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ELSEVIER Forensic Science International 175 (2008) 23-26 __ Interoatioval
www.elsevier.com/locate/forscjjnt
Abstract
Tooth formation is widely used to assess maturity and to predict age. 'Within clinical dentistry, such information aids in diagnosis and treatment
planning. Numerous methods exist that allow either the prediction of age or an assessment of maturation. One widely used method was first
described in 1973 by Demitjian et al., as based on a large number of French-Canadian children. The purpose of this study was to evaluate the
applicability of Demirjian's method for dental age estimation and for description of mandibular permanent tooth formation in northern Turkish
children, 4-12 years of age.
Panoramic radiographs of 900 healthy, northern Turkish children, 4-12 years of age were examined with Demiijian's method. Panoramic
radiographs were scored by one examiner. Dental age was compared to chronological age by using a paired t-test. The median age for individual
teeth for each stage was calculated.
The northern Turkish children were generally advanced in dental maturity compared with the children in Deniiijian's sample. The mean
difference between dental and chronologic ages of boys and girls varied from 0.36 to 1.43 years and 0.50-1.44 years, respectively.
The standards of dental age described by Denthjian et al. in 1973 and 1976 may not be suitable for northern Turkish children. Each population
of children may need their own specific standard for an accurate estimation of chronological age.
© 2007 Elsevier Ireland Ltd. All rights reserved.
Keywordc: Age estimation; Dental age calculation; Panoramic radiographs; Demirjian's method
0379-0738/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved.
doi:10.l016/j.forsciint2007.04.228
4-
24 E.S. Tunc, A.E. Koyuturkl Forensic Science international 175 (2008) 23-26
Table 1 provides an estimate of the subject's dental maturity, measured on a scale from 0
Distribution of age and gender in the study population to 100. The overall maturity score is then converted to a dental age by using
available tables and/or percentile curves. Standards are given for each gender
Age (years) Male Female Total
separately [7.8].
4-49 10 10 20
5-5.9 21 18 39 2.3. Assessment of the study sample
6-6.9 42 34 76
7-7.9 72 67 139 All assessments were performed in a darkened room with a radiographic
8-8.9 81 86 167 illuminator to ensure contrast enhancement of tooth images. The stages of seven
9-9.9 78 89 167 permanent teeth, excluding M3, in the mandible were assessed from panoramic
10-10.9 77 56 133 radiographs. After training and calibration, all radiographs were scored by the
11-11.9 51 49 100 second observer without knowing age or gender.
12-12.9 25 34 59 For each gender and age group in the study sample, the mean difference
457 443 900 between the dental age was determined from the French-Canadian standards
Total
[7,8] and the actual chronologic age of the child was calculated. A paired t-test
was used for statistical analysis.
In describing the formation of the mandibular permanent teeth, the same
this study were to evaluate the applicability of Demirjian's data were used. The mean and standard deviation was calculated separately for
method for dental age estimation and also describe the each stage of individual teeth for boys and for girls.
chronology of mandibular permanent tooth mineralization in
northern Turkish children, 4-12 years of age. 2.4. Reproducibility
Table 2
Differences between dental age determined by using the standards by Demirjian et al. and chronologic age
4-4.9 10 0.59 1.29 -0.33 1.51 0.182 10 0.81 0.75 0.26 1.35 0.008
5-5.9 18 1.32 0.81 0.91 1.72 0.000 21 1.43 0.49 1.20 1.66 0.000
6-6.9 34 1.12 0.57 0.92 1.32 0.000 42 1.18 0.35 1.07 1.29 0.000
7-7.9 67 0.88 0.79 0.68 1.07 0.000 72 0.72 0.62 0.58 0.87 0.000
8-8.9 86 0.50 0.82 0.32 0.67 0.000 81 0.50 0.94 0.29 0.71 0.000
9-9.9 89 0.65 1.15 0.41 0.89 0.000 78 0.55 1.05 0.31 0.79 0.000
10-10.9 56 0.75 1.02 0.48 1.03 0.000 77 0.50 1.04 0.27 0.74 0.000
11-11.9 49 0.95 1.46 0.53 1.37 0.000 51 0.64 1.04 0.34 0.93 0.000
12-12.9 34 1.44 1.20 1.02 1.86 0.000 25 0.36 1.50 -0.25 0.98 0.238
Table 3 / (/,lY S
Mean and standard deviation for the mineralization stages of mandibular permanent teeth for boys
Tooth A B C D E F G H
Table 4 V,- *
Mean and standard deviation for the mineralization stages of mandibular permanent teeth for girls /
Tooth A B C D E F G H
3.2. The an es of formation of mandibular somewhat advanced in dental maturity. As in our study, a
permanent teeth 9 common finding of Demirjian's method overestimated age
[1-3,13-18,24]. Liversidge et al. [15] believe that the over-
Descriptive statistics (me and standard deviation) for estimation in dental age in recent findings using Demirjian's
individual stages of each tooth are shown in Tables 3 and 4. method in different populations may be partly explained by a
Nearly all the mean ages of attainment of tooth developmental positive secular trend in growth and development during the last
stages were earlier in girls as compared to boys. 25 years.
In our study, the mean difference between the dental age and
4. Discussion the chronologic age ranged from 0.36 to 1.43 years in the boys
and from 0.50 to 1.44 years in the girls. This finding is in
The methods for determination of a child's growth and accordance with a previous Turkish study [17]. The mean
development are of great value from both medical and difference observed in this study sample were, however,
odontologic points of view [2]. Tooth formation is widely generally higher than that of the reported in the other Turkish
used to calibrate growth and maturity. Numerous methods exist study. The greatest mean difference was 1.44 years, compared
that allow either the prediction of age or an assessment of with 0.73 years reported in the study of Mentes et al. [ 17]. This
maturation [4,7-12]. Demirjian's method is one of the simplest, difference has been attributed to both regional differences
ti(►„4 1 most practical, and widely employed methods to predict age within the same country and the sample size.
and maturation [21,22], as it is comprised of clearly defined Although Hagg and Mattson [24] suggested that Demirjian's
)l >V'~
changes in shape that do not require speculative estimation method affords a high degree of reliability and precision,
[23]. Also, Demirjian's standard charts are an attempt to particularly in younger children, the largest discrepancy
provide an international means of evaluating the dental between dental and chronologic ages was observed in both
maturity for children [17]. Various investigators have applied genders in the 5-6.9 year age group in our study. This result was
and modified this method to their own populations. The in accordance with another Turkish study [ 17] and two of
investigations using Demirjian's method on several ethnic and different population-based studies [15,18]. This situation was
geographical groups showed some changes in dental formation explained due to growth prediction uncertainties in younger age
[1-3,13-20]. For that reason, the aim of this study was to group children [18].
appraise the suitability of Demirjian's method for assessing The discrepancy between dental and chronologic ages in 12-
dental maturation in northern Turkish children. This informa- year-old girls was higher than the other age groups of both
tion aids us in comparing the status of dental maturity of our genders in our study. This higher overestimation of the dental
population with those of other populations, which were age observed in the older girls in this study was probably due to
previously tested. the pre-pubertal or pubertal growth changes pertinent during
Comparison of results between northern Turkish children this age period.
and the French-Canadian reference sample in the present study One must remember that any difference found between the
showed that the northern Turkish children were generally standard population and the sample population can be attributed
f3rnr JQbA )-r;
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