odontostomatol, 2020 Sep 30;2(38):22-39.
PMID: 33174535

The goal of long term research on age assessment is to focus on the strengths and weaknesses of existing reliable methods of age estimation. In cases of age estimation when all teeth are present, maximum accuracy can be obtained using a 7 tooth model. Demirjian's system and Willems models require all seven mandibular teeth in the lower left quadrant for age assessment. Unfortunately, these methods cannot be applied in children with hypodontia. In 2019, Bedek et al., from Croatia, developed new models of age estimation based on a combination of one to seven mandibular teeth. In the present study, we tested the accuracy of the newly developed models for age estimation in South Indian children. Tested in parallel with Willems models, the accuracy of the new models was tested in terms of mean difference, mean absolute error (MAE) and percentage of correct estimations within intervals of +0.5 and +1 years. In terms of mean difference between chronological age (CA) and estimated dental age (DA), all models along with Willems models have underestimated the CA except Bedek et al's 6 tooth model where overestimation of CA was seen in boys. For MAE and percentage of correct estimations, the new models performed better than Willems models. With regards to our results, it can be concluded that the new models for dental age calculation are accurate and suitable. Therefore, we may encourage their use for age estimation in South Indian children, particularly in individuals with hypodontia or when multiple teeth are missing.
Above or below 14 years? An orthopantomographic study based on chronological course of eruption of mandibular premolars and second molars in a sample of south Indian children

Thomas LA, Thomas LR, Balla SB, Gopalaiah H, Kanaparthi A, Sai Sravanthi G, et al.

Leg Med (Tokyo), 2021 Feb;48:101814.
PMID: 33246253 DOI: 10.1016/j.legalmed.2020.101814

In the context of dental age assessment, two significant factors can be studied; tooth mineralisation and tooth emergence. Little is known about the role of a second molar eruption in forensic age estimation. This paper aims to contribute to forensic age estimation using an age threshold of 14 years, studying the eruption stages of permanent mandibular premolars and second molars. Totally 640 orthopantomograms (OPGs) of south Indian children, aged between 10 and 18 years, were evaluated using Olze et al. staging of tooth eruption stages (A-D). Spearman's rho correlation showed a strong, positive, and statistically significant correlation between the chronological age and the eruption stages of both sexes' teeth. Accuracy, sensitivity, specificity, likelihood ratios, and post-test probability values were calculated for all tested teeth. The best performance to discriminate individuals above or below 14 years showed stage D in second molars. The sensitivity varied between 89% and 94% and specificity between 75% and 84%, respectively. Receiver operating characteristic curve analysis revealed high diagnostic performance for stage D, with area under the ROC curve (AUC) values of 84% and 85% for tooth 37 and 85% and 83% for tooth 47 in males and females, respectively. In conclusion, it is possible to predict age over 14 years in south Indian children using tooth emergence stages from OPGs with a relatively high interobserver agreement and good diagnostic accuracy. However, there are some limitations and, therefore, must be used in conjunction with other methods.
Assessing the probability of having attained 16 years of age in juveniles using third molar development in a sample of South Indian population

Saranya K, Ponnada SR, Cheruvathoor JJ, Jacob S, Kandukuri G, Mudigonda M, et al.

J Forensic Odontostomatol, 2021 Apr 30;1(39):16-23.
PMID: 34057154

Juvenile crime or delinquency has been increasing at an alarming rate in recent times. In many countries, including India, the minimum age for criminal responsibility is 16 years. The present study aimed to estimate the probability of a south Indian adolescent either being or being older than the legally relevant age of 16 years using Demirjian's tooth formation stages. Orthopantomograms (OPG) of 640 south Indian adolescents (320 boys and 320 girls) aged between 12 and 20 years were retrospectively analyzed. In each OPG, Demirjian's formation stage of the mandibular left third molar was recorded and the data was subjected to statistical analysis. Descriptive and Pearsons correlation statistics were performed. The empirical probabilities were provided relative to the medico-legal question of predicting 16 years of age. The distribution of age throughout the 10th, 25th, 50th, 75th and 90th percentile follows a logical distribution pattern horizontally and vertically. Pearson's correlation statistics showed a strong positive correlation between the Demirjian's stages and age for both sexes. Therefore, it can be concluded that stage "F" can be used to predict the attainment of age equal to or older than 16 years with a probability of 93.9% for boys and 96.6% for girls.
Discriminatory ability of cervical vertebral maturation stages in predicting attainment of the legal age threshold of 14 years: A pilot study using lateral cephalograms

Banda TR, Komuravelli AK, Balla SB, Korrai BR, Alluri K, Kondapaneni J, et al.

Imaging Sci Dent, 2020 Sep;50(3):209-216.
PMID: 33005578 DOI: 10.5624/isd.2020.50.3.209

Purpose: In India, the age of 14 years is the legal age threshold for child labour. Therefore, in suspected instances of child labour, age assessment plays a crucial role in determining whether a violation of the law on the employment of children has occurred. The aim of this retrospective cross-sectional study was to assess the discriminatory ability of stages of cervical vertebral maturation (CVM) in predicting the legal age threshold of 14 years.
Materials and Methods: Routinely taken lateral cephalograms from 408 subjects aged 10 to 18 years were evaluated retrospectively using the CVM stages described by Baccetti et al. Descriptive statistics, accuracy, sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated for stages 2, 3, and 4 of CVM.
Results: Real age increased as the CVM stage gradually increased. The results of 2×2 contingency tables showed that CVM stage 4 produced an accuracy of 71% and 73%, a false positive rate of 7% and 18%, and a post-test probability of 59% and 68% for boys and girls, respectively.
Conclusion: Based on these findings, it can be concluded that the stages of CVM are of limited use for predicting the attainment of the legal age threshold of 14 years. Future studies should investigate whether combinations of skeletal and dental methods could achieve better accuracy and post-test probability.
Validation of Cameriere's third molar maturity index alone and in combination with apical maturity of permanent mandibular second molar for indicating legal age of 14 years in a sample of South Indian children

Balla SB, Banda TR, Galic I, N NM, Naishadham PP

Forensic Sci Int, 2019 Apr;297:243-248.
PMID: 30844636 DOI: 10.1016/j.forsciint.2019.02.009

The aims of the present study were to validate the discriminatory potential of Cameriere's third molar maturity index (I3M) cut-off value of I3M
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, Galić I, Balla SB, Kiş HC, Gómez Jiménez L, Zolotenkova G, et al.

Int J Legal Med, 2021 Nov;135(6):2423-2436.
PMID: 34228192 DOI: 10.1007/s00414-021-02656-2

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.
Third molar maturity index (I3M) assessment according to different geographical zones: a large multi-ethnic study sample

Angelakopoulos N, De Luca S, Oliveira-Santos I, Ribeiro ILA, Bianchi I, Balla SB, et al.

Int J Legal Med, 2023 Mar;137(2):403-425.
PMID: 36520207 DOI: 10.1007/s00414-022-02930-x

Identification of living undocumented individuals highlights the need for accurate, precise, and reproducible age estimation methods, especially in those cases involving minors. However, when their country of origin is unknown, or it can be only roughly estimated, it is extremely difficult to apply assessment policies, procedures, and practices that are accurate and child-sensitive. The main aim of this research is to optimize the correct classification of adults and minors by establishing new cut-off values for four different continents (Africa, America, Asia, and Europe). For this purpose, a vast sample of 10,701 orthopantomographs (OPTs) from four continents was evaluated. For determination and subsequent validation of the new third molar maturity index (I3M) cut-off values by world regions, a cross-validation by holdout method was used and contingency tables (confusion matrices) were generated. The lower third molar maturity indexes, from both left and right side (I3ML and I3MR) and the combination of both sides (I3ML_I3MR) were calculated. The new cut-off values, that aim to differentiate between a minor and an adult, with more than 74.00% accuracy for all populations were as follows (I3ML; I3MR; I3ML_I3MR, respectively): Africa = (0.10; 0.10; 0.10), America = (0.10; 0.09; 0.09), Asia = (0.15; 0.17; 0.14), and Europe = (0.09; 0.09; 0.09). The higher sensitivity (Se) was detected for the I3ML for male African people (91%) and the higher specificity (Sp) of all the parameters (I3ML; I3MR; I3ML_I3MR) for Europeans both male and female (> 91%). The original cut-off value (0.08) is still useful, especially in discriminating individuals younger than 18 years old which is the goal of the forensic methods used for justice.